DoD Electronic Health Record & Clinical Standardization Presented by James Ellzy, MD March 20, 2015
DHA Vision A joint, integrated, premier system of health, supporting those who serve in the defense of our country. 2
Agenda Overview EHR History & Background What are we Buying? Lessons from Industry Business Process Management 3
EHR Modernization Phases Requirement Phase I Milestone: RFP Release Planning & Resourcing Phase II Milestone: Contract Award Deployment & Testing Phase III Milestone: IOC Go-Live! FY 14 FY 15 FY 16 # of Human Resources 4
EHR Modernization Guiding Principles Standardization of clinical and business processes across the Services and the MHS Design a patient-centric system focusing on quality, safety, and patient outcomes that meet readiness objectives Flexible and open, single enterprise solution that addresses both garrison and operational healthcare Clinical business process reengineering, adoption, and implementation over technology Configure not customize Decisions shall be based on doing what is best for the MHS as a whole not a single individual area Decision-making and design will be driven by frontline care delivery professionals Drive toward rapid decision making to keep the program on time and on budget Provide timely and complete 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 health Approved by the ASD (HA) and Surgeons General July 2014 5
A Little History: The Path to Modernization 1988 CHCS 1996 DoD Inpatient EHR deployment begins 1999 GEMS 2004 CHCSII AHLTA 2008 DoD Inpatient Deployment Completes & DoD/VA Inpatient EHR begins 2012 DoD/VA integrated EHR (iehr) 2010 EHR Way Ahead (EHRWA) 2013 DoD Healthcare Management Systems Modernization (DHMSM) 1980-1989 1990-1999 2000-2009 2010-2019 Learning from the past is a gift for the future - Unknown 6
Electronic Health Record (EHR) Transformation - Background EHR Strategy Shifted (Feb Jun 2013) DoD and VA pursuing different COAs DoD pursuit of a full and open competition for an OTS EHR The Undersecretary of Defense of Acquisition, Technology & Logistics leading the acquisition New program office established: DoD Healthcare Management Systems Modernization (DHMSM) DHMSM will replace MHS legacy systems: AHLTA, CHCS, Inpatient EHR, TMIP Initial Fielding by FY2017 New Council of Colonels established: Functional Advisory Council Provides forum to oversee all functional aspects of DHMSM Liaison between the DHMSM Program Office, functional (clinical, business, force health, Guard & Reserve) and technical communities Validates, prioritizes, and recommends disposition of functional requirements 77 7
This brief is intended for Military and Civil Service attendees only DHMSM Overview Department of Defense Healthcare Management Systems Modernization Established in response to direction from the Secretary of Defense Acquisition of an off-the-shelf Electronic Health Record (EHR) for the Military Health System (MHS) to replace legacy MHS EHR systems, including AHLTA, Inpatient EHR, Composite Health Care System (CHCS), and the EHR components of the Theater Medical Information Program (TMIP): Using industry-proven technology to modernize MHS Collaboration with the Interagency Program Office (IPO) and Defense Medical Information Exchange (DMIX) Program Office to ensure compatibility and interoperability with non- DoD healthcare partners, including the VA Business transformation initiative; not an IT project DHMSM will: Meet ONC Standards Improve Usability Support the full DoD mission (Garrison & Operational) Have a Modular, Open Architecture Priorities: Usability Health service delivery requirements Interoperable Adoptable Configurable Scalable Reliable 88 8
Defining DHMSM Requirements DoD is leveraging all the work that was performed with the EHR Way Ahead (EHRWA) for DHMSM This includes previous documentation approved by the Joint Requirements Oversight Council (JROC) and the defined requirements from the tiger teams The three JROC approved Concepts of Operations (CONOPS) are the cornerstone for the DHMSM requirements Health Service Delivery (HSD) CONOPS Health System Support (HSS) CONOPS Force Health Protection (FHP) CONOPS 9
Requirements roadmap - Using JROC Approved Doctrine HSD CONOPS JP 4-02 HSS HSS CONOPS FHP CONOPS CV-1 HR CONOPS 2008 MHS Strategic Plan The primary purpose of the Health Readiness Concept of Operations (CONOPS) is to support rigorous assessment and analysis of healthrelated capability gaps and inefficiencies through a capabilities-based assessment (CBA) process to reach appropriate materiel and non-materiel solutions CV-2 CV-6 Key Terms: Joint, Health Readiness, Integrated, Interoperable, Flexible, Scalable, Modular 10 10
Developed a Normalized CONOPS Matrix JROC Approved CONOPS Consolidated Capabilities Matrix Developed Normalized Capabilities Combined and consolidated capabilities listed in CONOPS Removed duplications Identified DoD unique capabilities Capability Decomposition Normalization Acquisition Sensitive 11
Lessons Learned from Industry DHMSM is an opportunity for MHS to find ways of simplifying and standardizing the approaches to care delivery across the Services. This is a driver towards becoming a Highly Reliable Organization. 12 12
Keys to Transformation Success Industry experience shows that the engagement of functional communities early and throughout a technology transformation greatly reduces the risks inherent in these enormous and complex endeavors 13 13
Business Process Management Activities Phase 1 Test Scenarios Phase 2 Standardization Operational Testing: Process Design & Workflow Standardization Continuous Process Improvement Enterprise Business Processes (vendor-agnostic) Enterprise Workflows (vendor-specific) DoD Interfaces Foundational Scenarios Clinical Content Developmental Testing Scenarios Testing & Evaluation Contract Award IOC The business processing mapping work was prioritized into phases to support contract award and designed to ensure the functional community is ready for contract award. 14
Business Process Management Personnel Clinical TSWAG Behavioral Health Psychiatric Psychologist Substance Abuse Dental Primary Specialty OMFS Maternal-child Prenatal/Intrapartum Postpartum NICU Gyn Musculoskeletal Surgical Non-surgical Rehab medicine Surgical/Peri-op Primary Care/Ready Outpatient Primary Care Inpatient Age <18 APV Age 18+ OR/Sterile process Readiness Anesthesia Optometry Pre-op/PACU Audiology Secondary/Acute Outpatient Inpatient Emergency Med ICU/PICU 64 TSWAGs will standardize the clinical/business workflows Preventive Health Occ Health Clinical Supporting Lab Pharmacy Radiology Quality/Pat Safety Coding PAD Soc Work/Case Mgt Dietary Chaplain Anatomic Inpatient Diagnostic Quality Inpatient ADT Social Work Inpatient Clinical Outpatient Nuc Med Patient Safety Outpatient Medical Records Care Management Outpatient Blood Clinical Interventional Risk Management Case Management Privacy Business Patient Admin Logistics Wkforce Mgt Resource Mgt Facility Mgt Data Quality MTF Human Resources Cost Centers Medical Records Operational Training Budget Med Maintenance Credentialing/Priv Asset Tracking Clinical / business domain workgroup activity will feed into the TSWAGs 15
TSWAGs Leverage current TSWF (TriService Workflow) and CAG (Content Advisory Group) expertise to accomplish clinical standardization. All clinical TSWAGs include inpatient and outpatient unless otherwise stated. Includes Operational Medicine as well as the fixed facilities TSWAGs will continue to govern standardization past DHMSM full deployment. *** 16
Process Design Overview Objective The purpose of design prior to vendor selection is to make design decisions that will influence future state processes and modify draft processes to meet MHS vision, guidelines and principles Process Design Output Includes: Future State Clinical and Business Process flows (>700) Design Decisions Enterprise and Domain Specific Policy & Procedure Impacts for each Service Job Role Impacts for each Service Change Management Impacts Enterprise and Domain Specific System Requirements Peripheral devices needed to support workflow 17
SME Determination Methodology 4 Priority Levels (Enterprise, Level 2, Level 3, Vendor-Specific)* *Tri-Service process designation is independent of Priority Level. All Priority levels have process designs that have been assigned a Tri- Service designation Tri-Service Representation 29 Domain Workgroups 700 Processes SMEs Design Sessions Single Service Representation There are 29 Domain Workgroups (e.g., Ambulatiry Care, Clinical Documentation) Each process is owned by a domain workgroup Representatives from other Workgepups may be asked to particpate in process discussion Identified SMEs by role that should be present for each process design Reviewed processes across all prioroty levels and identifed those prcoess designs and the specific roles within the design that would benefit from Tri-Service representation Processes are then rolled into Design Sessions. Design sessions contain a logically grouped set of processes and the associated set of SMEs. Design Sessions are OWNED by a Domain Workgroup Design Sessions may contain SMEs from other workgroups Example Domain Workgroup: Perinatal Process: Newborn Admission SMEs Required: 7 Distinct SME Roles identified 6 Tri-Service L&D Nurse Inpatient Pediatric Specialty Nurse Unit Clerk Bed Planning Admission Staff Department Manager 1 Non Tri-Service Nursing Administration Design Session: Labor and Delivery Design Session Owner: Perinatal 18
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