MHS IM/ITProgram

Electronic Health Record (EHR)-System Way Ahead

LtCol Dan DavisChief, EHR Clinical Requirements

Presentation to

MEPRS Conference

July 26, 2010

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Purpose

• Provide overview of – EHR-S Way Ahead activities– EHR-Dependent analysis

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Challenges

• Over the last 20 years, the MHS has evolved its Information Management (IM) / Information Technology (IT) capabilities to accommodate changes in standards, technologies, healthcare delivery patterns, healthcare modalities and methodologies. There has been:– an increased emphasis on integrated / preventive care; – an increased complexity of medicine, standards of care, and

healthcare delivery; – an increase in consumerism and self-advocacy / participation of

the patient; – a high dependency on civilian managed care; – mandated data-sharing relationship with the Department of

Veterans Affairs;– increased Operational Tempo. – rapid evolution of the IT marketplace beyond our ability to adapt

and take advantage of advancements

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Problem Statement

• Current MHS EHR System is antiquated, incomplete and succumbs to source systems that do not provide the reliability, performance, usability and functionality needed to support the warfighter and his/her family through the continuum of care, which spans theater, en-route care, garrison, and VA/Civilian care.

• Fails to meet the MHS vision of a comprehensive EHR and does not effectively support presidential initiatives and directives.

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Capabilities-Based Assessment (CBA)

• Conducted August - September 2009• Clinical Medical Information Officers

– Services– TRICARE Management Activity

• Identified need to support execution of DoD’s medical mission as outlined in the Joint Force Health Protection pillars and the MHS Mission Elements

• Organized capabilities as a “Bulls Eye”

• Prioritized list of capability gaps– Clinically focused– See backup slide

HealthRecord

Patient Care Support

Business Intelligence

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Needs Assessment Results

• Capability gaps identified to meet current and future needs:– Some needed system solutions do not exist– Some existing system solutions need improvement– Some system solutions currently in development need

improvement

• Data collection to enhance completeness of DoD Health Record needed. Data available in:– Service systems– VA systems and other Federal Agency systems– Provider systems in the civil sector

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DOTMLPF – Policy AnalysisDoctrine: No changesOrganization:

– Need a governance structure that recognizes the functional role as primary in the acquisition process– Need functional and technical collaboration and cooperation throughout requirements development and the

acquisition life-cycle– Continuity of certified and accountable acquisition program managers

Training: Fundamental change in approach– EHR has to be central element in workforce training to understand its value and to leverage it– Schoolhouse training with demonstrated competency that continues throughout period of service

Materiel: – Fundamental transformation of current solution to move to new architecture– Identify business process changes

Leadership and Education: – No changes to current professional and military education; but

• Leadership understanding and support for EHR throughout the MHS critical to future success• Key to achieving organization and training changes

Personnel: – Qualified personnel needed to implement approach – Repurposing of some personnel after full implementation

Facilities: – Reconfigure current MTF to be more conducive to using EHR– Design future facilities with EHR in mind

Policy: need to align policy to better accommodate efficient, effective use of EHR– Replace existing paper-based record policies

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Recommendation

• Recommendation: Transformational materiel solution – Fundamental change of technical capabilities mix required to

move to new architecture– Shift in focus to concentrate on the patient, moving outward,

rather than from the business, moving inward.

• Successful implementation also requires changes described earlier to:– Organization– Training– Personnel– Facilities– Policy

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Initial Capabilities Document (ICD)

• Required because materiel solution needed• Validates

– Capabilities are required to perform mission– Priorities and operational risks– Need to address capability gaps

• Drafted September – October 2009• Approved by CPSC November 2009• Approved by JROC January 2010

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Tiger Teams

• Service CMIOs – Identified 64 “Lines of Business”– Identified Subject Matter Experts for individual Tiger

Teams• Tiger Team sessions November 2009 through

mid-February 2010 identified functional requirements and defined workflows– Most were one day sessions– Some were two day sessions– All sessions held via teleconference and DCO

• Functional requirements and workflows– Reviewed by Service Specialty Leads and

Consultants– CPMB approved in May 2010

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Capability Development Document (CDD)

• Contains– Concept of operations

• Theater, Enroute care, and Garrison

– Analysis of Alternatives (AoA) summary– Functional requirements and performance values for materiel

solution that will fill the capability gap– Initial / Full Operational Capability Definitions– Total Cost of ownership

• Program cost• DOTMLPF-P Costs

– Operational and System Architecture artifacts

• AoA complete December 2010• Milestone B Decision – March 2011

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AoA Discussion

• DoD Guidance– 7 approaches to consider

• Phase I analysis complete• Eliminated several approaches

• Phase II – Looking at remaining approaches– In context of enterprise EHR-S

• Includes business systems needs and impacts

– Complete December 2010

• Transition Plan for sun-setting current MHS EHR

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EHR-Dependent Analysis

• Mar 2010: – Business community initiated analysis on the impact of the new EHR on

current capabilities– Analysis included the Clinical and Force Health Protection community

• 19 Apr – 14 May 2010: Capability Analysis Stakeholder meetings:– Abbreviated CBAs

• Business Domain• Medical Logistics• Population Health• Force Health Protection and Readiness (FHP&R)

– Services and TMA representation– Identified existing capabilities and mapped them to MHS mission

requirements– Assessed

• How well existing solutions meet current needs• Accessibility of needed information

– Determined most capability gaps are result of data required in other Service systems, VA systems and other Federal Agency systems, and provider systems in the civil sector that are not consolidated into the DoD Health Record

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DOTMLPF-P Analysis

Doctrine: No changesOrganization: No changesTraining: Updates to HIPAA Training as revisions and new

rules become effectiveMateriel: See Recommendations (next slide)Leadership and Education: No changesPersonnel: Additional analysis requiredFacilities: No changesPolicy:

– Updates will be required for HIPAA reporting where interim and final rules are pending

– Any solution needs to support most current policy requirements

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Recommendations

• Materiel Solution Required– Evolutionary approach

• With links from new EHR to existing business systems to ensure access to EHR data when the new EHR is implemented

– Transformational approach• Replace

– PHIMT (for Privacy)

– WMNS (to expand to the entire healthcare team)

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EHR-Dependent Tiger Teams

• Tiger Teams– 25 May – 29 July 2010– See back-up slide

• Focus: – Data needs and data flows for business workflows

• Data required from EHR• Data provided to EHR

– HL7 requirements review

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HL7 Requirements

• MHS leadership has decided to use EHR-S/HL7 Functional Model (FM) for the EHR Way Ahead– Remain at the forefront of Health IT systems– Increase interoperability with

• Veterans Affairs• Managed Care Support Contractors (MCSCs)• Allies and coalition partners

• “Established in 1987, Health Level Seven (HL7) is an American National Standards Institute (ANSI) accredited, not-for-profit standards-development organization, whose mission is to provide standards for the exchange, integration, sharing, and retrieval of electronic health information…”

• In 2003, the HL7 group began efforts to develop a standardized functional specification for Electronic Health Records Systems (EHR-S)– Approved

• July 2004 as a Draft Standard for Trial Use• February 2007 as a fully accredited standard by the American National

Standards Institute (ANSI)• 2009 as an International (ISO) Standard

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EHR-S Functional Model

Functions describe the behavior of a system in user-oriented languageso as to be recognizable to the key stakeholders of an EHR System

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Next Steps

• Complete EHR-Dependent Tiger Team sessions and analysis

• Complete EHR Phase II AoA– Account for impacts on business capabilities

• Make necessary changes to MHS IM/IT portfolio

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QUESTIONS?

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Back up slides

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Top Ten Clinical Capabilities

Priority Capabilities

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Comprehensive Medical and Dental Documentation (including encounter data, medications, physical examinations, occupational health, and ancillary service data – both inpatient and outpatient), Documentation of care plan objectives, alternatives, patient education, health care services provided, patient disposition instructions (including deaths), and disposition of remains.

2Global capture and exchange of all health data for beneficiaries - Direct care, Network, Managed Care, Veterans Affairs, etc.

3Inpatient and Outpatient Order Entry and Management (laboratory, pharmacy, radiology, consults, health care plans, nutrition management, prescription spectacle orders)

4

Ancillary Services: - Laboratory Diagnostic Services (includes results, retrieval and reporting)- Pharmacy Services (includes dispensing, operations, and reporting)- Radiology Diagnostic Services

5 En-route Care Documentation

6 Results Retrieval (ancillary services and consults)

7 Data collection and decision support in austere environments

8 Consult and Referral Management

9 Assessments of medical deployability of individual service members

10 Patient Administration (Includes who the patient is, what he/she is entitled to, where he/she is located, etc.)

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Week Date Track 1 – Sessions Track 2 – Sessions

Week 1 

Tue, 5/25/2010 Billing (includes: Medical Affirmative Claims (MAC), Medical Services Account (MSA), and Other Health Insurance (OHI) Management)

N/AThu, 5/27/2010

Mon, 5/31/2010 - Memorial Day Holiday

Week 2  

Tue, 6/1/2010 HIPAA (Privacy and Security)Coding (Inpatient / Outpatient)

Thu, 6/3/2010 N/A

Week 3Tue, 6/8/2010

N/AOutpatient Appointing & Scheduling / Identity

ManagementThu, 6/10/2010

Week 4Tue, 6/15/2010

N/AMedical Logistics (includes Equipment and

Supplies)Thu, 6/17/2010

Week 5 

Mon, 6/21/2010

Credentialing/Privileging/Risk Management/Adverse Action

Processing/Population Health Quality/Patient Safety Reporting

(Part 1 of 3)

N/A

Tue, 6/22/2010Human Resources

(Part 1 of 2)

Medical Surveillance (includes: Disease and injury, Epidemiology, Prevalence (monitoring),

Deployment health surveillance, Syndromic surveillance, and Reportable medical events)

Wed, 6/23/2010

Credentialing/Privileging/Risk Management/Adverse Action

Processing/Population Health Quality/Patient Safety Reporting

(Part 2 of 3)

Thu, 6/24/2010Human Resources

(Part 2 of 2)

EHR-Dependent Tiger Team Session Schedule (weeks 1-5)

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Week Date Track 1 – Sessions Track 2 – Sessions

Week 6

Mon, 6/28/2010 Medical Logistics (Focus on Equipement)

N/ATue, 6/29/2010 Occupational and Environmental Health(Part 1 of 2)

Wed, 6/30/2010Spectacle Request Transmission Service (SRTS) (Part 1 of 2) (Part 2 of 2 – TBD) Military Entrance/Enlistment Processing Station

(MEPS)Thu, 7/1/2010

Occupational and Environmental Health(Part 1 of 2)

Mon, 7/5/2010 – Independence Day Holiday

Week 7

Tue, 7/6/2010

Population Health (includes: Condition / Disease Management, Health Promotion/Wellness (PHA),

and Individual Medical Readiness)

Referrals / Consultations / Teleconsultation (Part 1 of 2)

Wed, 7/7/2010 N/A

Thu, 7/8/2010Referrals / Consultations / Teleconsultation

(Part 2 of 2)

Week 8

Mon, 7/12/2010 N/A

Credentialing/Privileging/Risk Management/Adverse Action

Processing/Population Health Quality/Patient Safety Reporting

(Part 1 of 2)

Tue, 7/13/2010Patient Radiation Exposure

(Part 1 of 2)Outpatient Clinic Management

(Part 1 of 2)

Wed, 7/14/2010 N/A

Credentialing/Privileging/Risk Management/Adverse Action

Processing/Population Health Quality/Patient Safety Reporting

(Part 1 of 2)

Thu, 7/15/2010Patient Radiation Exposure

(Part 2 of 2)Outpatient Clinic Management

(Part 2 of 2)

EHR-Dependent Tiger Team Session Schedule (weeks 6-8)

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Week Date Track 1 – Sessions Track 2 – Sessions

Week 9Tue, 7/20/2010 Cost and Workload Assignment (includes Non-Lab,

Non-Rad Ancillaries)N/A

Thu, 7/22/2010

Week 10

Mon, 7/26/2010 N/AAdmissions, Discharge and Transfers (ADT)

(Part 1 of 2)

Tue, 7/27/2010Medical Command and Control (MC2)

(Part 1 of 2)Patient Movement

(Part 1 of 2)

Wed, 7/28/2010

Credentialing/Privileging/Risk Management/Adverse Action

Processing/Population Health Quality/Patient Safety Reporting

(Part 3 of 3)

Admissions, Discharge and Transfers (ADT)(Part 2 of 2)

Thu, 7/29/2010Medical Command and Control (MC2)

(Part 2 of 2)Patient Movement

(Part 2 of 2)

EHR-Dependent Tiger Team Session Schedule (weeks 9-10)