2016 AMSUS The Critical Role of Functional Communities in the MHS EHR Implementation

Disclosures The presenter has no financial relationships to disclose This continuing education activity is managed and accredited by Professional Education Services Group (PESG) 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

Learning Objectives Understand how business strategy supports an Electronic Health Record (EHR) implementation Identify key reasons for implementing a single integrated EHR for an organization of MHS’ scale and scope Understand the critical role that the functional communities play in a major EHR implementation SAY: CAPT Meier: Hello, I speak for the rest of the panel, when I say we are glad to have the opportunity to speak with you all today about MHS GENESIS End User Readiness and Approach to Go Live The learning objects for this session are: [READ each learning objective]

Agenda Why MHS GENESIS The Role of the Functional Communities MHS GENESIS Rollout Change Management and End User Engagement SAY: First we will explain the rationale for initiating MHS GENESIS Then we will provide an overview of the important role of the functional communities Next we will discuss plans for MHS GENESIS rollout We will close the presentation with a focus on change management and end user engagement There will be time at the end for Q&A so we ask that you save your questions until the end of the presentation

Why MHS GENESIS? CAPT Michael Meier ASK: So, why MHS GENESIS? Why are we doing this? And why now? Why MHS GENESIS? CAPT Michael Meier

MHS GENESIS is Critical to DHA’s Business Strategy Technology + People Enable Achievement of our Strategy Defense Health Agency (DHA) is a point, integrated Combat Support Agency that enables the Army, Navy and Air Force medical services to provide a medically ready force and ready medical force to Combatant Commands in both peacetime and wartime Technology provides the infrastructure needed to effectively execute DHA goals People execute technology – end user adoption is critical to the success of any technology we chose to implement A “Ready Medical Force” includes people ready to execute the technology needed to meet the needs of those served by DHA SAY: MHS GENESIS supports our business strategy Given the critical role that technology increasingly plays in the successful execution of business operations and subsequent patient outcomes, upgrades to the DHA’s technology were needed In addition to having a strong technology infrastructure, the future success of DHA depends on the ability of people to effectively use the technology put into place Together, technology plus people, will enable achievement of the business strategy Technology and people go hand in hand in facilitating a “medically ready force…ready medical force” So while MHS GENESIS involves implementing new technology, I want to be clear that it is bigger than a technology implementation. MHS GENESIS is about transforming how MHS does business in order to better meet the needs of those we serve

MHS GENESIS will Improve the MHS’s Quality of Service Challenges Solutions Globally disperse beneficiaries – many in remote locations Highly mobile beneficiaries and providers Separately managed Electronic Health Records (EHR) for each Service Approximately 50 legacy systems Integrated EHR, called MHS GENESIS One system for all Services that can securely manage healthcare records in globally disperse locations Joint Legacy Viewer (JLV) Web-based, integrated system to access legacy data, and allow a read-only view of data from the Department of Defense (DoD) and Veteran Affairs (VA) systems SAY: MHS is are undergoing a business transformation to improve the quality of service provided to beneficiaries Several challenges affect our quality of service - those listed on the screen are some of the key and also unique challenges that the MHS must deal with daily [READ the “Challenges”] An integrated EHR, called MHS GENESIS, was selected as a solution to address these challenges In addition, it was determined that a Joint Legacy Viewer would be used during the interim period to access legacy data while MHS GENESIS is being rolled out in waves

Benefits of MHS GENESIS Characteristics of an HRO MHS GENESIS will Help the MHS Become a High Reliability Organization (HRO) Implementation of MHS GENESIS is a joint effort across the Services to operate more like an HRO to benefit both beneficiaries and operators of the EHR Benefits of MHS GENESIS Characteristics of an HRO Better health record completeness Improved interoperability Reduced redundancies and costs Decreased potential for error in record sharing and reporting Simpler and safer transitions of care Easier access to health records for both beneficiaries and providers A proven product that is already functioning in the private sector Consistently performs complex, high risk, and highly technical tasks under conditions of tight coupling and extreme time, with minimal to no error Three Critical Components: Active leadership support A culture of safety, where safety is owned by all Robust process improvement methods SAY: The MHS has established the goal of transforming into a High Reliability Organization (HRO), and the EHR Modernization effort is a critical enabler of that transformation MHS GENESIS is expected to benefit both providers and beneficiaries – some of these benefits include: [READ a few from the slide] These improvements to MHS technology and how work is done, will move MHS closer to resembling the characteristics of an HRO

The Role of the Functional Communities Ms. Ann Wolford-Connors SAY: MHS GENESIS is an entire business transformation for the MHS (clinical and business) not just an Information Technology (IT) system The experience of commercial health systems nation-wide have shown that implementations that are conducted as collaborative missions between IT and functional communities are much more likely to succeed The Role of the Functional Communities Ms. Ann Wolford-Connors

This is a Large-Scale, Multi-Faceted Business Transformation Successful implementation of MHS GENESIS is dependent upon the ability to alter how individuals within MHS work together and think about work SAY: MHS GENESIS is a large and complex transformation – that is well known and understood What might be less well understood is that to be successful, MHS end users as a collective body need to alter how they think and actually perform work Organizational change is a function of individual level change – when individual end users own the success of MHS GENESIS, then the EHR modernization effort and MHS are better positioned for success This mindset change has to start with leadership – when leadership is aligned, the rest of the organization is more apt to support the effort - This is a collective effort between the Army, Navy, Air Force and DHA In 2014 the Functional Champions Leadership Group was established with the intent to provide a collaborative and transparent forum supporting oversight of all functional aspects of the DoD EHR and DoD interoperability efforts The Functional Champions, and its Functional Advisory Council, represents all functional interests of the Services and the larger clinical community; acts as a liaison with the functional (clinical, business, force health) and technical communities; and actively collaborates with DHMS program offices; DHMSM, Dod/VA Interagency Program Office, and Defense Medical Information Exchange (DMIX)

The MHS GENESIS Guiding Principles Serve as the MHS Roadmap to Success Standardize clinical and business processes across the Services and the 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 SAY: The MHS GENESIS Guiding Principles can be considered our roadmap to success They were carefully crafted and approved by the Surgeon General based on what must occur for MHS to succeed in the long-term Each of the principles is important and guide the design and implementation of MHS GENESIS

MHS Functional Communities Have Made Significant Impact to Date Using the Guiding Principles, the MHS functional communities collaborated to develop enterprise-leading order sets and workflows to ensure a high quality of care across the Department of Defense SAY: To date, functional communities have been engaged in a number of ways and have made a significant positive impact on the direction of MHS GENESIS Here are examples of how the functional communities have collaborated to ensure MHS GENESIS meets the needs of end users and beneficiaries Test Script Development – Developed scenarios reflecting MHS current state TSWAGs – Developed 680 future state standardized workflows and made 2500 design recommendations SMEs – 750+ specialist participated in the design of 450 order sets and 300 content sets These activities also demonstrate the following guiding principles in action: Standardize clinical and business processes across the Services and the MHS 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

SMEs Across the MHS are Engaged to Ensure an Enterprise Solution 800 + Tri-Service Subject Matter Experts (SMEs) are the voice of the functional communities providing expertise for: Workflow Design to develop standard workflows that leverage integrated functionality Process Redesign of clinical and business workflows outside MHS GENESIS Standardization of documentation, clinical hand-offs, paper forms, and protocols among the Services Training Material Review of over 140 training courses to ensure clinical content is accurate Testing of scenarios and scripts Issue Resolution as real-time questions and issues arise SAY: The functional communities continue to be actively engaged in our road to implementation of MHS GENESIS One way we ensure input from frontline care professionals in all three Services is through our Tri-Service Workflow Advisory Groups – The TSWAGS These SMEs provide expertise for: Workflow design Process re-design Standardization Training material review Testing Functional issue resolution

MHS GENESIS Rollout Col Ray Jeter SAY: Now I will discuss plans for rolling out MHS GENESIS MHS GENESIS Rollout Col Ray Jeter

MHS GENESIS Rollout Plan Deploy February 2017: Fairchild Air Force Base Deploy as early as June 2017: Oak Harbor Navy Hospital Bremerton Navy Hospital Madigan Army Medical Center Full deployment across MHS by 2022 SAY: MHS GENESIS deployment is built on a “wave” model Initial Operating Capability (IOC) sites in the Pacific Northwest will be the first to implement MHS GENESIS – starting with Fairchild in February 2017 Oak Harbor, Bremerton and Madigan will follow as early as June 2017 Note that each of the Services is represented by an IOC site MHS GENESIS will be fully deployed across MHS by 2022

A Standard Set of Rollout Activities Will Occur SAY: Regardless of location, a standard set of activities will unfold during MHS GENESIS waves They will each start with a Command Executive Brief and identification of key resources, followed by general session overview and model system reviews There will be user role assignments, and system validations End user training will occur about 3 months pre-go live Sustainment support will be provided post go-live

Sustainment Support will be Available to End Users Post Go Live A variety of external and internal post go live support will be available to meet individual End User needs External support will peak during the weeks following post go live and then gradually decline Internal support will remain on hand to assist End Users SAY: In recognition of the large nature of this business transformation, end users will have access to several forms of post-go live sustainment support While considerable external support will be provided for the first 90-days post go live, this is an effort MHS need to own Therefore, 90 days post go live, internal resources will provide the bulk of sustainment support in the form of: Super Users A 24/7 Help Desk Learning Aides

End User Engagement CAPT Scott Johnson SAY: So as previously indicated, end user engagement is a critical enabler of the success of MHS GENESIS and consequently the quality of service provided to beneficiaries Therefore, I want to spend some time discussing what has been done at MHS to build and sustain MHS GENESIS end user engagement End User Engagement CAPT Scott Johnson

Change Management Builds Individual Ownership for the New EHR Change management proactively plans for and addresses both the organizational and people side of change Integrated with project management, change management recognizes the importance of individual and environmental factors in supporting necessary behavior changes Current State Future State Change Management Sustained Outcomes Risk Without Change Management SAY: Change is hard Over 50% of large scale organizational changes fail – largely because they fail to plan for change Change Management is an integral part of the MHS GENESIS roll-out strategy Since change happens at an individual level, it is important to understand how people react to change and prepare accordingly

Functional Community Members Fill Several Change Management Roles Advocate for the MHS GENESIS and associated standardized processes Have direct access to and relationships with medical and health professionals Champions Serve as a key resource to Medical Treatment Facility/Dental Treatment Facility (MTF/DTF) personnel during transition to the new EHR system Provide clinical expertise across the lifecycle of the EHR deployment Super Users Ensure that correct user roles are assigned by Supervisors Responsible for communicating with Supervisors about specific process and roles changes Site User Role Assignment Coordinator Serve as main point of contact to plan, coordinate and conduct all deployment-related activities for a site (e.g., site visits and training, and user adoption metrics tracking) Site POC SAY: The MHS functional community has been engaged in a number of ways – some examples of specific roles include: [READ a few from the slide] Provide sustainment training support for new users post go-live Local Site Trainer Perform Tier 0 application troubleshooting and resolve local network connectivity issues Serve as primary point of contact for onsite MHS GENESIS user issues System Administrator 20

Change Management Activities are Planned from Pre to Post Go-Live Super User Calls Monthly calls that cover: Business process changes Super User responsibilities Favorites Fair Pre go-live in person event to customize order sets and preference lists User Adoption Feedback Assessments to measure adoption levels Change Network Calls Monthly calls to discuss: EHR and DHMSM program updates Program schedule updates Upcoming site activities Site feedback Change Discussion Workshop Prep session for Supervisors to communicate system impacts SAY: Efforts to engage end-users span the lifecycle of MHS GENESIS implementation from pre to post go-live For instance, some recurrent change management activities include: Soliciting User Adoption Feedback Hosting Super User Calls Holding Change Network Calls 21

Key Takeaways Infrastructure – MHS GENESIS will provide the infrastructure necessary to better meet the needs of the MHS’s global and highly transient beneficiaries and healthcare providers The Power of One – MHS GENESIS is an integrated EHR for all Services that will provide a more complete view of health records Collaboration – MHS GENESIS is a complex and long-term effort and success is highly dependent on the willingness of the Services to work together Strategic Rollout – The IOC wave is an important first step for charting the course of subsequent waves Individual Ownership – End User support is critical to the successful design and rollout of MHS GENESIS Resources – A variety of resource support will be provided to End Users post go live SAY: The key takeaways from this presentation can be summarized into 6 key points [READ key takeaways]

Thank You for your Attendance What questions do you have about MHS GENESIS? SAY: Thank you for attending this session ASK: What questions do you have about MHS GENESIS?

Obtaining CME/CE Credit If you would like to receive continuing education credit for this activity, please visit:   http://amsus.cds.pesgce.com