Defense Heath Information System A Case Study for National HIT Seong K. Mun, PhD Medical Research Fellow Institute of Advanced Study Virginia Tech Alexandria, VA

The Military Health System (MHS) 9.1 million eligible beneficiaries Active duty military Family members (spouses & children) Retirees Other eligible populations 65 hospitals & medical centers 412 medical clinics & 414 dental clinics 132,700 personnel 86,400 military 46,300 civilian Approximately 200,000 network providers at 2,800 network facilities under our purchased care

MHS Environment

Longitudinal Health Record 1991 Gulf War Syndrome Controversy Longitudinal Health Record To Enhance Force Health Protection Before, During and After Deployment System of Systems

disease surveillance, battlefield assessment, and patient care - Get’s the most attention occupational health, preventive medicine, medical strategic planning, and longitudinal patient health care

National Forum Washington DC, March, 2008 DoD with active participation of VA Review the Progress and Facilitate Strategic Discussion This Presentation Major Themes Emerging Concepts New Developments Lessons for National Heath IT

Major Themes (I) Longitudinal Health Record Computer Based Patient Record – To replace paper Electronic Medical Record - Connectivity Electronic Health Record – Integration of Records Longitudinal Health Record – Continuity of Care Personal Health Record – Comprehensive Med/Beh Record Interoperability and National Health IT Very little concern at the beginning Limited to Departmental and Institutional Interests Expanding Enterprise DoD with VA then Civilian (Ways to go) DoD-VA-National IT 70%

Major Themes (II) Knowledge Discovery and Management Key Promised Benefits – Yet To Be Achieved Computable Data – Structured and Natural Language Burdens and Cost of Structured Data Ownership and Access of Certain Data Practice Guidelines and It’s Usability Needs for Architecture Strategy Evolving Congressional Guidance Evolving Definition of LHR “High Priority” Tactical Issues Long Term Architectural Strategy

Major Themes (III) Software Engineering and Project Management Driven as a traditional acquisition activity Requirement – Budgeting – RFP – Delivery Rapid Technology Changes Designed to be obsolete No ways to accept innovation Development in Isolation No accumulated knowledge within DoD Unprecedented Open Discussion at All Levels Source Requirements Information Management PEO Program Managers Contractors Requirements Capability Gap Interoperability Gap Architecture After-the-factdocumentation

10 Storing & Accessing the Data Not a Complete EHR Architecture & Networks Mining the Data Catching the Data Five Greatest Challenges Taylor- Grumann

Emerging Concepts (I) Personal Health Record Possible Solution for Interoperability? Accuracy, Completeness, Privacy and Confidentiality Start with minimum set of data – Lindberg – Trust the Patients New Players Possibly with New Business Models Trust Patients Physician Groups, Employers, Insurers, IT Companies

Emerging Concepts (II) Predictive Genetic make-up – disease prediction Protein makers – health status Preventive Probability of disease Response to treatment Preventive treatment Personalized Optimized and targeted Participatory Personal choices of illness and wellbeing

Emerging Concepts (III) Decision Support Required for Evidence Based Medicine Sophistication is Growing Physician Adoption is a Challenge Health Services Research – Data Driven What works and What does not Work? How to improve quality? How to reduce whose costs?

More Recent Policy Directions Develop MHS Architecture Blue Print in partnership with VA, Industry and Civilian Sector Design the Architecture to take advantage of advances in technology Support Personal Health Record Approach Adopt Service Oriented Architecture (SOA) Regionalize computing infrastructure Enhance Information Sharing with VA and Private Sector via NHIN -- Work with Other Entities

Conclusion IT issues has emerged as a strategic center for policy Informed leadership and active participation of users IT is the primary process of business IT development has to remain open and nimble Data sharing and Interoperability The Promise of Knowledge Discovery and System Research – Easy of Data Generation Vs. Computablility New Workflow models required for the success of IT

Thank you. Ward S. Cassells, MD, LTC. Hon Pak, MD and COL. David Gilbrtson Jeff Collmann, PhD, Walid Tohme, PhD, Ron Gimble, PhD, Betty Levin, MS, Fred Prior, PhD, Chunhua Weng, PhD, Kenneth Wong, PhD, Leigh Jerome, PhD, Conrad Clyburn, MS, and Stephen Hufnagel, PhD.