No Patient Left Behind Leading Transition to Modernized
No Patient Left Behind: Leading Transition to Modernized Capability Colonel Rich Wilson, MS, CPHIMS U. S. Army Chief, Solution Delivery Division, Defense Health Agency (DHA)
Speaker Introduction Colonel Rich Wilson Chief, Solution Delivery Division COL Richard A. Wilson currently serves as the Division Chief for the Solution Delivery Division, the Health Information Technology Directorate (J 6) of the Defense Health Agency (DHA). DHA is a Combat Support Agency supporting the military services and its 9. 4 million beneficiaries worldwide. DHA supports the delivery of integrated, affordable, and high quality health services to beneficiaries of the Military Health System.
Agenda • Intro & Background • Military Health System’s (MHS) approach to transitioning legacy applications to modernized systems • Enterprise Planning & Patient Risk • Takeaways
EHR Portfolio Modernization Current EHR • ADT Backbone • Artifacts Future EHR • Outpatient CHCS AHLTA HAIMS Essentris RISKS • Inpatient 2017 Initial Deployment 2022 Full Deployment ADT: Admissions, Discharge, and Transfer AHLTA: Armed Forces Health Longitudinal Technology Application CHCS: Composite Health Care System EHR: Electronic Health Record HAIMS: Health Artifact and Image Management Solution MHS: Military Health System
Introduction and Background There isn’t another military medical force like it in the world—with the expertise, the assets, and the global reach of our health system…
Military Health System (MHS) by the Numbers
MHS in Perspective Locations Hospitals Staff Military Health System 1, 230 55 Inpatient Hospitals 373 Ambulatory Care Clinics 245 Dental Clinics 300+ Expeditionary Units 205, 000 Ascension Health 1, 900 131 Hospitals 30+ Sr. Health Facilities 160, 000 Kaiser Permanente 660+ 38 Hospitals 258, 000+ Intermountain Healthcare 44+ 22 Hospitals 185+ Clinics 37, 000 Who
Defense Health Agency in Context
Solution Delivery Division (SDD) Mission: To deliver information technology solutions to the Military Health System through expert acquisition program management, process reengineering, information translation and sharing, and training and integration activities in order to support and advance the delivery of health care to our patients.
Modernization Roles ∎ SDD: q Capability and rationalization evaluation q EHR sustainment Standardization Optimization q Interfaces q Workflow standardization q Sustainment training q Data ∎ Defense Healthcare Management Systems Modernization (DHMSM): q Acquisition and deployment q Full deployment by 2022 Change Management Integration
MHS approach to transitioning legacy to modernized systems
Current State of MHS Legacy Applications • Current EHR • 20+ years old • 4 separate applications (government and commercial products) • Client-server architecture with central data storage • ~70 enterprise applications • Future EHR – MHS GENESIS: • Modernized commercial product (Cerner) • Single, integrated system • Centrally hosted • Deploying Feb 2017 through 2022
EHR Modernization Guiding Principles Standardize clinical and business processes across the Services and the MHS Standardize clinical and Design a patient-centric system focusing on business processes across quality, safety, and patient outcomes that the Services and the MHS meet readiness objectives Flexible and open, single enterprise solution that addresses both garrison and operational healthcare Clinical business process reengineering, Design a patient-centric adoption, and implementation over technology system focusing on quality, Configure not customize safety, and patient Decisions shall be based on doing what is outcomes that meet best for the MHS as a whole – not a readiness objectives individual area Decision-making and design will be driven by frontline care delivery professionals Decision-making and Drive toward rapid decision making to keep design will be driven by the program on time and on budget frontline care delivery Provide timely and complete professionals communication, training, and tools to ensure a successful deployment Build collaborative partnerships outside the MHS to advance national interoperability Enable full patient engagement in their Decisions shall be based on health doing what is best for the MHS as a whole – not a individual area
Evaluating the Portfolio 250 Projected System Dispositions 34 200 150 111 LPI – Low Possibility of being replaced; requires Interface LPNI – Low Probability of being replaced; No Interface 100 50 0 96 High - Systems that will be replaced by DHMSM and will not interface to the EHR – consolidate or terminate (High) • • Interface Sustain • • Decommission Legacy Data • • Sustain Rationalization Targets
Transition Application Program (TAP) • Data drive evaluation of current portfolio: Systems & Capabilities • 242 Systems (enterprise and local)
What Happens to Legacy Applications
Enterprise Planning and Patient Risk
Enterprise Planning and Risk Continuity of care Human data entry Periodic and delayed data refresh Interoperability Rotational staff Maintenance of legacy systems Cyber security Data interface gaps Privacy Legal issues Policy, budget, and governance changes System outages Process standardization Data accuracy, post migration
Continuity of Care • Planned interfaces of legacy systems to MHS GENESIS • Joint Legacy Viewer (JLV) Legacy • Business process standardization o Mapping old to new; and new o Implementation to both legacy and new system JLV Health Information Exchange (HIE) VA
Legacy System Maintenance • Must meet patient and staff demands well into 2022 • Budget concerns • Reduced footprint over time • Governance role in balancing investment • Planned upgrades • Cyber • Critical fixes • Active deployments (e. g. anatomic pathology) • Maintenance and improvement interfaces of legacy systems to MHS GENESIS • Continued legacy data access for continuity of care, analytics, research
Systems Sustainment 73 | Number of Systems 770 | Releases 2634 | Completed Change Requests FY 2016
Planned Maintenance and Upgrades AHLTA Essentris • AHLTA v 3. 3. 9 Baseline release is scheduled for Fall 2017 • Major Release CIS • Cyber Security v 213. 02 offers new enhancements features and functionality • Tech Refresh • Security Patch Releases • CAC / PKI are implemented Authentication quarterly (at a minimum • Cache 2016. 2 4 per year) • Open VMS CAC • Security Maintenance Authentication Releases are done in up to 45 day intervals • Decommissioning • AHLTA LCS & CDR • AHLTA Web Print • Decommissioning CHCS Cyber enhancements, critical fixes, etc. HAIMS • Migration from Share. Point • Document expansion • JLV connection • Service Treatment Record (STR) Processing Operations Reports Tracking Solution (SPORTS) for Dep of VA • MHS GENESIS Go-Live Success
Business Process Standardization • Regardless of IT tools, process standardization saves lives • Implementation of revised workflows • Training: • Consolidation of training mission in the DHA SDD • “Trust agents” embedded in clinics and hospitals • Augmenting workforce of sustainment trainers with new EHR • Improved support model
DHA Data Vision DHA Data Canons Ensuring the right information is accessible to the right customers at the right time and in the right way Efficiency Speed § Streamlined information, clean of redundant data § Rationalized processes, tool utilization, and acquisition § Bimodal exploration to map current and future state § Tools o Data lake, Hadoop, Teradata, etc Trust § A single known source for up-todate data § Centralized, master data management Intelligence § Descriptive, prescriptive and predictive analytics in a one-stop-shop Enabling User Experience § User tools (Super Users, Analysts, and Researchers) § User centered § Speed
Data Modernization • Master Data Management • Data Governance • Legacy Data • Service Oriented Architecture • Enterprise Intelligence & Data Solutions PMO
Governance and Execution • Complex coordination and communication challenge • 3 legged Stool • Functional Champion • Information Technology • Acquisition • Functional Champion Leadership Group • Workstream Steering Committees (WSCs) • Tri. Service Workflow Advisory Groups Data Business Process Mgmt Deployment & Activation EHR WSC SYNCH Strategic Technical Config Comm Change Mgmt
Takeaways and Lessons Learned
Key Takeaways • The Military Health System is undergoing an unprecedented modernization • Highest risk to patients in during the transition • Careful analysis of current portfolio required • Standardize workflow • Impact on data and analytics
Questions?
Contact Information Colonel Rich Wilson, MS, CPHIMS Chief, Solution Delivery Division Defense Health Agency www. health. mil/sdd Richard. a. wilson 34. mil@mail. mil www. linkedin. com/in/Richard-wilson 1
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