1. Red Light, Green Light: Insight into Decision Making for a Large-Scale EHR
Dr. Paul Cordts, Military Health System (MHS) Functional Champion BG Ronald Stephens, Army Functional Champion Major General (Dr.) Roosevelt Allen, Air Force Functional Champion Dr. Michael Malanoski, Navy Functional Champion November 29, 2017

2. Disclosures Presenters have no interest to disclose.
AMSUS and PESG staff have no interest to disclose.
This continuing education activity is managed and accredited by Professional Education Services Group in cooperation with AMSUS. PESG, AMSUS, planning committee members and all accrediting organizations do not support or endorse any product or service mentioned in this activity.

3. Agenda
Introduction
Impact of MHS GENESIS Rollout at Initial Operating Capability (IOC) Sites
How Decisions Are Made: MHS GENESIS Guiding Principles
MHS GENESIS: Looking Ahead to Key Issues
Q&A

4. Learning Objectives
At the conclusion of this activity, the participant will be able to:
Understand how decisions are made about changes or updates to MHS GENESIS requested by the clinical community
Understand how the MHS GENESIS rollout at IOC sites has improved patient and provider experiences, increased efficiency and improved the quality and safety of care
Understand key challenges and opportunities as MHS GENESIS goes live in more and larger sites

5. Impact of MHS GENESIS Rollout at IOC Sites

6. AHLTA and CHCS EHRs Falls Short of MHS Vision
The Case for Change
AHLTA and CHCS EHRs Falls Short of MHS Vision
The MHS EHR must operate in a highly standardized and integrated environment for a “medically ready force” and “ready medical force”
MHS Armed Forces Health Longitudinal Tracking Application (AHLTA), Essentris, and Composite Health Care System (CHCS) Electronic Health Record (EHR):
is NOT functioning as a fully interoperable system within the DoD, VA, Tri-Services
does NOT provide a continuum of care of health information exchange (HIE) to the full range of Tri- Service military operations in all roles of care from point of injury, primary care, theater hospitalization, and sustaining healthcare in CONUS/OCONUS MTFs

7. MHS Transformation Strategy
Why MHS GENESIS?
MHS Transformation Strategy
Implement an integrated EHR, MHS GENESIS, beginning in 2017
Address the joint Tri-Service medical enterprise EHR challenge through enterprise BPR, workflow/clinical content standardization, change management, user testing, and training
Integrate 50+ legacy systems
Use an off-the shelf product – configurable, not customizable, with regular updates
Standardize processes across the Garrison and the Operational communities
Learn from large, global, private sector health care providers who have implemented an EHR
Implement an integrated EHR, MHS GENESIS, beginning in 2017
Address the joint Tri-Service medical enterprise EHR challenge through enterprise BPR, workflow/clinical content standardization, change management, user testing, and training
Integrate 50+ legacy systems
Use an off-the shelf product – configurable, not customizable, with regular updates
Standardize processes across the Garrison and the Operational communities
Learn from large, global, private sector health care providers who have implemented an EHR

8. Impact of MHS GENESIS Safety and Quality
Automate data capture/availability
Reduce preventable errors via technology
Embed evidence-based medicine
Expand clinical decision support to institutionalize best practice
Patient Engagement and Satisfaction
Improve patient environment and engagement
Streamline and enhance patient access
Enhance patient portal experience
Clinical Efficiencies
Enhance care team documentation
Engage referring providers
Create specialty-specific views
Expand the availability of external clinical data
Operational Efficiencies
Advance clinical integration
Optimize scheduling and staffing
Improve real-time access to information
Streamline patient-centered data

9. MHS GENESIS Deployment
February 2017
Fall / Winter 2017
Target 2022
Initial deployment of MHS GENESIS commenced at Fairchild Air Force Base
Deployment at remaining inpatient facilities in the Pacific Northwest
Enterprise wide wave deployment to all Military Treatment Facilities and Dental Treatment Facilities
Initial Deployment
Inpatient Deployment
Full Deployment
Training and Change Management Activities

10. Increasing Capabilities and Site Complexities
Sites Selected for IOC
Four facilities within the Pacific Northwest were selected to serve as the pilot sites for MHS GENESIS rollout, each representing different demographics and challenges representative of the larger MHS.
Fairchild
Oak Harbor
Bremerton
Madigan
Increasing Capabilities and Site Complexities
Service
Air Force
Navy
Army
Delivery Services
Outpatient only
Inpatient and Outpatient
Site Specific Selection Factors
Small size
Medical and dental services
First inpatient obstetrics site
Larger Inpatient facility
Greater variety of services
First site with intensive care units
Large emergency department
40 specialty areas

11. Lessons Learned from IOC Sites
Technical Readiness
Close coordination between DISA, J6, and the DHMSM PMO to get MED-COI deployed, tested, and ready for the site is critical
Training Methodology
Training approach and content requires improvement and closer ties to workflows
Subject matter expertise across the enterprise on all aspects of MHS GENESIS can be improved
Change Management
User role assignments/permissions must be studied at enterprise level
Communicating workflows; bridging knowledge gaps from old to new processes early in the transition is helpful
Continuous leadership communication and buy-in is key
Issue Resolution
Bucketing of tickets based upon responsibility – functional vs. technical – helps with addressing / remediating tickets, as does prioritizing issues and incidents
Communicate to end users about status of tickets

12. How Decisions Are Made: MHS GENESIS Guiding Principles

13. MHS GENESIS Guiding Principles
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
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

14. Functionally Driven
Functional Champions Leadership Group (FCLG) and Functional Advisory Council (FAC)
Serve in senior governance role for decision-making
Make decisions raised to them by representatives of the functional community working on the design of MHS GENESIS
Tri-Service Workflow Advisory Groups (TSWAGS)
19 lines of business across 6 branches:
Health Care Operations
Ambulatory Care / Readiness
Inpatient & Hospital Based Outpatient Care
Specialty Care
Clinical Support
Revenue Cycle

15. Enterprise Issue Resolution
Development involved 60+ stakeholders from across the MHS:
Services
PEO / PMO, Functional Community, DHA Heath IT
DHA Information Management
Leidos Partnership for Defense Health

16. MHS GENESIS: Looking Ahead to Key Issues

17. MHS GENESIS Key Capabilities
MHS GENESIS brings improved capabilities to the enterprise
19 “Showstoppers”
MHS GENESIS will not deploy beyond IOC sites if showstoppers are not implemented
Pharmacy Services – 7 showstoppers
Routine Ambulatory Care – 3 showstoppers
Utilization Management – 3 showstoppers
Diagnostic Services – 2 showstoppers
To be deployed at IOC sites
Improved capabilities
Patient Account
Blood Services
Clinical Decision Support and Analytics
Team Communication
Secure Messaging

18. How We Address Our Mobile Population
Joint Legacy Viewer (JLV) Patient Portal Access
Provider and Beneficiary

19. Cybersecurity

20. Medical Readiness

21. Visit booth 222 for live MHS GENESIS and JLV demonstrations
Key Takeaways
MHS GENESIS will improve outcomes at IOC sites in the areas of safety and quality; patient engagement and satisfaction; operational efficiencies; and clinical efficiencies
We are collecting lessons learned from IOC deployment to apply when MHS GENESIS rolls out in waves to other MTFs
MHS GENESIS guiding principles, governance structure, and issue resolution process enable responsiveness to requests for system changes
Issues facing MHS GENESIS rollout in the near future are deploying key capabilities; addressing patient mobility; cybersecurity; and medical readiness
Visit booth 222 for live MHS GENESIS and JLV demonstrations

22. Questions?
If we do not get to all your questions, feel free to contact us:
Dr. Paul Cordts, MHS Functional Champion
BG Ronald Stephens, Army Functional Champion
Major General (Dr.) Roosevelt Allen, Air Force Functional Champion
Dr. Michael Malanoski, Navy Functional Champion

23. Appendix

24. Glossary – MHS GENESIS Governance
FCLG = Functional Champion Leadership Group
FAC = Functional Advisory Group
SSG/CSB = Senior Stakeholders Group / Configuration Standardization Board
BPM WG = Business Process Management Working Group

25. CE/CME Credit
If you would like to receive continuing education credit for this activity, please visit: