Transcript Electronic Health Record (EHR) System Way Ahead

MHS IM/IT
Program
Electronic Health Record (EHR)-System
Way Ahead
LtCol Dan Davis
Chief, EHR Clinical Requirements
Presentation to
MEPRS Conference
July 26, 2010
MHS IM/IT
Program
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, enroute 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
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•
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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
Business Intelligence
Patient Care Support
Health
Record
– Clinically focused
– See backup slide
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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 Analysis
Doctrine: No changes
Organization:
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–
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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
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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:
–
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Fundamental transformation of current solution to move to new architecture
Identify business process changes
Leadership and Education:
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No changes to current professional and military education; but
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Leadership understanding and support for EHR throughout the MHS critical to future success
Key to achieving organization and training changes
Personnel:
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Qualified personnel needed to implement approach
Repurposing of some personnel after full implementation
Facilities:
–
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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
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•
•
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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 changes
Organization: No changes
Training: Updates to HIPAA Training as revisions and new
rules become effective
Materiel: See Recommendations (next slide)
Leadership and Education: No changes
Personnel: Additional analysis required
Facilities: No changes
Policy:
– 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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•
•
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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 language
so 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
1
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.
2
Global capture and exchange of all health data for beneficiaries - Direct care, Network, Managed Care, Veterans
Affairs, etc.
3
Inpatient 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
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Consult and Referral Management
9
Assessments of medical deployability of individual service members
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Patient Administration (Includes who the patient is, what he/she is entitled to, where he/she is located, etc.)
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Week
Week 1
EHR-Dependent Tiger Team Session Schedule
(weeks 1-5)
Date
Track 1 – Sessions
Track 2 – Sessions
Tue, 5/25/2010
Billing (includes: Medical Affirmative Claims
(MAC), Medical Services Account (MSA), and
Other Health Insurance (OHI) Management)
N/A
Thu, 5/27/2010
Mon, 5/31/2010 - Memorial Day Holiday
Week 2
Tue, 6/1/2010
HIPAA (Privacy and Security)
Thu, 6/3/2010
N/A
Coding (Inpatient / Outpatient)
Tue, 6/8/2010
N/A
Outpatient Appointing & Scheduling / Identity
Management
N/A
Medical Logistics (includes Equipment and
Supplies)
Mon, 6/21/2010
Credentialing/Privileging/Risk
Management/Adverse Action
Processing/Population Health Quality/Patient
Safety Reporting
(Part 1 of 3)
N/A
Tue, 6/22/2010
Human Resources
(Part 1 of 2)
Wed, 6/23/2010
Credentialing/Privileging/Risk
Management/Adverse Action
Processing/Population Health Quality/Patient
Safety Reporting
(Part 2 of 3)
Thu, 6/24/2010
Human Resources
(Part 2 of 2)
Week 3
Thu, 6/10/2010
Tue, 6/15/2010
Week 4
Thu, 6/17/2010
Week 5
Medical Surveillance (includes: Disease and
injury, Epidemiology, Prevalence (monitoring),
Deployment health surveillance, Syndromic
surveillance, and Reportable medical events)
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Week
EHR-Dependent Tiger Team Session Schedule
(weeks 6-8)
Date
Track 1 – Sessions
Mon, 6/28/2010
Medical Logistics (Focus on Equipement)
Tue, 6/29/2010
Occupational and Environmental Health
(Part 1 of 2)
Week 6
Wed, 6/30/2010
Thu, 7/1/2010
Spectacle Request Transmission Service
(SRTS) (Part 1 of 2) (Part 2 of 2 – TBD)
Occupational and Environmental Health
(Part 1 of 2)
Track 2 – Sessions
N/A
Military Entrance/Enlistment Processing Station
(MEPS)
Mon, 7/5/2010 – Independence Day Holiday
Tue, 7/6/2010
Week 7
Wed, 7/7/2010
Population Health (includes: Condition / Disease
Management, Health Promotion/Wellness (PHA),
and Individual Medical Readiness)
Referrals / Consultations / Teleconsultation
(Part 1 of 2)
N/A
Thu, 7/8/2010
Referrals / Consultations / Teleconsultation
(Part 2 of 2)
Mon, 7/12/2010
N/A
Credentialing/Privileging/Risk
Management/Adverse Action
Processing/Population Health Quality/Patient
Safety Reporting
(Part 1 of 2)
Tue, 7/13/2010
Patient Radiation Exposure
(Part 1 of 2)
Outpatient Clinic Management
(Part 1 of 2)
Week 8
Wed, 7/14/2010
N/A
Thu, 7/15/2010
Patient Radiation Exposure
(Part 2 of 2)
Credentialing/Privileging/Risk
Management/Adverse Action
Processing/Population Health Quality/Patient
Safety Reporting
(Part 1 of 2)
Outpatient Clinic Management
(Part 2 of 2)
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Week
EHR-Dependent Tiger Team Session Schedule
(weeks 9-10)
Date
Track 1 – Sessions
Track 2 – Sessions
Tue, 7/20/2010
N/A
Thu, 7/22/2010
Cost and Workload Assignment (includes Non-Lab,
Non-Rad Ancillaries)
Mon, 7/26/2010
N/A
Admissions, Discharge and Transfers (ADT)
(Part 1 of 2)
Tue, 7/27/2010
Medical 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, 7/29/2010
Medical Command and Control (MC2)
(Part 2 of 2)
Patient Movement
(Part 2 of 2)
Week 9
Week 10
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