Military Health System Health Information...

Military Health System Health Information Technology

April 13, 2015

Karen S. Guice, M.D. - Principal Deputy Assistant Secretary of Defense (Health Affairs)

David M. Bowen - Director, Health Information Technology, Defense Health Agency

DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

Conflict of Interest Karen S. Guice, M.D. and David M. Bowen Have no real or apparent conflicts of interest to report.

© HIMSS 2015

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Learning Objectives

1. Discuss the standup of the Defense Health Agency and the Military Health System strategic plan 2. Describe how the Military’s health care system looks to standardize, reengineer and consolidate Health IT (HIT) services 3. Explain why HIT is an essential element in fulfilling the important mission of the DHA in meeting the medical needs of the combat commanders

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The National Security Environment And the Future of Military Medicine

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The National Health Environment MHS Review

• In May 2014, the Secretary of Defense directed a 90-day comprehensive review of the MHS, focused on access, quality, and safety.

• Review led by DoD health experts,

supplemented by six leading external experts: three to review methodology and three to review performance.

• Secretary of Defense was presented with

final report in the Fall; it included six over-arching recommendations, with 77 specific recommendations.

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MHS Review Overarching Findings & Actions • MHS provides good, quality care that is safe and timely, and

comparable to that found in civilian sector…but there is wide performance variability, similar to civilian sector

• Secretary of Defense Action Plan

• Immediately address outliers in performance

• Introduce enterprise-wide metrics used across the enterprise to monitor performance in access, quality and safety – aligned across both direct care and purchased care components

• Expand transparency – full visibility of performance for beneficiaries, stakeholders and American public, along with ongoing patient engagement strategy

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High Reliability Organization Task Force

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High Reliability Organization Task Force (cont.) • Department working together, establishing enduring principles for

the MHS as a High Reliability Organization (HRO) • Developing recommendations for assessment tools to measure

progress on the journey to becoming an HRO

• Expanding efforts to become a more transparent organization • Consolidated all existing public-facing portals on access, quality,

safety and satisfaction into one location • Redesigning website to be more visually compelling and creating

more patient-centric language • Reaching out to CMS/Hospital Compare to include MTF data (our

civilian network providers are already there)

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Military Health System Reform What We Are Undertaking

• Creating a more globally integrated health system – built on our battlefield successes

• Driving enterprise-wide shared services; standardized clinical and business processes that produce better health and better health care

• Implementing future-oriented strategies to create a better, stronger, more relevant medical force

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MILITARY HEALTH SYSTEM STRATEGY MAP

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END

S

Ready Medical

Force

Medically

Ready Force

11


WAY

S EN

DS

MEA

NS

Healthy People

Medically Ready Force

Ready

Medical Force

12


WAY

S EN

DS

MEA

NS

Improve

Stewardship


Ready

Medical Force

Improve Clinical Outcomes and

Consistent Patient

Experience

Healthy People

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WAY

S EN

DS

MEA

NS

Improve Stewardship

Healthy People

Medically

Ready Force Ready

Medical Force


Consistent Patient Experience

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WAY

S EN

DS

MEA

NS

Improve Stewardship

Healthy People


Ready Medical Force



Align Resources Against Strategic Priorities

and Ensure Fiscal Accountability

Recruit, Train, & Develop the Total Force to Meet

Future Challenges

Improve

Information Infrastructure

OC4 Improve Process-

Based Management

OC5 Align Facilities, Personnel,

and Capabilities to Optimize Market Performance

Optimize DHA as a Support

Organization

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WAY

S EN

DS

MEA

NS

Improve Stewardship

Healthy People


Ready Medical Force



Align Resources Against Strategic Priorities and Ensure Fiscal Accountability

Recruit, Train, & Develop the Total Force to Meet

Future Challenges

Improve Information

Infrastructure Improve Process-

Based Management

Align Facilities, Personnel, and Capabilities to Optimize

Market Performance

Optimize DHA as a Support

Organization

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IP2 Improve

Operational Medicine

IP1 Improve

Global Health Engagement


WAY

S EN

DS

MEA

NS

PLS5 Improve

Stewardship

IP4 Enhance Strategic

Partnerships

IP8 Improve Comprehensive Primary Care

Enhance Emerging Medical

Capabilities in a Joint

Environment IP11 Reform TRICARE

F1 Align Resources Against Strategic Priorities


PLS3 Healthy People

PLS1 Medically

Ready Force PLS2 Ready

Medical Force

IP12 Align Incentives to Achieve Outcomes

IP9 Improve Safety IP6

Expand the Boundaries of

Healthcare



IP10 Optimize & Standardize Access & Other

Care Support Processes

OC1 Recruit, Train, & Develop the Total Force to Meet

Future Challenges

OC3 Optimize DHA as

a Support Organization

OC2 Improve



Based Management

PLS4 Improve Clinical Outcomes and


Fina

ncia

l O

rgan

izat

iona

l C

apab

ility

IP5 Improve Healthy

Behaviors

IP7 Improve Condition-Based Quality Care

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IP5 Improve Healthy

Behaviors


WAY

S EN

DS

MEA

NS

PLS5 Improve

Stewardship


Partnerships

IP8 Improve Comprehensive Primary Care IP3

Enhance Emerging Medical Capabilities

in a Joint Environment

IP11 Reform TRICARE



PLS3 Healthy People

PLS1 Medically


Medical Force


IP9 Improve Safety

Expand the Boundaries

of Healthcare






Future Challenges

OC3 Optimize DHA as


OC2 Improve



Based Management



Fina

ncia

l O

rgan

izat

iona

l C

apab

ility

IP7 Improve Condition-Based Quality Care

IP2 Improve


IP1 Improve


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WAY

S EN

DS

MEA

NS

PLS5 Improve

Stewardship


Partnerships

IP8 Improve Comprehensive Primary Care IP3

Enhance Emerging Medical Capabilities

in a Joint Environment

IP11 Reform TRICARE



PLS3 Healthy People

PLS1 Medically


Medical Force


IP9 Improve Safety IP6

Expand the Boundaries of

Healthcare






Future Challenges

OC3 Optimize DHA as


OC2 Improve



Based Management



Fina

ncia

l O

rgan

izat

iona

l C

apab

ility

IP5 Improve Healthy

Behaviors Improve Condition-Based

Quality Care

IP2 Improve


IP1 Improve


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Fundamentals of Our Approach • Our Strategy tells us WHAT we will focus on

• HRO principles will define HOW we will get there

– Improved performance – focused on access, quality, safety and satisfaction – is a leadership responsibility

– Culture of safety will pervade all levels of the organization; safety for both patients and staff; everyone is empowered to identify safety risks

– Continuous process improvement tools will be used by everyone

– We move forward with respect for our people

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DEPSECDEF Memorandum March, 11 2013 DSD Memo • Establishes a Defense Health Agency

• Led by 3-Star Director

• Combat Support Agency

• Initial Operating Capability, 10/1/13

• Full Operating Capability, 10/1/15

• Establishes Shared Services

• Transitions JTF CAPMED to a Directorate within the DHA

• Identifies Multi-Service Market Areas with enhanced authorities

• Eliminates dual-hatting in HA/TMA; clearer lines of policy and execution

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So Why a DHA and eMSMs? • DEPSECDEF Mar 12 Memo outlines that leaders at all levels (DEPSECDEF,

CJCS, Service Secretaries and Chiefs) participated in developing the Department’s position on reforms

• Approved establishment of the DHA with an NCR Directorate & eMSMs • Why?

– Opportunities for savings through adoption of clinical and business processes and consolidation of shared services

– Preserves alignment of medical support with Service missions – Most cost efficient means of transformation – Reform sets up two notably different regional governance models in the

MHS: cross-Service market management w/ greater authorities (i.e. San Antonio MHS) & a single authority model (NCR Directorate)

– As models mature, results will provide the Department greater insight, based on outcomes, informing further transformation

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Governance Reform: Influencing the Big Rocks

Opportunities exist for a properly organized management HQ to effect change with shared services

Management Activities represent a small part of DoD’s health care costs

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DHA Shared Services

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Defense Health Agency Leadership Team

Lt Gen Douglas Robb Director

Mr. Allen Middleton Deputy Director

CMDCM Terry Prince Senior Enlisted Advisor

MG Richard Thomas Director

Healthcare Operations

RADM Bruce Doll Director

Research & Development

Brig Gen Robert Miller Director

Education & Training

RADM Raquel Bono Director

NCR Medical

Mr. David Bowen Director

Health IT

Mr. Joseph Marshall Director

Business Support

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BLUF: DHA as a Combat Support Agency Supports the Combatant Commands

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Health Information Technology Directorate

Vision •A premier system of health information technology, enabling integrated health care delivery for those who serve in the defense of our country,

retirees, and their families.

Mission •Implement, manage, and sustain an integrated and protected medical

information enterprise in order to ensure the right information is accessible to the right customers at the right time

and in the right way.

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Goals & Strategies Goals

• Keep our Customers (the Services and COCOMs) happy • Support the EHR efforts • Don’t Break Anything! • Make our Business Case numbers

Strategies • Transform into functional organization – stand down existing commands • Eliminate duplication and redundancies • Reduce variability by means of standardization • Leverage existing IT best practices • Allocate resources to support EHR efforts

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HIT Directorate Organizational Chart

HIT Business Case: Savings Areas

• Our Business Case is driven by: • Consolidating management and management resources

across the Services

• Consolidating and standardizing our IT infrastructure: Datacenter to Desktop

• Rationalizing our MHS HIT application portfolio

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Projected Business Case Costs & Savings

BCA Category FY14 FY15 FY16 FY17 FY18 FY19* FY20* FY21* Total Primary Drivers of Implementation Costs

#1: Reengineering of IT Management

Savings ($M) $3.31 $5.67 $5.77 $5.88 $6.00 $6.13 $6.27 $6.42 $45.46 • IT costs to invest in tools (portfolio management, EA) needed to support and automate reengineered business processes. Cost ($M) $4.37 $2.58 $2.10 $2.14 $2.18 $0.00 $0.00 $0.00 $13.37

Net Savings ($M) ($1.07) $3.09 $3.67 $3.74 $3.82 $6.13 $6.27 $6.42 $32.09

#2: Infrastructure Consolidation

Savings ($M) $3.05 $6.19 $14.68 $16.56 $16.91 $74.71 $76.43 $78.27 $286.81 • Contract support for transition planning and PMO (e.g., product line analysis, scheduling, risk management).

• IT costs for product line consolidation (e.g., additional servers, storage, bandwidth).

Cost ($M) $0.00 $17.53 $13.63 $28.85 $31.64 $0.00 $0.00 $0.00 $91.66

Net Savings ($M) $3.05 ($11.34) $1.05 ($12.29) ($14.73) $74.71 $76.43 $78.27 $195.15

#3: Portfolio Rationalization

Savings ($M) $0.00 $21.33 $40.24 $66.21 $67.60 $69.08 $70.67 $72.37 $407.50 • IT costs for decommissioning and promotion of system to enterprise level (e.g., migrating/archiving data, increasing capacity of target system, hardware disposal, training, change management, BPR).

Cost ($M) $23.98 $24.32 $32.97 $0.00 $0.00 $0.00 $0.00 $0.00 $81.27

Net Savings ($M) ($23.98) ($2.99) $7.27 $66.21 $67.60 $69.08 $70.67 $72.37 $326.23

GRAND TOTAL NET SAVINGS

Annual ($M) ($22.00) ($11.24) $11.99 $57.66 $56.68 $149.93 $153.38 $157.06 $553.47

Cumulative ($M) ($22.00) ($33.23) ($21.25) $36.41 $93.10 $243.03 $396.41 $553.47 --

Funding needs to be provided each year in order to produce net savings in FY16 and reach annual steady-state net savings in FY19

FY14 – FY18 Inflation Rates Source: http://comptroller.defense.gov/defbudget/fy2014/FY14_Green_Book.pdf *FY19 – FY21 Inflation Rates are estimated

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http://comptroller.defense.gov/defbudget/fy2014/FY14_Green_Book.pdf

HIT BCA Current Year Savings Reflects Components’ Reported Savings & Costs through 28 Jul 14

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IOC to FOC Initiatives

• Consolidate Management and management resources across the Services Put “The Best” in leadership positions Inventory and consolidate duplicative contracts

• Consolidate and standardize IT infrastructure; Datacenter to Desktop One Forest: Active Directory and Enterprise Management One Network: consolidate multiple networks One E-mail: put everyone on the same e-mail system One Datacenter: a single datacenter hosting strategy

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IOC to FOC Initiatives • Consolidate and standardize IT infrastructure; Datacenter to Desktop

One Web: a 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

• Rationalize the MHS HIT application portfolio Identify duplicative applications Consolidate requirements, evaluate solutions Decide on a single solution Adapt the selected solution, decommission the others

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Challenges We Face

• Managing cultural change • Standardizing the HIT Infrastructure • Disrupting historical IT funding and approval processes • Keeping ahead of the Electronic Health Record program • Establishing clinical process standards for incorporation into

the Electronic Health Record • Eliminating duplicative applications • Establishing and maintaining the trust of our customers that

we’ll do this right !

•

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Vision Status - Full Operating Capability

• Manage IT functions “down to the desktop” • Deliver standardized IT solutions (and contracts)

in support of standardized clinical & business processes

• Facilitate communication, collaboration, and coordination with the Electronic Health Record Acquisition Team

• Fill leadership positions with permanent staff • Transition HIT funding into the DHA

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• This is a once-in-a-generation opportunity to shape the future of military medicine.

• Readiness and quality of care will be enhanced

and beneficiaries will receive the same level of care from a more efficient and effective organization.

• There are millions depending on us to get this

right!

HIT Transformation Final Thoughts

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Questions? • Want more information…

• www.health.mil

• www.tricare.mil

• Follow us on Twitter: @MilitaryHealth

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http://www.health.mil

http://www.tricare.mil

http://www.tricare.mil

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