Defense Healthcare Management Systems
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1 Defense Healthcare Management Systems Mr. Christopher Miller 18 February 2014 Distribution A: Approved for public release; distribution is unlimited 1
2 Transformation 3 Keys to Success People Technology is just a tool. -Bill Gates Technology Process
3 "Any intelligent fool can make things bigger, more complex, and more violent. It takes a touch of genius and a lot of courage to move in the opposite direction." - Albert Einstein
4 DoD s Health IT Challenge
5 Mission and Vision MISSION Acquire, integrate, and deploy electronic health record solutions that improve clinical decisionmaking and advance healthcare data interoperability VISION Positively impacting the health outcomes of Service Members, Veterans, and beneficiaries
6 Where We Fit VA Acquisition Secretary of Defense USD AT&L Functional USD P&R PEO DHMS ASD (HA) DHA IPO Lead and coordinate DoD and VA adoption of and contribution to health data interoperability standards DHMSM Competitively acquire, test, deliver and successfully transition to a state-ofthe-market EHR System DMIX Provide technical solutions for seamless data sharing and interoperable health records that evolve with national standards
7 Who We Support Globally, across all time zones, and to the full range of military operations (DoD) Total Health Staff Personnel Civilians 60K 146K Military Personnel 86K Active Duty 1.4M National Guard/ Reserve Corps & Family Members 1.1M Eligible Beneficiaries 9.7M Active Duty Family Members 2.0M Retirees and Family Members 5.2M Clinicians 70K Prime Enrolled Beneficiaries 5.5M
8 Where We Support Theater Hospitals 6 Naval Ships 117 Hospital Ships 2 Submarines 71 Medical Centers 57 Dental Clinics 281 Ambulatory Care Clinics 364 Veterinary Facilities 255
9 DHMS vs. Commercial Deployments The acquisition and deployment timelines required for an EHR implementation vary based on the number of facilities, the number of employees, and the geographic dispersion of the implementation sites. Hospital System Number of Hospitals Number of Clinics Number of Physicians Number of Employees Deployment Scope Time (Years) Department of Defense (Military Health System) 1 57* 364** 70,000* 146,440* Worldwide (estimated) Commercial System A , ,259 US Commercial System B ,572 14,400 Regional Commercial System C ,000 22,000 Regional Commercial System D ,073 Regional Commercial System E ,300 Regional Superscripts 1, 2, 3, 4, 5 sited in Appendix A * US and Abroad **Medical Clinics Only Pursuing an aggressive timeline to get this EHR implemented in a timely fashion to maximize our return and value to our users
10 Overall Approach to EHR Modernization Metcalfe s Law Leverage the commercial industry through competition Occam s Razor Reed s Law Mooers Law Simplify our acquisition strategy Maximize the data sharing and interoperability to increase clinical value Focus on usability and clinical value Sowa s Law Ensure system is open and flexible Achieving Greater Efficiency and Productivity in Defense Spending
11 Metcalfe s Law: Leverage the Commercial Industry through Competition Widespread EHR Adoption Over the Last Twelve Years U.S. Department of Health and Human Services NCHS Data Brief. January 2014 High US Spending on Health IT Projected Health IT Spending in the United States 2014: $34.5 Billion Health IT Spending Breakdown by IT Category Database & Middleware:13% BI/Analytics: 17% Productivity Applications:12% Systems Management:14% Industry Applications:24% Business Applications:20% Metcalfe s Law: The value of a telecommunications network is proportional to the square of the number of connected users of the system (n 2 ).
12 Occam s Razor: Simplify our Acquisition Strategy Streamlined Acquisition Documentation Tailored to fit the specific needs of an EHR system acquisition Requirements Driven by State of Commercial Market Releasing draft RFPs to maximize feedback and shape final product Hosting multiple Industry Days to make sure we develop an acquisition strategy that fits the state of the EHR market Extensive market research to drive requirements and minimize development Simplified Contracting Approach Competitive Single award contract Gating strategy Occam s Razor: A principle of parsimony, economy, or succinctness used in problem-solving. It states that among competing hypotheses, the hypothesis with the fewest assumptions should be selected.
13 Simplify our Acquisition Strategy (cont.): DHMSM Program Schedule DHMSM Milestones -Program Milestones -Technical Reviews -Cost Planning -Requirements -Acquisition Testing -Contractor Integration Testing -Developmental Testing -Operational Testing User Adoption & Training Fielding and Deployment Begin Interface/Data/ IA / Infrastructure Analysis Prioritized Functional Requirements FY14 FY15 FY16 FY17 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q WRAMC site visit RFP IGCE Technical Data Library Populated Draft RFPs #1-3 Test Strategy #1-3 Draft Training & Change Management Plans #1-3 Draft DSP #1-3 Preliminary IOC site visit 2/18/2014 RFP ATP Release RFP Cost Analysis Document with CARD elements Initial Requirements Review Final DSP GALS I&S Plan Complete Receive Vendor Proposals ICE & LCCE GALS Implementation GALS Implemented Identify Enterprise Learning Management System Develop Projected Enterprise Deployment Schedule Command Executive Briefs Develop Site Visit Materials Award ATP Capabilities Gap Analysis Use & Test Case Analysis Contract Award Define Enterprise User Roles Initial Design Review Executive & End User Briefing Final Requirements Review CIT Site MOA Complete Install in GAL Training for SME [Technical / Functional] CBT FAC Evaluation of Contractor Training Package Advanced Training IOC Site Visit & Kick-off SIT TRR Evaluate Contractor Training Package CBT Fixed Facilities Limited Fielding Decision IOC ATP Final Design Review SIT IATO Business User Role Site Checklist Process Assignment Complete Workshop OTRR Limited Fielding Training Advanced Initial End Training User Training Legend Upcoming Event: Completed Event: Upcoming Program Dependency: Completed Program Dependency: Milestone Decision Point: OT CBT Installed at IOC Sites Onsite Support User Provisioning Full IOC Fielding Training Advanced Training Initial End User Training Fixed Facilities FDD ATP Onsite Support Seg 1 IOC Distribution A: Approved for public release; distribution is unlimited 13
14 Simplify our Acquisition Strategy (cont.): Notional Evaluation Process Service Provider/Integrator (SPI) Integrator EHR Solution Set No-Go No-Go Unacceptable Gate 1A Gate 1B Unacceptable Integrator Go Criteria Deployment Experience Migration Experience Collateral System Interface Exp Security Commercial & DoD Transferable Software Licenses Small Business Participation Associate Contract Agreements Unified Training Plan Go Viable Competitor Performance / Price Trade off Best Value to Award Go Solution Go Criteria ONC Certification BoS Integrated BoS Requirements Mapping ONC Certification BoB Integrated Dental Module Potential Trade-offs Integration & Configuration Approach, Deployment Strategy & Approach, User Adoption, Functionality & Requirements, Open Systems Architecture, Product Usability, Management Approach, Past Performance Cost/Price Factors Award Phase I Integration, Configuration, Testing, & IOC Deployment Phase II Garrison Expeditionary Deployments & Initial Lifecycle Sustainment Distribution A: Approved for public release; distribution is unlimited 14
15 Simplify our Acquisition Strategy (cont.): Notional Contract Strategy Single Award Indefinite Delivery Indefinite Quantity (IDIQ); full and open competition Prime contractor will bring the right team Gate ( Go / No-Go ) criteria prior to best value trade-off Task Order Contract Line Item (CLIN) Cost Reimbursement & Fixed Price Cost Accounting Standards (CAS) FAR Part 30 Earned Value Management (EVM) DFARS Contract Period of Performance (PoP) 5 10 years (duration driven by site deployment) Request for Proposal (RFP) Schedule Draft #1 released 27 January 2014 Draft #2 scheduled to be released end of March Phased Approach Phase I Integration, Configuration, Testing, & IOC Deployment Phase II Permanent Military Treatment Facilities (MTFs) (garrison) Temporary MTFs (expeditionary) Deployments & Initial Lifecycle Sustainment
16 Reed s Law: Maximize Data Sharing and Interoperability to Increase Clinical Value Interoperability Engage with Private Sector More than 50% of DoD healthcare data is provided by private sector providers Expanding interoperability Is critical to complete the patient picture Continue to Partner with Veterans Affairs Most VA patients received care in DoD Many patients receive care in both DoD and VA Remain co-staffed on joint efforts Collaborate to ensure compatibility Collaborate on Data Standards Partner with ONC and other health standards setting organizations to identify, develop, implement, and adopt universal standards Reed's Law: The utility of large networks, particularly social networks, can scale exponentially with the size of the network. Distribution A: Approved for public release; distribution is unlimited 16
17 Mooer s Law: Focus on Usability and Clinical Value Main contracting focus on off-the-shelf Core EHR capability that allows little tailoring and provides a consistent platform across multiple domains to support training, clinician needs, and efficient business workflows. Seamless and effective EHR transition Utilize established technological support Conduct tailored training in multiple formats Use commercial interfaces and flexible workflows Buy a proven off-the-shelf solution Develop contract structure that incentivizes and rewards continual improvement Mooers s Law: An information retrieval system will tend not to be used whenever it is more painful and troublesome for a customer to have information than for him not to have it. Distribution A: Approved for public release; distribution is unlimited 17
18 Sowa s Law: Ensure System is Open and Flexible Core design principles: Open system architecture approach to support interoperability Platform Flexibility Scalability Data Centricity Make adding, upgrading, and swapping components easy Support deployments based on scalable system architecture Utilize open standards to broker data between stakeholder Sowa s Law: Whenever a major organization develops a new system as an official standard for X, the primary result is the widespread adoption of some simpler system as a de facto standard for X. Distribution A: Approved for public release; distribution is unlimited 18
19 What Does Success Look Like? Service Members and Veterans Increased record portability Improved record accessibility Clinicians Improved decision-making based on more complete and integrated patient information State-of-the-market EHR system that continues to mature with the robust health IT marketplace Distribution A: Approved for public release; distribution is unlimited 19
20 Positively impacting the health outcomes of active duty military, Veterans and their beneficiaries Distribution A: Approved for public release; distribution is unlimited 20
21 Data Sources Hospital System Source Department of Defense (Military Health System) 1 DoD Healthcare Management Systems Modernization (DHMSM) Draft Request for Proposal #1 (February 2014): chdoc=5634a1829b402d6e86257c6f007329cd&editflag=0 Kaiser Permanente 2 Duke University Bon Secours Health System, Inc Kennedy Health 5 MidMichigan Health MidMichiganHealthEvolution_June2007.pdf _MidMichigan_Health_Annual_Report.pdf Distribution A: Approved for public release; distribution is unlimited 21
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