MHS Help Desk Overviewfor

TRICARE Data Quality Course

September 15, 2009

2

Purpose

• Information briefing:– Provide overview of MHS Help Desk contract

scope and current operation including:• MHS Tier support structure• MHS trouble ticket process• Performance metrics/call volume

– Future: Remedy has replaced ManageNow• Implementation of Information Technology

Infrastructure Library (ITIL) processes/methodologies

– “Partnering” in data quality efforts

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Contract Scope • MHS Help Desk provides Tier I and II (functional) support

(24 x 7 x 365) for 22 MHS systems/applications– CHCS, AHLTA, NMIS, CCQAS, EAS IV, TOL, CCE, TPOCS,

DMLSS, DOEHRS-HC/IH/DR, SNPMIS, TMIP, M2, MCFAS, DMHRSi, MHS Learn, Essentris (CIS), PMITS, etc.

– + 80 COTS products, devices, interfaces, Service legacies (GEMS, TEWLS, ICDB)

– Future: Patient Safety Reporting (PSR), Neurocognitive Assessment Tool (NCAT)

• If call does not involve supported application, user helped to “best of our ability”– Broken EUD – trouble ticket passed to maintenance vendor/

organization– B2B Gateway password reset – trouble ticket passed to DISA– TRICARE eligibility question – TOL caller referred to DMDC– Pharmacy Data Transaction Service (PDTS) – call passed to PDTS HD

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Current Operation

• MHS users contact MHS Help Desk with all issues not resolved locally (i.e., at Tier 0 – MTF/site)– Issues normally linked to specific application– After triage, MHS HD resolves issue or escalates ticket

• MHS Help Desk resolves 85% of all issues• Unresolved issues (15%) include both functional & technical

problems – Functional issues are escalated to Tier III (software developer)– Technical issues emerge as subset of application problems; are

forwarded to MHS Network Operations Center (NOC)/DISA» Note: hardware issues often emerge from technical tickets

– Current business volume (CY09 averages):• 37,684 calls/month (23% increase versus CY08)• 30,536 trouble tickets/month (21% increase over CY08)

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Call Volume from 2006 Forward

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

Jan-

06

Feb-

06

Mar

-06

Apr

-06

May

-06

Jun-

06

Jul-0

6

Aug

-06

Sep

-06

Oct

-06

Nov

-06

Dec

-06

Jan-

07

Feb-

07

Mar

-07

Apr

-07

May

-07

Jun-

07

Jul-0

7

Aug

-07

Sep

-07

Oct

-07

Nov

-07

Dec

-07

Jan-

08

Feb-

08

Mar

-08

Apr

-08

May

-08

Jun-

08

Jul-0

8

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09

Feb-

09

Mar

-09

Apr

-09

May

-09

Jun-

09

Jul-0

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Calls Linear (Calls)

Call Volume

1. Oct 01-Nov 03 – Call volume remained in 5-10K call band. 2. Mar 04 – TOL start-up added 4000 calls per month.3. Jan 06 – AHLTA Deployment, post-holiday influx and 2000 additional TOL calls.4. Jan 07 – MHS mandatory HIPAA training commenced via MHS Learn.5. Sep 07 – Less workdays in Sep than Aug and MHS Learn revised password reset protocol 6. Jun 08 – 73% increase due to DMHRSI (49%) and AHLTA (24%) increases7. Jul – Dec 08 – 65% (6724 to 11084) increase in DMRHSi tickets per month. “Dip” due to less workdays

in Nov.

2.

5.4.3.1.

6.

7.

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MHS Tier Support Structure

• Tier 0 – Site support– Systems/database administrator, local information management

departments, or local help desk

• Tier I – MHS Help Desk– Log problem and create trouble ticket– Initial triage/document symptoms

• Tier II – MHS Help Desk– Resolve basic/functional issues (subject matter experts)

• Tier II+ – MHS Network Operations Center (NOC)– Address connectivity/infrastructure issues

• Tier III – Software developer or Defense Information Systems Agency (DISA)

– Address most complex issues

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MHS Help Desk Process

User ContactsMHS Help DeskUser Contacts

MHS Help Desk Resolved?Resolved?

Tier 1 createsTrouble Ticket in

ManageNow

Tier 1 createsTrouble Ticket in

ManageNow

Tier 1/2 HD resolve?

Tier 1/2 HD resolve?

Infrastructure issue?

Infrastructure issue?

Escalate to (or created by) Tier 3 (SW Developer)

for resolution

Escalate to (or created by) Tier 3 (SW Developer)

for resolution

Escalate to Tier 2+

(MHS NOC) forresolution

Escalate to Tier 2+

(MHS NOC) forresolution

Resolved?Resolved?

Escalate to DISA,SPAWAR, BOC,

etc. forresolution

Escalate to DISA,SPAWAR, BOC,

etc. forresolution

Ticket closed inManageNow

Ticket closed inManageNow Email originatorEmail originator

No further actionNo further actionYes

No

Yes

Yes

Yes

No

No

No

(Functional Issues)

(Functional Issues – SIRs & SCRs)

(Unresolved Functional & Technical Issues)

Legend:

Both Functional & Technical Issues =

Functional Issues (Only) =

Technical Issues (Only) =

Legend:

Both Functional & Technical Issues =

Functional Issues (Only) =

Technical Issues (Only) =

MHS Help DeskContract ScopeMHS Help DeskContract Scope

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Trouble Ticket Closure(prior to 19 July 09)

• MHS Help Desk (Tiers I & II)– Customer Service Representative (CSR) calls user to confirm

issue resolution

– Trouble ticket closed in ManageNow• Triggers E-Mail notification to originator with problem resolution

– up to 250 characters

– Customer Satisfaction Survey E-Mailed to ticket originator

• Tier II+ (MHS NOC) and Tier III (software developer/ DISA)– Trouble ticket closed in ManageNow

• Triggers E-Mail notification to originator with problem resolution

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Trouble Ticket Closure(since 19 July 09)

• For all MHS support organizations (Tiers I, II or III):– When Remedy incident ticket is placed in a “resolved”

status, e-mail notification with resolution summary is automatically sent to ticket requestor

– Requestor has five days to respond if they non-concur– Ticket is automatically moved into “closed” status

unless ticket requestor non-concurs (via e-mail or phone)

• Today, no customer satisfaction surveys sent when tickets are closed– Business process rules being developed

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Incentivized Performance Metrics (Jul 08 – Jun 09)

Green = PositiveGreen = Positive Yellow = AcceptableYellow = Acceptable Red = NegativeRed = Negative White = No payment

CriteriaAcceptable

Range Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May JunCustomer Satisfaction Survey Return Rate 15 -18% 21% 18% 20% 20% 17% 19% 19% 18% 21% 18% 17% 19%

Customer Satisfaction 85 - 90% 98% 97% 97% 97% 98% 97% 98% 97% 94% 97% 98% 97%

Call Abandoned Rate 3 - 5% 1% 1% 1% 1% 1% 1% 2% 2% 2% 1% 1% 2%

Average Speed to Answer20 - 30

seconds 18 sec 20 sec 23 sec 26 sec 27 sec 28 sec 44 sec 29 sec 26 sec 23 sec 23 sec 37 sec

Problem Resolution Rate for High Priority problems/requests

90% within 90 mins 98% 95% 97% 97% 95% 96% 94% 92% 96% 96% 94% 94%

Positive incentive rate 90% within 60 mins 97% 94% 94% 93% 92% 95% 87% 92% 94% 90% 92% 91%

Problem Resolution Rate for Moderate Priority problems/requests

90% within 6 hours 97% 97% 97% 95% 95% 95% 93% 94% 91% 90% 95% 93%

Positive incentive rate 75% within 4 hours 94% 94% 95% 92% 91% 91% 90% 90% 87% 87% 92% 90%

Problem Resolution Rate for Low Priority problems/requests

90% within 3 bus days 99% 98% 98% 97% 98% 97% 97% 96% 95% 97% 97% 95%

Positive incentive rate 50% within 2 bus days 98% 97% 97% 96% 96% 96% 96% 94% 93% 95% 95% 92%

First Contact Resolution 64 - 80% 84% 82% 81% 83% 82% 81% 81% 80% 80% 81% 74% 78%

Call Volume 33.1 K 34.1 K 34.1 K 34.5 K 29.3 K 34.6 K 39.2 K 37.6 K 37.1 K 37.1 K 35.7 K 39.1 K

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“Top 5” MHS Systems (Apr 09 – Jun 09)

Total Calls Month LEARN

37188 Apr-09 3440

35753 May-09 2902

39123 Jun-09 2989

Totals 9331

Month LEARN

Apr-09 11%

May-09 9%

Jun-09 9%

77%

35% 15% 8% 8% 77%

36% 16% 8% 5%

Month Totals

34% 16% 9% 6% 77%

DMHRSI AHLTA TOL IAS

2556 24545

32126 14551 8260 6098

31873 11270 4865 2865

1831 23185

29110 10663 4814 2546 1711 22636

29781 10193 4872 2849

"Top 5" Trouble Ticket Totals by System

Total Tickets Created DMHRSI AHLTA TOL IAS Month Totals

2nd Quarter in comparison to 1st Quarter: DMHRSI decreased from 32126 (0%), AHLTA increased from 12809 (60%), LEARN decreased from 11636 (20%), TOL decreased from 10497 (21%), and IAS decreased from 6701 (9%).

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Future

• 19 July 09: Remedy Information Technology Service Management (ITSM) Version 7.x replaced ManageNow as MHS enterprise trouble ticket management tool– Supports Information Technology Infrastructure Library (ITIL)

framework/processes• Commercially accepted best business process for IT service management

– Phased implementation approach for Remedy ITSM Modules• Incident (trouble ticket) Management Module implemented• Problem/Change Management in Sept/Oct 09

– 3-14 Aug 09: Conducted Problem Management workshops for MHS Stakeholders

– External business processes must be developed before tool functionality can be fully leveraged

• Configuration Management Database (CMDB) in Feb 10

• Remedy is Government Furnished Equipment (GFE), hosted by TIMPO– Users must have DoD Common Access Card (CAC)

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“Partnering”

• MHS Help Desk supports the applications that code encounters, create third party bills and document MTF workload– TPOCS, CCE, ADM, CHCS, EAS IV, AHLTA,

etc.

• We support TMA data quality improvement efforts– MHS Help Desk will assist in every way possible

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Backup Information

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Contact Information

• MHS Help Desk:– Telephone toll free (1-800-600-9332)(CONUS)

or by using country access code (OCONUS) – Fax: (210) 767-0449– E-mail (for questions): Help@mhs-

helpdesk.com– E-mail (to request incident ticket):

mhs_remedy@timpo.osd.mil– Via website (http://www.mhs-helpdesk.com)

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Acronym Definitions

• ADM – Ambulatory Data Module• B2B – Business to Business• CCE – Coding and Compliance Editor• CCQAS – Centralized Credentials and Quality Assurance

System• CHCS – Composite Health Care System• CIS – Clinical Information System• CONUS – Continental United States• CSR – Customer Service Representative• CUD – Common User Database• CY – Calendar Year• DISA – Defense Information Systems Agency• DMDC – Defense Manpower Data Center• DMHRSi – Defense Medical Human Resources System internet• DMLSS – Defense Medical Logistics Standard System• DOEHRS-HC – Defense Occupational and Environmental

Health Readiness System – Hearing Conservation• DOEHRS-IH/DR – DOEHRS – Industrial Hygiene/Data

Repository• EAS IV – Expense Assignment System IV• EUD – End User Device• GEMS – Global Expeditionary Medical System• HD – Help Desk• ICDB – Integrated Clinical Database

• ITIL – Information Technology Infrastructure Library• ITSM – Information Technology Service Management• ICDB – Integrated Clinical Database• M2 – MHS Management Analysis and Reporting Tool• MCFAS – Managed Care Forecasting and Analysis System• MHS – Military Health System• MHS NOC – MHS Network Operations Center• MTF – Military Treatment Facility• NMIS – Nutritional Management Information System• OCONUS – Outside Continental United States• PDTS – Pharmacy Data Transaction Service• PMITS – Patient Movement Items Tracking System• SCR – Software Change Request• SIR – System Incident Report• SNPMIS – Special Needs Program Management Information

System• SPAWAR – Space and Naval Warfare Systems Command• SW – Software• TEWLS – Theater Enterprise-Wide Logistics System• TMA – TRICARE Management Activity• TMIP – Theater Medical Information Program• TOL – TRICARE Online• TPOCS – Third Party Outpatient Collection System• TRICARE – Tri-Service Health Care