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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
Headquarters U.S. Air Force
1
Advancing Continuum of Care for
Military Members through Health IT
Lt Gen C. Bruce Green
Surgeon General
11 October 2011
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
Shaping the Future of Federal Healthcare
Patient-Centered
Care
Synergy-
Federal and State
Organizational
Agility
Precision
Healthcare
Technology
Integration
Working Together, Achieving Success Through A Common Vision
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
Health & Human Services (HHS)
IT Strategic Plan
3
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
AHLTA on the…
Information Highway E
xp
ecta
tio
ns
Time
Innovation
Trigger
Vehicle of
Opportunity!
Peak of Inflated
Opportunity!
Trough of
Disillusionment
Slope of
Enlightenment
Plateau of
Productivity
Swamp of
Diminishing
Returns
Cliff of
Obsolescence
* Gartner Inc., chart from Mastering the HYPE CYCLE by Jackie Fenn and Mark Raskino
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 Quadruple Aim is based on the Institute
for Healthcare Improvement’s Triple Aim
Aligning with the Quadruple Aim
(Variation of Triple Aim)
Common Ground and Focus Required to Avoid Extinction
AFMS Inpatient
MTF'sMeasures
CY10
Q1
CY10
Q2
CY10
Q3
CY10
Q4Annual Comparative
Reported Events 3911 2618 2908 2769 12206
Near Miss(%) 69.4 64.1 64.4 75.6 68.4 >72%
No Harm(%) 28.6 30.8 31.5 20.2 27.8 <28%
Harm(%) 2.0 5.1 4.1 4.2 3.8 0
Wrong Site Surgery (WSS) 1 2 2 2 7 0
Retained Foreign Objects 0 2 3 1 6 0
Pressure Ulcers (Stage III and IV) 0 0 0 0 0 0
Falls 0 0 0 0 0 0
Fall rate (per 1,000 OBD's) 0.1 0.3 0.3 0.4 0.4 2.1-3.1*
Serious Reportable Events*
Patie
nt S
afety M
easu
rem
en
ts
BETTER CARE: BEST VALUE:
BETTER HEALTH: READY:
Synergy
and
Balance
Readiness
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
EHR
PDTS
TMDS
DEERS
$ / M2
DMHRS
i
Leveraging Medical Informatics
Better Care
Through
Evidence Based
Practice
Registries
CarePoint
User
Interfaces
Better Health
Enhanced Patient
Safety
Best Value
Healthy Behavior
Clinical
Practice
Guidelines
Medication
Alerts
Home
Sensors
Expedited
Test Results
Better Care
Improved Patient
Experience
DATA INFORMATION WISDOM CHANGE KNOWLEDGE
Accelerating Information Exchange with Patient Activation
Health
Services
Data
Warehouse
(HSDW)
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
Meeting the Stakeholder’s Needs
7
Individual Med
Readiness
Prev Health
Assessment
Deployment
Assessment
Outside
Provider
Visit
Health Employer
Rating (HER)
HSDW Transforms Healthcare Delivery to Health
Patient
Employer
Provider
Ultimate
Health
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
Tri-Service Workflow: Improves Practice Management
AHLTA-based workflow tool to help healthcare teams personalize
care with standardized tools and templates
Improves readability of providers notes
Automatically captures credit for accurate coding
Tracks preventive services at point of care w/ Electronic-2766
Starts with Info to Provider at Point of Care; Clinical Practice Guidelines Now in AHLTA
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
Transforming Data Into
Knowledge
9
Diabetic patient
educated on
“remote
monitoring”
glucometer
Readings
automatically
sent to
healthcare
team
MTF calls
patient to
discuss
management
Patients receiving
massive transfusions
experienced 65%
mortality
JTTR
Database
analyzed
to identify
trends
Clinical Practice
Guideline developed
for 1:1 transfusion
protocol
Massive
transfusion
mortality
drops to
17%
Uncontrolled sugar
levels Identified
Ready Better Health Better Care
Empowering Patients & Staff with Tools to Improve Healthcare Delivery
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
75%
80%
85%
90%
95%
100%
Jan-11 Mar-11 May-11 Jan-11 Mar-11 May-11
PCMH Aggregate Non-PCMH Aggregate
% S
atis
fie
d
Percent of Patients Satisfied* Family Health Providers at PCMH Sites
UP is Good
Create The Setting
For “Right” Behaviors
10
HEDIS Aggregate: Goal > 40 ED/Urgent Care Rate: Goal < 3/100
Plan: Provide both monetary + non-monetary incentives to high performers
0
2
4
6
8
10
Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11
PCMH Aggregate Non PCMH Aggregate
Ave
rage
Mo
nth
ly V
isit
Rat
e (p
er 1
00)
Monthly Emergency Department and Urgent Care Utilization* Per 100 PCMH Patients
DOWN is
Good
123681
64954
121580
42400
21471
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Non-PCMH Sites (41/322163) PCMH Sites (34/351952)
Dec 2010 - May 2011
Continuity of Care MTF Primary Care Visit Distribution*
Family Health / PCMH Patients
Other Provider
PCMH Team
PCMH PCM
Other Provider (Family Health Clinic)
PCM (Non-PCMH Sites)
PCMH TEAM Continuity
0
10
20
30
40
Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11
PCMH Aggregate Non-PCMH Aggregate
Sco
re
HEDIS Measures - Patients Enrolled to PCMH Clinics
UP is Good
Inspiring Trust & Confidence by Measuring and Rewarding Outcomes
Continuity: Goal > 90% Satisfaction: Goal > 95%
Putting It All Together…
12
Improving Relations,
Empowering Patients, &
Changing Behaviors
Patient Decision Support Applied Clinical Epidemiology
Transforming Data into Actionable Info
To Advance Practice
Provider Decision Support
Deliver Best
Evidence-Based
Medicine To Patients
& Staff
Linking Individual Patients &
Providers To Health Information
Air Force Medical Home
Training, Education & Recapture
Maximizing Use
Of Teams To
Enhance Care
Building Capacity &
Improving Currency
Better Health “Population Health”
Best Value “Per Capita Cost”
MHS
Quadruple Aim
Better Care “Experience Of Care”
Ready
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
Patient
Centered
Health
Team
Decision
Support
Patient
Decision
Support
PCMH Provides Improved Decision Support For Patients & Healthcare Teams
Activating Patients & Care Teams
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 14
Electronic Health Initiatives
Project (eHIP)
Developing The US Air Force Virtual Medical Center
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
Social Networking Needs To Be
Integrated Into Common Practice
PHR
Enhancing and Complimenting The Health Team’s Practice of Care
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
Sec Def/Sec VA Decision
Combined Efforts Provide the Best Future EHR
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
DoD-VA “To-Be” iEHR Architecture
18
Mission
Requirements
& Performance
Outcomes
Team
Business
Process
Team Common Interface Standards
Common Interface Standards
Presentation (Common GUI)
Common Data Centers
Common Services Broker (includes Enterprise Service Bus (ESB) and Infrastructure Services)
Presentation
Layer Team
Systems
Capabilities
Team
Enterprise
Architecture
Team
Data Inter-
operability
Team
Common Information Interoperability Framework (CIIF) Common Information Model, Common Terminology Model,
Information Exchange Specifications, Translation Service
Common Data Standards: SNOMED CT and Extensions, LOINC and RxNorm
DoD Only VA Only Joint DoD/VA
Pharmacy
Disability
Evaluation
Dental Care
Personal
Health Record
Inpatient
Orders Mgmt
Consult &
Referral Mgmt Immunization
Laboratory
Emergency
Dept Care
Nursing
Home
Rehabilitative
Care
Long Term
Care
Transient
Outreach
DoD Unique (16) VA Unique (6) Common (Joint) Applications & Services (30) Battlefield
Care Pediatrics
Military
Readiness Obstetrics
Enroute
Care Veterinary
Operating
Room Mgmt
Blood Mgmt
Document
Mgmt
Applications and Services
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)
Common DoD-VA Measures of Effectiveness, Measures of Performance and key Performance Parameters
Occupational
Health (VA)
Pharmacy
Mail Order
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
Federal Health System
Integration
19
PHARMACY
RADIOLOGY
HOSPITAL
VISIT
LAB SYSTEM PUBLIC
HEALTH
SERVICE
PROVIDER
OFFICE
VISIT
Electronic
Health Record
Common
Logistics
Electronic
Health Record
Open-Source Provides Integration Without Barriers
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
Auto-Generated
Documentation – Doxygen
Code Repository – Git
Cross-Platform Build Tools –
CMake
Bug/Feature Tracker – Mantis
Documents/Resources – Wiki
Mailing Lists
Code Reviewer – Gerrit
Software Quality Dashboard –
CDash
Technical Journal – Insight
Journal
Federal Agencies Leading the
Way with Open Source
20
Source: Rick Avilo
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
Synergy Accelerates
Transformation
Leverage Federal expertise through “open” partnerships
Unleash the power of mass collaboration
Improve trust through transparency
Explore new avenues of development
Generating & Sharing Open-Source Knowledge Accelerates Innovation
www.max.gov
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
INTEGRATED ROADMAP
INTEGRATEDROADMAP
Website Content
PPC Roadmap Complete
Program Mgmt Plan
Planning Office Charter Complete
Risk/Issues Base-lined
Systems Engineering Plan
Acquisition Strategy
IMS Base-lined
CMM Deliverables
Integrated Roadmap Complete
Acquisition IA Strategy
SCHEDULED COMPLETE LEGEND:
Change
Readiness
Training
Press Clips &
Newsletters
Mission/Vision Statements
IN PROGRESS
MILESTONE DECISION
EHR Tri-Fold Complete
Final PESHE
Industry Days Held
ADM Complete
IA Strategy
TEMP
Capability Develop. Document
AoA Phase II
RFI-I / RFI-II Released
Information Support Plan
Data Mgmt Strategy
Engineering Action Plan
CARD
Idea Factory
Concept
Strategic Comms
Plan
Lifecycle Policies & Procedures
Strategy Document
Complete
Stakeholder
Analysis
EHRWA Style Guide
Interactive Presentations
Tech. Acronym
List
Leadership Engagement
Resource Library
Document Templates
Gov. Biographies
Complete
From, “EHR Way Ahead,” Aug 2011
Paula Friedman, Director, EHRWA, DoD MHS
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
Patient as the Decision Maker
Ready: Reassure patient that you “know them”
Accessible: Be there when the patient needs you
Prepared: Respect patient and their time
Precise: Clarify all treatment and follow-up
Organized: Don’t ask patient what you should know or have
available in their medical record
Respectful: Always answer phone calls/resolve patient concerns
Thorough: Tell patient what to do if they feel worse
23
The Ultimate Outcome of Integration & IT Initiatives is Better Patient Care
Source:
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
“TRUSTED CARE ANYWHERE”
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