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“Medically Ready Force…Ready Medical Force”

“Medically Ready Force…Ready Medical Force” 1

LTC Rich Wilson

2014 Defense Health Information

Technology Symposium

Current and Future Delivery of

Enterprise Tools

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“Medically Ready Force…Ready Medical Force” “Medically Ready Force…Ready Medical Force”

DHA Vision

2

“A joint, integrated, premier system of

health, supporting those who serve in

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“Medically Ready Force…Ready Medical Force” “Medically Ready Force…Ready Medical Force”

Learning Objectives

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“Medically Ready Force…Ready Medical Force”

∎ Describe the current state of enterprise tools and solutions

∎ Describe the Solutions Delivery Division of DHA Health

Information Technology (HIT) Directorate

Program Management

User Integration

Process Integration

System Integration

∎ Understand the future state of enterprise tool delivery and

integration

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Agenda

∎ Overview

∎ User Integration

∎ Process Integration

∎ Systems Integration

∎ Solutions Branch

∎ EHR Modernization (DHMSM)

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Cha lle ng es

Budget & DBC

Interoperability

Culture

Environment

Contracting

Priorities

Solution Objectives & Challenges

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Objectives

• Provides user tools to support and improve outcomes

• Timely, Efficient & Reliable • Error free

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“Medically Ready Force…Ready Medical Force” 7

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Current State

Who is managing the portfolio?

DHSS

DHCS

SDD

Regions

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Solutions Delivery

Programmatics Technical Architecture Process Integration System Integration User Integration

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CAPT Margaret Beaubien Deputy Director Innovation & Advanced Technology Development Division Execution Branch Mr. Mark Goodge CDR James Ellzy Strategy/Planni ng Branch Mr. Jake Jacobs CDR Art Anthony Information Delivery Division Data Architecture Branch Knowledge Management Branch CEI Branch Informatics Branch Col Al Bonnema Vacant Mr. A. Anderson

CAPT Joel Parker Lt Col D. Carnahan TBD Infrastructure & Operations Division CDR Tony Thornton Dr. Peter Marks Support Services Branch Ms. J. Pereira Lt Col Kevin Seeley

Security Operations Center Branch LtCol Jay Ludescher Mr. F. Echon Engineering, Design and Deployment Branch Mr. W. Spencer Mr. Albert Dickson Operations and Sustainment Branch Mr. Wayne Speaks Mr. Bill Novak Portfolio Management & Customer Relations Division

Col Richard “Chip” Terry

Ms. Sharon Larson External Relations & Performance Management Branch Ms. Lois Kellett Investment Management Branch Ms. Tricia Cantu Vacant Enterprise Architecture Branch Steven McAdams Maj G. Delaney Solution Delivery Division LTC Rich Wilson Mr. Dan Magee Systems Integration Branch LTC Dan Bridon Process Integration Branch

Lt Col Kevin Kaps

User Integration Branch Dr. Brian Jones Solutions Branch Mr. Mark Beckner Maj(P) R. Sennie Cyber Security Division Policy Branch Certification and Accreditation Branch Continuous Monitoring Branch Mr. Frank Rowland

Lt Col Michael Stone

LCDR D. McCullough Ms. C. Reberkenny Ms. Joan Luke Mr. Servio Medina Mr. Jeff Eyink Mr. W. Arrington Defense Health Services Systems (DHSS) Defense Health Clinical Systems (DHCS)

= Acting Deputy Director = Acting Chief of Operations

= Acting Branch Chief of Operations = Acting Branch Chief

= Deputy Program Executive Officer = Program Executive Officer

Dr. Dan Magee Mr. Chris Harrington Ms. Paula Friedman Ms. Lydia Mitchell Mr. David Bowen Director

HIT Directorate

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HIT Solution Delivery Division

Systems Integration Branch

Process Integration

Branch User Integration Branch Solutions Branch Solution Delivery Division

LTC Rich Wilson Mr. Dan Magee

Enterprise Integrated Master Scheduling (EIMS) Section

Enterprise Integrated Systems Management (EISM) Section

Ms. Nora Crossan Business Process Management (BPM)Section Organizational Change Management Section Ms. Kim Heermann-Do

End User Training Support Section

Operational & Integration Testing Section Ms. Arlene Ophof

Project Management Service Section (Business)

Project Management Service Section (Clinical) Mr. Brian Schafer

Mr. Chris Nichols LCDR Heather Ray TBD Mr. James Hickey

LTC Dan Bridon Lt Col Kevin Kaps Dr. Brian Jones Mr. Mark Beckner

Maj(P) Reginald Sennie

= Acting Chief of Operations = Acting Deputy Director

= Acting Branch Chief of Operations = Acting Branch Chief

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Current Functional Mapping

SDD Clinical Portfolio DHCS Clinical Systems DHSS Business Systems SD D B ra nc he s SDD Business Portfolio Solutions Delivery Division User Integration Process Integration System Integration O th er HI T D ivi sio ns I/O Security

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Agenda

∎ Overview

∎ User Integration

∎ Process Integration

∎ Systems Integration

∎ Solutions Branch

∎ EHR Modernization (DHMSM)

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Organization

DHA

NCR Medical Business Support Ed & Training Health IT R&D Healthcare Ops

DHA

Solutions Delivery User Integration End-User Training Operational and Integration Testing

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End-User Training Section

∎ Health Information Technology (HIT) Training Program Policy,

Planning and Analysis

∎ Conducts Analysis, Designs and Manages training standards

and policies

∎ Product Curriculum Lifecycle Development- System Workflow

and Training (SWAT) Packages for all systems in the HIT

Portfolio

∎ Provides comprehensive HIT training implementation and

sustainment

∎ Conducts workflow training on clinical and business solutions

∎ EHR Workflow and Training Backbone

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Clinical System Training & Workflow

Metrics

Service Cost (millions) CSU CST/CWA CST/CWA:CSU

Army ($24 GS Over-hire, $3.4 $27.4

Contract) ~49,000 291 1:168

Navy (Contract) $7.6 ~31,000 49 1:632

Air Force (Contract) $4.5 ~25,000 55 1:455

Total ($24 GS, $15.1 contract) $39.1 ~105,000 395 1:265

CSU—Clinical System User (Active) CST—Clinical System Trainer

CWA—Clinical Workflow Analyst

Tri-Service Workflow Contract $9M 22 Training and Workflow FTW

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Operational & Integration Testing

Section

∎ Define Operational testing requirements and

expectations for functional, role-based use

∎ Develop performance and User Acceptance metrics

for success and continued monitoring for all SWAT

packages

∎ Maintain testing methods and standards

∎ Conducts and manages testing, minimizes impact on

mission

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∎ COA 1 (DHA Tactical Mission)

DHA HIT Solution Delivery Division creates and delivers a standardized Training & Workflow Implementation package to the individual end user by migrating

current service capabilities into the DHA HIT SDD

∎ COA 2 (DHA Strategic Mission)

DHA HIT Solution Delivery Division creates and delivers a standardized Training & Workflow Implementation package to the Services. Services will be required to maintain infrastructure to meet DHA implementation requirements

∎ COA 3 (DHA Hybrid Mission)

DHA HIT Solution Delivery Division creates and delivers a standardized Training & Workflow Implementation package to the Services. DHA SDD capabilities will augment existing Service training and workflow implementation capabilities during deployments.

18

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Agenda

∎ Overview

∎ User Integration

∎ Process Integration

∎ Systems Integration

∎ Solutions Branch

∎ EHR Modernization (DHMSM)

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Process Integration Branch

∎ Subdivisions of Process Integration

Business Process Management (BPM)

Operational Change Management (OCM)

Tri-Service Workflow Team (TSWF)

∎ Aligned to address the typical barriers to efficiency

Non-standardization

Poor adoption

Difficulty identifying barriers and avoidance of them during

implementation

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Process Integration

Tools/Products

∎ BPM

 “AS Is” and “To Be” Workflows for a unified approach

 UCD (Use Case Descriptions) to capture stakeholder’s

requirements ∎ OCM

 Review and Refine Project Manager’s OCM plan

Identifying measures and assistance with plan revision taking

into consideration the results of those measures ∎ TSWF

Identify/develop clinical workflow

 Develop TSWF AIM form for standardized documentation with

CPG’s embedded when available and clinical decision support

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∎ When AIM Form used for Diabetics, it increased prescribing of

medications that decrease morbidity/mortality

∎ Depression Screening

∎ Low Back Pain CPG AIM Form

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“Medically Ready Force…Ready Medical Force”

Potential savings of $2.7M when applied across the enterprise

Increased screening using a validated tool in Primary Care 29% to 89%

41.2% to 97.8% in documentation of Red Flags

$300K savings

at a single MTF in 1st quarter by

unnecessary MRIs and

sub-specialty consult orders

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“Medically Ready Force…Ready Medical Force” 23

Agenda

∎ Overview

∎ User Integration

∎ Process Integration

∎ Systems Integration

∎ Solutions Branch

∎ EHR Modernization (DHMSM)

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“Medically Ready Force…Ready Medical Force” “Medically Ready Force…Ready Medical Force”

∎ Integrate MTF/HIT schedules, coordination and planning

 Enterprise-wide Scheduling Common Operating Picture

 Conceptual Tool – Enterprise Scheduling Platform (ESP)

∎ Integrate HIT portfolio systems

 Domain management - OP, IP, Ancillary, Med Devices, Network Infrastructure,

Data Center, Business, and Theater/Operational

 Provides enterprise application and system integration analysis and

recommendations

Work closely with EA, PMOs, Capability Mgrs, I&O etc.

Broad view of all systems in domain; cross-pollination between domain mgrs

∎ Integrate systems into MTFs

 Execution support for deployment/decommissioning processes for HIT

systems

Centralize deployment operations

24

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“Medically Ready Force…Ready Medical Force” “Medically Ready Force…Ready Medical Force”

∎ No Common Operating Picture (COP) for

the development, deployment, and

sustainment of IM/IT Infrastructure and

Information Systems

No central repository of information

No standardized view of the MTF

environment

Not customer-facing or globally

accessible

Manpower intensive

25

Enterprise Scheduling Platform

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∎ Currently, mixed media for scheduling exists throughout the

enterprise that do not communicate with one another

DHCS – Master Schedule Excel Spreadsheet

DHSS – Currently has no IMS

DHMSM – Currently working to create an IMS in MS Project

IA (DIACAP, IV&V, and ATO) - SharePoint/Excel Spreadsheets

Lifecycle Management- SharePoint/Excel Spreadsheets

MILCON - SharePoint/Excel Spreadsheets

26

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Current Army Medicine Strategic

Synchronization Matrix (AM2M)

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Mature Environment

28  Deployments Upgrades Decommissioning's Major Exercises Inspections Governance

IA (DIACAP, IV&V, and ATO status)

MILCON Projects

Training Schedules

Facility Updates (ex: Paging System)

Lifecycle Events (ex: refresh, OS upgrades)

Reports (trend analysis, etc.)

ADHOCS Schedule by System/Program Schedule by Facility Schedule by Service Schedule by Region Schedule by Capability

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Tool Mock-up

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Tool Mock-up – Customized View

30 NIPR 2nd ATO Site Scheduled: 6/4/2014 Exp: 8/4/2014 Information Services Facility 50% Schedule - 34% Actual BOD: 1 Mar 14 FOD: 30 Apr 14 AHLTA Update ORI

HSI Expires ATO

EHR Deploys CHCS Update MILCON Renovation DBSS Decommission EBMS Deploys

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

Eglin Regional Hospital – 96

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Agenda

∎ Overview

∎ User Integration

∎ Process Integration

∎ Systems Integration

∎ Solutions Branch

∎ EHR Modernization (DHMSM)

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“Medically Ready Force…Ready Medical Force” 32

Solutions Branch

Vision

To assure healthcare providers have the Information Technology tools and information required to deliver high quality healthcare by providing superior Project Management services to the Defense Health Agency and its

customers in a transparent, scalable, flexible, efficient and effective manner.

Mission

The Solutions Branch enables excellence in the area of Program Management in the Defense Health Agency and its customers by providing Program

Management services of varying sizes and shapes allowing the customer to choose the services to best meet their need. All services will be conducted leveraging standardized processes, templates and industry best practices all tailored to meet our unique environment as it undergoes significant change in an evolutionary manner with both organizational structure and technical

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Branch Structure

∎ Solutions Branch  Functions as PMO ∎ Sections  Clinical  Business ∎ Offices

 Offices have functional

alignment

 Contains Service applications

from all Services

 Structure aligns to rationalizing duplicative applications or management teams So lut io ns D eliv er y D iv isio n Solutions Branch Program Management Service (Business)

Business Function Program Office

Business Function Program Office

Business Function Program Office

Business Function Program Office

Program Management Service (Clinical)

Cliincal Function Program Office

Clinical Function Program Office

Clinical Function Program Office

Clinical Function Program Office Systems Integration Process Integration User Integration

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Assess the As-Is Organizational

Process

NAVMISSA USAMITIC AFMOA DHSS DHCS

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Identify Expected Portfolio

Navy Medicine e-Library ESAMS MEDRUMPMIS EAS IV BUMIS II EEDRS CBIS NMO WMSNi ICIB S3 AFIFHTC ANAM VSSM VSISM NSQIP IMED Consent TRDVS FTDTL AudioCare MedWeb OPADS OMAS ARMD MiCare MEDBOLTS MEBITT SRTS CDA/CDS ITS AMSPi MODS TAMMIS ACS-ECG AWCTS BHDP

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Define the To-Be Organizational

Processes

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Agenda

∎ Overview

∎ User Integration

∎ Process Integration

∎ Systems Integration

∎ Solutions Branch

∎ EHR Modernization (DHMSM)

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SDD & EHR Modernization

38

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Solutions Delivery Division User Integration Process Integration System Integration

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Evaluations

39

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Contact Information

40

LTC Rich Wilson

Deputy CIO, Solutions Delivery, HIT, DHA

Richard.a.wilson34.mil@mail.mil

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