San Francisco, CA: On November 5, 2018, Dr. Keith Campbell, Director of Informatics Architecture of Veterans Health Administration (VHA) alongside his colleagues, Dr. Eleanor Barone, Dr. Diane Montella, and Dr. Linda Wedemeyer, presented at the American Medical Informatics Association (AMIA) 2018 Annual Symposium on the topic of the need to standardize clinical decision support through “An Essential Strategy for Interoperability and Optimization of Patient and Provider Experience” (link to presentation). In front of an audience of over 100 participants, Dr. Campbell provided a detailed explanation of how SOLOR, an integrated terminology model, can be used alongside Analysis Normal Form (ANF), a standardized statement model, to help bring true interoperability of clinical decision support.

What is the AMIA Annual Symposium?

The AMIA Annual Symposium brings together informatics professionals from diverse backgrounds such as clinicians, researchers, industry professionals, educators, scientists, policy makers, and students who are committed to transforming health through informatics. Health informatics is the science behind the healthcare delivery system that seeks to improve outcomes, lower costs, increase safety and promote the use of high-quality services.

VA’s Situation

The Veteran’s Administration (VA) currently has nine million enrolled patients Department of Defense (DoD), as of 2017, had over one million active duty soldiers who represent potential VA patients over time. The VA electronic medical record, VistA, and its electronic health record (EHR) module known as Computerized Patient Record System (CPRS), were developed and enhanced largely by clinicians over the last 25 years. In June of 2017, Secretary of Veterans Affairs Dr. David Shulkin announced VA’s intent to adopt the same commercial EHR being adopted by the DoD – a maneuver intended to facilitate free flow of information between the two organizations that share patients.

An Urgency to Act

Regardless of eventual outcome, the announcement of this plan created an urgency to evolve clinical decision support (CDS) in the legacy VA electronic health record with intent to streamline and optimize CDS to improve patient and provider experience, reduce clinician cognitive burden, and reduce implementation burden by standardizing the representation of clinical statements and integrating the terminologies we use to populate those clinical statements.

The Challenge

How can we achieve true interoperability of clinical decision support, not only between VA and DoD, but among all health care entities, regardless of EHR platforms?

SOLOR

The SOLOR model brings together different terminology standards by using a single model that can encompass any customized content. Informaticists and developers can convert user-supplied terminologies into the single model by using open source software to produce SOLOR content. SOLOR “standardizes the standards,” and provides a consistent foundation for anyone to easily create and share customized clinical content to achieve interoperability between standards.

To learn more about SOLOR, please read the white paper available here.

ANF

The ANF model provides a set of guidelines to model clinical statements, enabling the understanding of data derived from clinical statements regardless of their clinical specialty source or location. A clinical statement represents an entry in the patient record that documents clinical information that are structured in a computable manner, ensuring that data can be expressed in an interoperable way.