Integrity - Service - Excellence MHS Capstone (27 Oct 2011) Lt Gen Green (1-Hour) Meeting: MHS Capstone, 27 October 2011, 1045 Theme: “Partnerships Among the Services” Audience: ~ Senior Leaders in MHS, OSD, VA Purpose: Updates on AFMS hot topic health issues Design: AFMS hot-topic issues: JUMC, mission and strategy, advances, and current situations and how the AFMS mission/strategy tie into Joint healthcare Format: Unclassified Sources: NIH/CTSA brief, Emergency Medicine Conference brief, Army Strategic message 1
1. MHS Capstone (27 Oct 2011) Lt Gen Green (1-Hour)Meeting: MHS
Capstone, 27 October 2011, 1045Theme: Partnerships Among the
ServicesAudience: ~ Senior Leaders in MHS, OSD, VAPurpose: Updates
on AFMS hot topic health issuesDesign: AFMS hot-topic issues: JUMC,
mission and strategy, advances, andcurrent situations and how the
AFMS mission/strategy tie into Joint healthcareFormat:
UnclassifiedSources: NIH/CTSA brief, Emergency Medicine Conference
brief, ArmyStrategic message Integrity - Service - Excellence
1
2. Headquarters U.S. Air Force Integrity - Service -
ExcellenceCapturing Care at Specialty Hospitals Lt Gen C. Bruce
Green Surgeon General 27 Oct 2011 2
3. Were All In! AF Mission The mission of the United States Air
Force is to fly, fight and win(in air, space and cyberspace AFMS
Mission AFMS VisionSeamless Health Service World-Class Healthcare
Support to USAF and for Our BeneficiariesCombatant Commanders
Anywhere, Anytime Through Global Vigilance, Reach, and Power!
Integrity - Service - Excellence
4. Our Focus and Alignment2 Strategies OverlappingMission Areas
Transform Deployable Capability Rapid Response to Any Worldwide
Contingency Fit Force Build Patient-Centered Care Continuity &
Prevention to Optimize Health Invest in Education, Training &
Research Sustain Our Future Capabilities Strategy Common Practice
Culture Integrity - Service - Excellence
5. Continuous Learning2 Guarantees Success Continuous Increase
In Level of Care ProvidedLevel of Care Lvl-III/CSH, Definitive
Lvl-II/Forward EMEDS, EMF Care BAS Surgical Teams En Route Wounded
Time Critical Care Rotary Transport Learning From Coalition
Partners, Single Intensivist We Leveraged Trauma Registry
Augmentation Data To Build Innovative Solutions -Two TCCET Teams -
1st Deployed June 2011 Tactical Critical Care Evacuation Team - 77
Critical Patients Moved as of Oct 11 Capability Must Constantly
Evolve to Meet Mission Requirements Integrity - Service -
Excellence
6. Constant Improvement of Capability Immediate < 20 min ER
< 2 hrsT+0 hrs T+3 hrs OR & ICU < 3 hrs EMEDS Health
Response Team a Reality! Self-Aid Combat Medics Forward In Theater
Care Definitive Care Buddy Care Navy Corpsmen Resuscitative
Rehab/Recovery Home w/Family Care AF Theater Hosp SAMMC
Expeditionary g r i t y - S e r v i c e - E x c e l l to Save
Lives! I n t e Operations2 Evolving e n c e
7. Recapturing Care Together Where It Makes Sense Delivering
Patient Centered Care To Our Beneficiaries Creating Currency
Opportunities To Support Readiness Allowing Medics To Practice Full
Scope Of Care Tackling Per Capita Cost Through Targeted Investments
Travis AFB, CA Wright Patterson AFB, OH Langley AFB, VA Nellis AFB,
NV Keesler AFB, MS Systems-Based Approach Required To Optimize Our
Integrated Delivery System Eglin AFB, FLElmendorf AFB, AK Building
Joint Capability...Expanding Services2Improving Currency Integrity
- Service - Excellence 7
8. AFMS Strategies Medical Home Family Health Clinics
Implemented 61 DATE MAJCOM MTF Purpose Enrolled FH Population
622,224 Seymour 01 Oct ACC PCMH Sr Consultant visit Johnson
Pediatric Clinics Implemented 11 3-5 Oct PACAF Eielson PCMH visit
#2 Enrolled Population 26,531 4-6 Oct AMC Dover PCMH Sr Consultant
visit 10-12 Oct AETC Vance PCMH visit #1 Total Population Enrolled
648,755 Altus 12-13 Oct AETC PCMH Sr Consultant visit 57% of AFMS
Enrollment 13-15 Oct AFMC Tinker PCMH Sr Consultant visit 83% FH
Enrollment 18-20 Oct AFGSC Whiteman PCMH Sr Consultant visit 11%
Pediatric Enrollment 24-26 Oct USAFA USAFA PCMH visit #2 26-Oct ACC
-ellis PCMH Sr Consultant Visit 1- 5 -ov PACAF Anderson PCMH visit
#2 1 -5 -ov PACAF Kadena PCMH visit #2 1-5 -ov PACAF Osan PCMH
visit #2 2 -ov AFSPC Peterson PCMH Sr Consultant visit 2 -ov ACC
Dyess PCMH visit #111/10/2011 Integrity - Service - Excellence Data
effective 1 Oct 11 from DSS enrollment numbers Sep 2011 8
9. Create The Setting For Right Behaviors Percent of Patients
Satisfied* Continuity of Care Other Provider $ Family Health
Providers at PCMH Sites MTF Primary Care Visit Distribution* 100%
Family Health / PCMH Patients 100% 21471 95% 90% PCMH Team 64954 %
Satisfied 80% 42400 90% UP is 70% Good 60% 85% PCMH PCM 50% PCMH
TEAM 40% 80% 30% 123681 121580 Continuity 20% Other Provider 75%
10% (Family Health Jan-11 Mar-11 May-11 Jan-11 Mar-11 May-11 0%
Clinic) Non-PCMH Sites (41/322163) PCMH Sites (34/351952) PCM PCMH
Aggregate Non-PCMH Aggregate (Non-PCMH Dec 2010 - May 2011 Sites)
Satisfaction: Goal > 95% Continuity: Goal > 90% $ $ Monthly
Emergency Department and Urgent Care Utilization* HEDIS Measures -
Patients Enrolled to PCMH Clinics Per 100 PCMH Patients 10
40Average Monthly Visit Rate (per 100) 8 30 6 Score 20 4 DOWN 10 UP
is 2 is Good $ Good 0 0 Dec-10 Feb-11 Apr-11 Dec-10 Feb-11 Apr-11
Dec-10 Feb-11 Apr-11 Dec-10 Feb-11 Apr-11 PCMH Aggregate Non PCMH
Aggregate PCMH Aggregate Non-PCMH Aggregate ED/Urgent Care Rate:
Goal < 3/100 HEDIS Aggregate: Goal > 40 Inspiring Trust &
Confidence by Measuring and Rewarding Outcomes Integrity - Service
- Excellence 9
10. Leveraging Medical InformaticsDATA INFORMATION KNOWLEDGE
WISDOM CHANGE Better CareTMDS Clinical Through Practice Evidence
Based GuidelinesDEERS Practice CarePoint Medication Better
HealthPDTS Alerts Enhanced Patient Registries Safety$ / M2 User
Home Best Value Interfaces Sensors Healthy BehaviorDMHRSi Expedited
Better CareEHR Test Results Improved Patient Experience Decision
Support Is No Longer Just For Our Providers Integrity - Service -
Excellence
11. Transforming Data Into Knowledge Ready Better Health Better
Care Patients receiving Diabetic patient massive infusions of >
educated on 10 pints experienced remote mortality of 33% monitoring
glucometer Clinical Study Readings Practice registry MTF calls
automaticallyGuideline to identify patient to sent todeveloped
trends discuss healthcare management team Conclude infusing whole
blood Uncontrolled sugar reduced mortality levels Identified to
less than 20%Using Informatics to Accelerate Change in Practice
Patterns & Behavior Integrity - Service - Excellence 11
12. Activating Patients & Care Teams Health Team
PatientDecision Patient DecisionSupport Support CenteredPCMH Is The
LynchpineTorBetter Decision Support ForlPatients & Health Teams
Int g ity - Service - Excel ence
13. Electronic Health Initiatives Project (eHIP)Integrity -
Service - Excellence 13
14. Consumer Driven Health Begins With Information &
Transparency Cost Access to Info Safety Alternatives For A Quality
Sustainable Future?On-line Resources Hospital Find It Fast! Compare
Risk Pay For Health HHS.gov Diseases & Conditions &
Readiness AZ - Health Savings AccountBenefits - Selective Co-pays
Concierge Care Self-Care Apps (PMPM) - Wounded Warriors - Chronic
Conditions Motivating patients to be proactive2 We Must Drive
Informed Decisions Integrity - Service - Excellence 14
15. Investing In Education, Training, & Research Opened
June 1stJoint Capability is Greater Than Any Single Service
Capability Integrity - Service - Excellence 15
16. Enduring Academic Partnerships Physician/Dentist Education
(GME/DME) Stand alone programs Masters with civilian universities
Integrated/affiliated with Federal partners 84 Advanced Education
General Dentistry-1 slots/yr Dental Specialty certificate/Masters
program opportunities Nurse Education (Transition Program)
Increasing to 241 enrolled students in FY10 New sites include:
Cincinnati, OH & Scottsdale Healthcare, AZ Nurse Enlisted
Commissioning Program (NECP) 50 per year with school of their
choice Research USAF Dental Hygiene Program Diabetes 10
scholarships per year Telepathology Trident Technical College (SC)
Teleradiology St. Petersburg College (FL)Education & Research
Absolutely Critical to Building & Sustaining Medical Services
Integrity - Service - Excellence
17. AHLTA on the2 Information Highway Peak of Inflated
Opportunity! Expectations Plateau of Swamp of Productivity
Diminishing Vehicle of Returns Opportunity! Innovation Trigger
Slope of Enlightenment Cliff of Obsolescence Trough of
Disillusionment Time* Gartner Inc., chart from Mastering the HYPE
CYCLE by Jackie Fenn and Mark Raskino Integrity - Service -
Excellence
18. Sec Def/Sec VA DecisionCombined Efforts Provide the Best
Future EHR Integrity - Service - Excellence
19. DoD-VA To-Be iEHR Architecture Common DoD-VA Requirements:
HL7 EHR-S Functional Model with DoD and VA vetted Extensions (SV-4)
Common DoD-VA Integrated Health Business Reference Model (OV-5)
Common DoD-VA To Be Process Flow Model (OV-6C) Presentation
Presentation (Common GUI) Layer Team Applications and Services DoD
Unique (16) Common (Joint) Applications & Services (30) VA
Unique (6) Systems Battlefield Pediatrics Pharmacy Personal
Laboratory Blood Mgmt Nursing Long TermMission Capabilities Care
Health Record Home CareRequirements Disability Inpatient Emergency
Document Team Military Obstetrics Evaluation Orders Mgmt Dept Care
Mgmt Rehabilitative Transient& Performance Readiness Care
Outreach Consult & OperatingOutcomes Enroute Veterinary Dental
Care Referral Mgmt Immunization Room Mgmt Pharmacy Occupational
Care Mail Order Health (VA)Team Common Interface StandardsBusiness
Enterprise Common Services BrokerProcess Architecture (includes
Enterprise Service Bus (ESB) and Infrastructure Services)Team Team
Common Interface Standards Common Data Centers Data Inter- Common
Information Interoperability Framework (CIIF) operability Common
Information Model, Common Terminology Model, Team Information
Exchange Specifications, Translation Service Common Data Standards:
SNOMED CT and Extensions, LOINC and RxNorm Common DoD-VA Measures
of Effectiveness, Measures of Performance and key Performance
Parameters Joint DoD/VA DoD Only VA Only Integrity - Service -
Excellence 19
20. Leading the Way with Open Source HOSPITAL PHARMACY VISIT
Electronic Electronic PROVIDERRADIOLOGY Health Record Health Record
OFFICE VISIT PUBLIC LAB SYSTEM HEALTH SERVICE Open-Source Provides
Integration Without Barriers Integrity - Service - Excellence
20
21. Federal Agencies Leading the Way with Open Source
Auto-Generated Documentation Doxygen Code Repository Git
Cross-Platform Build Tools CMake Bug/Feature Tracker Mantis
Documents/Resources Wiki Mailing Lists Code Reviewer Gerrit
Software Quality Dashboard CDash Technical Journal Insight Journal
Source: Rick AviloIntegrity - Service - Excellence 21
22. PPC Roadmap Complete Strategy IMS Document Base-lined
Complete Idea Factory Headquarters U.S. Air Force Change Readiness
Concept INTEGRATED Training Planning Office Stakeholder Charter
Complete Analysis Strategic Leadership ROADMAP Comms Engagement
Integrated Plan Resource Integrity - Service - Excellence Roadmap
Complete EHR Tri-Fold Library Complete Risk/Issues Press Clips
& Base-lined Newsletters Website Program Mgmt Content
Mission/Vision Plan Statements Tech. Gov. Lifecycle Policies &
Acronym Biographies Procedures List Complete CMM Interactive EHRWA
Deliverables Presentations Style Guide Document Templates
Acquisition Strategy Acquisition IA Strategy Systems Engineering
Plan Industry Days Held Final PESHE TEMP IA Strategy Capability
Develop. Document The image part with relationship ID rId2 was not
found in the file. Information AoA Phase II Support Plan CARD Data
Mgmt Strategy RFI-I / RFI-II Released Engineering Action Plan From,
EHR Way Ahead, Aug 2011 Paula Friedman, Director, EHRWA, DoD MHS
ADM Complete LEGEND: SCHEDULED IN PROGRESS COMPLETE
23. Integrating New Technology Current CCATT mission Future
CCATT mission - Wireless From Force Health Protection To Logistics
To Portable Surgical Tools AutomatedDirected Information
Hand-held,Energy & Data Battery-powered,Sensors Collection
Laser Cautery & Video (AIDC) Ablation Tool Assisted
IntubationImproving Our Environment Of Care To Deliver Better
Outcomes Integrity - Service - Excellence 23
24. Shaping the Future of Military Healthcare AMEDD Futures
2039 AFMS Futures 2045 Planning Factors Planning Factors Joint
Organization Patient-Centered Care MILHEALTH Military-Civilian
Synergy Synergy-Joint & Coalition (Education & Currency)
Cultural Adaptability Organizational Agility Personnel
Interoperability Global Engagement Precision Healthcare
Surveillance/Public Health Technology Integration Technology
IntegrationWorking Together, Achieving Success Through Common
Vision Integrity - Service - Excellence
25. The Focus is on Us Walter Reed National San Antonio
Military Medical Center Military Medical Center (WRNMMC) Walter
Reed National San AntonioMilitary Medical Center Military Medical
Center (WRNMMC) Joint Healthcare San Antonio Military Health System
SAMHS San Antonio Military Health System Ft Belvoir Community SAMHS
Hospital (FBCH)Ft Belvoir Community Hospital (FBCH) AF Theater
Hospital, Craig Joint Theater Wilford Hall TheaterAndrews
Ambulatory JointJoint BaseHospital, AF Theater Base- Balad- Balad
Andrews Ambulatory Craig Joint Hospital Center Hospital - - Bagram
Ambulatory SurgeryBagram Wilford Hall Ambulatory Surgery Center
Care Ctr Care Center Improving eSynergy Through E xCommon Vision
Int grity - Service - a cellence