Knowledge Based Systems (KBS) and Standards and Terminology Services (STS) are working to establish a collaborative Enterprise Terminology Service (ETS) that bridges clinical and technical domains in order to address both the Congressional and Executive mandates for interoperability, standardization, computability, and meaningful use. The ETS will consist of two primary components operating in tandem.
First, a robust Clinical Terminology Service (CTS) is necessary to establish and continually improve the VA’s ability to collect and accurately and fully represent healthcare data in the medical record. The CTS will address internal VHA terminology consultation and business ownership needs. These needs have grown tremendously because of the new demands from the Veterans Health Information Systems Technology Architecture (VistA) Evolution, Connected Health, and Compensation and Pension (C&P) and the shift of responsibilities back to VHA from the Interagency Program Office (IPO).
Secondly, a robust Technical Terminology Service (TTS) is necessary to publish standard terminologies and to ensure their complete integration with VA Health Information Technology (HIT) systems and applications. The TTS will address internal Office of Information and Technology (OI&T) technical needs, including terminology publication and distribution, as well as technical consultation for accessing terminology resources, for example, Service Oriented Architecture (SOA) integration.
Collectively, the ETS is foundational to establishing and maintaining robust interoperability with VA partners, such as DoD and VBA, and addressing longstanding Congressional concerns. Specific business objectives that necessitate stating these requirements include:
1. The safety and life-critical nature of the health data VA encodes and processes. Mistakes in the semantic encoding and/or processing of this health data result in morbidity and mortality to the Veterans we serve.
2. Health data must be ubiquitously standardized to deliver the full promises of HIT systems, including the ability to compare the processes, and quality, of care among national and
international health providing organizations. Achieving this ubiquitous standardization requires
participation in collaborative and open-source development efforts. We have a variety of existing relationships, and contemplated relationships, that center around particular open-source projects, such as the International Health Terminology Standards Development Organization (IHTSDO) Open Tooling Framework, and the IHTSDO workbench that is currently utilized by the IHTSDO, Denmark, Sweden, the United States National Library of Medicine, Kaiser Permanente, and some internal VA projects. In cases where contributions to, or extension of, these shared projects is a business requirement, we will specify requirements for specific development languages, libraries, developer operations automation frameworks, and database technologies.
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