Standardize Infrastructure from

1. Dr. Peter Marks • Chief of Operations, Infrastructure and Operations Standardize Infrastructure from Desktop to Datacenter (D2D) to deploy the new Electronic Health Record (EHR) 1

2. DHA Vision • “A joint, integrated, premier system of health, supporting those who serve in the defense of our country.”

3. Agenda • Why the DHA? Why a new EHR? Why? • Describe and explain the DHA HIT IO and the major integration initiatives. • Express why a standardized infrastructure is important to the deployment of the new EHR. • Compare the upcoming standardization work with the initiatives currently in the MTFs and look for integration opportunities. • Give the initial results of the infrastructure standardization process for the Initial Operating Capability sites in the Pacific North West.

4. Why did Congress and the Military create the DHA? • Creating a more globally integrated health system – built on our battlefield successes • Driving enterprise-wide shared services; standardized clinical and business processes that produce better health and better health care • Implementing future-oriented strategies to create a better, stronger, more relevant medical force • We are a single healthcare system and we have to support our Warriors and their families in the same manner regardless of physical location or Service affiliation 4

5. New Department of Defense Electronic Health Record (EHR) • Objective: Support an integrated healthcare environment through standardizing infrastructure technology (IT) infrastructure down to the desktop • Approach • Focus on strategic IT infrastructure initiatives in support of improved clinical care • Identify IT consolidation opportunities and rationalize contracts to save money with one IT provider • Recognize cost savings for critical infrastructure initiatives • Many clinical locations; same IT functionality! 5

6. The “Why”

7. Current State Impacts to Healthcare Current State Business Impact Future State • Wasted time for beneficiaries spent completing duplicative tests/images • Potential delay in timely healthcare provision • Increased beneficiary costs due to duplicate tests/images Integrated beneficiary information across the continuum of care Beneficiaries Hospitals cannot share all beneficiary health information • Difficult to manage technical complexity • Disparity of solutions and service levels across the enterprise • Fragmented, non-enterprise healthcare IT solutions Technology Duplicative platforms and system software environments Seamless delivery of standardized enterprise solutions Providers & Staff • Wasted time spent troubleshooting disparate user interfaces • Duplicative user training costs • Frustrated providers and staff • Inability to move freely between hospitals/clinics and must have numerous accounts and log-ons Seamless and integrated user experience

8. Medical Technical Infrastructure Objectives • Improve the quality of health care by implementing a single IT infrastructure from Desktop to Datacenter (D2D) • Eliminate IT redundancies across the enterprise to maximize effectiveness and achieve financial efficiencies  • Increase IT responsiveness and agility through a centrally managed and maintained technical architecture to support the military medical community • Implement first in the Pacific Northwest to support the EHR deployment and continue to deploy in advance of the program 

9. Scope of Infrastructure Consolidation Common Email Common Directory • Each of these areas are critical components to: • Clinical integration across the Military Health System • Clinical integration with external partners (VA and Commercial) • Cost Savings • EHR Solution Delivery Common Audio/Video Services MHS Health IT InfrastructureRoadmap Standard Desktop Hosting Infrastructure Common Service Desk Common Network Infrastructure Common Web Strategy

10. Scope of Infrastructure Consolidation IT Service To-Be Service Definition

11. Directory Services/Enterprise Management (DS/EM)

12. Directory Services/Enterprise Management (DS/EM) DS/EM Executive IT Roadmap for Pacific North West - Today DHMS Initial Pacific Northwest Region 1 2 3 5 6 4

13. Standard Medical Desktop

14. Standard Medical Desktop Standard Medical Desktop IT Roadmap for Pacific North West - Today DHMS Initial Pacific Northwest Region 1 2 5 3 4

15. How are we getting there? • Established Working Groups with Service and former TMA representatives to conduct an evaluation of the As-Is environments across cost, schedule, performance, and risk to develop potential solutions Courses of Action (COAs) INPUTS OUTPUTS Cost • Labor • Hardware • Software Build a solution from the ground up? Build Schedule • FOC • IT Roadmap • DHSM Deployment • Key Dependencies Purchase a COTS solution from outside vendor or govt entity that provides solution WG Evaluation Buy Performance • Reliability • Availability • Security Adopt Risk • Joint Governance • Funding • Enterprise Level Agreement Adopt a DoD/MSL capability and expand for the enterprise

16. Governance • COAs are developed and coordinated through DHA I&O IPT processes • COAs are briefed to DHA I&O Executive Committee for Decision • Infrastructure Decisions are briefed to DHA HIT Leadership for concurrence • Depending on size, cost, and mission impact infrastructure decision are briefed to other MHS governance bodies (MOG, MBOG, MDAG, etc.)

17. Our Goal: Future State DS/EM Future State Operational Environment Beneficiaries’ tests and images shared Tests/Images Set #1 Tests/Images Set #1 Beneficiary Distance: 17 Miles SAMMC WHASC MTF MTF Wilford Hall Ambulatory Surgical Center San Antonio Military Medical Center Account #1 Providers have access to same accounts Provider • 17

18. What you can expect from I&O • We are focused on MHS Enterprise Infrastructure Solutions (not Army, Navy, AF, or TMA solutions) • All current programs are on the table and being evaluated independently • You have representation at the table (reps from all Services and former EI as well as former MTF CIOs) • We are still getting our sea legs (new organization, new EHR, same mission) – but we are getting them quickly • We will admit when “We don’t know” • All great ideas do not originate from the DHHQ - We want your feedback and your ideas • We will get better at communicated to the field - quickly

19. How can you help? • Let us know what is working and what is not working • We want your feedback and your ideas • Don’t just come with problems – come with solutions • Let us know who yourexperts are • Keep the faith – if the IT community doesn’t believe this will enhance warrior care - who will?

20. Health Information and Technology (HIT) Pacific NW Site Visit Trip Report 16-20 June 2014 20

21. Pacific NW Site Visit Objectives Pacific Northwest DHMSM Locations • Objectives • In preparation for the implementation of DHMSM, DHA I/O leadership team conducted a site visit to the Pacific Northwest IOC facilities to ensure our collective preparedness for the new EHR. Facilities visited included: • Madigan Army Medical Center • Naval Hospital Bremerton • Naval Hospital Oak Harbor • Fairchild Air Force Base • To develop a comprehensive understanding of each PNW site our team met with Command Leadership, walked through a site assessment questionnaire, and conducted a tour of the IT operations. Naval Hospital Oak Harbor 3 Fairchild Air Force Base 4 Naval Hospital Bremerton 2 1 Madigan Army Medical Center

22. Purpose/ Benefits of Visit Purpose Benefits • Set the stage for the need for standard infrastructure across the DoD to support the new iEHR • Gained a sense of the level of standardization at the sites • Captured user, desktop, network, bandwidth, hardware, and software data • Formed relationships with key IT staff; they all want the IOC program to be a success • Met with Command Leadership and presented the “Desktop to Data Center” brief • Met with the CIOs and local IT staff to gain an understanding of their site-specific challenges and pain points • Reviewed and discussed the Site Assessment Questionnaire • Toured the IT Operations, Data Centers

23. Madigan Army Medical Center (MAMC) Madigan Army Medical Center • Site Information • 233 servers as of today • 7000-7500 customers • Windows 7 deployment complete end of July

24. Naval Hospital Bremerton Naval Hospital Bremerton • Site Information • 1300-1400 active users; 400 providers • DEE migration in December • 168 kiosks used in exam rooms • 17 workstations at Bangor for command submarine 9

25. Naval Hospital Oak Harbor Naval Hospital Oak Harbor • Site Information • Support 574 users; 350 clinical • 555 workstations • Couple outliers support vet clinic on other base

26. Fairchild Air Force Base Fairchild AFB Medical Group • Site Information • Workstations: Main site: 350, Vet:5, Dental: 30, HAWC: 8, APU: 8, Refill: 10, SERE: 10, DDRS: 3 • Users: Main site: 330, Vet:5, Dental: 30, HAWC: 3, APU: 3, Refill: 3, SERE: 10, DDRS: 2

27. Medical Technical Infrastructure Objectives • Improve the quality of health care by implementing a single IT infrastructure from Desktop to Datacenter (D2D) • Eliminate IT redundancies across the enterprise to maximize effectiveness and achieve financial efficiencies  • Increase IT responsiveness and agility through a centrally managed and maintained technical architecture to support the military medical community • Implement first in the Pacific Northwest to support the EHR deployment and continue to deploy in advance of the program 

28. The “Why”

29. Contact Information Pete Marks COO, DHA HIT Infrastructure and Operations Peter.marks@dha.mil

30. This is your Defense Health Agency…. Thank You For All Your Efforts!