The document provides an overview of the Captain James A. Lovell Federal Health Care Center (FHCC). It discusses the command demographics, factors driving integration between the VA and Navy, highlights since integration, and people-centric initiatives. It also reviews workload, staff satisfaction, and the status of information management/technology projects including single patient registration and a presentation layer. Challenges including combining the VA police and Navy security forces are also noted.

1. Captain James A. Lovell
Federal Health Care Center
Mr. Paul Grundy
August 08, 2012
Patrick L. Sullivan, FACHE David J. Beardsley CAPT, MC, USN
Lovell FHCC Director Lovell FHCC Deputy Director V8

2. Overview
About the Lovell FHCC
Command Demographics
Factors Driving Integration
Review: Since Integration
Highlights: Since Integration
The FHCC Demonstration
People-Centric
FHCC Score Card Summary (FY ‘12)
Information Management/Information Technology(IM/IT)
Challenges
Questions
2

3. Overview
• First-of-its kind integration:
• Former North Chicago VA Medical
Center and Naval Health Clinic Great
Lakes
• Unique combined mission:
“Readying Warriors and Caring for
Heroes.”
• Larger than a single facility:
• West Campus: 107-acres at former
Campus
North Chicago VA Medical Center
campus
• East Campus: USS Osborne, USS
Campus
Tranquillity, USS Red Rover and
Fisher Branch Medical Clinics; Bldg
200H.
• Community-Based Outpatient
Clinics: Kenosha, McHenry and
Clinics

4. 4

5. VA Navy
Civilian Employees:
1,352
Arm Civilian
y
Active Duty: 1 Employees: 530
Contract: 42 Active Duty: 728
Total 1,394 Contract : 261
Total: 1,519
Combined Staff Total: 2,914
5

6. VA Core Values Navy Core Values
Integrity, Commitment Honor, Courage , Commitment
Advocacy, Respect , Excellence
Lovell FHCC Mission Lovell FHCC Vision
Leading the way for Federal Creating the future of federal
Health Care by providing a healthcare
quality, patient-centered Lovell FHCC Promise Kept
experience, and ensuring Readying Warriors and
the highest level of Caring for Heroes
operational readiness. Lovell FHCC Values
Respect, Integrity, Trust,
Accountability , Teamwork/
Camaraderie 6

7. FHCC Reporting Structure
Joint Executive Council (JEC)
Health Executive Council (HEC)
Advisory Board
VA Director (SES)
Navy Deputy (O6)
Command Master
Stakeholders Chief (E9)
Advisory
Council
Patient Facility Dental Fleet
Patient Care Resources
Services Support Services Medicine
Mgmt. Auth. From Executive Agreement (EA) Communication and EA Compliance
Operational Line of Authority Military Reporting Relationship & Accountability
7

8. Factors Driving Integration
 Historic
 Base Realignment and Closure (BRAC) Committee 1995
 Presidential Priority
 Capital Asset Realignment for Enhanced Services (CARES) Study
 Center for Naval Analysis 2002 Recommendations
 Direction and leadership from the Health Executive Council and
Joint Executive Council
 Base Realignment and Closure (BRAC) Committee 2005
Recommendations
 Congressional Interest
 Current
 Two legacy EHR systems - Four applications – 3 Networks
 Joint VA / DoD Programs
 Disability evaluation system
 Electronic health records - iEHR
 Transition programs
 Joint pharmacy initiatives
 Recovery coordination for the wounded, ill, and injured.
8

9. Legislation to Integrate
National Defense Authorization Act (NDAA) 2010
Sec. 1702 Transfer of Property: Permission to transfer DoD real and
related personal property.
Sec. 1703 Transfer of Civilian Personnel to the VA: Permission for DoD
civilian personnel to move to the VA personnel system.
Sec. 1704 Establishment of Joint Medical Facility Demonstration
Fund: Establishment of a Treasury Fund with a reconciliation process.
Sec. 1705 Health Care Eligibility for Services at the Captain James A.
Lovell Federal Health Care Center: Obtain designation as Uniformed
Treatment Facility for beneficiary purposes.

10. Executive Agreement Summary
Signed by SECVA / SECDEF on 23 April 2010
 The formal agreement between the DoD and the
VA regarding the standup and operation of the
FHCC located in North Chicago, Illinois, and Great
Lakes, Illinois. Active Duty members and Active
Duty dependents enrolled in TRICARE Prime pay
no co-payments for inpatient or outpatient health
care services.
 9 specific areas directed by NDAA 2009
 5 specific areas directed by NDAA 2010

11. DoD/VA - Way Ahead
“The vision Secretary Panetta and I share is to provide an
integrated, seamless experience to our people across
their lifetime — from when they raise their hand to
take the oath, to when they leave active service and join
the veteran ranks, to when they are laid to rest with
final honors . . .February 27, 2012
"When DoD and VA health care providers begin
accessing a common set of health records, iEHR will
enhance quality, safety and accessibility of health care"
Department of Veterans Affairs Secretary Eric
Shinseki Senate Armed Services Military Construction
and Veterans Subcommittee. March 15, 2012
11

13. Strategic Objective Strategic Initiative
Patient-Centered Care 1. Good to Great: Transformational Leadership Model
2. Patient-Centered Care Council
3. Pain Management Program
4. Outreach
5. Kenosha CBOC Relocation/Expansion
6. Room Service Style Dining
7. Tele-Audiology
8. Expand GI, Surgery and Oncology Services
9. Construct New Dental Facility
10. Renovate/Expand Rehab Gym and Pool (Bldg. 132)
Lean 1. Conduct Facility Assessment
2. Implement LSS/SR Program
3. Reduce Medical Indeterminate Rate
Talent Management 1. Staff Development
•Succession Planning; Retention, Recruitment, Rewarding; HR
Process Improvement; Special-Emphasis Recruitment
Innovation 1. Increase Number of Correlated Records
2. Center of Health Care Education Excellence
3. Expand Imaging Services

14. Review: Readying Warriors and Caring for
Heroes
• Deployed 112 Lovell FHCC Sailors
throughout the world to support
various Department of Defense
missions
• Thirty four currently deployed
in support of global missions
• Twenty one deployed in
support of Operation
Continuing Promise 2011
• USS Red Rover processed more
than 38,000 U.S. Navy Recruits.
• Delivered more than 178,000
immunizations
14

15. FY 2011 – Readying Warriors and Caring for
Heroes
•86, 617 Unique Patients
•25,003 Veterans
•59,224 DoD Beneficiaries (inc Recruits)
• 2,390 Employee/Humanitarian/Other
non-Veteran
•816,639 outpatient visits (Includes Dental)
•186,007 dental visits
• 19,451 emergency room visits
•10,345 DoD / 9,106 Veteran
•1,870,170 total pharmacy prescriptions
•565,560 DoD outpatient prescriptions
•575,088 Veteran outpatient prescriptions
•729,522 inpatient unit doses produced and administered 15

16. Highlights: Improving on Excellence
16

17. Highlights: Improving on Excellence
17

18. Highlights: Since Integration
• Standup of the Lovell FHCC
• Successful Civilian Transfer of Function
•From 1,500 staff to more
than 3,000
• Implemented PIV / ANACI
• Enhanced clinical services
•Building Green House® Homes
A transformational approach for skilled
nursing emphasizing de-institutionalization
• Enhancing Patient-Centered Care
/Planetree® Healing Environment
•Approval for Fisher House
• Over 130, 000 medical records integrated since December 2010 18

19. The Green House Project
Elder centric
Staff engaged in
meaningful
relationships built on Ribbon Cutting Quality of life and
equality, empowerment,
and mutual respect 01 Oct 2012 care focused
Each house
•Capability
•10 Beds
•Staffing
• 2.5 RN
•10 Shahbazim

20. Workload Review – Thru May 2012
4,724 839K 816K 812K
4,463 4,489
3,122 511K
Admissions Outpatient Visits 20

21. People Centric – Staff Satisfaction
FY11 Command Climate Survey
“I think the overall level of
“My overall level of trust in the FHCC has…”
communication at the FHCC has…”
Gotten Better Stayed the Same Gotten Worse
 1038 FHCC Staff Participated in Jan 11 Climate Survey (1038/2758 = 37.6%) 21

22. Captain James A. Lovell
Federal Health Care Center
= Organizational Strength = Slight Organizational Concern = Moderate Organizational Concern = High Organizational Concern
22

23. People Centric – Staff Satisfaction
FY12 Command Climate Survey
23

24. Lovell FHCC: Results Driven
Phase I
• Combining the Behavioral Health Units of NHGL and NCVAMC
- Net Cost Savings of FY03 to FY07 $5,400,262
• DoD Blood Processing Center (one-time cost avoidance)
- Net Cost Savings of $3,130,000
Phase II
• Combining the Inpatient Medicine, Emergency Room, ICU/CCU,
and Surgery Departments
- Net Reduction of 51.04 FTEE
- Net Cost Savings $5,800,000 in FY05 to FY07
Phase III
• MILCON Construction - One time cost savings of $67M
• Recurring annual operating cost savings of $19M
• Projected recurring cost savings of $3.3M
• Center for Naval Analysis (CNA)
Full & comprehensive assessment of costs (Aug 11 – Jul 12)
Source: CBA by NHCGL/NCVAMC - Feb 06, 2009 24

25. Thirteen Year Cumulative Percent Change in Cost
VHA Cost Per
Patient Total
Medical Care
Obligations per
Total Unique
Patients (including
non-Veterans)
Average Medicare
Payment Per
Enrollee
Medicare Program
Benefits per
Enrollee
Consumer Price
Index
Bureau of Labor
Statistics
All Urban
Consumers
25

26. FHCC Economic Model
 Health Care inflation
 MHS Direct Care hospital reductions 70 (2004) to 59 (2009) have
opportunity to be reversed through VA/DOD integration and return of
hospital based opportunities for DOD providers/patients .
 Increasing Utilization
 Integrated systems (FHCC) have more incentives consistent with ACO
(HMO) or health systems approach found in VISN (includes long term care)
and large DOD MTF.
 Think whole life care (newborn to grave, in/outpatient medical home
concept). Current strategies of Joint Ventures, Med Home and Network
(PPO) relations have fewer incentives to contain utilization.
 Efficiencies of scale and continuity
 More Beneficiaries
- FHCC integration adds more capacity (both infrastructure and super med
home)

28. Source: HNFS Claims Mart
Financials by DMIS report
Purchased Care for FHCC DMIS Enrollees
Outpatient, Inpatient, and Total Paid Dollars
Jan 2010 - Nov 2011
Move
Merger Date
Completion
Date
28

29. $100M JIF IM/IT Solutions Identified
MSSO W/
Context Mgmt
(Single Desk
Top) - Sentillion
Evaluate and CareFX
Scheduling Single
Clinic Registration
Appointment
Consults
Order Portability
AHLTA<>VistA
Business Rad – Lab -
Intelligence Pharmacy
29

30. Spiral model (Boehm, 1988) 30

31. FHCC Enterprise Service Bus (ESB)
About 100K messages
across the bridge in last VistA
nine days including
weekends.
AHLTA

32. FHCC Enterprise Service Bus (ESB)
• Legacy constraints
• Use of Pix Stub / Error Exception
handling
• Supports failure of ID Management and
standard terminology issue
• Model for iEHR
32

33. IM/IT: Current Status
 Single Patient Registration: Operational
 Medical Single Sign On with Context Management: Operational
 iEHR Presentation Layer (GUI) – Powered by JANUS
 Phased Rollout starting December 2011
 Enhancements / Issues for contract award
 Expand to all users by May 2012
 Orders Portability
 Radiology: Deployed June 14, 2011
 Laboratory: 3-phased approach
 Phase I Deployed - January 6, 2012
 Phase II Deployed - February 27, 2012
 Full Deployment - March 20, 2012
 Consults :
 Business requirements – January 2012
 Contract Kick-off – March 2012
 Orders deployed – August 2012
 Referrals/notes deployed – February 2013
 Target for Completion – February 2013
 Pharmacy/Allergies: Interim plan in place
 Final capability part of iEHR?
33

34. IM/IT: Way Ahead
Network Services Data Sharing / Non-Clinical IT Issues
Reconciliation & Billing
Scheduling
Audit Mechanism for Exchange of MH Notes Across BHIE
CareFX at Lovell FHCC
Logistics Support (DMLSS)
Surgery Quality Workflow Manager (SQWM) as Beta Site
VA Enterprise Real Time Location System (RTLS)
Joint Wi-Fi Rollout
Disaster Recovery (DR)
Continuous Readiness in Information Security Prgm (CRISP)
Reciprocity -Information Security Computer training VA/DoD
Pharmacy iEHR
Presentation Layer - JANUS
34

35. Presentation Layer (JANUS)
Current Status
 Currently accessible on every desktop on both the VA and Navy
Medicine Network
 Limited training during initial start up and over the shoulder as
requested
Challenges
 Managing capability expectations
 Need document identifying current full capabilities, partial capabilities, and
near-term future enhancements
 No formal issue reporting/tracking mechanism
Planned way ahead
 Address identified challenges and incorporate into training plan for
expectation management of the end users
 Add as part of current AHLTA/CPRS training
 Provide road-show training to departments
 Add to existing training schedule and continue over-the-shoulder as
required
35

36. Status & Accomplishments: North Chicago Non-IT Issues
ISSUE Status Remarks Update
Combining VA Police 3/12/12 EDM submitted to Mr. Riojas raised specific questions in 4/11/12 – Questions from VACO
and the Naval Asst Sec for Security and the operational organization of the Security and Preparedness office to
Security Forces at Preparedness for review. proposed combined security plan. FHCC response due 05/07/12.
the JALFHCC Response to Dr. Petzel 3/21 Answers to be provided by RC, 4.25.12 – NME – positively endorsed
BUMED Legal and FHCC staff by 4/26.
concerns of jurisdictions, by NME and BUMED, and was sent to
Review of response at 5/2 Advisory
training, logistics, and Board.
HA on April 17.
administration. Dir, 6.18.12 – FHCC Advisory Board
Security and Law minutes: VA and DoD lawyers (Mr.
Enforcement to do fact Pope and Mr. Sherman) will review
finding on rules, regs, and with Navy and VA SME’s to complete
jurisdiction by 4/10. position requirements, training and
Response to questions experience crosswalk. Corey Joles,
raised due by 4/26. NME Civ as POC. June 26, 2012 charge
letter attached. Report due July 16,
2012 to Dr. Murawsky.
Use of the VA Request disapproved by HA, Presented to HEC, issue reframed 4/23/12 – Draft CMOP rewrite to address
Consolidated Mail as part of interim solution pending
t VISN12 & NME questions. Submitted to
Order Pharmacy iEHR pharmacy package. FHCC to h NME & VISN12 on 04/27/12. On FHCC
(CMOP) at the redraft for HA. Due 3/30. Received
e Advisory Board Agenda for 05/02/12.
by Advisory Board Co-Chairs on 4/5. 7/23/12-This topic has moved past NME
JALFHCC (narrowed
Sent back to FHCC for further work on to BUMED and is now on schedule for
to demonstration d
the business case. discussion at HEC.
period). o
c
u
m
36
e

37. Status & Accomplishments: North Chicago Non-IT Issues
ISSUE Status Remarks FHCC Status
FHCC to be designated as an IM FHCC will be an iEHR It was agreed at the HEC that the FHCC will not be POM –FY14.
IT alpha test site alpha test site for an independent alpha site. Inefficiencies exist in
Pharmacy module the current model that slows down progress and
the FHCC Budget needs to reflect this. To be
discussed at Advisory Board 05/02/12.
Request amendment of the EDM in coordination EDM in coordination process. 4.25.12 – NME -positively endorsed by
Acquisition & Contracting EDM process. NME and BUMED and was sent to HA on
(JUL 2008) to allow flexibility 17 April.
to use Great Lakes Center 7.12-13.12 – FHCC, VISN, VHA, DMLSS,
(GLAC)/VA , Navy Medical met and work plan drafted for piloting
Logistics Command DMLSS at FHCC.
(NAVMEDLOGCOM)or Navy 7.30.12 – DMLSS Work Group charter
Facilities Midwest (NAVFAC) forwarded to NME/VISN/FHCC Advisory
Board for approval.
7.31.12 – EDM still in coordination at HA
and VACO.
Change the executive 1. Hospital Corpsmen 1. Determined by Legal (Navy and VA Regional) Utilization of Navy Corpsmen privileges on
agreement to allow Navy policy is in that local policy is all that is necessary. Due the West Campus: Resolved - Since May
Hospital Corpsman privileges coordination for USH to Advisory Board 5/3/12. 14, 2012, the corpsmen work under the
on the West Campus signature. VISN 12 2. Independent Duty Corpsman issue still under license of their civilian preceptor nurse
and NME have review by Legal (VA RC and Navy) for who has direct responsibility for the
concurred. malpractice coverage issues. Due to Advisory patient care. Per the Executive Agreement,
2. Independent Duty Board 5/3/12. an active duty Division Officer Nurse
Corpsmen practice is position is responsible for the admin,
consistent with training, and over site of the program.
practice in Navy
MTFs. Not changes
required.
37

38. Status & Accomplishments: North Chicago Non-IT Issues
ISSUEC Status Remarks FHCC Status
Amend 10 U.S.C. 1091 to The proposal will be included in There is currently a process in place with FHCC standing by until FY14
designate the federal the DoD FY14 Legislative NAVMEDLOGCOM doing the personal
health care facility in program. services contracting.
North Chicago as an
organization eligible for
use of personal services
contracts authority
Financial Issues: 1. NME and VISN12 working 1. VA standards have been provided to 1. The legal review is expected to be
1.Construction with CFOs to plan. the Navy to review. Legal review by completed by July 13, 2012.
2.Atrium mitigation 2. FHCC contracted with RFI VA Regional Counsel and DoD 2. At NME /BUMED (3rd floor approved).
3.CBOC expansion for architectural risk Counsel continues to evaluate if Atrium and parking garage to be
mitigation plans for the variations from Navy standards can discussed at FHCC Advisory Board
Atrium and Garage. 90% be accomplished under the auspices 05/02/12.
submittal information for the of the FHCC Executive Agreement. 7.27.12 – BUMED approval received to
Lovell FHCC Atrium 2. NAVFAC has funds to execute Atrium proceed with garage and stairwell;
Mitigation project was mitigation in FY 12. Plans to be funding from FHCC.
received from the A/E firm. developed for FY13/14 for Garage.
3. Request for DMIS IDs - not 3. Request denied as complexity of 1. Resubmit FY14 without resources
required. expansion of Kenosha CBOC to DoD required.
is still under review in BUMED. VA
concurred. Submit FY14
Joint Incentive Fund October 10 EDM signed by Dr. CFO at Navy and VHA to develop parallel CFO’s Formed “Capital Purchasing Research
(JIF) Authority Taylor (DoD) and Dr. Petzel (VA) process for requesting funding for project Team” to develop recommendations for
Alternative to exclude the “totally / equipment that supplements Treasury handling capital procurement at the FHCC.
integrated” facility from Fund. Due 5/3/12 Team development & funded options for CFO
participating in the JIF. review. EDM & white paper was signed on 25
July.
38

39. It takes all of us to achieve the mission
39

40. Questions?
Readying Warriors
and Caring for Heroes
Facebook.com/LovellFHCC YouTube.com/LovellFHCC Twitter.com/LovellFHCC
http://www.lovell.fhcc.va.gov