1. CSPAR (3 Dec 2011) Lt Gen Green/CMSgt Cole (60-Minute)Meeting: CSPAR, 3 December 2011, 0800 (60 minutes includes Q&A)Theme: Transformational Pathways to Global HealthcareAudience: ~ 100 Airmen including Consultants and Enlisted FunctionalsPurpose: Future of the AFMSDesign: AFMS future updates, AFMS mission/strategyFormat: UnclassifiedSources: AMSUS brief, SLW brief, iEHR brief Integrity - Service - Excellence 1

2. Headquarters U.S. Air ForceIntegrity - Service - Excellence CSPAR: The Future is Now Lt Gen C. Bruce Green CMSgt Charlie Cole Surgeon General CMEF 3 Dec 2011 2

3. Were All In AF Mission The mission of the United States Air Force is to fly, fight and win&in air, space and cyberspace AFMS Mission AFMS VisionSeamless Health Service World-Class Healthcare Support to USAF and for Our BeneficiariesCombatant Commanders Anywhere, Anytime Through Global Vigilance, Reach, and Power! Integrity - Service - Excellence

4. Moving Forward- 2009: STRATEGIC IMPERATIVES -The Future & Communicating the Vision - 2010 : EXECUTING THE STRATEGY - Focus on Alignment- 2011: BREAKTHROUGH PERFORMANCE -Tools, Incentives, and Rewards - 2012: CULTURE OF ACCESS/INNOVATION/SERVICE - Patient-Centered Care Integrity - Service - Excellence 4

5. Focus and Alignment6 Through the AFMS Framework Strategies OverlappingMission Areas Transform Deployable Capability Rapid Response to Any Worldwide Contingency Fit Force Build Patient-Centered Care Continuity & Prevention to Optimize Health Invest in Education, Training & Research Sustain Our Future Capabilities Strategy Common Practice Culture Integrity - Service - Excellence

6. In Pursuit of Lighter & Leaner Medical Response Humanitarian Assistance EMEDS Health Response Team (HRT) Rapid Response Team (HARRT) Airlift Deployment Requirements:EarthquakesIndonesia < 24 HRS + C-17s Rapid Response Medical Capabilities: Emergency, Resuscitative, & Surgical CareEarthquakes Chile T+0 hrs Operational Results: Immediate Care < 20 min EREarthquakes < 2 hrs Haiti OR & ICU < 3 hrs T+3 hrsPursuing Perfection in Medical Response Capability Integrity - Service - Excellence

7. Continuous Advances in Casualty Care WWII 30% Learning From Coalition Partners, We Leveraged Trauma Registry Data To Build Innovative Solutions > 80 Patients Moved as of Nov 11Combat Mortality Rate Korea 25% Tactical Critical Care Evacuation Team (TCCET) Vietnam 24% INTERFLY AGREEMENT Applying Lessons Learned From the C-17 *AeroSpace Interoperability Council Persian Gulf 24% Creating a patient staging continuum Modular Aeromedical Staging Capability (MASC) OIF/OEF New CASF Activated at SAMMC 65 y/oExpanding Services to Recapture More DoD Beneficiaries Integrity - Service - Excellence 10

11. Transforming Focus from Healthcare To Health Healthcare Is A FH Clinics Started- 69 Team Sport Ped Clinics Started- 35 Clinic Health Management Management HEALTHCARE HEALTH Right Patient9 Right Prevention9 Right Time9 Right Outcome9Maximize Teamwork/Skill Set s to Deliver Better Health & Better Care Integrity - Service - Excellence 11

12. Create The Setting For Right Behaviors Percent of Patients Satisfied* Continuity of Care Other Provider $ Family Health Providers at PCMH Sites MTF Primary Care Visit Distribution* 100% Family Health / PCMH Patients 100% 21471 95% 90% PCMH Team 64954 % Satisfied 80% 42400 90% UP is 70% Good 60% 85% PCMH PCM 50% PCMH TEAM 40% 80% 30% 123681 121580 Continuity 20% Other Provider 75% 10% (Family Health Jan-11 Mar-11 May-11 Jan-11 Mar-11 May-11 0% Clinic) Non-PCMH Sites (41/322163) PCMH Sites (34/351952) PCM PCMH Aggregate Non-PCMH Aggregate (Non-PCMH Dec 2010 - May 2011 Sites) Satisfaction: Goal > 95% Continuity: Goal > 90% $ $ Monthly Emergency Department and Urgent Care Utilization* HEDIS Measures - Patients Enrolled to PCMH Clinics Per 100 PCMH Patients 10 40Average Monthly Visit Rate (per 100) 8 30 6 Score 20 4 DOWN 10 UP is 2 is Good $ Good 0 0 Dec-10 Feb-11 Apr-11 Dec-10 Feb-11 Apr-11 Dec-10 Feb-11 Apr-11 Dec-10 Feb-11 Apr-11 PCMH Aggregate Non PCMH Aggregate PCMH Aggregate Non-PCMH Aggregate ED/Urgent Care Rate: Goal < 3/100 HEDIS Aggregate: Goal > 40 Inspiring Trust & Confidence by Measuring and Rewarding Outcomes Integrity - Service - Excellence 12

13. Leveraging Medical InformaticsDATA INFORMATION KNOWLEDGE WISDOM CHANGE Better CareTMDS Clinical Through Practice Evidence Based GuidelinesDEERS Practice CarePoint Medication Better HealthPDTS Alerts Enhanced Patient Registries Safety$ / M2 User Home Best Value Interfaces Sensors Healthy BehaviorDMHRSi Expedited Better CareEHR Test Results Improved Patient Experience Decision Support Is No Longer Just For Our Providers Integrity - Service - Excellence

14. Transforming Data Into Knowledge Ready Better Health Better Care Patients receiving Diabetic patient massive infusions of > educated on 10 pints experienced remote mortality of 33% monitoring glucometer Clinical Study Readings Practice registry MTF calls automaticallyGuideline to identify patient to sent todeveloped trends discuss healthcare management team Conclude infusing whole blood Uncontrolled sugar reduced mortality levels Identified to less than 20%Using Informatics to Accelerate Change in Practice Patterns & Behavior Integrity - Service - Excellence 14

15. Generating Skills/Knowledge Through Medical Simulation Maximizing the skills of our entire healthcare team New DoD Center of Excellence Phase 1 Under Development METC Training Gaming Simulations Synthetic tissue to augment/replace live tissue Mobile Lightweight SimulatorImproving Healthcare Capabilities Through Realistic Scenarios Integrity - Service - Excellence 15

16. Activating Patients & Care Teams Health Team PatientDecision Patient DecisionSupport Support CenteredPCMH Provides Improved Decision Support- For Patients c eHealthcare Teams Integrity - Service Excellen &

17. Electronic Health Initiatives Project (eHIP)Integrity - Service - Excellence 17

18. Investing In Education, Training, & Research *METC Awarded Institute for Credentialing Excellences Presidential Citation 2011!Keeping Medics Ready Through Joint & Civilian Partnerships Integrity - Service - Excellence 18

19. Establishing Partnerships to Enhance Capabilities Physician/Dentist Education (GME/DME) Stand alone programs Masters with civilian universities Integrated/affiliated with Federal partners Nurse Education (Transition Program) New sites include: Cincinnati, OH & Scottsdale, AZNurse Enlisted Commissioning Program (NECP) USAF Dental Hygiene Program Research Partnerships are Vital Tools to Build & Sustain Medical Services Integrity - Service - Excellence 19

20. DoD-VA Sec Def/Sec VA Decision To-Be iEHR Architecture Common DoD-VA Requirements: HL7 EHR-S Functional Model with DoD and VA vetted Extensions (SV-4) Common DoD-VA Integrated Health Business Reference Model (OV-5) Common DoD-VA To Be Process Flow Model (OV-6C) Presentation Presentation (Common GUI) Layer Team Applications and Services DoD Unique (16) Common (Joint) Applications & Services (30) VA Unique (6) Systems Battlefield Pediatrics Pharmacy Personal Laboratory Blood Mgmt Nursing Long Term Health Record Capabilities Care Home CareMission Military Disability Inpatient Emergency DocumentRequirements Team Readines Obstetrics Evaluation Orders Mgmt Dept Care Mgmt Rehabilitative Care Transient Outreach s& Performance Enroute Veterinar Dental Care Consult & Immunization Operating Pharmacy Occupational Referral Mgmt Room MgmtOutcomes Team Care y Mail Order Health (VA) Common Interface StandardsBusinessProcess Team Enterprise Common Services Broker Architecture (includes Enterprise Service Bus (ESB) and Infrastructure Services) Team Common Interface Standards Common Data Centers Data Inter- Common Information Interoperability Framework (CIIF) operability Common Information Model, Common Terminology Model, Team Information Exchange Specifications, Translation Service Common Data Standards: SNOMED CT and Extensions, LOINC and RxNorm Common DoD-VA Measures of Effectiveness, Measures of Performance and key Performance Parameters Combined Efforts Provide theOnly Joint DoD/VA DoD Best Future EHR VA Only Integrity - Service - Excellence 20

21. Leading the Way with Open Source HOSPITAL PHARMACY VISIT Electronic Electronic PROVIDERRADIOLOGY Health Record Health Record OFFICE VISIT PUBLIC LAB SYSTEM HEALTH SERVICE Open-Source Provides Integration Without Barriers Integrity - Service - Excellence 21

22. Shaping the Future of Federal Healthcare Synergy- Patient-Centered Joint and Coalition Care Organizational Precision Agility Healthcare Technology IntegrationWorking Together, Achieving Success Through A Common Vision Integrity - Service - Excellence

23. Generating Knowledge6 PRIMARY CARE 2025: A Scenario Exploration of Forces, Challenges, and Opportunities Shaping Primary Care in the U.S. GENOMIC MEDICINE: An Active Consortium of Government, Academic, and Industry Leaders in the Field of Genomic Medicine Providing Expert Direction for PC2Z Program DOD/VA iEHR and GOVERNMENT HIE SUMMIT: Establishing a Common Roadmap for Today, Tomorrow, and the Future OPEN SOURCE SOFTWARE of the MILITARY HEALTH SYSTEM: A Product Lifecycle Management Workshop VETERANS AFFAIRS ROUNDTABLE: Future Performance Metrics to Assess Population Health, Patient Experience, and Healthcare Value USU-HJF Military Medicine Symposium: The TBI Spectrum, Challenges, Initiatives, & PreventionInnovative Collaboration to Shape the Future of Healthcare Integrity - Service - Excellence 23

24. Patient-Centered CareReady: Reassure patient that you know themAccessible: Be there when the patient needs youPrepared: Respect patient and their timePrecise: Clarify all treatment and follow-upOrganized: Dont ask patient what you should know or haveavailable in their medical recordRespectful: Always answer phones/resolve patient concernsThorough: Tell patient what to do if they feel worsePatient-Centered Care Begins with Access to Earn Trust! Integrity - Service - Excellence 24

25. TRUSTED CARE ANYWHERE Integrity - Service - Excellence