In 2015 the Department of Veterans Affairs (VA) was facing a problem. As the VA OI&T organization was charging forward to align with target architectural goals and prepare for the next phase of clinical data sharing with the DoD and other partners the VHA clinicians were becoming concerned. Their clinical data sharing applications, used daily in the treatment of thousands of veterans, which provide access to longitudinal health data from the DoD were slated to be sunset, and a viable replacement was not yet available on the enterprise level. VHA clinical staff recognized that this issue was not just a mere inconvenience but had the potential to cause patient safety issues and negatively impact the overall quality of care provided to our nation’s Veterans.
However, the question was what to do? Abandoning the long-term architectural and technical goals would have a severe impact on major data sharing initiatives planned for years to come, but the issue of access to DoD clinical data could not be ignored at the expense of veterans receiving health care services at VA. With less than 12 months to design and implement an enterprise solution that balanced the future agency goals with immediate clinical needs the VA needed to move fast and did not have the time or budget to plan a major contract effort to address this urgent need.
To solve this dilemma VA turned to Ellumen, a T4NG prime contractor and long-term partner in interagency data exchange efforts, to provide a solution under a small contract modification to an existing contract. Ellumen clinical data exchange experts leveraged historical knowledge and experience combined with forward thinking of the latest trends in health data sharing and the VA’s architectural way forward to implement a truly innovative solution; the first ever production environment FHIR (Fast Healthcare Interoperability Resources) data exchange service in the VA. FHIR was chosen for its wide acceptance as the preferred means to achieving national health IT interoperability and its potential for extensibility for future data exchange with commercial and government partners.
Ellumen’s Agile Approach and Dark Launch Accelerate Enhancements to Federal Health IT
To accomplish this lofty goal in the short timeline, it was imperative that Ellumen fully embrace a truly Agile approach to this project. Ellumen incorporated Agile principles and methodologies to accelerate the process of implementing demonstrable feature sets and then worked closely with product owners (VA clinicians) to review functionality in real time and rapidly incorporate feedback into the next release. To maximize efficiency, the team leveraged a combination of standard Agile practices such as automated build and test tools (customized to meet the unique requirements of VA such as Fortify compliance) with state-of-the-art technology innovations from Silicon Valley such as our dark launch process. The result of this approach was an overwhelming success for VA.
Ellumen’s FHIR Implementation Has Achieved Optimal Results While Paving the Way for More Innovation
In less than 12 months and with a total budget that pales in comparison to other Interagency data exchange efforts the Ellumen team delivered big results for VA. A fully deployed, enterprise level, ATO compliant, FHIR standard exchange service between VA and DoD that meets the immediate needs of VHA clinical staff while simultaneously making huge steps forward towards the future of healthcare interoperability is now fully operational in the production environment. Since deployed in September of 2016 Ellumen’ s FHIR service has provided real world benefit to our nation’s veterans, servicing thousands of queries for DoD clinical data per hour, totaling several million successful FHIR standard exchanges since “go live.” And the current usage in VA is only scratching the surface of the potential for this FHIR standard exchange. Internal IR&D efforts have already successfully proven interoperability with commercial partners, like Cerner’s test FHIR service, and compatibility with mobile platforms.
In the current climate of government contracting, which demands doing more with fewer resources, the story of Ellumen’ s FHIR service demonstrates how innovative problem solving and forward thinking can maximize the impact that a small investment of time and money can have for our nation’s Veterans.
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