Colonel Victor Eilenfield, MS, USA Program Manager, CITPO

1. Colonel Victor Eilenfield, MS, USA Program Manager, CITPO

2. 2 AgendaCHCS II: The Military Electronic Health Record (EHR) CHCS II in 2003 : The Year in Review CHCS II in 2004: Block 1 Worldwide Deployment A look at the application�s features and its future Critical Service Involvement Tri-Service Collaboration Forums CHCS II Implementation Strategy CHCS II Deployment Process Q and A 

3. 3 CHCS II in 2003: The Year in Review Since the last TRICARE Conference A limited deployment of CHCS II has been completed and analysis performed Approval granted for worldwide deployment of CHCS II Block 1

4. 4 Overview: Limited Deployment Limited Deployment occurred between February � December 03 at seven Army, Navy, and Air Force facilities Limited Deployment strategy was developed with the Service Medical Departments Focus Refinement of implementation and training processes Included creating efficiencies in facility preparation, customizing training, and providing the most effective deployment support Resolution of any functional or technical issues previously identified at the test sites Assessment of productivity and workflow issues In 2003, DoD completed its EHR limited deployment phase. We took CHCS II to seven MHS hospitals. The limited deployment included Army, Navy, and Air Force sites and a variety of medical specialties to ensure that the feedback would reflect the wide variety of care settings and any Service-specific differences. This limited deployment provided a rich opportunity to refine the processes for implementation and training and allowed us to take another look at any functional or technical issues and ensure that they had been fully addressed. It also gave us significant opportunity to look at provider productivity and workflow. Remember, one of our EHR Essentials is that the tool must support our providers workflow and must not be obtrusive to patient care. The amount of data and the increases in our understanding of how to create efficiencies in our implementation and training processes from this effort is astounding. After all, the providers in these hospitals and clinics were performing more than 65,000 patient encounters each month using the EHR. In 2003, DoD completed its EHR limited deployment phase. We took CHCS II to seven MHS hospitals. The limited deployment included Army, Navy, and Air Force sites and a variety of medical specialties to ensure that the feedback would reflect the wide variety of care settings and any Service-specific differences. This limited deployment provided a rich opportunity to refine the processes for implementation and training and allowed us to take another look at any functional or technical issues and ensure that they had been fully addressed. It also gave us significant opportunity to look at provider productivity and workflow. Remember, one of our EHR Essentials is that the tool must support our providers workflow and must not be obtrusive to patient care. The amount of data and the increases in our understanding of how to create efficiencies in our implementation and training processes from this effort is astounding. After all, the providers in these hospitals and clinics were performing more than 65,000 patient encounters each month using the EHR.

5. 5 Block 1 Limited Deployment Sites Tinker Air Force Base, Oklahoma (Completed � May 03) Fort Eustis, Virginia (Completed � Jun 03) Fort Story and Fort Monroe Goodfellow Air Force Base, Texas (Completed � Jun 03) Naval Medical Center Portsmouth, Virginia Cherette [Selected Clinics] (Completed � May 03) Naval Station Sewells Point (Completed � Aug 03) Naval Air Base Little Creek, Boone Clinic (Completed � Aug 03) Naval Air Station Oceana (Completed � Aug 03) Fort Bliss, El Paso, Texas (Completed � Aug 03) White Sands Missile Range Seymour Johnson Air Force Base, North Carolina (Complete � Oct 03) Langley Air Force Base, Virginia (Completed � Dec 03) There is a good chance that a military medical facility near you has been using CHCS II. The limited deployment took the EHR to military hospitals and clinics in four states: Oklahoma, Virginia, Texas, and North Carolina. McDonald Army Community Hospital at Fort Eustis, Virginia was the first to begin the limited deployment and William Beaumont Army Medical Center, Fort Bliss, Texas was the first tertiary care facility to complete limited deployment. Portions of Naval Medical Center Portsmouth, Virginia and ambulatory care facilities in the Tidewater area have implemented CHCS II. The Air Force�s aggressive stance resulted in completing deployments at four hospitals, including the 1st Medical Group at Langley Air Force Base, Virginia; the 4th Medical Group at Seymour Johnson Air Force Base, North Carolina; the 72nd Medical Group at Tinker Air Force Base, Oklahoma; and the 17th Medical Group at Goodfellow Air Force Base, Texas. There is a good chance that a military medical facility near you has been using CHCS II. The limited deployment took the EHR to military hospitals and clinics in four states: Oklahoma, Virginia, Texas, and North Carolina. McDonald Army Community Hospital at Fort Eustis, Virginia was the first to begin the limited deployment and William Beaumont Army Medical Center, Fort Bliss, Texas was the first tertiary care facility to complete limited deployment. Portions of Naval Medical Center Portsmouth, Virginia and ambulatory care facilities in the Tidewater area have implemented CHCS II. The Air Force�s aggressive stance resulted in completing deployments at four hospitals, including the 1st Medical Group at Langley Air Force Base, Virginia; the 4th Medical Group at Seymour Johnson Air Force Base, North Carolina; the 72nd Medical Group at Tinker Air Force Base, Oklahoma; and the 17th Medical Group at Goodfellow Air Force Base, Texas.

6. 6 CHCS II in 2003: The Year in Review On 6 November 2003, CHCS II Block 1 deployment was approved by the Senior Military Medical Advisory Committee (SMMAC) SMMAC membership: ASD (Health Affairs), DASDs, and the Surgeons General On 17 November 2003, based on the favorable results of a limited deployment of CHCS II, an�ADM�was issued by the OASD, NII authorizing worldwide deployment of CHCS II Block 1� The ADM states that the OASD, NII expects full Block 1 implementation by 30 June 2006

7. 7 CHCS II in 2004: Block 1 Worldwide Deployment Underway 30-month rollout beginning January 2004 Fields a longitudinal EHR that is Legible and accessible 24x7 Supports population health and disease management activities To be used in MHS facilities and in deployed settings Train as we fight Future blocks will build on Block 1

8. 8 Global Access

9. 9 Block 1 Clinical Capabilities Patient Demographics1 Patient Alerts1 New Results Cosign Orders/Encounters New Telephone Consult Appointment List1 Telephone Consult List Unscheduled Visit Creation Consult Tracking Questionnaires (e.g., HEAR) Problem Knowledge Couplers Standard Reports

10. 10 Block 2 Clinical Capabilities Dental Charting and Documentation Dental Notes for general dentistry� Emergency Triage Periodic Exam Multiple Data views Full Mouth � Diagnostic & immediate treatment views Individual Tooth Charting Specialist Diagnosis & Treatment Dental Radiology Orders Spectacle Request Transmission System II Prescription Eyewear Order Tracking Automated Clinical Practice Guidelines Ad Hoc Reporting Common Access Card � Patient Identification

11. 11 Block 3 Clinical Capabilities Replacement/enhancement of Legacy CHCS Ancillary Functionality (Includes Order Entry, Results Retrieval, and Alerts) Laboratory Anatomic Pathology Pharmacy Radiology Enhanced Dental Functionality Begin replacement of legacy system Begin replacement of legacy system

12. 12 Documentation

13. 13 HPIHPI

14. 14 ROSROS

15. 15 PEPE

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17. 17 Disposition and CodingDisposition and Coding

18. 18 Population Health

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23. 23 Copy Forward

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30. 30 Flow Sheet

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32. 32 Practice Guideline Support

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35. 35 A/P, Wellness, and CPG Protocol Mockup A/P, Wellness, and CPG Protocol MockupA/P, Wellness, and CPG Protocol Mockup A/P, Wellness, and CPG Protocol Mockup

36. 36 Standard Software & Components

37. 37 Forensics

38. 38 DoD Forensic Work Flow

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49. 49 Mobile Technology Use of handheld technology and capture of data from medical devices may be supported by CHCS II Use of handheld technology for inpatient care has been programmed System built to be capable of interfacing with myriad input devices: Electrocardiogram Ultrasound Blood Pressure Cuffs Joint Biological Agent Identification and Diagnostic Systems Handheld Devices Tablet PCs

50. 50 CHCS II: The Military EHR Creates a true longitudinal EHR that will span the entire Service members� (and other beneficiaries�) experience with the MHS Provides a comprehensive, patient-centric health record Integrates the record across locations and medical specialties Increases record availability to over 99 % Improves patient safety and record accuracy Supports the team approach to health care Automates much of the writing and coding of health records Supports preventive health care services delivery and disease management Addresses information assurance issues in depth Enables a �train as we fight� approach to health care

51. 51 �By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.� -President George W. Bush State of the Union Address 20 Jan 2004

52. 52 CHCS II (Block 1) Worldwide Deployment

53. 53 FY04 Deployment Sites NMC PORTSMOUTH - WW KENNER AHC-FT. LEE 43RD MEDICAL GROUP-POPE EISENHOWER AMC-FT. GORDON 375th MED GRP-SCOTT NH BREMERTON NH CAMP LEJEUNE 62nd MED GRP-MCCHORD WINN ACH-FT. STEWART 92nd MED GRP-FAIRCHILD 7th MED GRP-DYESS NH OAK HARBOR NH CHERRY POINT DARNALL ACH-FT. HOOD NMC SAN DIEGO BLANCHFIELD ACH-FT. CAMPBELL NH CORPUS CHRISTI 2nd MED GRP-BARKSDALE MARTIN ACH-FT. BENNING 314th MED GRP-LITTLE ROCK NH CAMP PENDLETON 47th MED GRP-LAUGHLIN NH TWENTYNINE PALMS NACC PORT HUENEME 71st MED GRP-VANCE NH LEMOORE 97th MED GRP-ALTUS WOMACK AMC-FT. BRAGG 59th MED WING-LACKLAND 82nd MED GRP-SHEPPARD 311TH MED SQUAD-BROOKS 12th MED GRP-RANDOLPH LYSTER ACH-FT. RUCKER FOX AHC-REDSTONE ARSENAL LANDSTUHL REGIONAL MEDCEN (Test Clinic) NH CHARLESTON 95th MED GRP-EDWARDS 30th MED GRP-VANDENBERG 61st MED SQUAD-LOS ANGELES

54. 54 Tri-Service Collaboration Forums Working Groups and Communication Process support the level of coordination and communication necessary

55. 55 Tri-Service Collaboration ForumsWorking Groups

56. 56 Tri-Service Collaboration ForumsCommunication Process

57. 57 Implementation StrategyRefined Based on Limited Deployment Define Roles and Responsibilities Use Standard Deployment Process Pre-Implementation Conferences Surveys Deployment Support Training Model Adapted to Meet Specific Service Needs Identification of Challenges and Lessons Learned

58. 58 Roles and ResponsibilitiesCITPO and TIMPO CITPO CHCS II Program Office Responsibilities Contract management of CHCS II Program Design, Development, Testing Tier III support Implement and Train CHCS II

59. 59 Roles and ResponsibilitiesCITPO and TIMPO TIMPO Responsibilities Design, Implement, and Maintain Infrastructure Procure, Install, Integrate, Test, and Maintain Hardware/ Software Performance Monitoring and Management Direct DISA activities on Communications and Computing Infrastructure Manage End User Device Program MHS Help Desk

60. 60 Roles and Responsibilities Key MTF Players Commander CHCS II Project Officer Clinical Champion(s) Information Management Facility Training Coordinator PAS Scheduler Public Affairs Officer Data Quality Manager CHCS I System Administrator Base DOIM Representative

61. 61 Roles and Responsibilities MTF Responsibilities Perform Business Process Reengineering Establish Local CHCS II Project Team Participate in Pre-Implementation Meetings Coordinate Local Approvals, e.g. Site Access Prepare for and Monitor Installation Activities Accept Equipment/System Coordinate Training Schedules and Clinic Activation Sequence Report Problems with System Provide Sustainment Training

62. 62 CHCS II Deployment Process*

63. 63 Deployment Operations Center Manages, coordinates, and integrates all activities required to deploy EHR to DoD health care facilities Brings together key players in one centralized location Provides central clearinghouse for deployment support to facilities Ensures prompt resolution of deployment issues Database used to capture and follow issues through resolution Leads all day-to-day implementation support meetings The CITPO, which serves as the project office for CHCS II, established the Deployment Operations Center to provide a central point of contact to assist Service Medical Chief Information Officers (CIOs) and treatment facilities with deployment, training, and activation issues. It is the mission of the Deployment Operations Center to support each site throughout this implementation. The Deployment Operations Center staffs a toll-free line (866-837-1924) with automated directory assistance to ensure that any facility with a question or issue can obtain help quickly and easily. The Deployment Operations Center published an Implementation Guide along with additional guidance documents and templates for use in developing customized, site-specific plans will be provided to each facility and its local implementation team members. The Deployment Operations Center maintains an electronic library of all implementation-related documents. The CITPO, which serves as the project office for CHCS II, established the Deployment Operations Center to provide a central point of contact to assist Service Medical Chief Information Officers (CIOs) and treatment facilities with deployment, training, and activation issues. It is the mission of the Deployment Operations Center to support each site throughout this implementation. The Deployment Operations Center staffs a toll-free line (866-837-1924) with automated directory assistance to ensure that any facility with a question or issue can obtain help quickly and easily. The Deployment Operations Center published an Implementation Guide along with additional guidance documents and templates for use in developing customized, site-specific plans will be provided to each facility and its local implementation team members. The Deployment Operations Center maintains an electronic library of all implementation-related documents.

64. 64 Training Model Components Service-Approved Training Models Combine: Classroom Training Structured-On-The-Job Training (SOJT) Computer-Based Training (CBT) Implementation Assistance (IA) Validated During Limited Deployment Adapted by Each Service Continuing Medical Education Credits Issued by Uniformed Services University of the Health Sciences (USUHS)

65. 65 Challenges Locking In and Optimizing Training Schedule Communicating Schedule to All End-Users Limiting No-Shows Filling Classes to Capacity Scheduling Classes Consecutively: Little or no down time between classes Training Reserve: There are limited additional resources when scheduling students for classes Only 10% of students can be rescheduled for classes

66. 66 Challenges Completing Structured On-The-Job Training (SOJT) Supporting Change Management from CHCS I to CHCS II Completing Coding in CHCS II Always Using CHCS II for Unscheduled Visits Staying Within Budget (Don�t Use Next MTF�s Resources)

67. 67 Where to Learn More Visit the CITPO Booth #2000 - 2001 Talk with Project Officers See Demonstrations It is highly likely that there will be more questions than there is time for Q&A. Please come visit us at the CITPO booth if we are unable to answer your question during the time allotted. Thank you. It is highly likely that there will be more questions than there is time for Q&A. Please come visit us at the CITPO booth if we are unable to answer your question during the time allotted. Thank you.

68. 68 Q & A Period