1. HIT Enterprise Transformation: EHR Rollout...It's Happening Now!
Mr. David Bowen, SES
Director, Defense Health Agency (DHA) Health Information Technology Directorate

2. Disclosures The presenter has no financial relationships to disclose.
This continuing education activity is managed and accredited by Professional Education Services Group in cooperation with AMSUS.
Neither PESG, AMSUS, nor any accrediting organization support or endorse any product or service mentioned in this activity.
PESG and AMSUS staff has no financial interest to disclose.
Commercial support was not received for this activity.

3. Learning Objectives:
At the conclusion of this activity, the participant will be able to:
Discuss the important changes, direction and benefits of the new EHR modernization
Discuss the strategic direction for the HIT Directorate and the concept of Shared Services
Explain how a culture of change is needed for operational success

4. Military Health System What We Currently Support
117
Naval Ships 6
Theater Hospitals 17
Submarines 57
Medical Centers
281
Dental Clinics
255
Veterinary Facilities 2
Hospital Ships
1,099 Locations in 16 countries
153,000 employees
364
Ambulatory Care Clinics
This graphic reflects the spectrum of MHS support today with our legacy systems. This will change somewhat with the deployment of the new EHR as COL Kerkenbush will discuss later in this session

5. HIT Transformation Modernizing MHS Management with an Enterprise Focus
Through DHA, we are --
Creating a more globally integrated health system
Driving enterprise-wide services and standardized clinical and business processes that produce better health and better health care
Implementing future oriented strategies and technologies to create a better, stronger, more relevant medical force
Transition from TMA to DHA is part of an effort to modernize MHS management—including management of DHA HIT—with an enterprise focus
This is a once-in-a-generation opportunity to shape the future of military medicine. Readiness and quality of care will be enhanced and beneficiaries will receive the same level of care from a more efficient and effective organization

6. Moving to a Shared Services Model
The Shared Services model organizes support functions to optimize delivery of reliable, flexible and cost effective services to customers in accordance with performance targets or service level agreements
When the DHA reached Initial Operating Capability (IOC) on October 1, 2013, the HIT Directorate was one of the first shared services to begin operating
Before the transition to DHA, HIT infrastructure and management were decentralized and managed within TMA and separately by the Services
Over the two-year period from October 2013 to October 2015, the HIT Shared Service consolidated assets from the Army, Navy, and Air Force to centralize HIT management
Services “All In” on HIT Shared Services from Day 1

7. Moving to a Shared Services Model October 2013 to October 2015
HIT Shared Service consolidates functions from the Army, Navy, and Air Force to centralize HIT management
Service IT management functions transitioned into DHA
DHA becomes single provider/coordinator of HIT services
Focus is on customer service optimization
To support the transition of the bulk of health IT functions to the DHA’s HIT Shared Service, the services’ IT management functions were transitioned into the DHA
Service CIOS have have been actively involved in the planning for the DHA’s HIT shared service
Consolidation and reengineering of IT management services and infrastructure services is being performed with a focus on customer service optimization
Ultimately, DHA becomes the single provider/coordinator of these services

8. HIT Shared Services Business Case Savings Areas
Re-engineering of IT management functions and processes
Consolidate management and management resources across the Services
Infrastructure Consolidation
Inventory and consolidation of duplicative contracts
Rationalize the MHS HIT application portfolio
Identify duplicative applications
Consolidate requirements, evaluate solutions
Decide on a single solution, decommission the others
Infrastructure Consolidation involves consolidation of
Identity Management
Engineering Services
Testing and Evaluation
Hosting Services
Network Operations
End User Support
Communications and Messaging, and
Information Assurance
We are realizing significant cost avoidance from our efforts to consolidate hardware and software contracts. At least $10M in cost avoidance has been achieved.
This is a DHA HIT good news story that demonstrates just how effective the reduction of duplication can be in reducing expenditures.
Rationalizing the MHS HIT application portfolio involves
Identifying duplicative applications
Consolidating requirements, evaluate solutions
Deciding on a single solution
Adopting the selected solution and decommissioning the others
Consolidation of hardware and software contracts alone
has yielded at least 10M in cost avoidance

9. HIT Shared Services Business Case Cost Savings for the DoD AND Improved, Simplified IT Support for the MHS
Consolidate and standardize IT infrastructure
One Forest: Active Directory and Enterprise Management
One Network: consolidate multiple networks
One put everyone on the same system
One Datacenter: a single datacenter hosting strategy
One Web: a single web hosting solution
One Desktop: a single desktop configuration and strategy
One Help Desk: a single help desk capability
One AV/Comm: a single AV/communications strategy
What does the consolidation of IT services under the HIT Shared Services business case mean for clinicians?
IT means we can successfully address two of your key pain points with HIT – system downtime and who to contact when you have an IT issue.
In addition to the consolidation and simplification achievements listed here, we are also working with DoD CIO to get you some relief from Common Access Card related challenges
DHA HIT is framing a set of use cases where utilization of a Common Access Card with the new EHR system may present significant challenges. These include
non-DoD personnel working in our healthcare system;
unmonitored computers such as ER tracking boards and central fetal monitors in a nursing station or provider on call room;
infection or contaminant control scenarios in lab settings; and
terminals routinely used by multiple staff members or beneficiaries in short time frames like those used for bedside charting or kiosks used for patient check in.
Potential means of addressing these situations under discussion include temporary token assignment, single sign-on with context roaming sessions: and proximity capability (radio frequency communication between the card and a reader).
We will be seeking a waiver from the DoD CIO to facilitate the implementation of solutions for some of these challenging scenarios to help our clinical community get their jobs done efficiently and securely.

10. Consolidated Infrastructure Services Objectives
Improve the quality of health care by implementing a single IT infrastructure from Desktop to Datacenter (D2D)
Eliminate IT redundancies across the enterprise to maximize effectiveness and achieve financial efficiencies
Increase IT responsiveness through a centrally managed and maintained technical architecture to support the military medical community
Support the requirements of the new EHR – implementing first in the Pacific Northwest (PNW) to achieve Initial Operating Capability (IOC)
Our objectives for consolidated infrastructure services include
Improving the quality of health care by implementing a single IT infrastructure from Desktop to Datacenter
Reforming the management of the IT infrastructure will, over time, give us the ability to manage health IT delivery all the way to the desktop (D2D concept)
The end result will be an enterprise-wide, integrated IT environment with standardized infrastructure and applications that are accessible through the devices used by MHS end users
Eliminating IT redundancies across the enterprise to maximize effectiveness and achieve financial efficiencies
Increasing IT responsiveness and agility through a centrally managed and maintained technical architecture to support the military medical community
AND
Supporting the requirements of the new EHR – implementing first in the Pacific Northwest (PNW) to achieve Initial Operating Capability (IOC) and then continue deploying enterprise-wide, leveraging lessons learned achieving IOC

11. Infrastructure Services Key Milestones for FY 16
Network
DHA Single Wide Area Network (Med-COI), as well as, Local Area and Wireless Network transition by end of Q2 FY16
Network
Desktop
Desktop
DHA manages standard Desktop by end of Q3 FY16
Enterprise Management
DHA Single Enterprise Management by end of Q2 FY16
IT Support
DHA manages the IT support model by end of Q3 FY16

12. Infrastructure Services Supporting the EHR Modernization
BUSINESS IMPACT
Network Security Management Service
Seamless integrated Wide, Local, and Wireless Network Management Single Security Architecture and centralized Designated Accrediting Authority, standardized monitoring and management resulting in Lower Costs and Improved Uptime
Directory Services/
Enterprise Management
Centralized and secure access and authentication capability to network resources
A Provider will be recognized on the network anywhere within the MHS!
Desktop as a Service
Desktop design standardization service across the application, desktop and server environments
Standardized desktop configuration and application virtualization capabilities across physical and virtual desktops for lower acquisition and management costs and improved problem resolution
Global Service Center
Consolidated MHS enterprise IT service desk
One number to call for help – from anywhere! Lower operating cost, 24 X 7 operation.

13. IOC Infrastructure End State Increased Bandwidth, Route Diversity and Backup Capability
DISA
NH Oak Harbor
NH Bremerton
Fairchild AFB
Madigan
Primary MED-COI Circuit
Secondary MED-COI Circuit
Physical Topology: Pacific Northwest Wide Area Network (WAN) IOC “To-Be” (As of 18 Nov)

14. Creating a Culture of Change
Success of the EHR implementation is equally dependent on technology AND change management
Optimal clinical community involvement to integrate the new EHR into the clinical workflow
Reengineer Business Processes
Decrease variation from site to site
To create a culture of change, the MHS clinical community – which drove EHR modernization requirements –must continue to lead
Ensuring that we optimally involve the clinical community is a key challenge in acquiring and implementing a modernized EHR
A culture of change is needed to for operational success. Success of the EHR implementation is dependent as much on effective change management as it is on technology
Our health IT community must work hand in glove with our clinical community to
Ensure that necessary business process re-engineering occurs to optimally integrate the EHR system into the clinical workflow across our health care delivery organization
Decrease unnecessary variation from site to site

15. DHA’s Dual Hatted Role Legacy and Sustainment Support
DHA is responsible for maintaining legacy systems and the new EHR in tandem
DHA HIT will support the clinical community throughout the transition period when both the new and legacy EHRs will be in use in different facilities by providing
Secure Messaging capabilities
Clinical lookback thru JLV (and the follow on solution)
Migration of data associated with key data domains into the new EHR
Refresher training for staff moving between sites with new EHR and legacy systems
Measurement of quality impacts using P41
Functional Champions (Services)
Legacy & Sustainment (DHA)
Acquisition (DHMS)
NEED TO REVALIDATE THIS INFORMATION
The clinical lookback capability is provided by JLV through the legacy and new EHRs
Lookback will be seamless to the new EHR user
When a troop goes from site with the new EHR to a site still using our legacy solutions, the information on those personnel captured in the new EHR will be visible through JLV
DHMSM information will flow to someplace where the current viewer can access it
7 Data Domains will be migrated natively into the new EHR . These include:
 1) Allergy
2) Medications
3) Procedures
4) Problem Lists
5) Immunizations
6) Demographics (Including PCM)
7) Payers (Other Health Insurance or OHI for patients)
Additional domains are being analyzed for potential inclusion.
Initially, any other historical data will be accessed via JLV when using the new EHR. Users of the new EHR will no longer have to AHLTA/CHCS

16. Preparations for IOC Rollout Modernization and Synchronization
Functional Champions (Services)
Legacy & Sustainment (DHA)
Acquisition (DHMS)
Coordination across Services, DHA and DHMS requires that we
Synchronize activities
Align decision making
Effectively partner with each other and the EHR vendor
DHA HIT and DHMS have built a strong partnership
8 EHR Synchronization Workstream Steering Committees maintain synchronization, make decisions and ensure optimal communication
With so many moving parts, it is imperative that we synchronize activities, align decision making and ensure effective partnering with each other and with EHR vendor
Examples of synchronization:
Nine Workstream Steering Committees
Acquisition, Governance and Program Management
Technical
Product Configuration
Change Management
Test and Evaluation
Training
Deployment / Activiation
Strategic Communications
Data
Schedule integration with local site personnel engaged in coordination activities
DHA HIT completed initial site visits to the first locations in the Pacific Northwest that will be receiving the new EHR and held follow on “summits” with local site coordination personnel
Information gathered informed infrastructure services requirements and the collaborative generation of site specific, tailored rollout plans for achieving IOC
Integration of D2D plan with the vendor deployment plan in EHR Kickoff meetings

17. EHR Modernization Guiding Principles
Approved by the ASD (HA) and Surgeons General
July 2014
Standardization of clinical and business processes across the Services and MHS
Design a patient-centric system focusing on quality, safety and patient outcomes that meet readiness objectives
Flexible and open, single enterprise solution that addresses both garrison and operational healthcare
Clinical business process reengineering, adoption, and implementation over technology
Configure not customize
Decisions shall be based on doing what is best for the MHS as a whole – not a single individual area
Decision-making and design will be driven by frontline care delivery professionals
Drive toward rapid decision making to keep the program on time and on budget
Provide timely and complete communication, training, and tools to ensure a successful deployment
Build collaborative partnerships outside the MHS to advance national interoperability
Enable full patient engagement in their health
Addressing Exceptions
As we receive requests for exceptions to our standardized way forward, these guiding principles will continue to serve as a reminder that to achieve standardization of clinical and business processes across the Services and MHS, we making decisions based on doing what is best for the MHS as a whole – not just an individual area.
We are moving forward in accordance with these principles and decisions will be made based on these principles