Health Technology Innovation Center (HTIC)

Enhancing Access to Clinical Records for DOD and VA Users

November 8, 2018  |  Download PDF

Many active duty service members transition to the Department of Veteran Affairs (VA) for ongoing care, especially those with disabilities when they separate from active duty. Many people, including reservists, continue to receive care in both the DoD and VA systems. Clinicians from DoD and VA need a total picture of the care rendered in both facilities for these cases. In response to the mandates of the National Defense Authorization Act (NDAA) of 2014, the Joint Legacy Viewer (JLV) was selected as a secured, standard-based, integrated read-only view of electronic health record (EHR) data from DoD’s CHCS and AHLTA, and VA’s VistA Electronic Health Record systems. This eliminated the need for VA or DoD clinicians to access separate viewers to obtain patient information from the other facility.

The Problem List is one of many widgets in the JLV application. It provides a listing of all the active diagnoses, or problems, associated with a given patient. When hovering with a mouse over a problem in the list, a user can view the SNOMED and ICD-10 codes associated with each problem. If a JLV user clicks on the problem, a more detailed description of the problem is shown including a listing of notes, encounters, orders, procedures, or consults related to that problem. However, links to those artifacts are not readily available from within the Problem List widget. In other words, JLV displays all the problems in its Problem List widget, but its users cannot simply click on a problem and easily see all associated notes, encounters, orders, procedures, or consults.

A sample screenshot of the Linked Problem List lab results page.A sample screenshot of the Linked Problem List lab results page.

In AHLTA, linking the associated artifacts with the problems in the Problem List is a standard feature. In a presentation to the Health Information Exchange Work Group earlier this year, COL John Scott, Director for Informatics Policy, Office of the Assistant Secretary of Defense for Health Affairs, clarified the feature this way, “[The] AHLTA Problem List Module creates a powerful navigation aid for record review. Associated encounters, medications, orders, and artifacts are displayed. One click navigation makes it easy to navigate to associated notes and artifacts.” To view the associated artifacts in JLV, a user must switch to each respective domain widget and must remember the identifying information about that artifact in order to retrieve the original note, encounter, order, procedure, or consult. This requires several mouse clicks and when a clinician is busy, this often does not get done. As Dr. Reese Omizo of the Defense Health Agency’s Innovation and Advanced Technology Development Division and the VA Office of Informatics & Analytics explains, “users need to be able to make associations between some of the AHLTA associations that are automatically brought in to the Linked Problem List and keep those associations for future use and for shared use.” He also believes that “the Linked Problem List feature in the JLV could change the way users interact with the EHR in a way that allows clinicians to be clinicians again.” This function would be a step toward focusing on clinical workflow while addressing the needs of other users that require access to this information such as Veterans Benefits Administration staff. “If we build this, there will be a lot of very happy providers out there and patients will get better care,” says Dr. Omizo.

To support this goal, TATRC’s Health Technology Innovation Center (HTIC) is prototyping a Linked Problem List to enhance the JLV widgets. The project produced a working prototype of enhancements to include a display of existing associations of data elements and artifacts to Problem List items in AHLTA. Current work, which is ready for deployment, will allow providers to create links to data and artifacts, “on-the-fly”, and store and share links to these artifacts among clinicians and other authorized personnel using JLV. In addition, the new prototype allows a detailed graphical display of the number of artifacts associated with a specific problem to show the problem with the most artifacts.

Ms. Ollie Gray, the Principal Investigator and Lab Manager for the HTIC, is happy to announce that the outputs from Phase 1 of the project are already being incorporated into JLV, and looks forward to Phase 2 outputs being incorporated in the near future.

This article was published in the November 2018 issue of the TATRC Times.