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

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.

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

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

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

Why Modernize?

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

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

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

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

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

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)

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

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

DHMSM Initial Operational Capability Timeline

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

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