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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
AAMA (17 Nov 2011)Lt Gen Green (1-Hour including Q&A)
� Meeting: AAMA, Air Force Breakout, 17 October 2011, 1330
� Theme: “The Future of Healthcare”
� Audience: ~ 150 MSC Officers to include many previous MSC Corp Chiefs
� Purpose: Future of the AFMS
� Design: AFMS hot-topic issues: JUMC, mission and strategy, advances, andcurrent situations and how the AFMS mission/strategy tie into Joint healthcare
� Format: Unclassified
� Sources: SLW Brief, iEHR brief, MHS Capstone
1
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
2
Air Force Strategies forFuture Healthcare
Lt Gen C. Bruce GreenSurgeon General
17 November 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
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
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
AFMS Framework ProvidesFocus and Alignment(
Transform Deployable CapabilityRapid Response to Any Worldwide Contingency
Build Patient-Centered CareContinuity & Prevention to Optimize Health
Invest in Education, Training & ResearchSustain Our Future Capabilities
FitForce
OverlappingMission Areas
Strategies
Strategy � Common Practice � Culture
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
Global Operations:~ 1,400 Total Force Medics Deployed
MSCDeploymentFrequency
(AD Only)
Building Partnerships& Partner Capacity
Major ConflictsIrregular Warfare
Homeland ResponseNatural Disasters & Humanitarian
Response
a/o 2010 a/o 20110 41% 29%1 38% 52%2 15% 15%3 4% 3%4 1% 0.75%5+ 1% 0.29%
MC14%
DC0.51%
NC16%
MSC4%
BSC5.8%
Enlisted60%
Distribution of CurrentTotal Force Deployments by Corps
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
T+0 hrs
CAF/MAF Improvement
T+3 hrs
EMEDS Health Response Team (HRT) a Reality!
Immediate< 20 min
ER< 2 hrs
OR & ICU< 3 hrs
Evolving Expeditionary Operations( Saving Lives Globally!
ForwardResuscitative
Care
Definitive CareHome w/Family
SAMMC
Self-AidBuddy Care
Combat MedicsNavy Corpsmen
In Theater CareRehab/RecoveryAF Theater Hosp
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
In Pursuit of Lighter &Leaner Medical Response
Humanitarian AssistanceRapid Response Team (HARRT)
MSC/Technician Role: Plans, Logistics, & Development
EarthquakesIndonesia
EarthquakesChile
EarthquakesHaiti
Airlift Deployment Requirements:
< 24 HRS +
Health Response Team (HRT)
Rapid Response Medical Capabilities:Emergency, Resuscitative, & Surgical Care
C-17’s
� Transition from Alaska Shelters to Utilis� AK Shelter Compatible; Decreased Build Time� Joint Program Testing w/ Collective Protection
� Developing “Portable” Functional SupplySystem (ER/OR/ICU/Peds/GYN/etc)� Improved Storage/Shipping�Secure/Weather Proof Versus Triwalls/Ropak�Standardized Packing Portable Drawer Modules
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
Recapturing Care TogetherWhere It Makes Sense
8
Building Capability...Expanding Services(Improving Currency
� Delivering Patient Centered Care To Our Beneficiaries� Creating Currency Opportunities To Support Readiness� Allowing Medics To Practice Full Scope Of Care� Tackling Per Capita Cost Through Targeted Investments
Travis AFB, CA
Nellis AFB, NV
Eglin AFB, FLElmendorf AFB, AK
Systems-Based ApproachRequired To Optimize OurIntegrated Delivery System
Langley AFB, VA
Keesler AFB, MS
Wright –PattersonAFB, OH
Innovation & Insight toRecapture Care
9
Specialty Hospitals Focused on Currency and Recapture
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
AF Medical HomeMSC and 4A Team’s Role Critical
Goal:>1M Enrolled
ProcessPracticeVariation
(GPM)
BalanceRSV
Training(Readiness)
Decision SupportKnowledge Mgmt
Tools(IM/IT)
MedicalSupply &
Equipment(Logistics)
HealthPlan
Mgmt(TOPA)
Healthcare Foundation – Every Team Must Improve Their 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
75%
80%
85%
90%
95%
100%
Jan-11 Mar-11 May-11 Jan-11 Mar-11 May-11
PCMH Aggregate Non-PCMH Aggregate
%Sa
tisfie
d
Percent of Patients Satisfied*Family Health Providers at PCMH Sites
UP isGood
Create The SettingFor “Right” Behaviors
11
ED/Urgent Care Rate: Goal < 3/100
0
2
4
6
8
10
Dec-10 Feb-11 Apr-11 Dec-10 Feb-11 Apr-11
PCMH Aggregate Non PCMH Aggregate
Aver
age
Mon
thly
Vis
it Ra
te (p
er 1
00)
Monthly Emergency Department and Urgent Care Utilization*Per 100 PCMH Patients
DOWNis
Good
HEDIS Aggregate: Goal > 40
0
10
20
30
40
Dec-10 Feb-11 Apr-11 Dec-10 Feb-11 Apr-11
PCMH Aggregate Non-PCMH Aggregate
Scor
e
HEDIS Measures - Patients Enrolled to PCMH Clinics
UP isGood
Inspiring Trust & Confidence by Measuring and Rewarding Outcomes
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 CareMTF Primary Care Visit Distribution*
Family Health / PCMH PatientsOther Provider
PCMH Team
PCMH PCM
Other Provider(Family HealthClinic)PCM(Non-PCMHSites)
PCMH TEAMContinuity
Continuity: Goal > 90%Satisfaction: Goal > 95%
$
$
$ $
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
PatientCentered
HealthTeam
DecisionSupport
PatientDecisionSupport
PCMH Is The Lynchpin To Better Decision Support For Patients & Health 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 13
Electronic Health Initiatives Project (eHIP)
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
14
Diabetic patient educated on
“remote monitoring” glucometer
Readings automatically
sent to healthcare
team
MTF calls patient to discuss
management
Patients receiving massive infusions of > 10 pints experienced
mortality of 33%
Study registry
to identifytrends
Conclude infusing whole blood
reduced mortality to less than 20%
ClinicalPractice
Guidelinedeveloped
Uncontrolled sugar levels Identified
Ready Better Health Better Care
Using Informatics to Accelerate Change in Practice Patterns & Behavior
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
DMHRSi
Leveraging Medical Informatics
Better Care Through
Evidence Based Practice
Registries
CarePoint
User Interfaces
Better Health Enhanced Patient
Safety
Best ValueHealthy Behavior
Clinical Practice
Guidelines
Medication Alerts
Home Sensors
ExpeditedTest Results
Better CareImproved Patient
Experience
DATA INFORMATION WISDOM CHANGEKNOWLEDGE
Accelerating Information Exchange with Patient Activation
HealthServices
DataWarehouse
(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
Investing In Education,Training, & Research
16
Open for Business
Joint Capabilities are Greater Than Any Single Service Capability
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
Nurse Education (Transition Program)� Increasing to 241 enrolled students in FY10� New sites include: Cincinnati, OH & Scottsdale Healthcare, AZ
Enduring Academic Partnerships
Physician/Dentist Education (GME/DME)� Stand alone programs� Masters with civilian universities� Integrated/affiliated with Federal partners� 84 Advanced Education General Dentistry-1 slots/yr� Dental Specialty certificate/Masters program opportunities
Research� Diabetes� Telepathology� Teleradiology
Education & Research – Critical Step Toward Building & Sustaining Medical Services
Nurse Enlisted Commissioning Program (NECP)� 50 per year with school of their choice
USAF Dental Hygiene Program� 10 scholarships per year� Trident Technical College (SC)� St. Petersburg College (FL)
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
Generating Knowledge(
18
PRIMARY CARE 2025: A Scenario Exploration of Forces, Challenges, and Opportunities Shaping Primary Care in the U.S.
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
GENOMIC MEDICINE: An Active Consortium of Government, Academic, and Industry Leaders in the Field of Genomic Medicine Providing Expert Direction for PC2Z Program
Innovative Collaboration to Shape the Future of Healthcare
USU-HJF Military Medicine Symposium: The TBI Spectrum, Challenges, Initiatives, & Prevention
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
Exp
ecta
tions
Time
Innovation Trigger
Vehicle ofOpportunity!
Peak of InflatedOpportunity!
Trough of Disillusionment
Slope ofEnlightenment
Plateau ofProductivity
Swamp ofDiminishing
Returns
Cliff ofObsolescence
* 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
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
21
MissionRequirements& Performance Outcomes Team
BusinessProcessTeam Common Interface Standards
Common Interface Standards
Presentation(Common GUI)
Common Data Centers
Common Services Broker(includes Enterprise Service Bus (ESB) and Infrastructure Services)
PresentationLayer Team
SystemsCapabilitiesTeam
EnterpriseArchitectureTeam
Data Inter-operabilityTeam
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
DisabilityEvaluation
Dental Care
PersonalHealth Record
InpatientOrders Mgmt
Consult &Referral Mgmt Immunization
Laboratory
EmergencyDept Care
Nursing Home
RehabilitativeCare
Long Term Care
TransientOutreach
DoD Unique (16) VA Unique (6)Common (Joint) Applications & Services (30)Battlefield
Care Pediatrics
MilitaryReadiness Obstetrics
Enroute Care Veterinary
OperatingRoom Mgmt
Blood Mgmt
DocumentMgmt
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
OccupationalHealth (VA)
PharmacyMail 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
Leading the Way with Open Source
22
PHARMACY
RADIOLOGY
HOSPITALVISIT
LAB SYSTEMPUBLIC HEALTH SERVICE
PROVIDEROFFICE
VISIT
ElectronicHealth Record
ElectronicHealth 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
4,000+ customers15+ million hits per second4+ Tbps normal trafficPeaks of 7+ Tbps
CLOUD COMPUTINGAkamai Network100,000+ Servers1900+ Locations1000+ Networks700+ Cities80+ Countries
Back-Up Site or Load Balanced Multi-Data Center
Transaction Server
DNS Server
Directory/Policy Server
LegacySystems
App Servers
Database
Load Balancer
Web Servers
Fire
Wall
Data Center
End Users
EDNS
EDNS
Edge Servers
Edge Servers
Edge Servers
Edge Servers
End Users
Edge Servers
EDNS
AkamaiSite ShieldNetwork
StorageEdge
Servers
End Users
End Users
Edge Servers
WAF
WAF
Better Access, Innovation, and Care For Patients
Akamai Architecture Operational View – OV-1
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
Integrating New Technology
24
Hand-held, Battery-powered, Laser Cautery & Ablation Tool
Directed Energy Sensors
Automated Information
& Data Collection
(AIDC)Current CCATT Mission
From Force Health Protection To Logistics To Portable Surgical Tools
Future CCATT Mission -Wireless
Reaching Beyond with Evolutionary Advances and Concepts
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-Joint and Coalition
Organizational Agility
PrecisionHealthcare
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
Patient-Centered Care
� 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 phones/resolve patient concerns� Thorough: Tell patient what to do if they feel worse
26
Patient-Centered Care Begins with Access to Earn Trust!
27
“TRUSTED CARE ANYWHERE”