AHLTA / EHR Way Forward: PART 1 – AHLTA and AHLTA Service Pack 1 PART 2 – EHR Way Forward Presented by: CAPT Robert Marshall, MD MPH MISM Chief Medical

AHLTA / EHR Way Forward:PART 1 – AHLTA and AHLTA Service

Pack 1PART 2 – EHR Way Forward

Presented by:

CAPT Robert Marshall, MD MPH MISMChief Medical Informatics Officer, BUMED M6

Robert L. Flores

AHLTA Program Manager, NAVMISSA

17-19 February 2011 Leading NAVMED through PortfolioManagement.

Learning Objectives

• AHLTA – Making it work better for patient care– Describe MAPS and COMPASS programs– Discuss IT applications to help– Discuss workflow analysis and AHLTA– Discuss AHLTA training and trainers– Describe the AHLTA Triumvirate– Discuss Secure Messaging, iMedConsent and

AHLTA

2

Learning Objectives (cont)

• AHLTA Service Pack 1• Understand Service Pack 1 milestones

• Beta test plans• Release management• Clinical Impact Analysis

• Service Pack 1 Fixes and Updates• Release contents• Fixes and Changes

• Release Tracking and Progress Reporting



• Deployment Plans• EUD Installation and Imaging • Reporting Process

• Troubleshooting• Reporting processes• Information gathering and Lessons Learned

• Communications and Coordination• Cross Discipline information sharing• Clinical User inclusion

• Training and User Awareness



• EHR Way Forward• Planning – Past, Present and Future

• EHRWF Tiger Teams review• Interagency (DoD/VA) planning – Before decision• Interagency (DoD/VA) planning – Post decision

• Products• Original Analysis of Alternatives• Directed AoA• Working Teams/Executive Team recommendations• Expected Interagency EHR



AHLTA – Present State

• Version 3.3 deployed to all Navy sites; all Army/Air Force sites by 12/31/2010

• Over 200 new and updated features – many not utilized; two turned off (aCPG and APV)

• No major upgrades after SP1 released• Possible for major Medcin upgrade (SOO)

6

MAPS and COMPASS

• What they are• The forms that support these• Workflow analysis and Business Process

Reengineering – why they are vital• WLAN – why it is critical to success• What does the Navy have?• What does the Navy need?• Dragon Naturally Speaking and AsUType• Tablets – PC, Android and iPad

7

Secure Messaging and iMedConsent

• Secure messaging - part of PCMH (Medical Home)– Web service – no Network or AHLTA interface– Copy and paste to document care

• iMedConsent - a library of consent forms– Both for procedures and for advanced directives– Also has research consent forms for IRB’s– Web service – no Network or AHLTA interface– Is the VA’s consent library (integrated)– Favorites, print and scan

8

AHLTA Training & Triumvirate

• Sustainment training contract– Sustainment trainers/consultants– Navy AHLTA web site– Regional Trainers from TMA

• Triumvirate– Consists of AHLTA trainer, Coder and Clinical

Champion– Need Command support to help clinics use AHLTA

better– Is a business/clinical process support asset

9

AHLTA Training & Triumvirate

• Sustainment training contract– Sustainment trainers/consultants– Navy AHLTA web site– Regional Trainers from TMA

• Triumvirate– Consists of AHLTA trainer, Coder and Clinical

Champion– Need Command support to help clinics use AHLTA

better– Is a business/clinical process support asset

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AHLTA SERVICE PACK 1


AHLTA Service Pack 1

• Service Pack 1 Milestones

– Beta test plans

– Clinical Impact Analysis

– Release management

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Beta Phases * 60 days Mon 1/17/11 Fri 4/8/11

Phase 1: Beta Tester 15 days Mon 1/17/11 Fri 2/4/11

Phase 2: Small Group of Providers 15 days Mon 2/7/11 Fri 2/25/11

Provide SP1 Briefing to New Users 15 days Mon 2/7/11 Fri 2/25/11

SP1A 16 days Fri 2/4/11 Fri 2/25/11

Phase 3: Full Clinic 15 days Mon 2/28/11 Fri 3/18/11

Provide SP1 Briefing to New Users 15 days

Full Site deployment 15 days Mon 3/21/11 Fri 4/8/11

Provide SP1 Briefing to New Users 15 days Mon 3/21/11 Fri 4/8/11


*All Dates and Milestones are subject to change

Milestones


• BETA Testing

– Plan includes testing by a representative site from each service

• Groton NH• Goodfellow AFB• Brooks Army Medical Center

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• BETA Test Plan– Users at the BETA sites using the software in live

encounters• DHIMS will collect usage info from BETA teams

– Testing on Windows 7 (32 bit) based EUDs for the first time in addition to Windows XP

• Windows 7 STIG creation• DHIMS will certify SP1 for both platforms• Windows Vista will not be supported

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• Clinical Impact Analysis– Plan includes analysis to be conducted on

implications of SP1 changes

• Clinical

• Business and Data Quality

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• Clinical Impact Analysis– TBD

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– HIGHLIGHTS from the release notes will go here

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• Data Quality Impact Analysis– TBD


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Data Quality Impact Analysis– TBD


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AHLTA Service Pack 1• Release Management

– Plan will include multiple facets

• Training Requirements– DHIMS has contracted to create training instruments

• Information on the Release to be communicated – IT specific deployment plans and instructions– Information resulting from functional impact analysis

efforts– Lessons learned from the BETA period

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Release Management– IT Organizations will need to develop plans prior to the release

• Magnitude of the SP1 code changes– Hundreds of fixes and thousands of code changes– Many modules have been completely re-written– Most massive update since 3.3 release

• Deployment plans should include creating new Gold Image from scratch (i.e., complete fresh installation of OS , etc)

» Re-imaging of EUDs is the deployment method sites should plan for» Re-imaging, while labor intensive and upsetting to the users, will pay

dividends in minimizing long term support issues» Start preparing users for the process well in advance

• Backing up users desktops, documents, etc.• Document printer settings, etc• Involve Clinical and Business/Data Quality managers in the process

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• Service Pack 1 Fixes and Updates

• Release contents and timetable• Beta Phases

• Fixes and Changes• Changes to Infrastructure• SP1 A plans

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Release Contents

Pieces to be included in SP1– Windows 7/XP Compatibility– CDR Stabilization – SQL Optimization (Integration

effort)– Remove unused AHLTA components– Oracle 10.2.0.5 (CDR)– Reflections 14.1

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AHLTA Service Pack 1Deployment

CDR Update 814o Delivery CM (11/17)o DT&E Testing (11/22 – 11/29)o Fielding (12/18)

3.6 Mid-Tier Update o Delivery CM (12/3)o DT&E Testing (12/8 – 1/7)o Fielding

Groton (1/15) Goodfellow (1/15) AMEDD site (1/15)

3.6 Web Service Update o Delivery CM (12/3)o DT&E Testing (12/8 – 1/7)o Fielding

Groton (1/15) Goodfellow (1/15) BAMC(1/15) 26

AHLTA Service Pack 1Deployment

ICD Update 469 o Delivery CM (12/3)o DT&E Testing (12/8 – 1/7)o Fielding

Groton (1/15) Goodfellow (1/15) AMEDD site (1/15)

SP1 Cliento Delivery CM (12/3)o DT&E Testing (12/15 – 1/15)

Codes (CPT 6.0)o Delivery CM (1/21)o DT&E Testing (1/24 – 1/28)

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BETA Phases

Phase 1: Beta Tester (1/17 – 2/4)

Phase 2: Provider (2/7 – 2/25)cannot start until CPT dates• Small group: includes codes and SP1A

SP1A (will happen between Phase 2 and 3)code fix of any bugs found in beta testing)

Phase 3: Full Clinic (2/28 – 3/18)

Phase 4: Full site deployment (3/21 – 4/8)28


• Troubleshooting

– Deployment processes• Procedures during Rollout• Reporting

– Information gathering and Lessons Learned• Communication plans• Sharing of lessons learned

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General Escalation Plan

– Successful completion of milestones will be reported and tracked

• Written communications primary means

– MHS Help tickets to be used to report problems during testing or deployment

• The word “BETA” must appear in the ticket title

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Mitigation Roll Back / Deployment

• Sites need to have a Roll Back plan– Beta testing, DT&E approval and a staggered

implementation does not guarantee a problem won’t appear

– Sites should minimize risk where possible» E.g., Monitor results of testing and BETA progress,

internal testing, staggered rollouts

Hope for the best but

plan for the worst!

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Communications

– Beta Period• Scheduled conferences will be held weekly and as

needed• Results of the Beta will be collated and

communicated to the sites• Sites should follow the progress of the Beta and

other information as they become available• “…if you’re not getting it, ASK for it!”

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Coordination

• Communications and Coordination at the local level


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Coordination

Cross Discipline information sharing

• Clinical User inclusion

• Business Office/Coding inclusion

• Use the Triumvirate process to get all stakeholders on board

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Coordination

• IT Managers should involve clinic managers, coders, and trainers when planning the deployment

• Users need to be aware of what is coming and when

– How to report issues

– Who to go to for help

– MHS Trouble Ticket processes

• Disseminate Lessons Learned

• Disseminate Impact Analysis

• AHLTA Clinical Champions can help coordinate these efforts 35


Training

• DHIMS has contracted to create training materials

– Briefings and CBTs are expected

• Site Deployment Plans should include training plans

– Use ‘Triumvirate’– Involve Clinic managers and Coding/Data Quality– Involve MTF leadership

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EHR WAY FORWARD


EHR Way Forward

• Past Planning– JCIDS-driven AoA– Down selected to four options– >90 clinical and non-clinical Tiger Teams– Full engagement by all three Services

• Pre-Decisional Interagency (DoD/VA) Planning – Driven by senior TMA leadership– Limited or no Service involvement initially– Multiple DoD/VA working groups

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EHR Way Forward (cont)

• Post-Decisional Interagency Planning– Decision made in January for future direction– Decision was…..– Based on decision, planning did this….– Future product expected to be….– Timeline for implementation….– Long term planning….

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Original/Interagency AoA

• DoD AoA process• Choices made• Alignment with Interagency decision• Why things changed?• Interagency AoA work• Working groups

– Mission Requirements and Performance Outcomes– Data Interoperability– Infrastructure and Enterprise Architecture– Systems Capabilities– Presentation Layer– Business Process

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What is next?

• Outcomes of Interagency working groups – slides• Future end state• Timeline – separate slides• Data model – separate slides• Enterprise Service Bus/Data Access Layer –

separate slides• Mid-tier – separate slides• Presentation layer – separate slides• Interoperability – separate slides• Nationwide Health Information Network - slides

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Click to edit Master title styleUse this two column slide for long lists of

bullets

• Click to edit Master text styles– Second level

• Third level– Fourth level

» Fifth level

• Click to edit Master text styles– Second level

• Third level– Fourth level

» Fifth level


Summary

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• Font is Arial – 26 pt at this level– Second level – 25.5 pt

• Third level – 24 pt– Fourth level - 22.5 pt

» Fifth level – 21 pt


Contact Information

• CAPT Robert C. Marshall, MD, MPH, MISM• [email protected]• 253-225-1690

• Robert L. Flores• [email protected]• 210-808-0789


mailto:[email protected]

mailto:[email protected]

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Documents

AHLTA / EHR Way Forward: PART 1 – AHLTA and AHLTA Service Pack 1 PART 2 – EHR Way Forward Presented by: CAPT Robert Marshall, MD MPH MISM Chief Medical