New IT Service Requests New IT Service Requests and New Commercial and New Commercial

Technology Requests: A Technology Requests: A How-To Guide for VHA How-To Guide for VHA

researchersresearchersMay 16, 2006May 16, 2006

David M. Douglas MDDavid M. Douglas MD

Geriatric PsychiatristGeriatric Psychiatrist

Associate Director for Associate Director for InformationInformation

Member IDMC Member IDMC Screening Screening CommitteeCommittee

Portland VAMCPortland VAMC

Mike Davey MD PhDMike Davey MD PhDACOS Research & InnovationACOS Research & Innovation

AGENDAAGENDA

What is the role of the Informatics and What is the role of the Informatics and Data Management Committee (IDMC)?Data Management Committee (IDMC)?

What are New IT Service Requests What are New IT Service Requests (NSR) and New Commercial (NSR) and New Commercial Technology (NCT) requests?Technology (NCT) requests?

What does a researcher need to do to What does a researcher need to do to place a request?place a request?

How can Research help OI?How can Research help OI?

Defining the Request:Defining the Request:NSR vs. NCTNSR vs. NCT

New IT Service RequestNew IT Service Request New IT Service Requests are requests for products, product New IT Service Requests are requests for products, product enhancements and changes to information systems enhancements and changes to information systems maintained by OI. maintained by OI.

New Commercial TechnologiesNew Commercial Technologies Commercial Technologies can be described as Commercial Technologies can be described as developmental software and/or information devices and developmental software and/or information devices and systems written by VA employees, by vendors, contractors, systems written by VA employees, by vendors, contractors, or development partners. The evaluation process applies to or development partners. The evaluation process applies to 1) Devices displaying VistA data in a different format, 1) Devices displaying VistA data in a different format, and/or 2) Any device, external system, or vendor or locally and/or 2) Any device, external system, or vendor or locally developed software writing to VistA other than Diagnostic, developed software writing to VistA other than Diagnostic, Imaging, or Clinical Procedures equipment using nationally Imaging, or Clinical Procedures equipment using nationally supported HL7 or DICOM protocols.supported HL7 or DICOM protocols.

IDMC Screening Committee evaluates both requests. IDMC Screening Committee evaluates both requests.

IDMC SC CharterIDMC SC Charter

SC established to work SC established to work cooperatively with OIcooperatively with OI

Perform analyses on all IT Perform analyses on all IT requests to ensure alignment with requests to ensure alignment with VHA prioritiesVHA priorities

Provide guidance on prioritization Provide guidance on prioritization of IT initiativesof IT initiatives

IDMC Screening IDMC Screening CommitteeCommittee

Informatics & Data Management Informatics & Data Management Committee (IDMC) is the advisory group Committee (IDMC) is the advisory group to the USH through the NLB on IT to the USH through the NLB on IT resources, policies, and issues. resources, policies, and issues.

The following committees report to IDMCThe following committees report to IDMCIDMC Screening Committee (IDMC SC or SC)IDMC Screening Committee (IDMC SC or SC)OI Health Information Systems Executive OI Health Information Systems Executive

Boards Boards VHA Data Consortium VHA Data Consortium

I & T (CIO)

Cyber & Info Sec

Info TechOperations

Policy, Portfolio

Oversight & Exec

Auto-mation Center

IT EnterpriseArchitecture

Dep CIO VHA

VA

VHA

Dir ServNet (E, C, W)

21 VISNOI

CHIO

HISEB

NLB

ESMs

IDMCEIB

DUSH O&M

Strat Plan C

Health System C

Finance C

Comm C

HRC

Screening Subcommittee

DUS Ops & Mgmt

Major Organizations

IT

Business

Permanent Organizations

Boards, Committees, Working Groups

Coordination

Direction

VHA Key Organizations & Relationships - VHA Key Organizations & Relationships - CurrentCurrent

Facilities

P/D

HPMO

HSD&DHealth Data &

Informatics

VHA Chief Architect Data

Consortium

Data Standard-

ization Oversight

Board

VHIM Stake-holder

Council

Patient Care Services Data

Workgroup

Collaborative Health

Information Partners (CHIP)

Domain Prioritization Workgroup

Domain Action Teams

Data Management Board

Data Archi-tecture

Working Group

VISN CIO Council

Architecture Planning

Workgroup

VSSC Oversight

Board

IDMC SC MembershipIDMC SC Membership

Renee Oshinski (Renee Oshinski (ChairChair)) Deputy Network Director, VISN Deputy Network Director, VISN 1212

William H. Beer, MDWilliam H. Beer, MD CIO, San Antonio VAMCCIO, San Antonio VAMCCynthia BreyfogleCynthia Breyfogle Chief Business Officer, VISN 23 Chief Business Officer, VISN 23 Kathryn Corrigan, MDKathryn Corrigan, MD Interim ACOS Amb Care Tampa Interim ACOS Amb Care Tampa

VAMCVAMCDavid Douglas, MDDavid Douglas, MD Assoc Dir Information Portland Assoc Dir Information Portland

VAMC VAMC Brian HeckertBrian Heckert Director, VAMC ColumbiaDirector, VAMC ColumbiaPeter HenryPeter Henry Director, Black Hills VAMC Director, Black Hills VAMC James LaubJames Laub Chief Information Officer (CIO), Chief Information Officer (CIO),

VISN 18VISN 18Michael Simberkoff, MDMichael Simberkoff, MD COS, NY Harbor Health VAMC COS, NY Harbor Health VAMC

Initial Assessment & Briefings (IABs) prepared byOffice of Information’s

Health Systems Design & Development - Planning & AnalysisWith input from Office of Information’s

Enterprise Systems Management HISEBs (Executive Boards)

NLB’s Informatics & Data Management Committee

HISEBHealth Data Systems

HISEBHealth Provider Systems

HISEBManagement &

Financial Systems

HISEBInfrastructure

HISEBCommon Services

IDMC Screening Committee

HISEBVeterans Programs

Executive Board input Executive Board input to IDMC SCto IDMC SC

Health Provider Systems (HPS)Health Provider Systems (HPS) Supports health care providers in the care of veterans. Key HPS systems Supports health care providers in the care of veterans. Key HPS systems

include BCMA, CPRS, Lab, Nursing, Pharmacy, and VistA Imaging.include BCMA, CPRS, Lab, Nursing, Pharmacy, and VistA Imaging. Primary Stakeholders: Clinical ProvidersPrimary Stakeholders: Clinical Providers

Health Data Systems (HDS)Health Data Systems (HDS) The storage and use of dataThe storage and use of data and related efforts for interoperability and and related efforts for interoperability and

standardization of information. Key HDS systems include data standardization of information. Key HDS systems include data standardization, information sharing, clinical data repositories, warehouses, standardization, information sharing, clinical data repositories, warehouses, and data marts.and data marts.

Primary Stakeholders: Groups who use clinical data, external users. (Patient Primary Stakeholders: Groups who use clinical data, external users. (Patient care, research, epidemiology, biostatistics, patient safety, decision support, care, research, epidemiology, biostatistics, patient safety, decision support, quality/ performance improvement, clinical and administrative management)quality/ performance improvement, clinical and administrative management)

Management, Enrollment & Financial Systems (MEFS)Management, Enrollment & Financial Systems (MEFS) Management, financial, and business aspects of VHA.   Includes financial Management, financial, and business aspects of VHA.   Includes financial

systems, logistics systems, pay, enrollment and eligibility, scheduling and systems, logistics systems, pay, enrollment and eligibility, scheduling and billing.billing.

Primary Stakeholders: Chief Business Officer, Chief Logistics Officer, Chief Primary Stakeholders: Chief Business Officer, Chief Logistics Officer, Chief Financial OfficerFinancial Officer

Executive Board input Executive Board input to IDMC SCto IDMC SC

Veteran Programs (Under discussion, may leave with HPS)Veteran Programs (Under discussion, may leave with HPS) Systems used directly by veterans, their families, veteran Systems used directly by veterans, their families, veteran

advocates, and designated VA and non-VA health providers. advocates, and designated VA and non-VA health providers. Included are MyHealtheVet (MHV) and Home Telehealth.Included are MyHealtheVet (MHV) and Home Telehealth.

Primary Stakeholders: Veteran RepresentativesPrimary Stakeholders: Veteran Representatives

Systems for External Information Exchange (Under Systems for External Information Exchange (Under discussion)discussion)

An outward looking portfolio for information exchange with users An outward looking portfolio for information exchange with users outside VA/VHA, to include CDC, IHS, DOD, RHIO’s.outside VA/VHA, to include CDC, IHS, DOD, RHIO’s.

Primary Stakeholders: External UsersPrimary Stakeholders: External Users

Infrastructure, Common Services, Foundations (may be Infrastructure, Common Services, Foundations (may be renamed)renamed)

Common requirements of the primary programs, such as Common requirements of the primary programs, such as hardware, platforms, and software infrastructure.hardware, platforms, and software infrastructure.

Primary Stakeholders: Internal to OIPrimary Stakeholders: Internal to OI

New Service Requests New Service Requests (NSR)(NSR)

NSR process initiated via NSR process initiated via Planning and Analysis Service (PAPlanning and Analysis Service (PAS) WebpageS) Webpage

NSRs must be authorized by an NSRs must be authorized by an approving authorityapproving authority

Submit RequestSubmit Request View RequestView Request Guidance PolicyGuidance Policy

Authorized Approving Authorized Approving AuthoritiesAuthorities

Approved List of Endorsers Approved List of Endorsers Secretary of Veterans AffairsSecretary of Veterans Affairs Deputy Secretary for Veterans AffairsDeputy Secretary for Veterans Affairs Under Secretary for Veterans BenefitsUnder Secretary for Veterans Benefits

– Veterans Benefits Administration CIOVeterans Benefits Administration CIO– Director, C&P ServiceDirector, C&P Service– Associate Deputy Under Secretary for Associate Deputy Under Secretary for

Programs & Policy (VBA)Programs & Policy (VBA) Under Secretary for National CemeteryUnder Secretary for National Cemetery

– National Cemetery Administration CIONational Cemetery Administration CIO Director, Office of Financial ManagementDirector, Office of Financial Management Deputy Assistant Secretary, Acquisition and Materiel Deputy Assistant Secretary, Acquisition and Materiel

ManagementManagement Assistant Secretary, Human Resources and AdministrationAssistant Secretary, Human Resources and Administration Assistant Secretary, Information and TechnologyAssistant Secretary, Information and Technology Assistant Secretary, Public and Intergovernmental AffairsAssistant Secretary, Public and Intergovernmental Affairs Assistant Secretary, Congressional and Legislative AffairsAssistant Secretary, Congressional and Legislative Affairs Assistant Secretary, Policy and PlanningAssistant Secretary, Policy and Planning Assistant Secretary, ManagementAssistant Secretary, Management a. VHA Board of Directorsa. VHA Board of Directors Under Secretary for HealthUnder Secretary for Health Principal Deputy Under Secretary for HealthPrincipal Deputy Under Secretary for Health Chief of Staff (USH)Chief of Staff (USH) Chief Compliance & Business Integrity OfficerChief Compliance & Business Integrity Officer Chief Management Support Officer Chief Management Support Officer Deputy USH for Operations & ManagementDeputy USH for Operations & Management Deputy USH for Health Policy CoordinationDeputy USH for Health Policy Coordination Medical InspectorMedical Inspector Chief Quality and Performance OfficerChief Quality and Performance Officer Director, Office of Research OversightDirector, Office of Research Oversight Chief Patient Safety OfficerChief Patient Safety Officer

Assistant Deputy USH for Policy & PlanningAssistant Deputy USH for Policy & Planning Director, Strategic Initiatives OfficeDirector, Strategic Initiatives Office Chief Communications OfficerChief Communications Officer Director, National Center for Ethics in Health CareDirector, National Center for Ethics in Health Care Chief Prosthetics and Clinical Logistics OfficerChief Prosthetics and Clinical Logistics Officer Chief Patient Care Services OfficerChief Patient Care Services Officer Chief Research and Development OfficerChief Research and Development Officer Chief Public Health and Environmental Hazards OfficerChief Public Health and Environmental Hazards Officer Chief Academic Affiliations OfficerChief Academic Affiliations Officer Chief Readjustment Counseling OfficerChief Readjustment Counseling Officer Chief Business OfficerChief Business Officer Chief Financial OfficerChief Financial Officer Chief Facilities Management OfficerChief Facilities Management Officer Chief Information Officer Chief Information Officer Chief Health Informatics OfficerChief Health Informatics Officer Chief Employee Education System OfficerChief Employee Education System Officer Director, Veterans Canteen ServiceDirector, Veterans Canteen Service Chief Nursing OfficerChief Nursing Officer b. All VISN Directorsb. All VISN Directors c. All VISN Chief Information Officersc. All VISN Chief Information Officers d. Office of the Chief Information Officerd. Office of the Chief Information Officer

– Director, Health Enterprise StrategyDirector, Health Enterprise Strategy– Director, Enterprise Systems ManagementDirector, Enterprise Systems Management– Enterprise System ManagersEnterprise System Managers– Director, Health System Implementation, Director, Health System Implementation,

Training and Enterprise SupportTraining and Enterprise Support– Director, Health Systems Design & Director, Health Systems Design &

DevelopmentDevelopment– Director, Health Data and InformaticsDirector, Health Data and Informatics

NCT RequestsNCT Requests

NCT requests NCT requests requirerequire two key endorsers: two key endorsers: VISN Chief Information Officer (CIO) and VISN Chief Information Officer (CIO) and Medical Facility Chief of Staff (COS)/Director. Medical Facility Chief of Staff (COS)/Director.

NCT requests require that the product must NCT requests require that the product must be entered in the be entered in the Commercial Products RegistryCommercial Products Registry

NCT requests require a NCT requests require a Vendor Product Evaluation PacketVendor Product Evaluation Packet

What are the steps in the What are the steps in the Process?Process?

Once the request is submitted, Planning and Analysis Once the request is submitted, Planning and Analysis (P&A) team members will begin the analysis process.  (P&A) team members will begin the analysis process. 

The initial steps include: assigning of a functional and The initial steps include: assigning of a functional and business analyst, contacting the appropriate business analyst, contacting the appropriate development team(s), verifying endorsement and development team(s), verifying endorsement and contacting the requestor.  contacting the requestor. 

P&A determine whether the request will need to be P&A determine whether the request will need to be submitted to the Screening Committee for approval. If submitted to the Screening Committee for approval. If so, the functional analyst and business analyst will so, the functional analyst and business analyst will contact the requestor and subject matter experts to contact the requestor and subject matter experts to gather information to support the request. The gather information to support the request. The development teams are also asked for impact development teams are also asked for impact information. information.

Once the necessary information is gathered, the Once the necessary information is gathered, the completed packet is submitted up for approval.  completed packet is submitted up for approval.  

How do New Service or How do New Service or New Technology Requests New Technology Requests

get screened?get screened? After requests have been After requests have been

submitted to the website, P&A submitted to the website, P&A staff create a document which staff create a document which serves as the basis for screening serves as the basis for screening by the committee. The document by the committee. The document comes to the IDMC SC in 2 formscomes to the IDMC SC in 2 formsIntent to ProceedIntent to ProceedInitial Assessment and BriefingInitial Assessment and Briefing

ITP: Intent to ProceedITP: Intent to Proceed

Projects with legal, political, or Projects with legal, political, or financial implications so financial implications so compelling that they come to the compelling that they come to the SC basically as a SC basically as a fait accomplifait accompli

SC asked to provide input but not SC asked to provide input but not asked to approve or prioritizeasked to approve or prioritize

IAB: Initial IAB: Initial Assessment and Assessment and

BriefingBriefing Decision Support Decision Support

Memo to SC Memo to SC OverviewOverview Description of RequestDescription of Request BackgroundBackground Description of ProjectDescription of Project Legacy Vista ChangesLegacy Vista Changes HeV Vista HeV Vista

EnhancementsEnhancements

High Level ImpactsHigh Level Impacts Resources NeededResources Needed Project ScheduleProject Schedule Considerations/ Considerations/

RecommendationsRecommendations AS-IS vs. TO-BE AS-IS vs. TO-BE

flowchartsflowcharts

SC reviews IAB and then recommends disposition SC reviews IAB and then recommends disposition to IDMCto IDMC

SC Meeting Agenda SC Meeting Agenda

VANTS call 4VANTS call 4thth Thurs 2-4PM Thurs 2-4PM EasternEasternITP reviewITP reviewIAB review/discussion/dispositionIAB review/discussion/dispositionWeekly summary of new IT service Weekly summary of new IT service

requests (is Fast Track warranted?)requests (is Fast Track warranted?)Quarterly Review of Parking Lot Quarterly Review of Parking Lot

ItemsItems

DispositionDisposition

IDMC reviews/approves SC recommendationsIDMC reviews/approves SC recommendations ““Approved” projects may be parked or put Approved” projects may be parked or put

on hold and might be subject to lengthy on hold and might be subject to lengthy delays due to competing projects/ scarce delays due to competing projects/ scarce resourcesresources

SC/IDMC SC/IDMC Approved ProjectsApproved Projects Decision memos sent to requestors via Decision memos sent to requestors via

OutlookOutlook Decisions can be appealedDecisions can be appealed

Parking Lot items AKA Parking Lot items AKA Parked Projects Parked Projects

These projects have been approved but These projects have been approved but are parked awaiting funding or are are parked awaiting funding or are dependent on another application under dependent on another application under development before work can start.development before work can start.

Parked projects are reviewed quarterly to Parked projects are reviewed quarterly to determine the need for re-prioritization, determine the need for re-prioritization, deletion, or acceleration based on deletion, or acceleration based on current VHA strategic initiatives, current VHA strategic initiatives, performance goals, and/or business performance goals, and/or business drivers drivers

Common Reasons for Common Reasons for DisapprovalDisapproval

Insufficient business caseInsufficient business case Enhancements to legacy Vista Enhancements to legacy Vista

would not be complete until after would not be complete until after anticipated release of HeVanticipated release of HeV

Project would cause unacceptable Project would cause unacceptable delays in other high priority delays in other high priority projectsprojects

Limited national applicability (one Limited national applicability (one facility or only one VISN affected)facility or only one VISN affected)

Recent Enhancements to Recent Enhancements to NSR/NCT ProcessNSR/NCT Process

SC to ask for IDMC review/approval of SC to ask for IDMC review/approval of items in the Parking Lotitems in the Parking Lot

SC to develop a Fast Track ProcessSC to develop a Fast Track Process SC to revisit/propose process for SC to revisit/propose process for

evaluation of New Commercial evaluation of New Commercial TechnologiesTechnologies

Promote/Improve input from HISEBsPromote/Improve input from HISEBs Publicize the NSR and Fast Track Publicize the NSR and Fast Track

ProcessesProcesses

Fast TrackFast Track

Process clarified and enhanced after Process clarified and enhanced after August NLB meetingAugust NLB meeting SC and IDMC review items in the Parking SC and IDMC review items in the Parking

Lot quarterlyLot quarterly Business Owners/Requestor and OI ESMs Business Owners/Requestor and OI ESMs

invited to directly participate in SC invited to directly participate in SC meetingsmeetings

SC will review weekly summaries of NSRs SC will review weekly summaries of NSRs to identify projects which should be Fast to identify projects which should be Fast TrackedTracked

Fast Track, cont’dFast Track, cont’d

HISEB input sought earlier in the HISEB input sought earlier in the process so as to be included in the process so as to be included in the IABs referred to the SCIABs referred to the SC

HISEB review and response time HISEB review and response time shortened from 2 weeks to 1shortened from 2 weeks to 1

Fast Track projects will have an Fast Track projects will have an expedited reviewexpedited review

5 - 7 DAYS

Notification sent to Requestor Indicating IDMC Decision

Preparation of Intent to Proceed

(ITP)“Must Do Work”

HISEB Review Period

1-2 Weeks

Preparation of Initial Assessment and Briefing

(IAB)OI Leadership Review

Period

Development Teams and SME’s/User

Groups

HSD&D Conducts Initial Planning & Analysis

Functions

VHA Fast Track IT Service RequestPatient Safety Initiative or a

Legislative/Strategic Initiative endorsed by USH/PDUSH

New IT Service RequestMust be endorsed by NLB Member (VISN

Director or Program Officer)http://vista.med.va.gov/pas/NewITRequestForm.asp

Endorsed by Facility/VISN Leadership

Screening Committee Review ALL Feedback is forwarded for

review process.

Multidisciplinary SC

Membership

IDMC Review of Screening

Committee’s Recommendations

Multidisciplinary IDMC

Membership

APPROVEDEntered OI Technical Service

Project Repository

DISAPPROVEDRequestor may re-submit request or ask for appeal through IDMC Manager

3 - 4 MONTHS

Notification Sent to

Appropriate HISEB

Scenario 1: NSR for a Scenario 1: NSR for a change to a VistA change to a VistA

package to roll data up package to roll data up nationallynationally Researcher submits NSR after obtaining endorsementResearcher submits NSR after obtaining endorsement

NSR indicates national rollup of data is neededNSR indicates national rollup of data is needed Planning and Analysis staff assist in solidifying requirements which Planning and Analysis staff assist in solidifying requirements which

includes setting up Kick-Off Callincludes setting up Kick-Off Call Packet workup then begins to assemble the documentation to Packet workup then begins to assemble the documentation to

support further discussion and decision makingsupport further discussion and decision making IAB (or ITP) sent to HISEBs for commentIAB (or ITP) sent to HISEBs for comment IAB AND HISEB feedback sent to IDMC SC members prior to IAB AND HISEB feedback sent to IDMC SC members prior to

monthly call where requestor will participatemonthly call where requestor will participate IDMC SC makes recommendation to IDMCIDMC SC makes recommendation to IDMC IDMC approves, disapproves, requests further analysisIDMC approves, disapproves, requests further analysis Requestor notifiedRequestor notified

Scenario 2: NCT for a Scenario 2: NCT for a clinical decision support clinical decision support systemsystem

Researcher enters product into registry, completes Researcher enters product into registry, completes paperwork, obtains endorsement and submits NCTpaperwork, obtains endorsement and submits NCT

Planning and Analysis staff request security and Planning and Analysis staff request security and architecture reviewarchitecture review

Packet workup then begins to assemble the documentation Packet workup then begins to assemble the documentation to serve as the basis for discussion and decision makingto serve as the basis for discussion and decision making

IAB sent to HISEBs for commentIAB sent to HISEBs for comment IAB and HISEB feedback sent to IDMC SC members prior to IAB and HISEB feedback sent to IDMC SC members prior to

monthly call where requestor will participate in the monthly call where requestor will participate in the discussiondiscussion

IDMC SC makes recommendation to IDMCIDMC SC makes recommendation to IDMC IDMC approves, disapproves, requests further analysisIDMC approves, disapproves, requests further analysis Requestor notifiedRequestor notified

New Commercial New Commercial Technology Process will be Technology Process will be

re-engineered re-engineered 5 aspects of NCT process reviewed at 5 aspects of NCT process reviewed at

special February meeting of SCspecial February meeting of SC

1) 1) GovernanceGovernance

2) 2) Funding to Maintain InnovationFunding to Maintain Innovation

3) 3) NCT Review Process TimelinesNCT Review Process Timelines

4) 4) Procurement for Testing Procurement for Testing ProductsProducts

5) 5) Market AnalysisMarket Analysis

Summary and ForecastSummary and Forecast

NSR Process ClarifiedNSR Process Clarified Insufficient resources and competing Insufficient resources and competing

projects mean that many worthwhile projects mean that many worthwhile projects will be delayedprojects will be delayed

Centralization, IT Reorg and Budget cuts Centralization, IT Reorg and Budget cuts cast further uncertainty on the processcast further uncertainty on the process

HISEB and field input essential but not HISEB and field input essential but not well operationalizedwell operationalized

NCT process will be re-engineered later NCT process will be re-engineered later this yearthis year

Questions?Questions?