San Antonio AFCEA Chapter Luncheon - c.ymcdn.com · PDF fileSan Antonio AFCEA Chapter Luncheon Air Force Medical Service Air Force Health IT (HIT) ... “Medically Ready ForceReady

Air Force Health Information TechnologyTransformation

May 19, 2015

Lt Col Kevin SeeleyChief Technology Officer

Office of the Surgeon General

San Antonio AFCEA Chapter Luncheon

Air Force Medical Service

Air Force Health IT (HIT)

Digital Health Trends

Defense Health Agency (DHA)

DHA HIT Transition

Electronic Health Record Acquisition

Summary

Agenda

2“Medically Ready Force…Ready Medical Force”

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

CSAF’s Charge

“Each Airman has a

compelling story that

needs to be told. Tell your

story. Let your fellow

Americans know that their

Air Force provides Global

Vigilance, Global Reach,

and Global Power to

defend our great Nation.”

- General Welsh

Fly, Fight & Win … In Air, Space & Cyberspace

3


US Air Force Medicine

Enable Medically Fit Forces,

Provide Expeditionary Medics,

and Improve the Health of All

We Serve to Meet Our

Nation’s Needs

The Mission of the

United States Air Force is

To Fly, Fight and Win…in Air,

Space and Cyberspace

AF MISSION

AFMS VISION

AFMS MISSION

Trusted Care Anywhere 4

Our Supported Population is the

Healthiest & Highest Performing

Segment of the U.S. by 2025


Air Force Medical Service

Mission: Enable Medically Fit Forces, Provide Expeditionary Medics, and

Improve the Health of All We Serve to Meet Our Nation’s Needs

Total Force Personnel

32,661 Active Duty

7,439 Civilians

4,056 Contractors

16,318 AF Reserve/Guard

FY14 Budget/Infrastructure

$6.5B (all programs)

75 Medical Facilities

61 CONUS

14 OCONUS

Deployed

>102K patients moved out of

CENTCOM since 11 Sep 01

1,289 medics deployed to 19

countries in 38 locations

Homestation

2.6M eligible beneficiaries (AF)

10.3M ambulatory visits/year

34K inpatient admissions/year

59K Prescriptions/day

Air Force Medicine…Delivering “Trusted Care, Anywhere!”

5


CENTCOM

AFRC

SOUTHCOM

EUCOM

PACOMANG

AFRICOM

International Total Force

Engagement

6


Lighter, Leaner, and Faster

Medical Response

Joint Tactical

Radio System (JTRS)

TM60

TM60

TM60

TM60 TM60

SM5 SM5

ER

OB/GYN

ORAdmin

Log/BMET

ICU

Pharm

Lab

BEE

PHO

Xray

PED

PCM

Dental

EMEDS

HRT

40 Medics / 1 C-17

Pt Care in < 15 Mins

ER/OR/ICU < 6 hours

Rapid Capability to Stabilize and Evacuate

Enhanced

Logistics

Package

Physical Therapy

Enhanced Dietary Services

Exp C2, Admin, Log

Exp Ancillary Services

Exp Med/Surg Services

Dental Augmentation

Surgical Augmentation

15 Additional Beds

Complex Med/Surg Svc

All EMEDS+10 Capability

Enhanced Critical Care

Enhanced Med Log

Laboratory Support

PAM Augmentation

6 Additional Beds

Medical Command

All EMEDS HRT Capability All EMEDS HRT Capability

HSS Admin

Medical Logistics

Field Surgery

Dental

Prev Med

(Pub Health, BEE, IDMT)

Primary Care or Flt Med

Critical Care

Pharmacy

Radiology

PAM Augmentation*

Specialty Care Aug

International Health

Specialist (IHS)*

EMEDS HRT

(4 holding beds)

EMEDS+10

(10 beds total)

EMEDS+25

(25 beds total)

* Mission Dependent

7


Closing the Gap in the

En Route Care Continuum Create a Patient Staging Continuum

Advance “Care in the Air” Capabilities

Continue to Decrease Combat Mortality

Transition System to

Enroute Patient Staging

System (ERPSS)

Single/Integrated

Training Platform

Patient StagingTCCET

Tactical Critical Care Evacuation Team

Increasing Number of Teams in

AOR

Initiated Point of Injury Mvt

292 patients to date

> 1,135 Critical Patients Moved

Modular/Flexible for any

Contingency or DSCA

CCATT

In-Flight EHR

Modernizing Equipment

Critical Care Air Transport Team

187K Patients Moved Since

October 2001

(> 8K CCATT Pts)

Specialty Capabilities

Evidence Based Refinement of En Route Care8


Building Our Capabilities

Coordinated Care to Deliver Expertise and Value

Trained

Current

Deployable

Department

of

Defense

CIVILIAN

HOSPITALSACADEMIA

VETERANS

AFFAIRS

Goals

Increase Capacity and

Currency of Staffs

Build “Win-Win”

Partnerships in Training,

Research and Development

Recapture Care

Effects

Improves Quality of Care

More Patient Choices

Retains Providers

Reduces Cost

Saves Lives

9


Air Force Medics…Owning the Mission

Wing/CCs Own Their Medics and Medics Own Their Wing Mission 10

AFMS HIT Role

Core Services & Non-Medical IT Requirements

DHP $ & Enterprise Medical Systems

AF MHSAFMS HIT

CIO/SG6


- Leverage tech & data to drive high reliability / accountable care- Navigate hype vs. value to patient outcomes- Bridge all stakeholders across enterprise- Support standardization to conserve resources, reduce one-offs- Critical to provision of patient care, services, mission assurance


HIT Functional Mission

Critical “Mission Enabler”

Information Security(Data is protected and recoverable)

Information Technology(Phones work, networks work, PCs work…reliably)

Information Assurance(Data from a system is reliable)

Information Management(The right data is available)

Knowledge Mgmt(Right person/place/time)

Insight& Action

(Change Agent)

Analytics &Informatics

We operate a Full Spectrum of:Health Systems, Infrastructure, Devices & Data


• MiCare• ASIMS/PIMR• MRDSS Ultra• CarePoint• CHAS• KX• S3• ARMD – Innovian• ICDB• Dragon• RMS• PACs• AIDC-RTLS• Wireless LAN• SDC• CEMM

• AHLTA• CHCS• HAIMS• Essentris• TMIP• DMLSS• DHMRSi• MEPRS• TOL• BHDP• BHIE/FHIE• PDTS• TPC• CCE• ICD10• DBLS


We keep this working

Manage the Hype Cycle



Digital Health Trends

• Activity Trackers

• Smart Watches

• Ingestibles

• Implantables

• Smart Clothing

• Patches/Tattoos


What is AFMOA?

AFMOA will provide direct reach-back

capability related to clinical processes

and administrative management in

support of 75 MTFs and 11 MAJCOM

activities

Realigned mission based upon HQ AF

Directive in January 2008. (7 yrs ago)

Air Force Medical Support Agency

(AFMSA) is policy arm of the AFMS;

AFMOA is execution and operations

MTF Reachback – 1st stop for IM/IT answers/field guidance

Medical ESD/GSD – Centralized helpdesk – Tier 1

Network Ops – Interface w/ AF network/firewalls/net security

Deployment Ops – Clinical systems deployments/sustainment

MSIM – LAN/WLAN Infrastructure/cable plants/switches/phones

Info Ops – Knowledge X-change/SharePoint/Web/Media Portals

EUD Refresh – Desktops/Laptops/Tablets

PMOs – Program offices/responsible/accountable system owners

Cyber Ops – AFSPC Medical Liaisons/Fellowships

AFMOA HIT Capabilities



So why the DHA?


Opportunities for efficiency

We must …

“Medically Ready Force…Ready Medical Force” 22


From Task Force to Transition

Outcome - 10 DHA Shared Services

1

TRICARE Health Plan

2

Pharmacy Programs

3

Medical Education & Training4

Medical Research & Development5

Health Information Technology

Facility Planning

Public Health

Medical Logistics Contracting

Budget & Resource Management

6

7

8

9

10

24

“Medically Ready Force…Ready Medical Force”

DHA Joint Leadership

Health Information Technology (HIT) shared services aims to create an integrated HIT environment in support of an integrated Military Health System

To support this vision, HIT will fully consolidate operations to be “all-in” under the management of the Defense Health Agency (DHA)

A DHA Chief Information Officers (CIO), Service Chief Medical Information Officers (CMIO), management functions, and operational services were put in place first at IOC (1 Oct 2013)

DHA HIT “All In” Shared Service


DHA HIT

MissionImplement, manage, and sustain an integrated and protected

medical information enterprise that delivers the right

information to the right customers at the right time

VisionA premier health information technology environment

enabling integrated care delivery for our nation’s defenders,

retirees, and their families


Organizations Forming DHA HIT, 1 Oct 2013


Deputy Director, HIT (Deputy CIO)

Portfolio Management and Customer Relations

Enterprise Architecture Branch

Communications & Customer Relationship Branch

• Information Reachback

Investment Management Branch

Strategy & Process Management Branch

HIT Operations Support Branch

Infrastructure & Operations

Business Operations Branch

• Strategic Investment Process (SIP)

Security Operations Center Branch

Engineering, Design and Deployment Branch

• Medical Systems Infrastructure Modernization (MSIM)

Operations and Sustainment Branch

• iNOSC/Network Svcs• MESD• IT Refresh

Solution Delivery

Solutions Integration, Implementation, and Sustainment Branch

• Deployment Ops

Director Defense Health Agency

DHA HIT – AF HIT Assimilation

Cyber Security

Cyber Security Policy, Coordination and Compliance Branch

Privacy Office & Policy Collaboration - HIPAA Security Branch

Information Assurance Branch

Cyber Security Operations Branch

Innovation & Advanced

Technology Development

Strategy/Planning Branch• Innovation and SOA

Realization Section• Innovation and SOA

Transition and Program Mgmt Section

Execution Branch• Research and

Development (R&D) Section

• Alliance, Coordination, and Execution (ACE) Section

Modernization Branch• Requirements Liaison

Section• Project Liaison Section

Informatics Branch• Intelligence & Analytics

Section• Knowledge Management

Section

Operations Branch• Data Governance &

Management Section• Platform & Apps Section

Information Delivery

Director HIT (CIO)

182 MEDICAL FACILITIES WORLDWIDE


Textbook Challenges:Forming, Storming, Norming…


Copyright ©2014 TeamQuest Corporation

“The concept of IT service optimization is often associated with increased efficiency and reduced risk, two forces that will drive valuable improvements. But without a full understanding of the business objectivesand how IT needs to be aligned with those, full optimization is not possible.”

- 31 -

For Official Use Only

*** Shared Service ***(Proposed Name: “Joint Capability and Requirements Development”)

Business Process Owners (Capability Manager/Functional Proponent)

• Accountable for the total cost and performance for a given area of the business

(e.g., primary care, pharmacy, referral management).

• Has responsibility and authority to drive standardization and reengineering of

business processes needed to improve performance.

• Prioritizes improvement projects and requirements for business area.

• Represents respective organization in the development of joint capabilities and

requirements throughout acquisition lifecycle.

Function stays in Services to ensure the alignment with Service customers and

to drive the necessary business changes within organization.

Business Owner (MDAG)

• Determines “operating model” for the business – the targeted level of

business/clinical process standardization and integration.

• Accountable for overall cost and performance of business.

• Reviews, prioritizes, and approves business cases and investment proposals.

• Accountable for driving change needed to realize benefits from improvement

projects throughout acquisition lifecycle.

Joint Capability & Requirements Developers (Information Manager)

• Facilitates and coordinates:

• Joint capability and full spectrum requirements development

• Development of standard business processes/data

• Development of standard measures of performance

• Prioritization, consolidation, and rationalization of portfolio

• Functional input throughout acquisition lifecycle

• Supports the joint governance process

Function resides in Defense Health Agency to ensure enterprise focus and to

drive the level of process standardization and integration specified by MDAG.

Concept for Joint Capability and Requirements Development

Business

Owner

Business

Process 1

Business

Process 2

Joint Requirements

Standard Business Processes & Data

Business

Process N

A N AF A N AF A N AF

….

….Joint

Capability

Joint

Capability

Joint

Capability

Timely development and validation of joint

requirements and standard business processes is

key to the success of HIT.

Horizontal & Vertical

Communication

32

What we have to do:Portfolio Rationalization Decisions

Business/Clinical Value

- 33 -

For Official Use Only

Conceptual Design End to End Process Design Implement

Deve

lop

an

d E

xe

cu

te • Current State Assessment

• Process Inventory

• Funding, Cost and Savings Figures

• Functional Requirements

• Personnel/Headcount

• Transition Plans

• End-to-End Processes

• Measures/KPIs

• Technical Requirements

• Help Desk Platform Analysis

• Vendor Selections

• Acquisition Plan

• Consolidation Plan

• Reports Development

• System Rollout

• Help Desk Decommissioning Plan

• Personnel Transition

• Funding Realignment

Example of Product Line Consolidation: Help Desk

= Governance Decision Point

To realize its projected cost savings, HIT will conduct portfolio rationalization and business process reengineering (BPR)

for all product lines. As it consolidates and reengineers each product line, HIT will gain approval from leadership at pre-

established decision points, allowing Service leadership to approve plan development, review and accept estimates of

costs and savings, and sign off on technology acquisition and implementation plans before each phase begins. Below is

an illustration of how the consolidation of one product line, Help Desk, might proceed within DHA HIT.

Air Force Help Desk

Army Help Desk

Navy Help Desk

Decision Point:

Design and Development

Decision Point:

Planning

DHA Help Desk

Decision Point:

Implementation

DHA HIT “To-Be” at Maturity


Consolidate & Standardize: Datacenter to Desktop (D2D) “One Forest” – identity & enterprise mgmt, active directory

“One Network” – consolidate multiple networks

“One Email” – everyone on same email system

“One Datacenter” – single datacenter hosting strategy

“One Web” – single web hosting solution

“One Desktop” – a single desktop configuration and strategy

“One Help Desk” – a single help desk capability

“One AV/Comm” – a single AV/communications strategy

“One e-Learning” – a single shared platform

“One EHR” – single integrated EHR platform

“One Analytics Platform” – everyone using common data service

HIT Infrastructure Plan in Place

IT SERVICE CAPABILITY BUSINESS IMPACT

Network Security Management Service (NSMS)

Seamless integrated Wide, Local, and Wireless NetworkCapabilities include a Single Security Architecture and centralized Designated Accrediting Authority (DAA), standardized monitoring/ management, and improved provider mobility

Systems and applications will be accessible across the entire DoD health care environment allowing complete access to all patient information regardless of health care location.

Directory Services (DS)/ Enterprise Management (EM)

Centralized and secure access and authentication capability to network resourcesLeverages ability to centrally manage DS infrastructure throughout the enterprise

Health care providers and staff will be able to move from hospital to hospital and be able to authenticate to all IT services without needing new accounts.

Desktop as a Service (DaaS)

Desktop design standardization service across the application, desktop and server environments Includes standardized desktop configuration and application virtualization capabilities across physical and virtual desktops

All desktops will be standardized so providers and staff will be able to move within the medical facility and have access to their information resources.

Compute and Storage Management Service (CSMS)

Centrally managed, integrated, and robust computing: infrastructureGeographically-distributed infrastructure designed todeliver low-latency services close to the point of careor point of need

Provides a standard method to host applications and the ability for the DoD health care system to use single applications to support all care encounters.

Global ServiceCenter (GSC)

35

Consolidated MHS enterprise IT service desk Provides a single point of contact for all customers to obtain support for all systems regardless of physical location.


Need for ConsolidatedMedical Network

DHA Standard Desktop


38

Med-COI Network Transition

Medical Cyber Enterprise


Shared ServicesCulture vs. Technology


Buying a New EHR


New Electronic Health Record (EHR)Acquisition Mandate

21 May 13: SECDEF completed 30 day review of the DoD/VA integrated EHR

Pursue full, open competition for EHR modernization led by USD Acquisition, Technology & Logistics (AT&L)

21 Jun 13: USD (AT&L) authorized a DoD EHR acquisition to “buy”

Established new program office: Defense Health Management Systems Modernization (DHMSM)

25 Aug 14 – Final EHR RFP released for bid

Projected contract award 30 Jun 15

Goal: Begin replacing MHS legacy medical systems by January 2017


Defense Healthcare Management Systems Modernization (DHMSM): Next 24 months…


EHR Modernization Guiding Principles


Initial Operating Capability (IOC)Wave Zero


Are we making progress?


Transformation Journey


Summary

Contact Info


Lt Col Kevin Seeley

Chief Technology Officer

Office of the Air Force Surgeon General

[email protected]

DSN: 969-9871 COMM: 210-395-9871

mailto:[email protected]


You Have Questions.- Captain Obvious, Hotels.com

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San Antonio AFCEA Chapter Luncheon - c.ymcdn.com · PDF fileSan Antonio AFCEA Chapter Luncheon Air Force Medical Service Air Force Health IT (HIT) ... “Medically Ready ForceReady