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AHLTA / EHR Way Forward: PART 1 – AHLTA and AHLTA Service Pack 1 PART 2 – EHR Way Forward

AHLTA / EHR Way Forward: PART 1 – AHLTA and AHLTA Service Pack 1 PART 2 – EHR Way Forward. Presented by: CAPT Robert Marshall, MD MPH MISM Chief Medical Informatics Officer, BUMED M6 Robert L. Flores AHLTA Program Manager, NAVMISSA. Learning Objectives.

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AHLTA / EHR Way Forward: PART 1 – AHLTA and AHLTA Service Pack 1 PART 2 – EHR Way Forward

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  1. AHLTA / EHR Way Forward:PART 1 – AHLTA and AHLTA Service Pack 1PART 2 – EHR Way Forward Presented by: CAPT Robert Marshall, MD MPH MISM Chief Medical Informatics Officer, BUMED M6 Robert L. Flores AHLTA Program Manager, NAVMISSA Leading NAVMED through PortfolioManagement.

  2. Learning Objectives • AHLTA – Making it work better for patient care • Describe MAPS and COMPASS programs • Discuss IT applications to help • Discuss workflow analysis and AHLTA • Discuss AHLTA training and trainers • Describe the AHLTA Triumvirate • Discuss Secure Messaging, iMedConsent and AHLTA

  3. Learning Objectives (cont) • AHLTA Service Pack 1 • Understand Service Pack 1 milestones • Beta test plans • Release management • Clinical Impact Analysis • Service Pack 1 Fixes and Updates • Release contents • Fixes and Changes • Release Tracking and Progress Reporting Leading NAVMED through PortfolioManagement. 3

  4. Learning Objectives (cont) • Deployment Plans • EUD Installation and Imaging • Reporting Process • Troubleshooting • Reporting processes • Information gathering and Lessons Learned • Communications and Coordination • Cross Discipline information sharing • Clinical User inclusion • Training and User Awareness Leading NAVMED through PortfolioManagement. 4

  5. Learning Objectives (cont) • EHR Way Forward • Planning – Past, Present and Future • EHRWF Tiger Teams review • Interagency (DoD/VA) planning – Before decision • Interagency (DoD/VA) planning – Post decision • Products • Original Analysis of Alternatives • Directed AoA • Working Teams/Executive Team recommendations • Expected Interagency EHR • Training and User Awareness Leading NAVMED through PortfolioManagement. 5

  6. AHLTA – Present State • Version 3.3 deployed to all Navy sites; all Army/Air Force sites by 12/31/2010 • Over 200 new and updated features – many not utilized; two turned off (aCPG and APV) • No major upgrades after SP1 released • Possible for major Medcin upgrade (SOO)

  7. MAPS and COMPASS • What they are • The forms that support these • Workflow analysis and Business Process Reengineering – why they are vital • WLAN – why it is critical to success • What does the Navy have? • What does the Navy need? • Dragon Naturally Speaking and AsUType • Tablets – PC, Android and iPad

  8. Secure Messaging and iMedConsent • Secure messaging - part of PCMH (Medical Home) • Web service – no Network or AHLTA interface • Copy and paste to document care • iMedConsent - a library of consent forms • Both for procedures and for advanced directives • Also has research consent forms for IRB’s • Web service – no Network or AHLTA interface • Is the VA’s consent library (integrated) • Favorites, print and scan

  9. AHLTA Training & Triumvirate • Sustainment training contract • Sustainment trainers/consultants • Navy AHLTA web site • Regional Trainers from TMA • Triumvirate • Consists of AHLTA trainer, Coder and Clinical Champion • Need Command support to help clinics use AHLTA better • Is a business/clinical process support asset

  10. AHLTA Training & Triumvirate • Sustainment training contract • Sustainment trainers/consultants • Navy AHLTA web site • Regional Trainers from TMA • Triumvirate • Consists of AHLTA trainer, Coder and Clinical Champion • Need Command support to help clinics use AHLTA better • Is a business/clinical process support asset

  11. AHLTA Service Pack 1 Leading NAVMED through PortfolioManagement. 11

  12. AHLTA Service Pack 1 • Service Pack 1 Milestones • Beta test plans • Clinical Impact Analysis • Release management

  13. AHLTA Service Pack 1 Milestones *All Dates and Milestones are subject to change

  14. AHLTA Service Pack 1 • BETA Testing • Plan includes testing by a representative site from each service • Groton NH • Goodfellow AFB • Brooks Army Medical Center

  15. AHLTA Service Pack 1 • BETA Test Plan • Users at the BETA sites using the software in live encounters • DHIMS will collect usage info from BETA teams • Testing on Windows 7 (32 bit) based EUDs for the first time in addition to Windows XP • Windows 7 STIG creation • DHIMS will certify SP1 for both platforms • Windows Vista will not be supported

  16. AHLTA Service Pack 1 • Clinical Impact Analysis • Plan includes analysis to be conducted on implications of SP1 changes • Clinical • Business and Data Quality

  17. AHLTA Service Pack 1 • Clinical Impact Analysis • TBD

  18. AHLTA Service Pack 1 • Clinical Impact Analysis • TBD • HIGHLIGHTS from the release notes will go here

  19. AHLTA Service Pack 1 • Clinical Impact Analysis • TBD • HIGHLIGHTS from the release notes will go here

  20. AHLTA Service Pack 1 • Data Quality Impact Analysis • TBD • HIGHLIGHTS from the release notes will go here

  21. AHLTA Service Pack 1 Data Quality Impact Analysis • TBD • HIGHLIGHTS from the release notes will go here

  22. AHLTA Service Pack 1 • Release Management • Plan will include multiple facets • Training Requirements • DHIMS has contracted to create training instruments • Information on the Release to be communicated • IT specific deployment plans and instructions • Information resulting from functional impact analysis efforts • Lessons learned from the BETA period

  23. AHLTA Service Pack 1 Release Management • IT Organizations will need to develop plans prior to the release • Magnitude of the SP1 code changes • Hundreds of fixes and thousands of code changes • Many modules have been completely re-written • Most massive update since 3.3 release • Deployment plans should include creating new Gold Image from scratch (i.e., complete fresh installation of OS , etc) • Re-imaging of EUDs is the deployment method sites should plan for • Re-imaging, while labor intensive and upsetting to the users, will pay dividends in minimizing long term support issues • Start preparing users for the process well in advance • Backing up users desktops, documents, etc. • Document printer settings, etc • Involve Clinical and Business/Data Quality managers in the process

  24. AHLTA Service Pack 1 • Service Pack 1 Fixes and Updates • Release contents and timetable • Beta Phases • Fixes and Changes • Changes to Infrastructure • SP1 A plans

  25. AHLTA Service Pack 1 Release Contents Pieces to be included in SP1 • Windows 7/XP Compatibility • CDR Stabilization – SQL Optimization (Integration effort) • Remove unused AHLTA components • Oracle 10.2.0.5 (CDR) • Reflections 14.1

  26. AHLTA Service Pack 1 Deployment CDR Update 814 • Delivery CM (11/17) • DT&E Testing (11/22 – 11/29) • Fielding (12/18) 3.6 Mid-Tier Update • Delivery CM (12/3) • DT&E Testing (12/8 – 1/7) • Fielding • Groton (1/15) • Goodfellow (1/15) • AMEDD site (1/15) 3.6 Web Service Update • Delivery CM (12/3) • DT&E Testing (12/8 – 1/7) • Fielding • Groton (1/15) • Goodfellow (1/15) • BAMC(1/15)

  27. AHLTA Service Pack 1 Deployment ICD Update 469 • Delivery CM (12/3) • DT&E Testing (12/8 – 1/7) • Fielding • Groton (1/15) • Goodfellow (1/15) • AMEDD site (1/15) SP1 Client • Delivery CM (12/3) • DT&E Testing (12/15 – 1/15) Codes (CPT 6.0) • Delivery CM (1/21) • DT&E Testing (1/24 – 1/28)

  28. AHLTA Service Pack 1 BETA Phases Phase 1: Beta Tester (1/17 – 2/4) Phase 2: Provider (2/7 – 2/25)cannot start until CPT dates • Small group: includes codes and SP1A SP1A (will happen between Phase 2 and 3)code fix of any bugs found in beta testing) Phase 3: Full Clinic (2/28 – 3/18) Phase 4: Full site deployment (3/21 – 4/8)

  29. AHLTA Service Pack 1 • Troubleshooting • Deployment processes • Procedures during Rollout • Reporting • Information gathering and Lessons Learned • Communication plans • Sharing of lessons learned

  30. AHLTA Service Pack 1 General Escalation Plan • Successful completion of milestones will be reported and tracked • Written communications primary means • MHS Help tickets to be used to report problems during testing or deployment • The word “BETA” must appear in the ticket title

  31. AHLTA Service Pack 1 Mitigation Roll Back / Deployment • Sites need to have a Roll Back plan • Beta testing, DT&E approval and a staggered implementation does not guarantee a problem won’t appear • Sites should minimize risk where possible • E.g., Monitor results of testing and BETA progress, internal testing, staggered rollouts Hope for the best but plan for the worst!

  32. AHLTA Service Pack 1 Communications • Beta Period • Scheduled conferences will be held weekly and as needed • Results of the Beta will be collated and communicated to the sites • Sites should follow the progress of the Beta and other information as they become available • “…if you’re not getting it, ASK for it!”

  33. AHLTA Service Pack 1 Coordination • Communications and Coordination at the local level • Training and User Awareness

  34. AHLTA Service Pack 1 Coordination Cross Discipline information sharing • Clinical User inclusion • Business Office/Coding inclusion • Use the Triumvirate process to get all stakeholders on board

  35. AHLTA Service Pack 1 Coordination • IT Managers should involve clinic managers, coders, and trainers when planning the deployment • Users need to be aware of what is coming and when • How to report issues • Who to go to for help • MHS Trouble Ticket processes • Disseminate Lessons Learned • Disseminate Impact Analysis • AHLTA Clinical Champions can help coordinate these efforts

  36. AHLTA Service Pack 1 Training • DHIMS has contracted to create training materials • Briefings and CBTs are expected • Site Deployment Plans should include training plans • Use ‘Triumvirate’ • Involve Clinic managers and Coding/Data Quality • Involve MTF leadership

  37. EHR Way Forward Leading NAVMED through PortfolioManagement. 37

  38. EHR Way Forward • Past Planning • JCIDS-driven AoA • Down selected to four options • >90 clinical and non-clinical Tiger Teams • Full engagement by all three Services • Pre-Decisional Interagency (DoD/VA) Planning • Driven by senior TMA leadership • Limited or no Service involvement initially • Multiple DoD/VA working groups

  39. EHR Way Forward (cont) • Post-Decisional Interagency Planning • Decision made in January for future direction • Decision was….. • Based on decision, planning did this…. • Future product expected to be…. • Timeline for implementation…. • Long term planning….

  40. Original/Interagency AoA • DoD AoA process • Choices made • Alignment with Interagency decision • Why things changed? • Interagency AoA work • Working groups • Mission Requirements and Performance Outcomes • Data Interoperability • Infrastructure and Enterprise Architecture • Systems Capabilities • Presentation Layer • Business Process

  41. What is next? • Outcomes of Interagency working groups – slides • Future end state • Timeline – separate slides • Data model – separate slides • Enterprise Service Bus/Data Access Layer – separate slides • Mid-tier – separate slides • Presentation layer – separate slides • Interoperability – separate slides • Nationwide Health Information Network - slides

  42. Click to edit Master title styleUse this two column slide for long lists of bullets • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level • Click to edit Master text styles • Second level • Third level • Fourth level • Fifth level Leading NAVMED through PortfolioManagement.

  43. Summary • Font is Arial – 26 pt at this level • Second level – 25.5 pt • Third level – 24 pt • Fourth level - 22.5 pt • Fifth level – 21 pt Leading NAVMED through PortfolioManagement. 43

  44. Contact Information • CAPT Robert C. Marshall, MD, MPH, MISM • robert.marshall@med.navy.mil • 253-225-1690 • Robert L. Flores • Robert.flores@med.navy.mil • 210-808-0789 Leading NAVMED through PortfolioManagement.

  45. Questions Leading NAVMED through PortfolioManagement. 45

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