MRAR: Innovation in action Reflections on a disruptive innovation Copyright (c) 2014, Apex Data Solutions, LLC. All Rights Reserved.

Agenda Background on VAi2 Innovation 5021: “Technology-enabled Digital Documentation” Describe how our innovation ideas design principles were applied to building a real Medical Reconciliation component for the Veterans Point of Service initiative. Demonstrate our in-progress work on the MRAR Provider/Patient Web UX Discuss what we’ve learned in the process about disruptive innovation Copyright (c) 2014, Apex Data Solutions, LLC. All Rights Reserved.

prime Movers at the VA Jorge Ferrer – sponsor of the innovation Mike Davis, Director of VPS – early adopter of the innovation’s core concepts Maureen Layden – Business sponsor representing Pharmacy Benefits Management (PBM) Blake Lesselroth and Vicki Church – business owners of the MRAR application at the Portland Informatics Center Advisory Committee Copyright (c) 2014, Apex Data Solutions, LLC. All Rights Reserved.

Federal-Academia-Industry Innovation Advisory Team Dr. Maureen Layden, VHA, Dr. Clayton Curtis, VHA; Dr. Paul Nichol, VHA; Dr. Steve Brown, VHA; Dr. Murielle Beene, OHI; Dr. Neil Evans, VHA; Dr. Michael Weiner, VHA; Donna Harrigan-Thrailkill, VHA; Mike Davis, VA; Dr. Jonathan Nebeker, VHA; Dan Marsh, RN, VHA; Dr. Bill Rudman, AHIMA; Dr. Bria Bria, AMDIS; Dr. Caitlin Cusack, AMIA; Dr. Larry Ozeran, Clinical Informatics Inc; Dr. Doug Rosendale, CAIRNformatics; Dr. Jiajae Zhang, UT; Dr. Chris Gibbons, JHU; Marc Wynne, CMS; Dr. Jon White, AHRQ; Dr. Lana Lowry, NIST; Wei Ma, NLM; Dr. Suzie Burke-Bebee, ASPE; Dr. Alicia Morton, ONC; Dr. Ross Koppel, U of Penn; Matt Reid, AMA; Rocco Bagala, VHA; John Edge R.N., VHA; Lois Hooper, VHA; Angelica Midgett, VHA; Dr. Susan Woods, VHA; Teresa Paguio-Palarca R.N., VHA; Thomas Shelton R.N., VHA; Dr. Alan Calvitti, UCSD; Dr. Zia Agha, UCSD; Dale Marie Ryan, MS, RN, VHA; Dr. Debora Simmons, St. Luke's Health System, Dr. Paul Latkany, DoD; Dr. David Hunt, ONC: Dr. Jim Sorace, ASPE.

Innovation History Focus: Technology-enabled clinical documentation at the point of service. VAi2 Innovation 5021 20/4000 Objectives: Improve the User Experience (UX): Easy to use, reduce cognitive load, support better clinical decision making, Improve the Patient Experience (PX) : less intrusive, more inclusive Support the concept of a service-based , overarching documentation session: emphasis on a facilitating a defined process and all the participants (“the team”) Started with a blank slate and these “First Principles”: Tell the patient story Fill in knowledge gaps Design strategy: transition from a monolithic UX to a modular, scenario-specific UX Copyright (c) 2014, Apex Data Solutions, LLC. All Rights Reserved.

Innovation History Explored many possible use cases: Anesthesiology, DBQ, etc. Settled on Medical Reconciliation Allergy Reconciliation (MRAR) - an excellent test case for many of our innovative concepts Rationale: All of our Veteran patients have the right to expect that, at the onset of the “visit”, someone will assemble an accurate, up to date list of all medications and allergies Patient safety Clinical decision support Phased, low risk approach Copyright (c) 2014, Apex Data Solutions, LLC. All Rights Reserved.

Innovation DEMO in a nutshell What it is: “The Round Trip”… Starts in CPRS MRAR review session with patient and provider Ends with a TIU Note being written back to VIstA where is immediately available for viewing in CPRS What it isn’t (yet)… Not a complete solution (yet) to the general problem of clinical reconciliation (but was built with that in mind) Not yet integrated with decision support services (on the horizon!) Not yet integrated with Order Entry (but that is in scope in Phases 2 and beyond) No built-in metrics or connection to a comprehensive analytic environment (Phase 2 and beyond) What it demonstrates… Secure, web-based solution totally integrated with CPRS Practical example of scenario specific UXs with interesting telemed and mobile health implications Copyright (c) 2014, Apex Data Solutions, LLC. All Rights Reserved.

Innovation DEMO: What to look for What’s under the hood: VistA.js Enables modular solutions Inclusion of data from multiple VA locations across the USA: fast secure Resolution of the “last mile” issue Enables differentiated development The UX/PX Scenario-specific user interfaces Workflow driven Team oriented: involves patient, MRAR reviewing provider, primary provider Copyright (c) 2014, Apex Data Solutions, LLC. All Rights Reserved.

Copyright (c) 2014, Apex Data Solutions, LLC. All Rights Reserved.

Quick Demo MRAR Web UX Copyright (c) 2014, Apex Data Solutions, LLC. All Rights Reserved.

Human Conditions for innovation In order for innovation to be disruptive in practice you need a “golden triad”: A Business Owner with strategic vision willing to let innovation happen in real-time A Customer willing to lay aside pride of ownership and rethink the requirements afresh A Development Team willing to take on business risk to solve the real problem In order to build business value with technology you must Challenge Every Assumption About the Art of the Possible. Focus on what the Customer really wants, not on what they agreed to accept just because they didn’t think it was possible to get what they really wanted. Vision – breaking out of skeuomorphic metaphors (like the tab chart) Copyright (c) 2014, Apex Data Solutions, LLC. All Rights Reserved.

Why We innovate “Bob you cannot retire, leave or fall deathly ill for any time frame. You must see this project thru as I have hope now that we will be successful. I was brought to tears that all this dedication of my career is going to actually come to production and change the lives of the veterans. Thank you from the bottom of my heart.” Victoria Church RN, CNS-BC Northwest Innovation Center (NWIC) Associate Director PIC Patient Safety Center of Inquiry Cardiac Telemetry/Alaris Pumps …..From an email dated October 17, 2014 Copyright (c) 2014, Apex Data Solutions, LLC. All Rights Reserved.

Feedback is WElcomE! If you have any questions, please contact: Howard Hays MD MSPH, Senior VP, Healthcare Email: Howard.Hays@apexdatasolutions.net Dr. Greg Shorr, CMIO Email: Greg.Shorr@apexdatasolutions.net Greg Matton, CEO Email: Greg@apexdatasolutions.net Copyright (c) 2014, Apex Data Solutions, LLC. All Rights Reserved.