Sara Sterkenburg - CTO Health Team Orientation

[LynneJohnson224]

CTO Health Team Orientation

Welcome Sara ! We can use this ticket to track your onboarding activities to the CTO Health team.

Tasks

Intro to team members

Please schedule a short chat with each of these folks, either individually or in groups.

• [x] Patrick Bateman (OCTO Product - Team Product Owner)
• [x] Member of OCTO team related to your Community of Practice

More details about the team and our business partners can be found in the Product Brief.

Initial access request info

Following the instructions listed on the Platform is imperative to getting access to the applications and systems you will need in a timely manner. Please make these requests in the order listed on the Platform website, and note that the Slack request and GitHub write access should be requested by your Program Manager.

Learn more about our team

• [x] Our Team charter provides information on our mission, vision, who we are, and how we work.

Helpful terminology

• a11y - an abbreviation for accessibility coined by the a11y project. The 11 in the middle represents eleven letters in the middle of the word accessibility.
• CAG - Citrix Access Gateway - gets you access to the VA virtual desktop. Will need your PIV card to authenticate.
• CPRS - Computerized Patient Record System - clinician-facing view of VistA
• Cerner - generally used to refer to Oracle Cerner's electronic health care product (EHR) that runs on their Millennium platform. This system started being implemented in VA healthcare facilities in 2018, but was temporarily halted after five facilities due to issues. That rollout is anticipated to resume in June 2023. Cerner also owns a patient-facing portal called My Healthy Life.
• FHIR (pronounced "fire") - Fast Healthcare Interoperability Resources is a standard defines how healthcare information can be exchanged between different computer systems regardless of how it is stored in those systems.
• Memo - in the context of My HealtheVet on VA.gov, "the memo" refers to the memorandum signed by Donald Remy, Deputy Secretary of the VA on 11/2/2022, officially marking the start of the two years to complete My HealtheVet on VA.gov integration work.
• My HealtheVet - often abbreviated MHV - refers to the "classic" My HealtheVet portal, originated in 2003. Note that there is always a space after "My". It has been in its current iteration for roughly six years, and its core tools are currently being integrated into VA.gov.
• My HealtheVet on VA.gov - the new MHV experience on VA.gov. This initiative has had a few working names that you may run across in older documents, labels in ZenHub, etc -- Digital Health Modernization, Health Modernization Initiative, Health Home, Health Apartment, My Health.
• OCTO - Department of Veterans Affairs Office of the Chief Technology Officer
• OCC - Office of Connected Care. This includes the
• PAMPI - Problems, Allergies, Medications, Procedures and Immunizations
• PGHD - Patient-Generated Health Data - health data that is self-entered by the patient
• PHR - Patient Health Record - often used to refer to an API used to retrieve data stored in VisTA
• VistA - The Veterans Health Information Systems and Technology Architecture (VISTA) is an Electronic Health Record (EHR), one of the first in the country, and one of the only open source EHRs. There are 147 different installations for each of the VA medical centers (VISN).
• WTF bot - a bot in the DSVA Slack workspace that can be used to look up the meaning of acronyms. Enter the command /WTF followed by the abbreviation in question.

Background history

• Early 1970s - the National Center for Health Services Research and Development, a component of the U.S. Public Health Service, began planning for development of what would become Electronic Health Records (EHR).
• 1977 - VA Massachusetts General Hospital Utility Multi-Programming System (MUMPS), a precursor to VistA, was developed by the Computer Assisted System Staff (CASS) Team
• Early 1980s - VA made its software available without restriction in the public domain to other government and private sector organizations, in compliance with the Freedom of Information Act. VA recognized this opportunity to support widespread EHR adoption and offered use of VistA as the standard-bearer for EHR implementation around the world
• June 1981 - VA MUMPS was renamed the Decentralized Hospital Computer Program (DHCP), and VA Administrator Robert Nimmo joined Rep. G.V. "Sonny" Montgomery to establish DHCP as VA's Medical Information System Development Program to formalize its organization and management.
• December 1981 - Congressman Sonny Montgomery arranges for the DHCP to be written into law as VA's medical-information systems development program. VA Administrator Robert P. Nimmo followed up on February 18, 1982 with an Executive Order describing how the DHCP was to be organized and managed within VA's Department of Medicine and Surgery.
• 1990 - VistA, VA's first image management system, provided VA physicians with immediate access to patient medical images, regardless of location. VistA first became operational at the Washington, D.C. VA Medical Center (VAMC) to manage radiologic, pathology, gastroenterology, and laparoscopic images, as well as electrocardiograms.
• 1994 - VA's Under Secretary for Health, Kenneth W. Kizer, M.D., renames DHCP as VistA, the Veterans Health Information Systems and Technology Architecture.
• 2003 - VA launches My HealtheVet nationwide on Veterans Day 2003. The personal health record portal now has over 2.5 million registered users.
• 2015 - DOD awards a $3.4 billion contract to Cerner Corporation for new electronic health record system.
• 2017 - VA decides to acquire the same Cerner system as DOD
• April 2018 - the Department of Veterans Affairs introduces the VA Digital Modernization Strategy, which includes a plan for updating VA.gov, shared credentials across all VA services, personalization, mobile access, self-service tool standardization, and API consolidation.
• May 2018 - VA awards a contract to Cerner for an Electronic Health Record System
• October 1, 2020 - VA announces plan to launch Cerner's patient portal alongside My HealtheVet
• October 24, 2020 - After several delays related to the Covid-19 pandemic and infrastructure problems, Cerner's EHR is partially deployed at the Spokane Washington VA Medical Center (VAMC)
• October 2020 - April 2020 - It becomes evident that having two disparate systems running in parallel during the Cerner rollout is a poor experience for Veterans. Veterans who have received care at sites where Cerner has been integrated must access Cerner's My Healthy Life patient portal (referred to as My VA Health when accessed through My HealtheVet) for Cerner data, and continue using My HealtheVet for information related to other facilities.
• April - July 2021 - A series of OCTO-OCC Digital Health Modernization Workshops is held, and the concept of bringing My HealtheVet into VA.gov, previously referred to as Health Home becomes the Health Apartment, in reference to a metaphor describing it as an apartment within the larger "building" of VA.gov.
• December 2021 - President Biden signs an Executive Order stating that, in part, The Secretary of Veterans Affairs shall "provide digital services through a single, integrated, and equitable digital platform on VA.gov and the VA mobile app".
• March 2022 - The Office of Inspector General (OIG) conducted two inspections and identified deficiencies in data migration, medication orders, and medication reconciliation.
• Mar - Jun 2022 - Cerner's EHR and patient portal deployed at four more VAMCs (Walla Walla, WA; Columbus, OH; Roseburg, OR; White City, OR)
• Oct 2022 - VA announced it would delay upcoming deployments of its new EHR until June 2023 to address challenges with the system and make sure it is functioning optimally for Veterans and VA health care personnel
• Nov 2022 - a memorandum was signed by Donald Remy, Deputy Secretary of the VA, that officially gave approval for My HealtheVet to be integrated into VA.gov as an untethered patient portal versus using Cerner's patient portal.

Sources:

• History of IT at VA
• US Congress' Timeline - VA's Electronic Health Record History

Team Dynamics

We are working very closely with the very same Office of Connected Care (OCC) stakeholders who were instrumental in designing and building "classic" My HealtheVet in 2003. Their product teams have been responsible for maintaining and enhancing it over the last 20 years and have a very close working relationship with OCC. OCC and their product teams are all extremely knowledgeable in their respective areas, understand the dependencies between their teams and products, and like us, are thoroughly vested in doing what's best for our Veterans.

Throughout this endeavor, it will be crucial that we collaborate closely with our OCC partners and maintain a professional, mutually respectful rapport. In years past, a different team external to OCC came in and said they were going to take over and shut down MHV. Understandably, that approach generated a great deal of angst and eroded trust between OCC stakeholders and external organizations. With that history in mind, it is important that our team be aware of those sensitivities in our daily interactions.

We should use every interaction with our business partners as an opportunity to demonstrate our expertise and commitment to helping them succeed in getting this work across the finish line. We want to earn their trust by reinforcing that we are on the same team, and are partnering with them, versus actively trying to replace them. At the end of this initiative, the expectation is that OCC and their respective product teams will continue to own and maintain their products long-term.

Review documentation and project information

We currently store our project documentation in markdown files in GitHub. Here are some helpful documents to review on the MHV to VA.gov initiative.

• [x] Product brief for My HealtheVet on VA.gov
• [x] My HealtheVet on VA.gov initiative outline
• [x] Project roadmap - includes work being done by all teams involved in the MHV on VA.gov
• [x] MHV on VA.gov Top-Level View Zenhub board
• [ ] CTO Health Team PI planning board - this is updated before each PI Planning to reflect the upcoming Product Increment.
• [x] MHV to VA.gov product directory on GitHub - contains directories for the various parts that make up My HealtheVet on VA.gov
• [x] Digital Health Modernization directory on GitHub - contains the research and prototypes that preceded the MHV on VA.gov MVP
• [x] MHV on VA.gov Mural room - requires VA.gov email address and invitation to join

Get familiar with the MHV on VA.gov work

Product outlines for the tools, integration efforts, and rollout info related to this initiative. There's a lot to consume and it may take some time to get acclimated. Bookmark these and come back often as you dive deeper into to each area.

• [x] Landing page
• [x] Secure Messaging
• [x] Medical Records
• [x] Medications
• [x] Appointments - VAOS team will be doing the work to integrate this into the health portal.
• [x] Newsletter (not yet started)
• [x] Community Care (not yet started)
• [x] Health Resources (not yet started)
• [x] Rollout information - Rollout gates, phases, and readiness checklists

Learn a little about GitHub and documentation in markdown files

• [x] VA Platform GitHub guidelines - provides info on where to put your files, file naming standards, file types.
• [x] GitLFS - GitHub desktop add-on for uploading large files
• [x] LaTex table generator tool
• [x] Mermaid diagramming tool

Log into staging and check out the MyHealtheVet on VA.gov landing page (requires access to the VA network)

Follow the steps below to find user credentials for logging in:

• Log into the VA network
• Log into Slack from a browser on the VA virtual desktop and navigate to this ticket so you can copy/paste
• Open a new browser tab and navigate to the Test User Dashboard https://tud.vfs.va.gov/?page=1
• Log in using your GitHub account
• Filter the results to show users with Healthcare and ID Type ID.me.
• Find user whose email contains 377
• Go to https://staging.va.gov
• Click Sign In in the main nav
• Select the ID.me option
• Enter the test user's email address and password
• When prompted to receive a code by phone:
  • Make sure Text me is selected
  • Leave the phone number field as-is
  • Click the Continue button
• The screen will refresh, and a six-digit code will be displayed. Press Continue.
• Once logged in, click the My HealtheVet link at the far-right in the main nav
• You should see the My HealtheVet on VA.gov landing page load
• As of April 3, 2023, the links on this page go to tools and content on the "classic" My HealtheVet (MHV) web site or VA.gov
• As MHV applications and content is integrated into VA.gov, the links on this landing page will be updated to point to the new experience

[sterkenburgsara]

@LynneJohnson224 fysa - my practice-area lead for IA is Mikki Northuis, who is out of the office for a while. I have been working with her for months though, so I'm going to go ahead and check the box that I've synced with her already in the area above :-)

[LynneJohnson224]

@sterkenburgsara sounds good, thanks!

[sterkenburgsara]

@LynneJohnson224 the "how we sprint" document linked above has a 404 error.

[sterkenburgsara]

@LynneJohnson224 I also cannot access this resource - could you let me know if it has moved? Thank you! CTO Health Team PI planning board

[LynneJohnson224]

@sterkenburgsara looks like our access was removed or the board was deleted. I'm not so worried about this - the PI planning board is/was used by other MHV teams who use the Scaled Agile framework and go through PI Planning (which our team does not). This link was as an FYI only - I'll remove it from the orientation. Thanks for letting me know!

[sterkenburgsara]

Thanks @LynneJohnson224!