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SG DoD IEHR Oct 2011

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  • 1. Headquarters U.S. Air Force Integrity - Service - Excellence Advancing Continuum of Care forMilitary Members through Health IT Lt Gen C. Bruce Green Surgeon General 11 October 2011 1
  • 2. Shaping the Future of Federal Healthcare Synergy- Patient-Centered Federal and State Care Organizational Precision Agility Healthcare Technology IntegrationWorking Together, Achieving Success Through A Common Vision Integrity - Service - Excellence
  • 3. Health & Human Services (HHS) IT Strategic PlanIntegrity - Service - Excellence 3
  • 4. AHLTA on the 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
  • 5. Aligning with the Quadruple Aim (Variation of Triple Aim) READY: BETTER HEALTH: Readiness BETTER CARE: BEST VALUE:AFMS Inpatient Measures CY10 CY10 CY10 CY10 Annual Comparative Synergy Q1 Q2 Q3 Q4 MTFs Reported Events 3911 2618 2908 2769 12206 and Near Miss(%) 69.4 64.1 64.4 75.6 20.2 68.4 >72% Balance 27.8 <28% P a t ie n t S a f e t y M e a s u r e m e n t s No Harm(%) 28.6 30.8 31.5 Harm(%) 2.0 5.1 4.1 4.2 3.8 0 Serious Reportable Events* Wrong Site Surgery (WSS) 1 2 2 2 7 0 Retained Foreign Objects 0 2 3 1 6 0 Pressure Ulcers (Stage III and IV) 0 0 0 0 0 0 Falls 0 0 0 0 0 0 Fall rate (per 1,000 OBDs) 0.1 0.3 0.3 0.4 0.4 2.1-3.1* Common Ground and Focus Required to Avoid Extinction Integrity - Service - Excellence Quadruple Aim is based on the Institute for Healthcare Improvement’s Triple Aim
  • 6. Leveraging Medical Informatics DATA INFORMATION KNOWLEDGE WISDOM CHANGE Better CareTMDS Clinical Through Practice Evidence Based GuidelinesDEERS Practice CarePoint Medication Better HealthPDTS Health Alerts Enhanced Patient Services Registries Data Safety$ / M2 Warehouse User Home Best Value (HSDW) Interfaces Sensors Healthy BehaviorDMHRS i Better Care Expedited EHR Test Results Improved Patient ExperienceAccelerating Information Exchange with Patient Activation Integrity - Service - Excellence
  • 7. Meeting the Stakeholder’s NeedsIndividual Med Readiness Patient Health Employer Rating (HER)Prev HealthAssessment Employer UltimateDeploymentAssessment Health Outside Provider Visit Provider HSDW Transforms Healthcare Delivery to Health Integrity - Service - Excellence 7
  • 8. Tri-Service Workflow: Improves Practice Management AHLTA-based workflow tool to help healthcare teams personalize care with standardized tools and templates Improves readability of providers notes Automatically captures credit for accurate coding Tracks preventive services at point of care w/ Electronic-2766Starts with Info to Provider at Point of Care; Clinical Practice Guidelines Now in AHLTA Integrity - Service - Excellence
  • 9. Transforming Data Into Knowledge Ready Better Health Better Care Patients receiving Diabetic patient massive transfusions educated on experienced 65% “remote mortality monitoring” glucometer Massive JTTRtransfusion Database Readings MTF calls mortality analyzed automatically patient to drops to to identify sent to discuss 17% trends healthcare management team Clinical Practice Guideline developed Uncontrolled sugar for 1:1 transfusion levels Identified protocolEmpowering Patients & Staff with Tools to Improve Healthcare Delivery Integrity - Service - Excellence 9
  • 10. Create The Setting For “Right” Behaviors Percent of Patients Satisfied* Continuity of Care Family Health Providers at PCMH Sites MTF Primary Care Visit Distribution* Other Provider 100% Family Health / PCMH Patients 100% 95% 90% 21471 PCMH Team % Satisfied 80% 64954 90% UP is 70% 42400 85% Good 60% PCMH PCM 50% PCMH TEAM 40% 80% 30% 123681 121580 Continuity 20% Other Provider 75% (Family Health 10% Jan-11 Mar-11 May-11 Jan-11 Mar-11 May-11 Clinic) 0% 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% Plan: Provide both monetary + non-monetary incentives to high performers 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 2 DOWN 10 UP is is Good 0 Good 0 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 PCMH Aggregate Non PCMH Aggregate PCMH Aggregate Non-PCMH Aggregate ED/Urgent Care Rate: Goal < 3/100 HEDIS Aggregate: Goal > 40Inspiring Trust & Confidence by Measuring and Rewarding Outcomes Integrity - Service - Excellence 10
  • 11. Getting Info to Patients for Shared Decision Making Patient Centered Medical HomeHIDDEN SLIDEFor Printing Purposes Linking Individual Patients &Due To Animation Providers To Health Information Maximizing Use Of Teams To Enhance Care Building Capacity & Transforming Data into Actionable Info Improving Currency To Advance Practice Training, Education & Recapture Provider Decision Support Deliver Best Improving Relations, Evidence-Based Empowering Patients, & Medicine To Patients Changing Behaviors & Staff Patient Decision Support Applied Clinical Epidemiology Integrity - Service - Excellence 11
  • 12. Putting It All Together Air Force Medical Home MHS Linking Individual Patients & Quadruple Aim Providers To Health Information Maximizing Use Of Teams To Enhance Care Ready Better Health Building Capacity & Transforming Data into Actionable Info Improving Currency “Population Health” To Advance PracticeTraining, Education & Recapture Provider Decision Support Deliver Best Better Care & Improving Relations, Best Value Evidence-Based Medicine To Patients Empowering Patients, “Experience Of Behaviors Changing Care” “Per Capita Cost” & Staff Patient Decision Support 12 Applied Clinical Epidemiology
  • 13. Activating Patients & Care Teams Health Team PatientDecision Patient DecisionSupport Support CenteredPCMH Provides Improved Decision Support- For Patients c eHealthcare Teams Integrity - Service Excellen &
  • 14. Electronic Health Initiatives Project (eHIP)Integrity - Service - Excellence 14
  • 15. Developing The US Air ForceVirtual Medical Center
  • 16. Social Networking Needs To Be Integrated Into Common Practice PHREnhancing and Complimenting The Health Team’s Practice of Care Integrity - Service - Excellence
  • 17. Sec Def/Sec VA DecisionCombined Efforts Provide the Best Future EHR Integrity - Service - Excellence
  • 18. 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 18
  • 19. Federal Health System Integration HOSPITAL PHARMACY VISIT Electronic Electronic PROVIDERRADIOLOGY Health Record Health Record OFFICE VISIT Common Logistics PUBLIC LAB SYSTEM HEALTH SERVICE Open-Source Provides Integration Without Barriers Integrity - Service - Excellence 19
  • 20. 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 20
  • 21. Synergy Accelerates Transformation Leverage Federal expertise through “open” partnerships Unleash the power of mass collaboration Improve trust through transparency Explore new avenues of development www.max.govGenerating & Sharing Open-Source Knowledge Accelerates Innovation Integrity - Service - Excellence
  • 22. PPC Roadmap Complete Strategy IMS Document Base-lined Complete Idea Change Factory Readiness Concept INTEGRATED Training Planning Office Stakeholder Charter Complete Analysis Strategic Leadership ROADMAP Comms Engagement Integrated Plan Resource 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 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 I n t e LEGEND: t SCHEDULED e IN PROGRESS - COMPLETEc e l l e n c e gri y - S rvice Ex
  • 23. Patient as the Decision Maker Ready: Reassure patient that you “know them” Accessible: Be there when the patient needs you Prepared: Respect patient and their time Precise: Clarify all treatment and follow-up Organized: Don’t ask patient what you should know or have available in their medical record Respectful: Always answer phone calls/resolve patient concerns Thorough: Tell patient what to do if they feel worseThe Ultimate Outcome of Integration & IT Initiatives is Better Patient CareSource: Integrity - Service - Excellence 23
  • 24. “TRUSTED CARE ANYWHERE” Integrity - Service - Excellence