<s>
BHIE	B-Application
(	O
Bidirectional	B-Application
Health	I-Application
Information	I-Application
Exchange	I-Application
)	O
is	O
a	O
series	O
of	O
communications	O
protocols	O
developed	O
by	O
the	O
US	O
Department	O
of	O
Veterans	O
Affairs	O
(	O
VA	O
)	O
.	O
</s>
<s>
BHIE	B-Application
is	O
one	O
of	O
the	O
most	O
widely	O
used	O
healthcare	O
data	O
exchange	O
systems	O
in	O
routine	O
healthcare	O
use	O
,	O
and	O
is	O
used	O
to	O
facilitate	O
healthcare	O
data	O
exchange	O
associated	O
with	O
a	O
patient	O
's	O
medical	O
record	O
.	O
</s>
<s>
Outpatient	O
pharmacy	O
data	O
,	O
allergy	O
data	O
,	O
patient	O
identification	O
correlation	O
,	O
laboratory	O
result	O
data	O
(	O
including	O
surgical	O
pathology	O
reports	O
,	O
cytology	O
and	O
microbiology	O
data	O
,	O
chemistry	O
and	O
hematology	O
data	O
)	O
,	O
lab	O
orders	O
data	O
,	O
radiology	O
reports	O
,	O
problem	O
lists	O
,	O
encounters	O
,	O
procedures	O
,	O
and	O
clinical	O
notes	O
are	O
examples	O
of	O
the	O
types	O
of	O
healthcare	O
data	O
that	O
are	O
exchanged	O
using	O
BHIE	B-Application
.	O
</s>
<s>
BHIE	B-Application
is	O
currently	O
integrated	O
into	O
the	O
VistA	B-Application
EMR	I-Application
(	O
electronic	B-Application
medical	I-Application
record	I-Application
)	O
system	O
used	O
nationwide	O
in	O
VA	O
hospitals	O
.	O
</s>
<s>
Their	O
VistA	B-Application
medical	O
records	O
are	O
able	O
to	O
be	O
transmitted	O
in	O
their	O
entirety	O
using	O
this	O
protocol	B-Protocol
.	O
</s>
<s>
In	O
response	O
to	O
1998	O
Presidential	O
Review	O
Directive	O
5	O
,	O
the	O
Department	O
of	O
Defense	O
(	O
DoD	O
)	O
,	O
the	O
VA	O
,	O
and	O
the	O
US	O
Indian	O
Health	O
Service	O
(	O
IHS	O
)	O
collaborated	O
to	O
create	O
the	O
first	O
developmental	O
instances	O
of	O
a	O
secure	O
data-sharing	B-Application
system	O
for	O
electronic	B-Application
patient	I-Application
record	I-Application
data	O
.	O
</s>
<s>
The	O
development	O
of	O
GCPR	O
used	O
UML	B-Language
modeling	O
tools	O
to	O
define	O
the	O
various	O
expected	O
use	O
cases	O
where	O
medical	O
Care	O
Providers	O
in	O
any	O
Medical	O
Treatment	O
Facility	O
(	O
MTF	O
)	O
would	O
need	O
to	O
have	O
access	O
to	O
patient	O
records	O
or	O
other	O
data	O
from	O
within	O
another	O
participating	O
agency	O
.	O
</s>
<s>
The	O
UML	B-Language
modeling	O
design	O
was	O
selected	O
for	O
its	O
ability	O
to	O
clearly	O
define	O
the	O
business	B-Architecture
logic	I-Architecture
that	O
would	O
be	O
required	O
for	O
the	O
GCPR	O
Framework	O
and	O
for	O
its	O
ability	O
to	O
provide	O
detailed	O
tracking	O
of	O
the	O
iterative	O
development	O
of	O
the	O
Framework	O
software	O
.	O
</s>
<s>
The	O
UML	B-Language
model	O
for	O
the	O
Framework	O
is	O
still	O
used	O
for	O
the	O
ongoing	O
maintenance	O
and	O
support	O
of	O
the	O
BHIE	B-Application
system	O
.	O
</s>
<s>
Early	O
development	O
of	O
the	O
GCPR	O
system	O
proved	O
that	O
it	O
could	O
meet	O
the	O
requirements	O
of	O
a	O
robust	O
interagency	O
data	B-Application
sharing	I-Application
system	O
,	O
but	O
details	O
of	O
implementation	O
,	O
policy	O
,	O
and	O
security	O
management	O
issues	O
caused	O
delays	O
in	O
full	O
implementation	O
of	O
the	O
GCPR	O
system	O
as	O
it	O
was	O
originally	O
designed	O
.	O
</s>
<s>
This	O
one-way	O
transfer	O
of	O
data	O
from	O
DoD	O
to	O
the	O
VA	O
repository	O
continues	O
to	O
be	O
one	O
of	O
the	O
principal	O
functions	O
of	O
the	O
BHIE	B-Application
system	O
.	O
</s>
<s>
Initially	O
called	O
the	O
Data	B-Application
Sharing	I-Application
Initiative	O
(	O
DSI	O
)	O
,	O
adapters	O
were	O
added	O
to	O
the	O
FHIE	O
system	O
using	O
the	O
Web	O
Services	O
XML-based	B-Language
protocol	B-Protocol
standard	O
.	O
</s>
<s>
Direct	O
cross-Domain	O
write	O
capability	O
and	O
fully	O
computable	O
data	B-General_Concept
storage	I-General_Concept
and	O
transfers	O
are	O
not	O
supported	O
at	O
this	O
time	O
.	O
</s>
<s>
With	O
the	O
addition	O
of	O
the	O
DSI	O
components	O
to	O
the	O
FHIE	O
system	O
,	O
the	O
entire	O
project	O
was	O
renamed	O
the	O
Federal	O
Bi-Directional	O
Healthcare	O
Information	O
Exchange	O
,	O
or	O
BHIE	B-Application
.	O
</s>
<s>
BHIE	B-Application
represents	O
the	O
previous	O
Framework	O
System	O
as	O
was	O
deployed	O
for	O
the	O
VA	O
,	O
and	O
all	O
additional	O
capabilities	O
added	O
to	O
support	O
near-real-time	O
data	O
exchange	O
between	O
the	O
Framework	O
and	O
participating	O
DoD	O
Medical	O
Treatment	O
Facilities	O
(	O
MTFs	O
)	O
.	O
</s>
<s>
In	O
short	O
:	O
FHIE	O
+	O
DSI	O
=	O
BHIE	B-Application
.	O
</s>
<s>
The	O
current	O
BHIE	B-Application
Project	O
participants	O
are	O
exclusively	O
the	O
DoD	O
and	O
the	O
VA	O
,	O
though	O
any	O
number	O
of	O
additional	O
domains	O
will	O
probably	O
be	O
added	O
over	O
time	O
with	O
proper	O
development	O
of	O
adapters	O
and	O
policies	O
.	O
</s>
<s>
Since	O
2Q-FY05	O
,	O
the	O
DoD	O
is	O
supporting	O
the	O
development	O
of	O
a	O
separate	O
DoD	O
BHIE	B-Application
Domain	O
,	O
including	O
dedicated	O
hardware	B-Architecture
and	O
infrastructure	O
to	O
support	O
this	O
new	O
system	O
within	O
the	O
DISA	O
network	O
.	O
</s>
<s>
The	O
details	O
of	O
the	O
DoD	O
system	O
are	O
still	O
in	O
development	O
,	O
as	O
are	O
the	O
details	O
of	O
the	O
expected	O
interoperability	O
with	O
the	O
existing	O
VA	O
BHIE	B-Application
system	O
.	O
</s>
<s>
In	O
March	O
2006	O
,	O
the	O
usage	O
of	O
BHIE	B-Application
across	O
the	O
country	O
was	O
outlined	O
before	O
the	O
House	O
Committee	O
on	O
Veterans	O
Affairs	O
.	O
</s>
<s>
In	O
2007	O
the	O
DoD	O
's	O
AHLTA	O
interface	O
was	O
connected	O
to	O
BHIE	B-Application
to	O
allow	O
AHLTA	O
clinicians	O
to	O
see	O
VA	O
data	O
and	O
VA	O
clinicians	O
to	O
see	O
DoD	O
data	O
stored	O
within	O
the	O
CDR	O
.	O
</s>
<s>
Additionally	O
in	O
2007	O
the	O
Theater	O
Medical	O
Data	O
Store	O
(	O
TMDS	O
)	O
was	O
connected	O
to	O
BHIE	B-Application
to	O
allow	O
VA	O
and	O
DoD	O
clinicians	O
to	O
access	O
medical	O
records	O
from	O
combat	O
theaters	O
.	O
</s>
<s>
In	O
the	O
2007	O
–	O
2009	O
years	O
,	O
a	O
parallel	O
“	O
two-pass	O
”	O
system	O
for	O
exchanging	O
imaging	O
metadata	O
was	O
added	O
to	O
the	O
scope	O
of	O
BHIE	B-Application
.	O
</s>
<s>
A	O
special-purpose	O
server	O
,	O
the	O
BHIE	B-Application
Imaging	O
Adapter	O
(	O
BIA	O
)	O
was	O
added	O
to	O
the	O
other	O
BHIE	B-Application
systems	O
.	O
</s>
<s>
This	O
BIA	O
server	O
takes	O
the	O
first	O
pass	O
of	O
an	O
Image	O
Study	O
query	O
,	O
obtains	O
metadata	O
about	O
the	O
images	O
for	O
a	O
specific	O
patient	O
from	O
the	O
BHIE	B-Application
system	O
,	O
then	O
presents	O
a	O
list	O
of	O
available	O
images	O
to	O
the	O
end-user	O
,	O
who	O
can	O
then	O
select	O
the	O
images	O
of	O
interest	O
from	O
the	O
list	O
.	O
</s>
<s>
As	O
of	O
2011	O
,	O
other	O
additional	O
functions	O
related	O
to	O
images	O
are	O
being	O
added	O
to	O
both	O
the	O
BIA	O
and	O
BHIE	B-Application
systems	O
.	O
</s>
<s>
From	O
2008	O
through	O
2011	O
,	O
the	O
central	O
focus	O
of	O
BHIE	B-Application
was	O
to	O
upgrade	O
the	O
system	O
hardware	B-Architecture
and	O
migrate	O
all	O
of	O
the	O
production	O
functions	O
onto	O
the	O
new	O
hardware	B-Architecture
.	O
</s>
<s>
The	O
upgrades	O
began	O
in	O
the	O
spring	O
of	O
2009	O
,	O
when	O
the	O
initial	O
sets	O
of	O
hardware	B-Architecture
were	O
delivered	O
and	O
development	O
began	O
to	O
create	O
a	O
set	O
of	O
identical-hardware	O
environments	O
on	O
which	O
the	O
BHIE	B-Application
systems	O
 '	O
migration	O
could	O
occur	O
.	O
</s>
<s>
The	O
migration	O
to	O
the	O
new	O
production	O
BHIE	B-Application
location	O
in	O
Philadelphia	O
,	O
Pennsylvania	O
,	O
was	O
accomplished	O
in	O
January	O
2011	O
,	O
and	O
enhancements	O
to	O
all	O
of	O
the	O
systems	O
continue	O
as	O
an	O
ongoing	O
process	O
.	O
</s>
<s>
The	O
Austin	O
"	O
Legacy	O
"	O
BHIE	B-Application
system	O
remained	O
in	O
production	O
operation	O
until	O
2011	O
,	O
when	O
the	O
replacement	O
BHIE	B-Application
hardware	B-Architecture
installed	O
in	O
Philadelphia	O
,	O
Pennsylvania	O
,	O
assumed	O
all	O
of	O
those	O
functions	O
.	O
</s>
