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10/28/2015
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Department of Defense Technology Update
CDR David Hardy MSC USNCDR Angie Klinski MSC USNMaj Justin Lusk USAF BSCCOL Keith Wagner MS USA
CPE Information and Disclosures
The American Pharmacist Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
• David W. Hardy, Angelica A. Klinski, Justin D. Lusk, and Keith A. Wagner declare no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.
• Source of information and slides have been provided or previously presented by respective agencies and program offices: DHMS, DHA HIT, DHA POD, DMLSS
CPE Information
• Target Audience: Pharmacists & Technicians
• ACPE#: 0202-0000-15-205-L04-P/T
• Activity Type: Knowledge-based
Learning Objectives
At the completion of this activity, participants will be able to:
1. Discuss innovative ways that federal pharmacies have implemented current technologies available to them.2. Describe the impact of pharmacy technology and automation on the quality of patient care.
3. Identify key aspects of the future DOD Healthcare Management System Modernization (electronic health record).
Self-Assessment Question 1
PITAC membership consists of:
A. Army pharmacy representation
B. Navy pharmacy representation
C. Air Force pharmacy representation
D. All of the above
Self-Assessment Question 2
What is DHMSM?
A. Inventory management system
B. Hazardous waste manual
C. New DoD electronic health record
D. A chinese appetizer
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Self-Assessment Question 3
Which of the following vendors received the DHMSM contract?
a. Leidos
b. Epic
c. AHLTA
d. VistA
Outline
PITAC Committee
Pharmacy Technology Footprint
Service Projects and Initiatives
Enterprise Program Updates and Initiatives
DHMSM and TSWAG
Joint Legacy Viewer-Health Information Portal
Pharmacy Information Technology Advisory Committee
• Committee responsible for reporting to and advising the Pharmacy Workgroup (PWG) and MHS leaders on issues related to DoD pharmacy information technology
• Chaired by Branch Chief, Pharmacy Informatics Integration Branch, DHA Pharmacy Operations Division
• Members consist of tri-service representatives appointed by service consultants
PITAC Members
Position Member LocationChair Henry Gibbs DHA POD, DHHQ
Deputy Matt York DHA POD, DHHQ
Air Force Rep(s) Justin Lusk, Maj (Primary)Jeffrey Barnes, Capt (Alternate)Traci England, TSgt (Alternate)
JBSA‐RandolphAFIT – UNCMalmstrom AFB
Army Rep(s) Doreene Aguayo, LTCKeith Wagner, COL
SAMMCEisenhower AMC
Navy Rep(s) David Hardy, CDRAngie Klinski, CDR
BUMED Det BremertonBUMED Det San Antonio
Section Chief PASS Hector Morales DHA POD, San Antonio
Current Technology Footprint—Outpatient Systems
Automation/Workflow Air Force Army Navy
Innovations(Symphony, RDS) √ √Automed Technologies (Optifill, Fastfill) √ √ √Parata Systems (P2000, Max, Mini) √ √Scriptpro(SP Central, Datapoints) √ √ √
Dispensing Solutions Air Force Army Navy
Pickpoint RDS √ √ √Asteres Scriptcenter √ √
Current Technology Footprint—Outpatient Systems
Will Call Solutions Air Force Army Navy
GSL Intellicabs √ √ √Pickpoint Will Call System √ ?Innovation’s Will Call System √
Patient Interaction (Queuing) Air Force Army Navy
QMATIC √ √ √ACF Qflow √ √ √
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Current Technology Footprint—Inpatient Systems
Automated Dispensing Cabinets
Air Force Army Navy
Pyxis(Medstations, C2Safe) √ √ √Omnicell(G4 cabinets, CSM) √ √
Other technologies• Counting devices• Unit-dose packaging systems• Barcode label printers• Thermal and monograph printers
Service Projects & Initiatives
Automation/Workflow
Telepharmacy
Will Call Systems
Queuing Systems
Automated Dispensing Cabinet Modernization
Navy Telepharmacy
• Outpatient module installed in over 120 pharmacies utilizing hub-spoke model– TRDVS
• Inpatient module in pilot phase and will support sites without 24/7 inpatient pharmacists– HMS
Army Telepharmacy
• Multiple vendor verification system
• Regional remote verification for RHC-Europe
• Regional remote verification between RHC-Atlantic and Puerto Rico
Will Call Systems (WCS)
• Army: standardized WCS for the Army– Currently reviewing utilization data for
repurposing current assets
• Navy: one pilot site to be implemented in the next 6 months—this will be evaluated and considered for Navy-wide solution.
• Air Force: evaluating multiple vendors/ multiple pilot sites for the various systems
Queuing Systems
• Air Force Modernization to Windows 7 platform and regionalization
• Army Hospital Workflow– Ft Carson and Ft Riley
• Navy – Standardization and modularization efforts
– OHI collection at kiosk
– Front Window Dashboard/Analytics Initiative
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Enterprise Program Updates & Initiatives
E-prescribing Update
Electronic Clinical Reference
RxRefill Program
Tricare Online
Pharmacy Mobile Application Initiative
Inventory Pilot
DMLSS/Automation Interface
Electronic Prescribing Update
• 1.25 Million prescriptions processed
• Averaging around 40K per week
• Monitoring
• Top Pharmacies
• Open discussion: lessons learned
• http://health.mil/POD
Electronic Clinical Reference
• Lexicomp in 6 month bridge (Dec 2016) with another 6 month option (Jun 2016)
• New Enhancements– UpToDate Linking*
– Briggs’ Pregnancy and Lactation Content
– Linking to SDS
– Pediatric Preparation for Administration
– Improved Drug ID Search
– Updated Detailed User Guide
RxRefill and Tricare Online
• New RxRefill contract– Vendor : AudioCARE Systems, Inc.
• Award Date: 10 September 2015– 5 year contract (1- base year & 4 – option periods)
• Modules – AudioREFILL
TM(w/TMOP)
– AudioOFFLINETM
– AudioRxMINDERTM
– AudioREMINDERTM
– AudioCANCELTM
– AudioCOMMUNICATORTM
& AudioCOMMUNICATOR–DM
• Contract does not include refill requests via internet– Enterprise solution is Tricare Online (TOL)
Tricare Online (TOL) Refills
• TOL Redesign: target go-live mid Jan 2016
Pharmacy Mobile Applications
• DHA HIT recently charted a tri-service Mobile Technology Workgroup– Goal: Identify, recommend and implement the standards,
policies, and procedures necessary to incorporate mobile technology into the MHS
• Pharmacy Mobile Application Efforts– Past Navy effort to use Refill system/CHCS not scalable
– Leverage TOL interface to process Refills and access medication profiles
– Research funding approved for Army-led mobile application development
– Coordinate with DHA HIT Innovation and Technology Development Division (IATD)
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Pharmacy Inventory Pilot
• 18-month pilot of pharmacy inventory system at Tuttle AHC
• DMLSS/Automation Interface Initiative– 5 vendors to be tested
– 26 Oct go-live at Tuttle
– Followed by Madigan AMC
• Navy has enterprise initiative to develop supply/budget analytics
MHS Requirements Process
SubmitRequest
Integrated Product Teams• DOTMLPF‐P Analysis• Problem Statement
• Develop Requirements• Cost & Schedule Estimate
Communities of Interest (SMEs)
MTFs
HIT Funding
MHS Funding
Prioritization
Authorization
Resourcing
Capability Gaps
Capability Areas
Process FlowInformation Flow
Legend
Resource IPT
Validate & Prioritize Reqts
DHA
Request Management Requirements Development Resource Management Execution Management
Portfolio ofCapabilities
SMMAC/SIC
MDAG
MOG MBOG
JPB
COCOMS brought in, as needed*
$
Management Boards / FAC
Certify Funds
Supporting
Supported
Lifecycle Feedback Loop (To Governance, Services & Functional Champions)
CapabilityManagers*
(Army, Navy, AF)
Functional Champion
MHS Request Portal
Information Management• Analyze & Triage Request• Coordinate Thru Governance
FundReqts
We are
here
You
DHA Governance Board Structure
Assistant Secretary of Defense (Health Affairs) ASD(HA)
Senior Military Medical Action Council (SMMAC)
Policy Advisory Council (PAC)
Medical Deputies Action Group (MDAG)
eMSM Leadership Group
Medical Operations Group (MOG)
Medical Business Operations Group
(MBOG)
Manpower and Personnel
Operations Group (MPOG)
Policy Creation
Policy Execution
Military Health System Executive Review (MHSER)
Clinical Portfolio Management Board (CPMB)
Force Health Protection Portfolio
Management Board (FHPPMB)
Business Portfolio Management Board (BPMB)
Health IT Coordinating
Committee (HITCC)
SecDef/DepSecDef
Senior Investment Council (SIC)
Joint Portfolio Board (JPB)
Functional Advisory Council
(FAC)
Direct Report
Charter Approval Pending
Information Flow
Tentative Boards Currently in Review
Management Board ‐ Recommends
Operational Group ‐ Endorses
Decisional Authority ‐ Approves
Additional Governance Boards we may brief‐ CEISC ‐ CAE‐ Program Office PEO
Air Force
• IA is not just annual training
• DIACAP, RMF
• ATO, ATC, ATD
• Timelines
• Reciprocity
• MEDCOI
• Lions and TIGERS and Bears…
• FSS, ECAT, SS
Army
• Transfer of MEDCOM IT Program Manager
• Regional consolidate support agreements
Navy IT Portfolio
• NAVMISSA disestablished 30 Sep 15 and transferred most programs to DHA Health Information Technology Directorate
• Navy Pharmacy Portfolio transferred to DHA Pharmacy Ops Division/Informatics Integration Branch
• ADC refresh
• Continue standardization efforts
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DHMSM
Source of information: DHMSM Program Office
DHA Vision
“A joint, integrated, premier system of health, supporting those who serve in the defense of
our country.”
DHMSM Mission
• To efficiently improve healthcare for the active duty military, veterans, and beneficiaries by:
• Establishing seamless medical data sharing between DoD, the VA, and the private sector
• Modernizing the Electronic Health Record (EHR) for the MHS
DHMSM Pharmacy POCs
Team Member
DHMSM SFC Joel Colon
DHA Henry Gibbs
TSWAG Maj Justin Lusk
DDWG Maj Justin Lusk
AF Lt Col Robert RaineyMaj David Jarnot
Army MAJ Todd Schwarz
Navy CDR David HardyCDR Angie Klinski
Collaborative Delivery of a Modernized EHR
36
To deliver a modernized EHR to the military garrison and operational points of care, and transform how the military health system provides healthcare, the Services, DHA and Acquisition Teams will collaboratively work with the care locations to configure, test, train and deploy the new solution
Conclusion
AcquisitionDHMS
Solution Delivery & InfrastructureDHA
Site PreparationServices
Modernized EHRBusiness Processes
& RequirementsFunctional Champion
Deploy to 1,200+ Care Locations
& 205,000+ providersacross the world
Where We Came From…
February 2013:
DoD and VA announce
EHR programs
January 2014:
Defense Medical Information Exchange
(DMIX) formed to oversee legacy
interoperability tools
June 2013:
Defense Healthcare Management
Systems Modernization
(DHMSM) Program Office Stood up
December 2013:
Interoperability capabilities
enhanced, including an integrated
display of data
October 2013:
First DoD EHR Modernization Industry Day
May 2013:
DoD announces it will buy an off-the-shelf EHR
USD AT&L directed to oversee acquisition
July 2014:
EHR Draft RFP#3 Released
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EHR Modernization Guiding Principles
Standardization of clinical and business processes across the Services and the MHS
Design a patient-centric system focusing on quality, safety, and patient outcomes that meet readiness objectives
Flexible and open, single enterprise solution that addresses both garrison and operational healthcare
Clinical business process reengineering, adoption, and implementation over technology
Configure not customize
Decisions shall be based on doing what is best for the MHS as a whole—not a single individual area
EHR Modernization Guiding Principles
Decision-making and design will be driven by frontline care delivery professionals
Drive toward rapid decision making to keep the program on time and on budget
Provide timely and complete communication, training, and tools to ensure a successful deployment
Build collaborative partnerships outside the MHS to advance national interoperability
Enable full patient engagement in their health
Approved by the ASD (HA) and Surgeons General
July 2014
Top 10 Reasons ERP Implementations Fail
• Governance - No single person in charge who reports directly to senior executives
• Scope - The implementation contract doesn’t align with an enterprise solution, but is aligned with programs, systems, or other non- enterprise artifacts
• Change Management - Insufficient investment in Change Management initiatives
• Skills - Implementation team doesn’t have a thorough understanding of enterprise technologies
• Decision Making - Consensus decision making as opposed to rapid decision making
Source: U.S. Army Enterprise Solutions Competency Center, Enterprise Resource Planning Reference Guide
Top 10 Reasons ERP Implementations Fail
• Communications - Lack of communication at all levels
• Solution Architecture - No solution architecture and appropriate implementation methodology
• Training - Insufficient investment in project team and user training
• and executive education.
• Culture – trying to force the enterprise software into a stovepiped culture
• Leadership – lack of project continuity because of Military Rotation and Mobility of Civilian Workforce
Source: U.S. Army Enterprise Solutions Competency Center, Enterprise Resource Planning Reference Guide
Functional Advisory Council (FAC)
SECRETARY OF DEFENSE
Organizational Structure/Governance
Senior Military Medical Advisory Committee
(SMMAC)
USD(P&R)DoD Senior
Stakeholder Group (SSG)
SECRETARY OF VETERANS AFFAIRS
DHMSM DMIX JOMIS IPOMedical DeputiesAction Group
(MDAG)
Director DHA
Functional Champion Leadership Group
(FCLG)
DoD / VA Executive Committee
USD(AT&L)
PEO DHMS
ASD (HA)Military Health System
Executive Review (MHSER)
MHS EHR Functional
Champion (FC)
DSG WG TSWAGs
BPM WG HIE WG
The MHS EHR Functional Champion (FC) serves as the Single “Voice of the Customer”
Communicates issues involving garrison and operational medicine requirements, configuration, and implementation to the DHMSM and JOMIS program offices
Leads the Functional Champions Leadership Group (FCLG) and utilizes the FCLG governance body to:
o Consolidate and align requirements related to workflow and performance
o Validate garrison and operational requirements
Single Voice of the Customer to PEO DHMS Programs
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TriService Workflow Advisory Groups (TSWAGs)
• Multidisciplinary groups representing all three Services
• Leverage current TSWF (TriService Workflow) and CAG (Content Advisory Group) expertise to accomplish optimized clinical standardization
• Includes operational medicine, as well as fixed facilities
• TSWAGs will continue to govern standardization past DHMSM full deployment
• All clinical TSWAGs include inpatient and outpatient unless otherwise stated
DHMSM Working Groups
TSWAG CSP FAC
DDWG
Business Process Management Activities
The business processing mapping work was prioritized into phases to support contract award and designed to ensure the functional community is ready for contract award.
Phase 1 Test Scenarios
Phase 2 Standardization
DoD InterfacesFoundational Scenarios
Enterprise Business Processes
(vendor‐agnostic)
Enterprise Workflows(vendor‐specific)
Continuous Process Improvement
Operational Testing: Process Design & Workflow Standardization
Testing & Evaluation
Developmental Testing Scenarios
Contract AwardIOC
Clinical ContentClinical Content
Business Process Management Personnel
Psychiatric
Psychologist
Substance Abuse
Behavioral Health
Primary
Specialty
OMFS
Dental
Prenatal/Intrapartum
Postpartum
NICU
Gyn
Maternal-child
Surgical
Non-surgical
Rehab medicine
Musculoskeletal
Outpatient
Inpatient
APV
OR/Sterile process
Anesthesia
Pre-op/PACU
Surgical/Peri-op
Age <18
Age 18+
Primary Care
Readiness
Optometry
Audiology
Preventive Health
Occ Health
Primary Care/Ready
Outpatient
Inpatient
Emergency Med
ICU/PICU
Secondary/Acute
Clinical TSWAG
Anatomic
Clinical
Blood
Lab
Inpatient
Outpatient
Clinical
Pharmacy
Diagnostic
Nuc Med
Interventional
Radiology
Quality
Patient Safety
Risk Management
Privacy
Quality/Pat Safety
Inpatient
Outpatient
Coding
ADT
Medical Records
PAD
Social Work
Care Management
Case Management
Soc Work/Case Mgt
Inpatient
Outpatient
Dietary Chaplain
Clinical Supporting
Data Quality
Medical Records
Patient Admin
MTF
Operational
Med Maintenance
Asset Tracking
Logistics
Human Resources
Training
Credentialing/Priv
Wkforce Mgt
Cost Centers
Budget
Resource Mgt Facility Mgt
Business
Clinical / business domain workgroup activity will feed into the TSWAGs
64 TSWAGs working to standardize and
optimize clinical/business
workflows
It is up to all of us to put
the past behind us and not let
future things out of our control
distract us from being successful
today.
Challenge:Staying Focused
What is DHMSM?
DHMSM will deliver an Electronic Health Record (EHR) System and
related services to a complex, geographically dispersed, global
enterprise in an extremely dynamic environment.
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What is DHMSM?
Unify and increase accessibility of integrated, evidenced-based healthcare delivery and decision-making
Collaboration with the DoD/Department of Veterans Affairs (VA) Interagency Program Office (IPO) and the Defense Medical Information Exchange (DMIX) program
Will replace DoD legacy healthcare systems
What is DHMSM?
State-of-market Off-the-Shelf (OTS) EHR System Features
Clinically Focused
Ongoing upgrades
Open architecture
Most advanced, Best of Suite system
Best of Breed as required to meet mission requirements
Standards-compatible
Evaluation Process
Service Provider/Integrator (SPI)
Best Value Allowing for Cost / Price and Technical
Trade‐Offs
“No-Go”Unacceptable
Non‐Cost / Price Evaluation Criteria • Technical Approach
• IOC Deployment • Global Deployment • Interoperability & Open Systems Architecture (OSA)• Cybersecurity
• Product • DoD Operational Healthcare Environment• Product Usability• Product Capability
• Past Performance• Small Business Participation
Non‐Cost / Price Evaluation Criteria • Technical Approach
• IOC Deployment • Global Deployment • Interoperability & Open Systems Architecture (OSA)• Cybersecurity
• Product • DoD Operational Healthcare Environment• Product Usability• Product Capability
• Past Performance• Small Business Participation
Contract Award
Acceptable (Viable Competitor)
“Go”
Gate Criteria• Deployment Experience• Cybersecurity Experience• Best of Suite (BoS) Capabilities• Office of the National Coordinator (ONC) Certification
Cost / Price Evaluation Criteria
Cost / Price Evaluation Criteria
What Did We Buy?
DHMSM will be an Off the Shelf Best of Suite augmented by Best of Breed solutions as needed to fulfill DoD requirements
SOFTWARE
• Functional replacement for DoD legacy MHS clinical systems
• Best of Suite
• Best of Breed as required
• Targeted tailoring to meet approved DoD unique requirements
• Licenses
• Maintenance agreements
DESIGN & DEVELOPMENT
• Modular approach
• Scalable solution
• Maximum reutilization of existing infrastructure
• Modular Open Architecture – No “vendor lock”
• Focus on managing modular inputs, outputs, and interfaces leveraging commercial standards
TEST & EVALUATION
• Government-Approved Lab (GAL) mockups of Fixed Facilities and Operational Medicine environments to enable verification of all requirements in the RTM by testing under operationally and technically realistic conditions
• Test Data Center to emulate the infrastructure required for the IT components of the DHA domain and its connectivity to the DHMSM EHR system
Fixed Facilities Scope
Replace Military Health System (MHS) legacy clinical systems
Deploy the EHR System to all fixed facilities worldwide, approximately
– 55 Inpatient Hospitals and Medical Centers– 352 Ambulatory Care Clinics – 282 Dental Clinics
Deployment Regions and Scope
Clinics Dental Hospitals Platforms BAS
Air Force 73 72 13 0 0
Army 163 148 22 0 0
Navy 112 60 18 278 78
NCR 4 2 2 0 0
Total 352 282 55 278 78
The deployment regions consist of approximately 153,000 FTEs in 16 countries.
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There are 8 facilities located in the following 6 installations with an estimated 7,000 total FTEs
• Bremerton, WA
– Naval Hospital Bremerton (Hospital)
• Everett, WA
– NBHC Everett (Medical/Dental Clinic)
• Spokane, WA
─ 92nd Medical Group (Medical Clinic)
• Tacoma, WA─ Madigan AMC (Hospital)─ Madigan-Puyallup Medical Home
(Medical Clinic)• Oak Harbor, WA
─ Naval Hospital Oak Harbor (Hospital)
• Silverdale, WA
─ NBHC Bangor (Medical/Dental Clinic)
Washington
92ND Medical Group & Aeromedical DEN SQ/SGD
Naval Hospital Oak Harbor
NBHC Everett
Naval Hospital Bremerton
NBHC Bangor
Madigan AMC
Puyallup Medical Home
** Ft Detrick, MD (Operational Medicine)
Initial Operating Capability (IOC) Sites IOC Tests the Standards
• Planned IT infrastructure standardization
– Support of the DHMSM deployment
– Wired Network
– Wireless Network
– Application access
– End user devices
• TSWAG processes will be implemented at the IOC sites
• All future deployments throughout the MHS will be based on the TriService configurations and processes tested and refined in IOC
This is our opportunity to change the way healthcare is delivered to all Operational, Marines, Reserves, and shore based units
Operational Medicine Scope
DHMSM will provide the Operational Medicine Gold Disk to deploy the EHR System to permanent and temporary operational environment platforms to meet required capabilities
The EHR System Gold Disk is the final tested product following OT&E Phase 2 Testing (IOC) of Operational Medicine
Operational Military Treatment Facilities (current): 225 Naval ships (Role 1 & 2)
75 submarines (Role 1)
2 Hospital ships (Role 3)
6 Theater Hospitals (Role 3)
450+ Forward & Resuscitative Sites (Role 2)
3 Aeromedical Staging Facilities (ASF) and numerous aeromedical evacuation teams to support military operations abroad (En route)
Fixed Facilities IT Infrastructure Overview
59
IT SERVICE CAPABILITY
Network Security Management Service (NSMS)
Seamless integrated Wide, Local, and Wireless Network (Medical Community of Interest (Med- COI) WAN & LAN/WLAN)Capabilities include a Single Security Architecture and centralized Designated Accrediting Authority (DAA), standardized monitoring/ management, and improved provider mobility
Directory Services (DS)/Enterprise Management (EM)
Centralized and secure access and authentication capability to network resourcesLeverages ability to centrally manage DS infrastructure throughout the enterprise
Desktop as a Service (DaaS)
Desktop design standardization service across the application, desktop and server environmentsIncludes standardized desktop configuration and application virtualization capabilities across physical and virtual desktops
Global Service Center (GSC)
Consolidated MHS enterprise IT service desk
DHMSM Execution Timeline
Load CBT & ILT Schedule in LMS
Site Visit in Pacific Northwest ‐Executive Briefing, End User Briefing,
Workshops & MOA
Identify IOC Sites Leadership Level
Champions & Super User Leads Start IOC Training: Super
Users & Train the Trainer
Complete User Roles Matrix per IOC Site
Complete Deployment Checklist
Develop ILT Schedule
Configure JKO LMS
Identify Training Facilities
Super User Provisioning
Training Facilities Set‐up
Operational Readiness Review
Sep2015
Oct2015
Nov 2015
Dec2015
Jan2016
Feb 2016
Mar2016
Apr2016
May 2016
June 2016
July2016
Aug 2016
Sep 2016
Oct2016
Nov 2016
Dec2016
= IOC Site Responsibility = DHMSM Responsibility= DHMSM & IOC Site Responsibility
Infrastructure Upgrades Complete (DHA)
Limited Fielding Decision (Go‐Live)
Configuration and Integration Test Developmental T&E Operational T&E
Initial Design Review / Final Requirements Review
Final Design Review / Test Readiness Review
System Verification Review / Operational Test Readiness Review
= Technical Review
End UsersRegistration
Start Deployment Checklist West Region (1)
IOC
OT&E
Contact Award ATP
OT&E Phase 1 *
Rest of CONUS and OCONUS
Decision for Full IOC [ASD(HA) & Service SGs]
DT&ELimited Fielding for IOC ATP [USD(AT&L)]
Deployment Continuum
NLT 31 Dec 2016
OT&E Phase 2
FD (FOC)
Acronyms:ASD – Assistant Secretary of Defense for Health Affairs ATP – Authority to ProceedDT&E – Developmental Test & EvaluationFD – Full DeploymentFDD – Full Deployment DecisionFOC – Full Operational CapabilityIOC – Initial Operational CapabilityNLT – No Later ThanOT&E – Operational Test & EvaluationSG – Surgeon GeneralUSD(AT&L) – Under Secretary of Defense for Acquisition, Technology, and Logistics
IllustrativeNot to Scale
* Note: Segment 2 IOC and FD (FOC)
DHMSM Road to Full Deployment
FDD ATP [USD(AT&L)]
IOC Declaration [ASD(HA) & Service SGs]
Distribution D: Distribution authorized to the DoD and U.S. DoD contractors only. Other requests for this document shall be referred to DHMSM PMO. FOIA Exemption 5 (Pre‐decisional/deliberative)
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Current Activities, Milestones and Deliverables
Present to
Contract AwardPhase 1
12 months prior
to Go‐LivePhase 2
12 months to 3 months prior to Go‐Live
Phase 33 months prior
to Go‐Live Phase 4
FY14 FY15 FY16 FY17
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
IOC
T&E Demonstrated Readiness for FD
D(Test Cases Su
ccessfully Completed)
Request For Proposal ATP
Contract Award ATP
IDR/FRR Preliminary TRR
FDR/TRR SVR/OTRR
Preparation of GALs Detailed Test Planning CIT DT&E OT&E
Limited Fielding IOC ATP
Preliminary OTRR
FDD ATP
Legend:Event:Milestone Decision:Readiness Level:
NLT 31 DEC 16
• Assessed through integrated T&E and Systems Engineering Technical Reviews
• Bulk of work to demonstrate readiness occurs during CIT (with Government observation)
• DT&E and OT&E serve as Government due diligence
Acronyms:
ATP – Authority to ProceedDT&E – Developmental Test & EvaluationFDD – Full Deployment Decision
FDR – Final Design ReviewFRR – Final Requirements ReviewIDR – Initial Design Review
IOC – Initial Operational CapabilityNLT – No Later ThanOT&E – Operational Test & Evaluation
OTRR – Operational Test Readiness ReviewSVR – System Verification ReviewTRR – Test Readiness Review
GALs Readiness Report
Functional End-User Engagement: Building Commitment to Change
System is implemented – the new status quo
Status Quo
COMMITMEN
T
High
Individuals have heard about the implementation
Individuals are aware of benefits, basic scope and
concepts of the system
Individuals understand how the operational transformation impacts them and their job
Individuals understand and are willing to accept the transitions required to help the
organization respond to the changing landscape
Employees make the transformation their own and
look for continuous improvement opportunities
Awareness
General Understanding
Personal Understanding
Willing to Accept
Buy‐In
Ownership
Low
TIME
Contact
Organization has communicated
the implementation
Vision
Change Management is the application of the set of tools, processes, skills and principles for managing the people risks related to change to achieve the required outcomes of a project or initiative. Individuals, rather than organizations, must go through the stages of building
commitment to change in order to move the organization to a new future state.
Source: Deloitte Consulting LLP, 2014
Distribution D: Distribution authorized to the DoD and U.S. DoD contractors only. Other requests for this document shall be referred to
DHMSM PMO. FOIA Exemption 5 (Pre‐decisional/deliberative)
Stakeholder Engagement Activities Throughout Implementation
Awareness General Understanding
Personal Understanding
Acceptance & Reinforcement
Buy-In & Ownership
DISCOVERY
• Strategic communications
• Leadership Alignment• FCLG Establishment• BPM Phase 2
Business Process Design
• BPM Phase 2 Clinical Content
• IOC Site Visits
VALIDATION
• Strategic and Tactical Communications
• Contractor Kick Off• Establish Change
Agent Network –Service FCs, TSWAG members, MTF Super Users, MTF Clinical Champions
BUILD
• MTF level Site Visits and Engagement
• Workflow Review Sessions
• Socialize Change Impact Assessment
• Demonstrations• “Need to Knows” • FAQs, Glossary• Pilot Training• Pulse Measure
TEST & TRAIN
• Frequent End-user Communications
• Engage Super Users • User Acceptance
Testing• Workflow Dress
Rehearsal• Security Testing• “Soft” Go-Live• End User Training • Continue
Demonstrations
IMPLEMENT
• Practice Activities• Key Skills
Assessments• Cyber Cafes• Personalization Labs• Operational/Clinical
Cutover• Job Aids• Go-live
Communications• “Quick Fixes”
ST
AK
EH
OLD
ER
S E
NG
AG
ED
PROJECTED TIMELINE
Measure Progress
FY15 Q2 – Q3 (Jan‐Jun 15)
FY15 Q4 ‐ FY16 Q1(Jul‐Dec 15)
FY16 Q2 – Q4(Jan‐Sep 16)
FY16 Q4(Jul‐Sep 16)
FY17 Q1(Oct‐Dec 16)
Distribution D: Distribution authorized to the DoD and U.S. DoD contractors only. Other requests for this document shall be referred to DHMSM PMO. FOIA Exemption 5 (Pre‐decisional/deliberative)
Key Take-Aways
• Critical factor in MHS’ journey to High Reliability
• This Business Transformation and EHR implementation will have the greatest impact on DoD Medicine of any undertaking in the past 10 years
– Its effects will be felt for the next 10-20 years
• Leadership support and focus is critical to success
• Implementation of the new EHR and related transformation fundamentally affects the entire healthcare mission
– There will be many clinical and business workflow changes as we move to the new EHR
– This effort must remain an important Command level concern until successful completion
• Successful implementation requires good coordination between IT and End Users and continuous bi-directional communication between the Implementation Team and Commands
Final Thought
"Coming together is a beginning.
Keeping together is progress.
Working together is success."
‐Henry Ford
Joint Legacy Viewer (JLV) –Health Information Portal (HIP)
• JLV-HIP provides an integrated, read-only view of healthcare data from DoD, VA and community health care partners in a common viewer.
• JLV-HIP may be configured by clinicians through the use of mini applications called “widgets” to match their workflow.
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JLV/HIP Screenshot
DMIX is working to make JLV an Enterprise tool with more complete data for the benefit of clinicians in every MTF. The priority areas are:
– Expand JLV User Base – Enterprise Capability– Retire Duplicative Tools – Viewers and Adaptors– Increasing Access to Private Sector Health Data
• If you have any questions please contact: – Malissa Smith – [email protected]
Joint Legacy Viewer (JLV) - Health Information Portal (HIP)Joint Legacy Viewer (JLV) –Health Information Portal (HIP)
Key Points
• Technology solutions are transitioning from individual MTF initiatives to joint standardized solutions
• DHMSM has a milSuite site dedicated to the replacement EHR
– https://www.milsuite.mil/book/groups/dod-ehr
Answer To Self-Assessment Question 1
Pharmacy Information Technology Advisory Committee (PITAC) membership consists of:
a. Army pharmacy representation
b. Navy pharmacy representation
c. Air Force pharmacy representation
d. All of the above
Answer To Self-Assessment Question 2
What is DHMSM?
a. Inventory management system
b. Hazardous waste manual
c. New DoD electronic health record
d. A chinese appetizer
Answer To Self-Assessment Question 3
Which of the following vendors received the DHMSM contract?
a. Leidos
b. Epic
c. AHLTA
d. VistA
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Closing Remarks-Air Force
Justin Lusk, Major, USAFJBSA-Lackland Pharmacist
JBSA-Randolph Pharmacy Flight CommanderAir Force Pharmacy Technology and Informatics Chief
210-652-1565 | DSN 487-1565 | Mobile [email protected]
Closing Remarks-ArmyCOL Keith Wagner
US Army Pharmacy Informatics ConsultantClinical Capability Program Manager (DHA)
LTC Doreene Aguayo Program Manager, MEDCOM Pharmacy HIT
San Antonio Military Medical Center, Department of [email protected]
Closing Remarks-NavyCDR David Hardy
BUMED Team Leader, IOC DHMSM Implementation [email protected]
757-374-1087
CDR Angie KlinskiBUMED Capability & Requirements Lead
Navy IT Pharmacy Capability [email protected]
210-536-7011
Attendance Code
[FOR APHA USE ONLY]
To obtain CPE credit for this activity, you are required to actively participate in this session. You will need this attendance code in order to access the evaluation and CPE form for this activity. Your CPE must be filed by November 18, 2015, at 1700 EST in order to receive credit.
DHMSM Back Up Slides
Distribution D: Distribution authorized to the DoD and U.S. DoD contractors only. Other requests for this document shall be referred to DHMSM PMO.
Contract Strategy
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• Gate (Go / No-Go) criteria prior to best value consideration that allows for trade-offs
– Offerors’ proposed team's solution must meet all gate criteria for consideration in trade-off analysis
• CLIN Types – Cost Type and Fixed Price
– Integration, Configuration, Testing, and Initial Operational Capability (IOC) Deployment – Cost w/ Fixed Price Elements
– Post-IOC Deployment for Fixed and Non-Fixed Facilities – Fixed Price w/ Cost Elements
• Ordering Periods – 10 year contract
– Base Period – two (2) year ordering period (through IOC)
– Deployment Option Period – option for two (2) three (3) year ordering periods to allow for deployment task orders from post-IOC though Full Deployment (FD)
– Sustainment Award Term – up to 24 months for sustainment support post-FD
Earned through exceptional deployment
• Incentives
– Cost plus Incentive Fee (CPIF) and Fixed Price Incentive (FPI) – utilized to incentivize contractors adherence to cost schedule and performance parameters throughout IOC and deployment phases
– Award Term – utilized to incentive quality of work during IOC and deployment phases; final two (2) years of contract earned through quality of performance
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• A user can access JLV via the AHLTA Folder List, if they are using AHLTA 3.3.8 Client File 6.1 or later and have been assigned JLV SnareWorks Key
• If a user does not have access or does not use AHLTA frequently and requires access to JLV, JLV can be accessed via https://jlv.health.mil/JLV and requires the user to have a CHCS User Name and Password
– If the user does not have an AHLTA account, but a CHCS account, your System Admin can “assign the AHLTA Flag” within CHCS, then add the JLV SnareWorks key
Access to JLV & VLER
User Type Pre 19 Sep 2015 Post 19 Sep 2015
JLVAHLTA Folder List
JLV in AHLTA: Joint Legacy Viewer SnareWorks Key
JLV URLhttps://jlv.health.mil/JLV
JLV in Web Browser: EDIPI registered with DMIX andCHCS User Name and Password
JLV in Web Browser: JLV SnareWorks Key Only
VLER Opt In Opt OutAHLTA Folder List
VLER OptInOptOut SnareWorks Key
