Integrated Investment Decision Making at the Veterans Health Administration (VHA)

Transcription

1 Integrated Investment Decision Making at the Veterans Administration (VHA) Troux Worldwide Conference April Ian Komorowski, Deputy Director, Business Architecture (BA) Jim Sant Amour, Office of Strategic Integration (OSI)

2 Agenda Department of Veterans Affairs (VA) - Veterans Administration (VHA) Size and Complexity Our Approach Business and Information Technology (IT) Governance Structure Business Architecture Information for Decision Making Implementation & Execution Project Management Approach Early Results 2

3 Veterans Today Today, there are more than 22 Million living Veterans. 8.9M+ Veterans are enrolled in the VA health care system 3M+ Veterans and survivors receive VA compensation and pension benefits 3

4 VA Major Business Lines Fiscal Year 2013 Total VA Funding: $127 Billion National Cemetery Administration (NCA) Memorials & Burials Headstones & Markers National Shrines State Grants Veterans Benefits Administration (VBA) Life Insurance Home Mortgage Education (G.I. Bill) Compensation & Pension Vocational Rehabilitation Employment Services Veterans Administration (VHA) Primary & Specialty Care Long-Term Care Rehabilitative Care Promotion Mental Services Prosthetics Services Medical Research Office of Information & Technology (OI&T) Centralized Information Technology (IT )Organization Direct Appropriation 4

5 VHA By the Numbers Annual budget exceeds $56 billion (FY 13) 6.5 million unique patients treated 150 medical centers, 819 outpatient clinics, and 135 community living centers 288,000+ employees including 177,000 clinical staff Care Delivery (FY 13) 86.4 million outpatient visits 292,600 outpatient surgeries 694,700 inpatient admissions 266 million lab tests (inpatient and outpatient) million prescriptions dispensed Nation s largest provider of graduate medical education Major contributor to medical research Service in national emergencies 5

6 VHA Organization Interim Under Secretary for (I-USH) (10) (Acting) Principal Deputy Under Secretary for (10A) Chief of Staff (10B) (Acting) Deputy Under Secretary for Operations and Management (10N) 21 VISNs (10N1-10N23) Acting ADUSH for Operations and Management for Administrative Operations (10NA) ADUSH for Operations and Management for Clinical Operations (10NC) Selected Veterans Administration Organizations Created March Office of Informatics & Analytics (OIA), Strategic Investment Management (SIM) Office of Nursing (10A1) ADUSH for Workforce Services (10A2) Office of Finance (10A3) ADUSH for for Quality, Safety and Value (10A4) Office of Strategic Integration (10A5) Deputy Under Secretary for for Policy and Services (10P) ADUSH for Policy & Planning (10P1) ADUSH for Informatics and Analytics (10P2) Informatics (10P2A) Analytics & Business Intelligence (10P2B) Information Governance (10P2C) Strategic Investment Management (10P2E) Public (10P3) Connected (10P2D) ADUSH for Patient Care Services (10P4) 6

7 Introduction to OSI and SIM/BA Office of Strategic Integration (OSI) The Office of Strategic Integration (OSI) facilitates the successful implementation of the VHA Strategic Framework and supports the development of a systematic approach to the design, evaluation, and diffusion of new capabilities. OSI collaborates with stakeholders to define and achieve common goals while optimizing standardized business processes to ensure coordination, integration, and effective execution of the VHA Strategic Plan. Strategic Investment Management (SIM) Business Architecture (BA) As an integral part of the Strategic Investment Management (SIM) Office, BA develops and manages the VHA business architecture, which structures and communicates the VHA health care business and includes descriptions of business behaviors, functionality, processes, and the flow of information that is required to achieve VHA's mission. The VHA business architecture supports and integrates with Veterans Affairs (VA) and federal enterprise architectures. 7

8 Our Challenges Governance boards and Department leadership need to be able to make the most informed decisions about investments; however information can be fragmented and out of sync OSI Business Planning Currently top-down funding for facilities / backward projecting Goal is bottom-up / forward-looking SIM BA lack of business priority leading and strongly connected to IT governance Needs critical mass maturity of Troux implementation 8

9 Business Owners VHA Governance Structure VHA Business Governance Committees Clinical CMB Business CMB NLC/I-USH ITC IB Pop. Anal. & Mgmt.. CMB R&D CMB Decision-making Organizational Strategy Recommendation-making Functional Planning Coordination with IT PM OI&T Coordination with VHA BO Legend: NLC: National Leadership Council ITC: IT Committee CMB: Capability Management Board ARIWG Cost Estimation/Tech & Sys Arch IT Product Mgmt. Invest Portfolio I-USH: Interim Under Secretary for IB: Integration Board ARIWG: Architecture, Requirements & Investment Working Group 9

10 Breast Cancer Clinical Case Registry and Tracking of Abnormal Results Breast Cancer Clinical Case Registry and Tracking of Abnormal Results Breast Cancer Clinical Case Registry and Tracking of Abnormal Results 689, 774 Allow RT/NRT querying of the system to track all diagnostic test results (abnormal or normal) and provide notification to providers of abnormal test results. 689, 774 Establish a registry to ultimately improve detection, diagnosis, and treatment of breast cancer. 689, 774 Provide breast cancer patients the ability to directly interact with the care team and to provide key input into their preventative and curative care. VHBAO:NEED233 VHBAO:NEED234 VHBAO:NEED235 Monitor and Follow-up on Patients Status and Outcomes Monitor and Follow-up on Patients Status and Outcomes Monitor and Follow-up on Patients Status and Outcomes 7 - New Models of Care (NMOC) - Women s (W H) 7 - New Models of Care (NMOC) - Women s (W H) 7 - New Models of Care (NMOC) - Women s (W H) Common Care Business Activity DoD Organization Specific A.1 Provide Access to Care A1.1 Determine Beneficiary Care Eligibility Status A1.2 Perform Assessment and Plan for Care A1.3 Schedule Beneficiary Care Services A1.4 Manage Beneficiary Continuum of Services A1.5 Manage Beneficiary Encounter A1.6 Support Beneficiary Services A1.7 Establish Access to Care Performance Measures A1.8 Support Community Outreach VHA Organization Specific A.2 Manage Population A2.1 Define / Assess Population A2.2 Develop Population Management Practices A2.3 Support Proactive Activities A2.4 Establish Effective Communication and Workflow Facilitation A2.5 Evaluate Population Management A2.6 Perform Medical Surveillance No DoD References Available A.3 Manage Care Administration A3.1 Provide Logistics Management A3.2 Manage Finances A3.3 Manage Human Resources A3.4 Develop and Implement Policies A3.5 Perform Medical Management A3.6 Administer Patient Care Administrative Services A3.7 Monitor Business Management Activities A3.8 Support Managed Care Contracts A3.9 Perform Medical Situation Awareness A3.10 Identity Management A.0 Provide care A.4 Provide Clinical Decision Support A4.1 Manage the Targeted Population Database A4.2 Provide Access to Information Resources A4.3 Create/Manage Clinical Documents A4.4 Provide Communications Support A4.5 Provide Information and Decision Support Management A4.6 Provide Inter- Agency Interoperability A4.7 Provide for Communications with Civilian Providers A4.8 Provide Immunization and Medication Alerts A4.9 Provide Automated Support for Care and Treatment Plans A4.10 Utilize Acceptable Care Messaging Standards A4.11 Provide Technology Assessment A.5 Manage Care Delivery A5.1 Assess Beneficiary Status A5.2 Plan Services A5.3 Manage care Services A5.4 Manage Clinical Information and Documentation A5.5 Ensure Quality of Services A5.6 Perform Operations Management and Communication A.6 Provide Care Research A6.1 Services Research and Development (HSR&D) A6.2 Coordinate Rehabilitation Research and Development Programming A6.3 Coordinate and Develop Medical Research Service Programs A6.4 Administer Cooperative Studies Program (CSP) A.7 Provide Care Education A7.1 Manage Allied Education A7.2 Manage Graduate Medical Education A7.3 Provide Adequate Supply of Personnel VHA Business Architecture Alignment Model Improving Veterans Mental (IVMH) Enhancing the Veteran Experience & Access to care (EVEAH) New Models of Care (NMOC) Portfolio Research & Development (R&D) Application System Pharm: Bar Code Medication Administration (BCMA) Pharm: Benefits Management (PBM) Pharm: National Drug File (NDF) Acronym Application System Description BCMA PBM NDF Bar Code Medication Administration (BCMA) software provides a real-time, pointof-care solution for validating the administration of Unit Dose (UD) and Intravenous (IV) medications to inpatients in Veterans Administration Medical Centers (VAMCs). BCMA uses a Graphical User Interface (GUI), MS Windows-based Client/Server architecture, designed to improve the accuracy of the medication administration process, and to increase the efficiency of the administration documentation process. The end result is enhanced patient safety and patient care at VAMCs. The software extracts medication dispensing data elements from the Outpatient Pharmacy, Inpatient Medications IV and Unit Dose, Automatic Replenishment/Ward Stock, and Controlled Substance modules; Procurement information from Drug Accountability, Integrated Funds Control, Accounting and Procurement (IFCAP); and a limited amount of Laboratory data on a monthly basis. The software makes data extraction reports available at Department of Veterans Affairs Medical Centers (VAMCs) and allows local management to use the data to project local drug usage and identify potential drug accountability problem areas. The National Drug File (NDF) package provides standardization of the local drug files in all VA medical facilities. Standardization includes the adoption of new drug nomenclature and drug classification, as well as linking the local drug file entries to data in the National Drug files. For drugs approved by the Food and Drug Administration (FDA), NDF provides VA medical facilities with the ability to access information concerning dosage form, strength and unit, package size and type, manufacturer s trade name, and National Drug Code (NDC) information. The NDF software also lays the foundation for sharing prescription information among medical facilities. VA Care IT Applications VA / VHA Strategic Drivers Care Focused VA Portfolios and Programs Segment Informatics Initiative (hi 2 ) Care Efficiency (HCE) VHA Business Function Framework Care Segment VA Capabilities Model OneVA Enterprise Architecture Federal Enterprise Architecture (FEA) Business Reference Model (BRM) Line of Business Sub-Function Access to Care (217) Population Mgmt. & Consumer Safety (246) Care Administration (247) FEA Business Provide Line of Business Care (0) Provide Access Manage Manage Care Manage Provide Provide Function Reference to Care Public Administration Care Delivery Model Care Research Care Education (1) (2) (3) (4) (5) (6) (7) VHA Business Architecture Business Function Framework (110) Care Delivery Services (248) Care Research & Practitioner Education (249) Manage Business Enabling Services VHA IT Projects Request ID VHA Business Requirements Request Name VHA IDs Need Description Need Tag Arch/BFF Category Line of Business Provide Access to Care Manage Public Provide Care Administration Deliver Care Conduct Care Research VHA Business Process Models and Information Models Provide Care Education Manage Business Enabling Services VistA 4 Product Roadmap DoD/VA Integrated Business Reference Model (ibrm) VA VBA BRM 10

11 Phased Implementation Troux Insight & Navigate Implementation Where We Are Sept 2014 Oct 2014 Nov 2014 Dec 2014 Jan Feb Mar Apr May Jun July Aug Sep Kick-Off Success Planning Workshop Phase 1 Phase 2 Phase 3 Phase 4 Perspectives & Reports Defined Data Loading Analysis Success Planning Workshop Perspectives & Reports Defined Data Loading Analysis Success Planning Workshop Perspectives & Reports Defined Data Loading Analysis Success Planning Workshop Business Value Perspectives & Reports Defined Data Loading Analysis Business Value Workshop Business Value Workshop Business Value Workshop Business Value Workshop 11

12 Business Capability Provide Prosthetics and Sensory Aids Plans, develops, administers, and implements national policies and procedures governing comprehensive National Prosthetic Programs Plans, develops, and executes the VHA delivery system for prosthetic and orthotic appliances Manage National Prosthetic Program Provide Prosthetic and Orthotic Lab Services Provide Prosthetic Devices Manage Prosthetic Clinical Program Provides specialized patient care by furnishing properly prescribed prosthetic equipment Coordinates the development of clinical practice recommendations that will enhance the appropriate use of prosthetic devices 12

13 Provide Prosthetics and Sensory Aids Related Components 8 Programs, 1 Strategy, 2 Applications, and 7 Business Processes 13

14 Future Intent Use Roadmaps and other Insight analytics to proactively inform governance 14

15 Future Intent 15

16 Contact Information Strategic Investment Management, Business Architecture Ian Komorowski, Deputy Director (202) Office of Strategic Integration James D. Sant Amour, PMP, FAC-P/PM (202)

17 Posted Abstract Tue, 04/14/ - 1:00pm Track A - VHA: Integrated Investment Decision Making at the Veterans Administration (VHA) Ian Komorowski, SIM BA Deputy Director - VHA and Jim Sant Amour, Office of Strategic Integration VHA VHA is integrating information technology and business capability investment processes to support governance boards and VHA leadership in making the most informed decisions about investments. Please join us for this session to learn about the trials and tribulations of implementing the process that will allow VHA to change decision making for the better at both the strategic and tactical levels for the development of the multiyear investment plan in the second largest Federal organization. 17