Patient Administration\'s Integrated Disability Evaluation System (IDES) process redesign that will save the Department of the Navy over $11.9 million in 2012.

1. Integrated Disability Evaluation System Process Redesign
LT Ryan Shiek, LT Meg Potter, LTJG Sean Oehrlein, LT Johnny Oliva
PROGRAM BACKGROUND AND INTRODUCTION PATIENT ADMINISTRATION AND VA MSC TEAM IDES TIMELINE PROGRESS
Average Days to Complete Referral (10 day) and MEB Stages (35 day)
120
100
80
USMC MEB
60 USN MEB
USMC Ref.
USN Ref.
40
20
0
JUL AUG SEP OCT NOV DEC JAN FEB
IDES PROCESS REDESIGN RESULTS
Metric Before After Reduction
The Integrated Disability Evaluation System (IDES) process involves (Tracking System) (JUL/AUG 2011) (FEB 2012)
multiple government entities, electronic tracking systems, and hand-
offs between stages within phases to complete a single IDES case for Referral Stage 46 Days (USN) 8 Days (USN) 38 Days
our Wounded, Ill, and Injured patient population. The result of the PROGRAM OBJECTIVES, CHALLENGES, AND ACTIONS (VTA) 39 Days (USMC) 7 Days (USMC) 32 Days
IDES process is a determination of fitness for duty; and if found unfit,
PAD leadership critically evaluated the NMCSD IDES process and found MEB Stage (VTA) 106 Days (USN) 63 Days (USN) 43 Days
a disability rating percentage from the Veterans Administration.
the following issues were causing delays: 114 Days (USMC) 57 Days (USMC) 57 Days
The goal of this project was to align the processing times for Naval - IDES team understaffed
MEB Average Open 115 Days 39 Days 76 Days
Medical Center San Diego (NMCSD) IDES cases with the processing - No detailed method to track IDES case progress Case (IDES Tracker)
times defined in SECNAVINST 1850. Specifically PAD leadership was - IDES referral “no shows”
tasked to complete the following objectives in a sustainable manner: % MEB Cases > 35 80% 38% 42%
- IDES staff difficulty balancing different stage processes
Days (IDES Tracker)
- Addendums found necessary at end of the process
- Reduce the Referral Stage average to 10 days
- Redundant signatures required on multiple documents Open Cases (IDES 524 Cases 308 Cases 216 Cases
- Reduce the MEB Stage average to 35 days
Tracker)
NAVY MEDICINE WEST PATIENT CATCHMENT AREA PAD Leadership used the Continuous Process Improvement (CPI)
methodologies Just-Do-It and Lean to make these sustainable CONTINUOUS PROCESS IMPROVEMENT
Navy Medicine West (NMW)
improvements: NMCSD is leveraging technology to meet the MEB Stage goal. NMCSD
provides medical care to more
than 675,000 beneficiaries. The - Increased IDES staffing by 11 conducted a multi-disciplinary Lean Six-Sigma Rapid Improvement
NMW patient catchment area - Increased IDES supervision by 4 Event (RIE) in December 2011, resulting in an e-routing solution using
includes Navy Military Treatment - Developed the IDES Tracker the IDES Tracker. The e-routing function electronically transmits:
Facilities on the West Coast as well - Created IDES escort to eliminate “no-shows”
as Hawaii, Japan, and Guam. – IDES Referral form from Referring Physician to PAD
- Specialized IDES staff in Referral Stage or MEB Stage
NMCSD is the regional Echelon III – C&P Exam from PAD to Referring Physician
command and processes more than - Pre-screened files for Addendums
- Provided IDES Physician signature authority – NARSUM from Referring Physician to Jr. Physician, CA, and to PAD
1,200 MEB cases annually.
Complicated cases are referred to – Addendums and Rebuttals from PAD to Physician and back to PAD
NMCSD for MEB processing. NMCSD NMCSD now meets the Referral Stage goal and reduced the MEB Stage
is a main recovery site for average. The result will save the military an estimated $11.9 million Case documents are immediately e-routed upon completion of action,
Wounded, Ill, and Injured in in 2012 compensation (Pay, Subsistence, Housing). generating an automatic e-mail alert to the appropriate staff. CAC-
conjunction with the Combat and enabled signature and digital signature pads ensure secure, encrypted
- Referral Stage: $4.9M (((35 days x 1200 cases)/365 days)*$42,418.08**)
Complex Casualty Care (C5) data transfer resulting in 100% tracking and accountability for every
program. - MEB Stage: $7.0M (((50 days x 1200 cases)/365 days)*$42,418.08) IDES case. All of NMCSD will be using e-routing by April 2012.
**Compensation calculated for E-4, 4 years of service, CONUS average, 0 dependents
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