Transcript ACT/IAC Panel - Home Page | Defense Daily Network

Enabling Health Care Efficiencies via
an Interoperable Health Record
Paul Tibbits
Deputy CIO for Enterprise Development
Department of Veterans Affairs
November 12, 2009
Interoperability: Current and
Planned
Current State
HEC IM/IT WORK GROUP
BEC IS/IT WORK GROUP
Pharmacy Data
Allergy Data
Lab Results
Discharge
Summaries
Theater Clinical
Data
Radiology Reports
Pre-Deploy
Assessment
Post-Deploy
Assessment
Post-Deploy
Reassessment
Inpatient Consults
Operative Reports
Provider Notes
Procedures
Problem Lists
Social History
Other History
Family History
Vital Signs
Additional Inpatient
Data
Sep 09
Inpatient Documentation
Expansion
Sep 09
Gateways - Data
Migration
Sep 09
Document Scanning
(initial)
Sep 09
Expansion of
Questionnaires
Questionnaires
DoD and VA
Shared Health
Data
Oct 09 Lab Results (computable)
Std Ambulatory
Data Record
Combat Military
Pay
Accessions &
Separations
Activation /
Mobilization
Military Pay
Information
MGIB Eligibility
Information
Add’l Education
Benefit Data
UIC Mailing
Address Data
Insurance/ Benefit
Eligibility
Compensation &
Pension Data
MGIB Program
Usage Data
Member / Veteran Family Member Information
for Insurance and Cemetery Benefits
Plan Completed Jun 08
Images
(Enterprise-Wide)
Plan Completed Jun 08
Images
(Enterprise-Wide)
Add’l Data Elements
(Viewable)
Add’l Data Elements
(Viewable)
Add’l Data Elements
(Computable)
Interoperability Plan, V 1.0
Completed Sep 08
Add’l Data Elements
(Computable)
Interoperability Plan, V 1.0
Completed Sep 08
Cognitive
Assessment Tool
(LOA2)
Web-Based
Training (LOA2)
TBI / PTSD
Telehealth
Consult (LOA2)
Document
Mgmt. System
(LOA1)
VA Disability
Exam Templates
(LOA1)
Imaging - Theater
(LOA4)
TBI Extender
Codes (LOA2)
Research
Clearing / Datamart (LOA2)
Clinical Case
Mgmt. (LOA3)
Web-Based FIRP
(LOA3)
Reserve Health
Records Access
(LOA4)
Behavioral
Health Notes
(LOA2)
TBI Patient
Registry (LOA2)
ADT to DFAS
(LOA8)
Non-Clinical
Case Mgmt.
(LOA3)
Defense Center
of Excellence
(DCOE)
Phase 1 of
Common
Services Initiative
Phase 2 of
Common
Services Initiative
Military Service Imaged
Record via DPRIS
DoD and VA
Shared
Personnel /
Administrative
Data
Dis Eval Sys Pilot
- VTA Tracking
(LOA1)
Wounded Warrior
Indicators (LOA4)
eBenefits Portal
(LOA4)
KEY
Current Sharing (Viewable)
Current Sharing (Computable)
Clinical
Enhancements
Planned Sharing (funded)
Potential Sharing (unfunded & uncosted)
Potential Sharing (DoD funded)
Potential Sharing (VA funded; DoD identified
funding requirements – FY09 supplemental)
On Contract
3
North Chicago –
Captain James A. Lovell Federal Health Care Center
• First FHCC managed
jointly by VA and DoD
• Opening Day October
2010
• On Schedule
• Provide Information
Management/Information
Technology
• Key to establishing VA/DoD
electronic health record
Ambulatory Care Center site
4
Proposed Future State
Beneficiary /
Stakeholder
Other Government
Agencies
Other
Uniformed
Services
Army
Marine Corps
Managed Care / Fee
Private Providers
Common Services
DoD
Navy
Air Force
JOINT
Pharmacy*
Lab*
Single Sign-On
Radiology*
Self-Service
Logon
Consults
Portable Order
Entry
Service
History
Identity
Management
Benefits &
Eligibility
VA
VHA
VBA
Compensation
NCA
Education
DoD Unique Data
Ex: Enrollment,
Operational/Theater
Information
VA Unique Data
Ex: Extended Care Data,
Veteran/Dependent
Benefits
Virtual Lifetime Electronic Record
Health | Benefits | Personnel
* Orders and results
5
Nationwide Health Information Network
Health Bank or
PHR Support Organization
State and
Local Gov
Community
Health Centers
CDC
Community #1
VA
Mobilizing Health Information Nationwide
DoD
Labs
SSA
Integrated
Delivery
System
Pharmacies
Community #2
The Internet
Standards, Specifications and Agreements
for Secure Connections
CMS
Architecture and Technical
Challenges
Top 10…
SOA General Misconceptions
10. Orchestration = dynamic discovery = dynamic
consumption
9. Configurable = loosely coupled
8. Identity is Identity, and there is only 1
7. SOA is a “Big Bang Theory”
6. Granularity of services is easy to define
5. Standards and Specifications compliance is strictly defined
4. WSDL exchange = interoperability
3. Security and auditing can be retrofitted
2. Service-Oriented Architectures are primarily a technical or
management approach
And the #1 General misconception is…
1. SOA is the answer to interoperability (and you can buy one)
•
•
Approaching Service Orientation
Strategic Governance needs to
enforce the “design by standards”
approach versus “design by
product” across the Enterprise
BRM
Critical elements required to
scale Tactical Governance Model
– Enterprise review boards
– Programmatic Governance
Boards: Enterprise
Management Processes
– Functional Governance
Boards: portfolio and capability
establishment
– Technical Governance Boards
• Roadmap for core services
utilized by all development
efforts
• Reference Architecture to
enable experimentation and
development including
Standards, Specifications,
Patterns and Practices
(SSPPs)
PRM
Strategic
Goals &
Objective
s
Business
Components
(Functions,
Sub-functions,
and
Capabilities
Information
& Data
VBA
NCA
VBA
Strateg
y
NCA
Strateg
y
VBA
Lines of
Business
NCA
Lines of
Business
VBA
Business
Area
NCA
Business
Area
Medical
Educatio
n
Care Mgmt
Employee
Health Record
SubFunction
2
SubFunction
3
Information
Element 4
Information
Element 1
Information
Element 2
Information
Element 3
SubFunction
4
Information
Element 6
VBA
NCA
Sub-Functions Sub-Functions
VBA
Information
Element
NCA
Service 6
Service 1
Composite Apps
Services
Infrastructur
e
Components
Service 1
VBA
Service 4
Services
2
…
Service n
VA Internal Use Only
Requirement
Framework
Organizational
Governance
Open
Community
Process
Business
Process
Modeling
Data
Strategy
VHA
Service
NCA
Service
VBA
Service
VBA
Service
VBA
Service
NCA
Service
VBA
Service
6
NCA
Service
6
Metrics
Test &
Assessment
Certification &
Accreditation
Deployment
Strategy
Messagin
g
Discovery
Security
Core Services
TRM
NCA
Information
Element
E-SOA
Governance
Information
Element 5
Service 3
Application
s
SRM
VHA
Domains of
Value
Eight for
Excellence
Medical
Researc
h
Medical
Care
SubFunction
1
DRM
Governanc
e
VA Pillars
FEA
ESM
Education &
Training
Technical Standards
9
•
Example: Chapter 33 Tactical Governance
Implementing Governance for Chapter 33
– Established OED / Chapter 33 Architecture and Engineering Governance Board
– Established ESOA / Chapter 33 Architecture Integrated Product Team (IPTs) to
manage issues in key areas
• Security, Architecture, Infrastructure
•
Identifying and managing critical gaps in
Governance for Chapter 33
–
•
Process and artifacts that:
• Identify connection to systems outside CH33
• Determine responsibility for changes to these
systems
• Determine service agreement type
• Enable CH33 service deployment and
certification
Developing service-oriented Standards,
Specifications, Patterns and Practices
(SSPP) and an associated reference
implementation of core services
Chapter 33 Tactical Governance
ESOA / Ch 33 Arch IPT Charter
SPAWAR (Chair)
Ch 33 Technical Team
VBA-SE
EIE
OED-SE
OED / Ch 33 Arch-Eng
Governance Board Charter
OED-SE (Chair)
VBA Architect
PM Rep
EIE Rep
BOIBI Rep
Field Ops
Security
Chapter 33 Governance Model is scalable to the Enterprise level
VA Internal Use Only
10
Innovation
Innovation Components






Greenfield Incubation—field innovators propose new
opportunities
Strategic Incubation*—leadership identifies opportunities
Innovation Diffusion—evaluation of the quality of products
and how products work in the healthcare delivery process
Collaborative Tools—technologies used to advance
innovation and encourage the building of communities of
interest
Workforce Development—activities undertaken to build a
culture of innovation and a knowledgeable workforce
VA OI&T Innovation Advancement Program (IAP)
*cross-Administration strategic initiatives to be undertaken; points of contacts have been identified
12
Innovation Evaluation
•
Innovation criteria
–
–
–
–
–
•
•
Improves patient care (e.g., safety, quality or access)
Improves efficiency (e.g., clinical workflow or cost/benefit)
Impacts numerous Veterans, staff or other stake holders
Addresses an unmet need rather than incrementally improves existing methods
Helps meet an organizational requirement (e.g., Joint Commission or
Congressional mandate)
Three review teams, five reviewers per team with multi-discipline and
leadership level mix
Preliminary Review Process:
– Addressed Conflicts of Interest
– Randomly assigned LOI to teams
– Used blinded independent review with established Innovation Evaluation Criteria
on 1-5 scale
– Group discussed and determined final scoring
•
Final Review Process and Criteria:
– Same review teams, evaluated full proposals
– Benefit factors: Quality, Efficiency, Scope, Novelty, Requirement
– Feasibility factors: Team, Approach, Environment
Greenfield Award Overview
Reviewed LOI
Impacting
Category
Awards
Impacting
Category
Award
Percent
Administrative
114
29
25%
Clinical
159
43
26%
Education
56
21
38%
Other
34
9
26%
Veteran Direct
Impact
124
36
29%
Category
44 TOTAL CONCEPTS SELECTED FOR FUNDING
Program Management and
Acquisitions
Analysis of Ongoing VA Programs
• 280+ programs reviewed
• 8 program attributes analyzed
• Many programs exhibited signs of trouble
– Greater than 13 months behind schedule
– Greater than 50% over initial cost estimate
– Decrease in software quality between
releases
– Inadequate skills to complete program
• Substantial change required
16
Incremental Development
• All new VA IT projects/programs must use an incremental
development approach
– Frequent customer delivery milestones at maximum of six months
– Customer must test and accept functionality
• To be approved for investment, a program or project must
have:
–
–
–
–
–
–
–
An identified customer sponsor and integrated project team (IPT)
Program plan that documents frequent delivery milestones
Documented, agreed to requirements for initial milestones
Clear plan for necessary program disciplines
Clear access to necessary program resources
Customer, program, and vendor acceptance of PMAS
Jointly established success criteria
17
Program Management Accountability
System (PMAS)
• All incremental development programs will be managed rigorously to
schedule
– A program/project will be halted on its third missed customer delivery
milestone
• Once halted, substantial changes must be made before the program
can restart
–
–
–
–
–
–
–
Need for program/project will be re-assessed
Program approach will be re-assessed
Make/buy and program design decisions will be re-assessed
Program management assignment will be revisited
Government staff assignments will be revisited
All service contracts will be re-visited
New program plan must be approved
• Flexibility can be earned
Collaboration is key to IT success.
18
Acquisitions
• Established a dedicated acquisition office to
support OIT program planning and execution
• Provide life cycle acquisition support from
program inception through completion by a multifunctional IPT
• Implementing joint Program Management
Reviews to improve contract performance and
program execution
• Collaboration with industry through early
involvement of requirements and transparency
Acquisitions plays a dedicated and integral role in project IPTs.
Conclusions
• Investment vs. Value
• Consensus of IT “Sellers” and “Buyers” on
Business Need
• Need for Incentives
• Information Interoperability
• Collaboration at all Levels Essential
• Rigorous Program Management and
Acquisitions Process