advancing continuum of care for military members through...

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Headquarters U.S. Air Force

1

Advancing Continuum of Care for

Military Members through Health IT

Lt Gen C. Bruce Green

Surgeon General

11 October 2011


Shaping the Future of Federal Healthcare

Patient-Centered

Care

Synergy-

Federal and State

Organizational

Agility

Precision

Healthcare

Technology

Integration

Working Together, Achieving Success Through A Common Vision


Health & Human Services (HHS)

IT Strategic Plan

3


AHLTA on the…

Information Highway E

xp

ecta

tio

ns

Time

Innovation

Trigger

Vehicle of

Opportunity!

Peak of Inflated

Opportunity!

Trough of

Disillusionment

Slope of

Enlightenment

Plateau of

Productivity

Swamp of

Diminishing

Returns

Cliff of

Obsolescence

* Gartner Inc., chart from Mastering the HYPE CYCLE by Jackie Fenn and Mark Raskino

I n t e g r i t y - S e r v i c e - E x c e l l e n c e Quadruple Aim is based on the Institute

for Healthcare Improvement’s Triple Aim

Aligning with the Quadruple Aim

(Variation of Triple Aim)

Common Ground and Focus Required to Avoid Extinction

AFMS Inpatient

MTF'sMeasures

CY10

Q1

CY10

Q2

CY10

Q3

CY10

Q4Annual Comparative

Reported Events 3911 2618 2908 2769 12206

Near Miss(%) 69.4 64.1 64.4 75.6 68.4 >72%

No Harm(%) 28.6 30.8 31.5 20.2 27.8 <28%

Harm(%) 2.0 5.1 4.1 4.2 3.8 0

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 OBD's) 0.1 0.3 0.3 0.4 0.4 2.1-3.1*

Serious Reportable Events*

Patie

nt S

afety M

easu

rem

en

ts

BETTER CARE: BEST VALUE:

BETTER HEALTH: READY:

Synergy

and

Balance

Readiness


EHR

PDTS

TMDS

DEERS

$ / M2

DMHRS

i

Leveraging Medical Informatics

Better Care

Through

Evidence Based

Practice

Registries

CarePoint

User

Interfaces

Better Health

Enhanced Patient

Safety

Best Value

Healthy Behavior

Clinical

Practice

Guidelines

Medication

Alerts

Home

Sensors

Expedited

Test Results

Better Care

Improved Patient

Experience

DATA INFORMATION WISDOM CHANGE KNOWLEDGE

Accelerating Information Exchange with Patient Activation

Health

Services

Data

Warehouse

(HSDW)


Meeting the Stakeholder’s Needs

7

Individual Med

Readiness

Prev Health

Assessment

Deployment

Assessment

Outside

Provider

Visit

Health Employer

Rating (HER)

HSDW Transforms Healthcare Delivery to Health

Patient

Employer

Provider

Ultimate

Health


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-2766

Starts with Info to Provider at Point of Care; Clinical Practice Guidelines Now in AHLTA


Transforming Data Into

Knowledge

9

Diabetic patient

educated on

“remote

monitoring”

glucometer

Readings

automatically

sent to

healthcare

team

MTF calls

patient to

discuss

management

Patients receiving

massive transfusions

experienced 65%

mortality

JTTR

Database

analyzed

to identify

trends

Clinical Practice

Guideline developed

for 1:1 transfusion

protocol

Massive

transfusion

mortality

drops to

17%

Uncontrolled sugar

levels Identified

Ready Better Health Better Care

Empowering Patients & Staff with Tools to Improve Healthcare Delivery


75%

80%

85%

90%

95%

100%

Jan-11 Mar-11 May-11 Jan-11 Mar-11 May-11

PCMH Aggregate Non-PCMH Aggregate

% S

atis

fie

d

Percent of Patients Satisfied* Family Health Providers at PCMH Sites

UP is Good

Create The Setting

For “Right” Behaviors

10

HEDIS Aggregate: Goal > 40 ED/Urgent Care Rate: Goal < 3/100

Plan: Provide both monetary + non-monetary incentives to high performers

0

2

4

6

8

10

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

Ave

rage

Mo

nth

ly V

isit

Rat

e (p

er 1

00)

Monthly Emergency Department and Urgent Care Utilization* Per 100 PCMH Patients

DOWN is

Good

123681

64954

121580

42400

21471

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Non-PCMH Sites (41/322163) PCMH Sites (34/351952)

Dec 2010 - May 2011

Continuity of Care MTF Primary Care Visit Distribution*

Family Health / PCMH Patients

Other Provider

PCMH Team

PCMH PCM

Other Provider (Family Health Clinic)

PCM (Non-PCMH Sites)

PCMH TEAM Continuity

0

10

20

30

40

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

Sco

re

HEDIS Measures - Patients Enrolled to PCMH Clinics

UP is Good

Inspiring Trust & Confidence by Measuring and Rewarding Outcomes

Continuity: Goal > 90% Satisfaction: Goal > 95%

Putting It All Together…

12

Improving Relations,

Empowering Patients, &

Changing Behaviors

Patient Decision Support Applied Clinical Epidemiology

Transforming Data into Actionable Info

To Advance Practice

Provider Decision Support

Deliver Best

Evidence-Based

Medicine To Patients

& Staff

Linking Individual Patients &

Providers To Health Information

Air Force Medical Home

Training, Education & Recapture

Maximizing Use

Of Teams To

Enhance Care

Building Capacity &

Improving Currency

Better Health “Population Health”

Best Value “Per Capita Cost”

MHS

Quadruple Aim

Better Care “Experience Of Care”

Ready

https://www.relayhealth.com/default.aspx


Patient

Centered

Health

Team

Decision

Support

Patient

Decision

Support

PCMH Provides Improved Decision Support For Patients & Healthcare Teams

Activating Patients & Care Teams

http://apod.nasa.gov/apod/image/0703/horizonmoon_nasa_big.jpg

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 14

Electronic Health Initiatives

Project (eHIP)

Developing The US Air Force Virtual Medical Center


Social Networking Needs To Be

Integrated Into Common Practice

PHR

Enhancing and Complimenting The Health Team’s Practice of Care

http://www.webmd.com/www/default.htm


Sec Def/Sec VA Decision

Combined Efforts Provide the Best Future EHR


DoD-VA “To-Be” iEHR Architecture

18

Mission

Requirements

& Performance

Outcomes

Team

Business

Process

Team Common Interface Standards

Common Interface Standards

Presentation (Common GUI)

Common Data Centers

Common Services Broker (includes Enterprise Service Bus (ESB) and Infrastructure Services)

Presentation

Layer Team

Systems

Capabilities

Team

Enterprise

Architecture

Team

Data Inter-

operability

Team

Common Information Interoperability Framework (CIIF) Common Information Model, Common Terminology Model,

Information Exchange Specifications, Translation Service

Common Data Standards: SNOMED CT and Extensions, LOINC and RxNorm

DoD Only VA Only Joint DoD/VA

Pharmacy

Disability

Evaluation

Dental Care

Personal

Health Record

Inpatient

Orders Mgmt

Consult &

Referral Mgmt Immunization

Laboratory

Emergency

Dept Care

Nursing

Home

Rehabilitative

Care

Long Term

Care

Transient

Outreach

DoD Unique (16) VA Unique (6) Common (Joint) Applications & Services (30) Battlefield

Care Pediatrics

Military

Readiness Obstetrics

Enroute

Care Veterinary

Operating

Room Mgmt

Blood Mgmt

Document

Mgmt

Applications and Services

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)

Common DoD-VA Measures of Effectiveness, Measures of Performance and key Performance Parameters

Occupational

Health (VA)

Pharmacy

Mail Order


Federal Health System

Integration

19

PHARMACY

RADIOLOGY

HOSPITAL

VISIT

LAB SYSTEM PUBLIC

HEALTH

SERVICE

PROVIDER

OFFICE

VISIT

Electronic

Health Record

Common

Logistics

Electronic

Health Record

Open-Source Provides Integration Without Barriers


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

Federal Agencies Leading the

Way with Open Source

20

Source: Rick Avilo


Synergy Accelerates

Transformation

Leverage Federal expertise through “open” partnerships

Unleash the power of mass collaboration

Improve trust through transparency

Explore new avenues of development

Generating & Sharing Open-Source Knowledge Accelerates Innovation

www.max.gov


INTEGRATED ROADMAP

INTEGRATEDROADMAP

Website Content

PPC Roadmap Complete

Program Mgmt Plan

Planning Office Charter Complete

Risk/Issues Base-lined

Systems Engineering Plan

Acquisition Strategy

IMS Base-lined

CMM Deliverables

Integrated Roadmap Complete

Acquisition IA Strategy

SCHEDULED COMPLETE LEGEND:

Change

Readiness

Training

Press Clips &

Newsletters

Mission/Vision Statements

IN PROGRESS

MILESTONE DECISION

EHR Tri-Fold Complete

Final PESHE

Industry Days Held

ADM Complete

IA Strategy

TEMP

Capability Develop. Document

AoA Phase II

RFI-I / RFI-II Released

Information Support Plan

Data Mgmt Strategy

Engineering Action Plan

CARD

Idea Factory

Concept

Strategic Comms

Plan

Lifecycle Policies & Procedures

Strategy Document

Complete

Stakeholder

Analysis

EHRWA Style Guide

Interactive Presentations

Tech. Acronym

List

Leadership Engagement

Resource Library

Document Templates

Gov. Biographies

Complete

From, “EHR Way Ahead,” Aug 2011

Paula Friedman, Director, EHRWA, DoD MHS


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 worse

23

The Ultimate Outcome of Integration & IT Initiatives is Better Patient Care

Source:


“TRUSTED CARE ANYWHERE”