1. HIT Enterprise Transformation: EHR Rollout...It's Happening Now!
COL Nicole Kerkenbush
Military Deputy Program Executive Officer, Program Executive Office
Defense Healthcare Management Systems

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 have no financial interest to disclose.
Commercial support was not received for this activity.

3. PEO DHMS Mission
To efficiently improve healthcare for the active duty military, veterans, and beneficiaries by:
Establishing seamless medical data sharing between DoD, the VA and the private sector
Modernizing the Electronic Health Record (EHR) for the Military Health System

4. PEO DHMS Organization Where We Fit
Department of Veterans Affairs
Secretary of Defense
USD for Acquisition, Technology, and Logistics
Program Executive Office DoD Healthcare Management Systems
(PEO DHMS)
USD for Personnel and Readiness
ASD, Health Affairs
DoD/VA Interagency Program Office (IPO)
Standards
Defense Medical Information Exchange (DMIX)
Information Exchange
DoD Healthcare Management System Modernization (DHMSM)
Modernized EHR Acquisition
Defense Health Agency (DHA)
Office of Information Technology
Joint Operational Medicine Information Systems (JOMIS)
Deployment of EHR to operational forces

5. A Common Goal “I walk slowly, but I never walk backward.”
2009
EHR Way Ahead
2010
iEHR
2013
DHMSM Kick-Off
2015
Contract Award
2006
AHLTA Fielding Complete
“I walk slowly, but I never walk backward.”
- President Abraham Lincoln

6. Why Modernize?

7. Collaborative Delivery of a Modernized EHR
To deliver a modernized EHR to the military garrison and operational points of care, and transform how the military health system provides healthcare, the Services, DHA and Acquisition Teams will collaboratively work with the care locations to configure, test, train and deploy the new solution
Conclusion
Acquisition
DHMS
Solution Delivery & Infrastructure
DHA
Site Preparation
Services
Modernized
EHR
Business Processes
& Requirements
Functional Champion
Deploy to
1,200+ Care Locations
& 205,000+ Providers
Across the World

8. 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

9. MHS Approved Requirements Operating Environment
Enterprise EHR
EHR Modernization Guiding Principle: A flexible and open, single enterprise solution for
both garrison and operational healthcare
DHMSM
JOMIS
EHR
60+
Capabilities
JROC CDD
Requirements
DHMSM Configured EHR +
Theater Capabilities (Low to No Communications) + =
Medical Command and Control (Med C2)
Medical Logistics (Med LOG)
Health Care Delivery (HCD)
Patient Movement
Medical Situational Awareness (Med SA)
MHS Approved Requirements
Consolidated Data Center
Small & Distributed Form Factor
MED COI Infrastructure
Service Tactical Infrastructure
Competitively acquire, test, deliver, and successfully transition to a state-of-the-market EHR
Deployment of the new EHR and new theater capabilities to expeditionary locations
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
55 Military Medical Centers
& Inpatient Hospitals
352 Health Clinics
282 Dental Clinics
450+ Forward & Resuscitative Sites
300+ Ships
2 Hospital Ships
6 Theater Hospitals
3 Aeromedical Staging units
Operating Environment

10. Industry Experience Risks to EHR Deployment Lack of Standardization
Lack of Agile Decision Making
Poor Governance Process
Ineffective Communication

11. EHR Modernization Synchronization Workstream Steering Committees (WSCs)
Objectives:
Support coordination, communication, and recommendations of EHR related activities
Provide agile O-5/O-6 decision making and subject matter expertise
Maintain synchronization across multiple organizations
Objective is not to:
Direct the contractor
Replace existing organizational missions or structure

12. Workstream Steering Committee Descriptions and Leads
PEO DHMS Lead – COL Nicole Kerkenbush DHA HIT Lead – LTC(P) Rich Wilson
Workstream
Mission
Leads
Data
Data management activities
Patti Lothrop (DHMS)
Andy Anderson (DHA HIT)
Technical & Configuration Management
Technical & Environmental Configuration Management
Medical & End User Device Integration
Security
Interfaces/Conversion
Jim Bates (DHMSM)
Nick Saund (DHA HIT)
Infrastructure
Hardware
Network
Heather Burke (DHMS)
Dr. Pete Marks (DHA HIT)
Product Configuration
Reconciliation of MHS workflows with EHR vendor-provided workflows
COL Jacob Aaronson (DHMSM)
FAC Chair (Services)
Test & Evaluation (T&E)
Technical
Cyber Security
Operational
Dr. Greg Guernsey (DHMSM)
Giancarlo Osorio (DHA HIT)
*SDD Test Manager TBD
Training
Initial and ongoing (sustainment) user training
LCDR Kent Bui (DHMSM)
Michele McCormick (DHA HIT)
Strategic Communications
Provide public affairs guidance, communications support, and
COL Nicole Kerkenbush (DHMS)
Tanya Bradsher (DHA—MHS Communications)
Deployment / Activation
Technical preparations, support plans and resources, and practice trials before executing the deployment of a new EHR system
Len Cayer (DHMSM)
Dr. Brian Jones (DHA HIT)

13. Standardization Supports:
Why Standardize?
Standardization Supports:
Effectiveness
Agility
Cost Efficiency
Quality
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

14. EHR Configuration Management
Multi-Service Market Leadership
Medical Operations Group
Medical Business Operations Group
Manpower and Personnel Operations Group
Functional Advisory Council
Service Deputy
Surgeons General
EHR Functional Champions Leadership Group (FCLG)
DHMSM EHR program requirements have been formally established
Changes will be addressed by a formal Configuration Steering Board (CSB)
Co-Chaired by USD, AT&L and ASD, HA
Prevent unnecessary changes that could have an adverse impact on cost or schedule
Functional requirement modifications will be handled and addressed by the FCLG
FCLG
DHA: RADM (Ret) Roberts
Army: BG Place
Navy: CAPT Zinder
Air Force: Maj Gen Allen
FAC
DHA: CAPT Meier
Army: Ann Wolford-Connors
Navy: CAPT Ellzy
Air Force: Col Jeter

15. DHMSM Initial Operational Capability Timeline

16. DHMSM Initial Operational Capability Sites
Washington
92ND Medical Group & Aeromedical DEN SQ/SGD
Naval Hospital Oak Harbor
NHCL Everett
Naval Hospital Bremerton
NBHC Sub-base Bangor
Puyallup Medical Home
Madigan AMC
Madigan AMC 16

17. Contact Us
health.mil/dhms @DoD_EHR Defense Healthcare Management Systems