1. Enterprise Level Data Restructuring in the Military Health System
Chris Nichols
Andrew Holdaway
David Carnahan
Enterprise Level Data Restructuring in the Military Health System
“Medically Ready Force…Ready Medical Force”

2. “Medically Ready Force…Ready Medical Force”
DHA Vision
“A joint, integrated, premier system of health, supporting those who serve in the defense of our country.”
“Medically Ready Force…Ready Medical Force”

3. “Medically Ready Force…Ready Medical Force”
Overview
Background
Approach to restructuring
Product of restructuring: Analytics
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4. Military Health System Overview
55 Military Hospitals
Academic
Community
International
Combat Areas
373 Medical Clinics
All Specialties
245 Dental Clinics
Source:
“Medically Ready Force…Ready Medical Force”

5. Military Health System Overview
Total
Direct Care
Purchased Care
Week
Year
Hospitalizations
20,000
1.04 M
4,800
250,000
15,200
795,000
Births
2,300
119,000
900
46,000
1,400
73,000
Clinic Visits
1.3 M
70 M
752,000
39 M
603,000
31 M
Prescriptions**
2.4 M
128 M
889,000
46 M
1 M
56 M
**Mail Order Pharmacy: 490,000 week, 25.5 M annually Sources:
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6. Information Systems History
Composite Health Care System (CHCS)
Developed in 1988 with a modular approach to orders
Continues to serve as the backbone for clinical & business services
Armed Forces Health Longitudinal Technology Application (AHLTA)
Developed in-house, deployed in 2004, extension of CHCS
Outpatient clinical documentation system
Offered central storage for global availability of records
Essentris
Inpatient clinical charting record
Does not have a direct interface with CHCS/AHLTA
Additional ad hoc systems to support business, clinical, and military specific readiness requirements
-Locally cached data repository, synced to a central data warehouse – the MHS Data repository (MDR)
-Many developed independently by services to fill specific niche requirements
“Medically Ready Force…Ready Medical Force”

7. Modernizing Data Architecture
In 2013 the Defense Health Agency (DHA) was established to provide shared support services to the Army, Air Force and Navy medical communities
Consolidated IT infrastructure support
Data standardization and hosting
Overall concept is DHA provides a standardized data repository for customers to use to support service specific data requirements.
“Medically Ready Force…Ready Medical Force”

8. “Medically Ready Force…Ready Medical Force”
EHR modernization
In July 2015, the DoD Awarded Leidos, Cerner, and Accenture a contract to implement Cerner Millennium across the MHS enterprise.
Seen as an opportunity to rationalize the MHS IT portfolio and consolidate EHR systems (CHCS, AHLTA, Essentris) into a single platform
“Medically Ready Force…Ready Medical Force”

9. Transition Challenges
NDAA Title VII, Section transfer of information technology to DHA
Constrained fiscal environment within the DoD
How do we ensure functional capabilities are not lost as budgets are reduced ?
What methodology is being used to reduce duplication?
What is the role of the IT, Informatics and the Functional Users?
Synchronizing IT portfolio with MHS GENESIS (New Enterprise Wide EHR)
“Medically Ready Force…Ready Medical Force”

10. Enabling User Experience
Health IT Data Vision
The Defense Health Agency (DHA) Health Information Technology (HIT - J6) mission is to “Implement, manage, and sustain an integrated and protected medical information enterprise in order to ensure the right information is accessible to the right customers at the right time and in the right way.”
DHA Data Canons
Ensuring the right information is accessible to the right customers at the right time and in the right way
Efficiency
Streamlined information, cleaned redundant data
Rationalized processes, tool utilization, and acquisition
Speed
Bimodal exploration to map current and future state
Tools: Data lake, Hadoop, Teradata, etc
Intelligence
Descriptive, prescriptive and predictive analytics in a one-stop-shop
Trust
A single known source for up-to-date data
Centralized, master data management
Enabling User Experience
User tools (Super Users, Analysts, and Researchers)
User centered
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11. “Medically Ready Force…Ready Medical Force”
The Big Picture
Forces are driving change throughout the MHS data management and business intelligence environment. This change is being addressed by the following initiatives which must communicate to ensure the most effective implementation.
Data & Application Consolidation
Legacy Data Repository Strategy
Cloud Migration engineering efforts
Data Virtualization, ESB and business logic
Cerner HealtheIntent
Data Management Capabilities
Business Intelligence Capabilities
Future Capabilities
Capacity Services
Technologies
People
ZBR ES-1 – Rationalization Effort
Streamline Legacy Resources
Reduce Redundancy of Data Resources
Driving Forces:
1.) Constrained fiscal environment within the DoD
2.) Acquisition of a new Electronic Health Record and undetermined business intelligence capabilities
3.) Growing role of analytics in health care
4.) Progression of technology across compute, storage and algorithms.
“Medically Ready Force…Ready Medical Force”

12. Enterprise Intelligence & Data Solutions (EIDS) Mission
Mission: To support MHS strategic goals and facilitate informed decision-making through the delivery of information services in a timely, relevant, and actionable manner.
Presentation
EIDS Solution Layers
Logic
Data
The Enterprise Intelligence and Data Solutions (EIDS) PMO was established within the Solution Delivery Division (SDD) of the Defense Health Agency (DHA) to help execute the DHA Data Vision of providing seamless data services and decision support for clinicians, patients, beneficiaries, analysts, researchers, and DoD leadership.
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13. Program Management Approach
EIDS oversees a number of program activities to bring together data, information technology, and data science, delivering analytics-driven insights for customers.
Data System Assets (Data)
Consolidate data warehousing for legacy systems such as AFCHIPS, COHORT, and other cached data sources
Strategize a legacy data repository to archive clinical and business data as MHS GENESIS is rolled out to Military Treatment Facilities (MTFs)
Program Management Activities
Project Management
Contract Support
Engineering
Technical Requirements
Information Assurance
Procurement
Network, Hosting, and System Administration
Software Licensing
Hardware Licensing
DoD CIO Alignment
Delivery Platforms (Information Technology)
Offer and maintain a suite of data tools including the CarePoint Application Portal for business intelligence, customer reports, and decision support
Provide data science support for tools such as SAS, Enterprise Miner, STATA, AsterData, R, and Tableau
Domain Expertise (Data Science)
Provide expertise from a team of highly trained Data Scientists, Informaticists, Epidemiologists, Biostatisticians, Health Services Researchers, Mathematicians, Data Modelers and Architects, ETL Developers, Database Administrators, and Business Intelligence Developers with advanced analytical skills
“Medically Ready Force…Ready Medical Force”

14. Capability Rationalization Analysis
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15. Current State Reference Architecture
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16. Enterprise Data Layers
All systems’ and applications’ functions can be classified into one of three defined data layers. Functionality outside these categories, and its associated cost has been excluded.
Data Integration
Data Storage
Data Analytics
Functions include manual and automatic:
Data Transformations
Data Profiling
Data Cleansing
Data Parsing
Data Blending
Data Enrichment
Functions include to create and maintain:
Relational and non- relational databases.
Various data views
Hardware / Software
Data access controls
Functions include:
Operational Reporting
Visualizations
Dashboarding
Predictive Modeling
Data Exploration/Discovery
Data Mining
“Medically Ready Force…Ready Medical Force”

17. Future State Reference Architecture
Based on the proposed strategy of streamlined information delivery, and utilizing a blend of quantitative factors, System Owner interviews and current state documentation, a future state classification was prescribed to each system.
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18. Multidimensional Products & Services
Presentation Layer
Information Portal
Logic Layer
Analytic Workbench
Data Layer
Data Science Lab
Measurement
Analytics
Research
Self-Service BI
Registries
“Medically Ready Force…Ready Medical Force”

19. Learning Health System
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20. “Medically Ready Force…Ready Medical Force”
Readmissions Use Case
High risk admissions that need primary care follow-up to reduce readmissions
Exploratory
Predictive
Prescriptive
DC Plans
PC F/U
Home Hlth PC F/U
Med Recon
Age
Chronic Condition
LOS
Gagne Score
Primary Care F/U*
RUB
DRG Group
ICU Stay
Age
Chronic Condition
Gagne Score
RUB
16% of Admissions
40% of Readmissions
Comparative Effectiveness Studies
#IHIFORUM
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21. Learning Health System
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22. “Medically Ready Force…Ready Medical Force”
Opiate Use Registry
#IHIFORUM
“Medically Ready Force…Ready Medical Force”

23. “Medically Ready Force…Ready Medical Force”
Opiate Use Registry
#IHIFORUM
“Medically Ready Force…Ready Medical Force”

24. “Medically Ready Force…Ready Medical Force”
Acknowledgements
Carepoint Team
MHS Population Health Portal Team
SPAWAR & CACI
Solutions Delivery Division
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