Defense Healthcare Management Systems AFCEA: Federal Networks Conference Mr. Christopher Miller PEO DHMS 18 February 2014 AFCEA: Federal Networks Conference 02/18/2014 PEO DHMS Distribution A: Approved for public release; distribution is unlimited 1 Transformation – 3 Keys to Success “Technology is just a tool.” -Bill Gates People Technology AFCEA: Federal Networks Conference 02/18/2014 Process PEO DHMS "Any intelligent fool can make things bigger, more complex, and more violent. It takes a touch of genius – and a lot of courage – to move in the opposite direction." - Albert Einstein AFCEA: Federal Networks Conference 02/18/2014 PEO DHMS DoD’s Health IT Challenge AFCEA: Federal Networks Conference 02/18/2014 PEO DHMS PEO DHMS Mission and Vision MISSION Acquire, integrate, and deploy electronic health record solutions that improve clinical decisionmaking and advance healthcare data interoperability VISION Positively impacting the health outcomes of Service Members, Veterans, and beneficiaries AFCEA: Federal Networks Conference 02/18/2014 PEO DHMS Where We Fit Acquisition Secretary of Defense VA Functional USD AT&L USD P&R PEO DHMS ASD (HA) DHA IPO Lead and coordinate DoD and VA adoption of and contribution to health data interoperability standards AFCEA: Federal Networks Conference 02/18/2014 DHMSM Competitively acquire, test, deliver and successfully transition to a state-ofthe-market EHR System DMIX Provide technical solutions for seamless data sharing and interoperable health records that evolve with national standards PEO DHMS Who We Support Globally, across all time zones, and to the full range of military operations (DoD) Total Health Staff Personnel Eligible Beneficiaries 9.7M 146K Civilians Military Personnel 60K 86K Clinicians 70K AFCEA: Federal Networks Conference 02/18/2014 Active Duty Active Duty Family Members 1.4M 2.0M National Guard/ Reserve Corps & Family Members Retirees and Family Members 1.1M 5.2M Prime Enrolled Beneficiaries 5.5M PEO DHMS Where We Support Theater Hospitals Medical Centers Ambulatory Care Clinics 6 57 364 Naval Ships Dental Clinics Veterinary Facilities 117 281 255 Hospital Ships 2 Submarines 71 AFCEA: Federal Networks Conference 02/18/2014 PEO DHMS DHMS vs. Commercial Deployments The acquisition and deployment timelines required for an EHR implementation vary based on the number of facilities, the number of employees, and the geographic dispersion of the implementation sites. Number of Hospitals Hospital System Number of Clinics Number of Physicians Number of Employees Deployment Scope Time (Years) Department of Defense (Military Health System)1 57* 364** 70,000* 146,440* Worldwide 2014 – 2019 (estimated) Commercial System A2 38 611 16,942 174,259 US 2003 - 2010 Commercial System B3 3 223 2,572 14,400 Regional 2011 - 2014 Commercial System C4 20 43 10,000 22,000 Regional 2006 – 2008 Commercial System D5 3 42 900 4,073 Regional 2009 – 2009 E6 4 Regional 2009 – 2011 2011 – 2011 Commercial System Superscripts 1, 2, 3, 4, 5 sited in Appendix A * US and Abroad **Medical Clinics Only AFCEA: Federal Networks Conference 02/18/2014 51 315 6,300 Pursuing an aggressive timeline to get this EHR implemented in a timely fashion to maximize our return and value to our users PEO DHMS Overall Approach to EHR Modernization Metcalfe’s Law Leverage the commercial industry through competition Occam’s Razor Simplify our acquisition strategy Reed’s Law Maximize the data sharing and interoperability to increase clinical value Mooers’ Law Focus on usability and clinical value Sowa’s Law Ensure system is open and flexible Achieving Greater Efficiency and Productivity in Defense Spending AFCEA: Federal Networks Conference 02/18/2014 PEO DHMS Metcalfe’s Law: Leverage the Commercial Industry through Competition Widespread EHR Adoption Over the Last Twelve Years High US Spending on Health IT 100 Projected Health IT Spending in the United States 2014: $34.5 80 Billion 78.4 71.8 60 Health IT Spending Breakdown by IT Category 57.0 Database & Middleware:13% 48.3 51.0 40 Systems Management:14% 42.0 34.8 20 18.2 17.3 17.3 20.8 0 2000 2002 2004 23.9 BI/Analytics: 17% 29.2 2006 2008 2010 2012 2014 Productivity Applications:12% Business Applications:20% Industry Applications:24% U.S. Department of Health and Human Services NCHS Data Brief. January 2014 Metcalfe’s Law: The value of a telecommunications network is proportional to the square of the number of connected users of the system (n2). AFCEA: Federal Networks Conference 02/18/2014 PEO DHMS Occam’s Razor: Simplify our Acquisition Strategy • Streamlined Acquisition Documentation – Tailored to fit the specific needs of an EHR system acquisition • Requirements Driven by State of Commercial Market – Releasing draft RFPs to maximize feedback and shape final product – Hosting multiple Industry Days to make sure we develop an acquisition strategy that fits the state of the EHR market – Extensive market research to drive requirements and minimize development • Simplified Contracting Approach – Competitive – Single award contract – Gating strategy Occam’s Razor: A principle of parsimony, economy, or succinctness used in problem-solving. It states that among competing hypotheses, the hypothesis with the fewest assumptions should be selected. AFCEA: Federal Networks Conference 02/18/2014 PEO DHMS Simplify our Acquisition Strategy (cont.): DHMSM Program Schedule FY14 1Q 2Q FY15 3Q 4Q 1Q 2Q 3Q RFP ATP DHMSM Milestones FY16 4Q 1Q 2Q SIT TRR Begin Interface/Data/ IA / Infrastructure Analysis Planning -Requirements Technical Data Library Populated Initial Design Review Cost Analysis Document with ICE & CARD elements LCCE RFP IGCE -Cost Prioritized Functional Requirements 3Q Capabilities Gap Analysis Initial Requirements Review Release RFP Receive Vendor Proposals 4Q 1Q Fixed Facilities Limited Fielding Decision IOC ATP Award ATP -Program Milestones -Technical Reviews FY17 2Q Fixed Facilities FDD ATP OTRR Final Design Review Final Requirements Review Legend Upcoming Event: Completed Event: Upcoming Program Dependency: Completed Program Dependency: Milestone Decision Point: Contract Award -Acquisition Draft RFPs #1-3 GALS I&S Plan Complete Testing -Contractor Integration Testing GALS Implemented CIT SIT Test Strategy #1-3 GALS Implementation -Developmental Testing Use & Test Case Analysis OT Install in GAL -Operational Testing IATO Evaluate Contractor Training Package Training for SME Limited Fielding Training [Technical / Functional] User Adoption & Training Draft Training & Change Management Plans #1-3 Identify Enterprise Learning Management System Define Enterprise User Roles CBT Advanced Training CBT Advanced Initial End Training User Training FAC Evaluation of Contractor Training Package Fielding and Deployment Develop Projected Enterprise Deployment Schedule Draft DSP #1-3 WRAMC site visit Preliminary IOC site visit Final DSP Command Develop Site Executive Visit Briefs Materials IOC Site Visit & Kick-off Executive & End User Briefing Site MOA Complete Full IOC Fielding Training Installed at IOC Sites Onsite Support Business User Role Site Checklist Process Assignment Complete Workshop PEO DHMS Distribution A: Approved for public release; distribution is unlimited Onsite Support User Provisioning 2/18/2014 AFCEA: Federal Networks Conference 02/18/2014 CBT Advanced Initial End Training User Training Seg 1 IOC 13 Simplify our Acquisition Strategy (cont.): Notional Evaluation Process Service Provider/Integrator (SPI) Unacceptable “No-Go” Integrator “Go Criteria” • Deployment Experience • Migration Experience • Collateral System Interface Exp • Security – Commercial & DoD • Transferable Software Licenses • Small Business Participation • Associate Contract Agreements • Unified Training Plan Integrator EHR Solution Set Gate 1A Gate 1B “Go” “Go” Viable Competitor “No-Go” Unacceptable Solution “Go Criteria” • ONC Certification – BoS • Integrated BoS Requirements Mapping • ONC Certification – BoB • Integrated Dental Module Performance / Price Trade off “Best Value” to Award Potential Trade-offs Integration & Configuration Approach, Deployment Strategy & Approach, User Adoption, Functionality & Requirements, Open Systems Architecture, Product Usability, Management Approach, Past Performance Cost/Price Factors Award Phase I – Integration, Configuration, Testing, & IOC Deployment Phase II – Garrison | Expeditionary Deployments & Initial Lifecycle Sustainment AFCEA: Federal Networks Conference 02/18/2014 PEO DHMS Distribution A: Approved for public release; distribution is unlimited 14 Simplify our Acquisition Strategy (cont.): Notional Contract Strategy • Single Award • • • Cost Reimbursement & Fixed Price Cost Accounting Standards (CAS) –FAR Part 30 Earned Value Management (EVM) –DFARS 234.2 • 5 –10 years (duration driven by site deployment) • Draft #1 released 27 January 2014 Draft #2 scheduled to be released end of March • Task Order Contract Line Item (CLIN) Indefinite Delivery Indefinite Quantity (IDIQ); full and open competition Prime contractor will bring the right team Gate (“Go / No-Go”) criteria prior to best value trade-off • Contract Period of Performance (PoP) Request for Proposal (RFP) Schedule • • Phased Approach AFCEA: Federal Networks Conference 02/18/2014 • Phase I –Integration, Configuration, Testing, & IOC Deployment Phase II –Permanent Military Treatment Facilities (MTFs) (garrison) | Temporary MTFs (expeditionary) Deployments & Initial Lifecycle Sustainment PEO DHMS Reed’s Law: Maximize Data Sharing and Interoperability to Increase Clinical Value • Engage with Private Sector – More than 50% of DoD healthcare data is provided by private sector providers – Expanding interoperability Is critical to complete the patient “picture” • Continue to Partner with Veterans Affairs Interoperability – – – – Most VA patients received care in DoD Many patients receive care in both DoD and VA Remain co-staffed on joint efforts Collaborate to ensure compatibility • Collaborate on Data Standards – Partner with ONC and other health standards setting organizations to identify, develop, implement, and adopt universal standards Reed's Law: The utility of large networks, particularly social networks, can scale exponentially with the size of the network. AFCEA: Federal Networks Conference 02/18/2014 PEO DHMS Distribution A: Approved for public release; distribution is unlimited 16 Mooer’s Law: Focus on Usability and Clinical Value Main contracting focus on off-the-shelf “Core” EHR capability that allows little tailoring and provides a consistent platform across multiple domains to support training, clinician needs, and efficient business workflows. Seamless and effective EHR transition Utilize established technological support Conduct tailored training in multiple formats Use commercial interfaces and flexible workflows Buy a proven off-the-shelf solution Develop contract structure that incentivizes and rewards continual improvement Mooers’s Law: An information retrieval system will tend not to be used whenever it is more painful and troublesome for a customer to have information than for him not to have it. AFCEA: Federal Networks Conference 02/18/2014 PEO DHMS Distribution A: Approved for public release; distribution is unlimited 17 Sowa’s Law: Ensure System is Open and Flexible Core design principles: Open system architecture approach to support interoperability Platform Flexibility Scalability Make adding, upgrading, and swapping components easy Support deployments based on scalable system architecture Data Centricity Utilize open standards to broker data between stakeholder Sowa’s Law: Whenever a major organization develops a new system as an official standard for X, the primary result is the widespread adoption of some simpler system as a de facto standard for X. AFCEA: Federal Networks Conference 02/18/2014 PEO DHMS Distribution A: Approved for public release; distribution is unlimited 18 What Does Success Look Like? • Service Members and Veterans − Increased record portability − Improved record accessibility • Clinicians − Improved decision-making based on more complete and integrated patient information − State-of-the-market EHR system that continues to mature with the robust health IT marketplace AFCEA: Federal Networks Conference 02/18/2014 PEO DHMS Distribution A: Approved for public release; distribution is unlimited 19 Positively impacting the health outcomes of active duty military, Veterans and their beneficiaries AFCEA: Federal Networks Conference 02/18/2014 PEO DHMS Distribution A: Approved for public release; distribution is unlimited 20 Data Sources Hospital System Source Department of Defense (Military Health System)1 Kaiser Permanente2 Duke University3 Bon Secours Health System, Inc. 4 Kennedy Health5 MidMichigan Health6 AFCEA: Federal Networks Conference 02/18/2014 DoD Healthcare Management Systems Modernization (DHMSM) Draft Request for Proposal #1 (February 2014): https://ecommerce.sscno.nmci.navy.mil/Command/02/ACQ/navhome.nsf/homepage?readform&db=navbusopor.nsf&whi chdoc=5634A1829B402D6E86257C6F007329CD&editflag=0 http://tricare.mil/tma/dhcape/program/downloads/TRICARE2013%2002_28_13%20v2.pdf http://share.kaiserpermanente.org/article/fast-facts-about-kaiser-permanente/ http://share.kaiserpermanente.org/article/kaiser-permanente-completes-electronic-health-recordimplementation/ http://www.dukehealth.org/health_library/news/duke-medicine-completes-implementation-ofelectronic-health-records-across-all-outpatient-facilities-and-duke-university-hospital http://www.dukemedicine.org/AboutUs/PatientCare http://www.bshsi.org/about-us-about-us.html http://careers.bonsecours.com/ http://www.kennedyhealth.org/kennedys-facts-and-history.html https://www.midmichigan.org/about/facts-figures/ https://www.midmichigan.org/app/files/public/849/pdf MidMichiganHealthEvolution_June2007.pdf https://www.midmichigan.org/app/files/public/711/pdf-2011 2012_MidMichigan_Health_Annual_Report.pdf’ PEO DHMS Distribution A: Approved for public release; distribution is unlimited 21
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