New IT Service Requests and New Commercial Technology Requests: A How-To Guide for VHA researchers May 16, 2006

1. New IT Service Requests and New Commercial Technology Requests: A How-To Guide for VHA researchersMay 16, 2006

2. David M. Douglas MD Geriatric Psychiatrist Associate Director for Information Member IDMC Screening Committee

3. Portland VAMC Mike Davey MD PhD ACOS Research & Innovation

4. AGENDA • What is the role of the Informatics and Data Management Committee (IDMC)? • What are New IT Service Requests (NSR) and New Commercial Technology (NCT) requests? • What does a researcher need to do to place a request? • How can Research help OI?

5. Defining the Request:NSR vs. NCT • New IT Service RequestNew IT Service Requests are requests for products, product enhancements and changes to information systems maintained by OI. • New Commercial TechnologiesCommercial Technologies can be described as developmental software and/or information devices and systems written by VA employees, by vendors, contractors, or development partners. The evaluation process applies to 1) Devices displaying VistA data in a different format, and/or 2) Any device, external system, or vendor or locally developed software writing to VistA other than Diagnostic, Imaging, or Clinical Procedures equipment using nationally supported HL7 or DICOM protocols. • IDMC Screening Committee evaluates both requests.

6. IDMC SC Charter • SC established to work cooperatively with OI • Perform analyses on all IT requests to ensure alignment with VHA priorities • Provide guidance on prioritization of IT initiatives

7. IDMC Screening Committee • Informatics & Data Management Committee (IDMC) is the advisory group to the USH through the NLB on IT resources, policies, and issues. • The following committees report to IDMC • IDMC Screening Committee (IDMC SC or SC) • OI Health Information Systems Executive Boards • VHA Data Consortium

8. VHA Key Organizations & Relationships - Current VA VSSC Oversight Board Patient Care Services Data Workgroup I & T (CIO) Data Management Board IT Enterprise Architecture NLB VHA EIB Strat Plan C IDMC DUS Ops & Mgmt Health System C Policy, Portfolio Oversight & Exec Screening Subcommittee Finance C VHA Chief Architect OI Data Consortium DUSH O&M 21 VISN Comm C Data Archi-tecture Working Group Info Tech Operations Dep CIO VHA VHIM Stake-holder Council Dir ServNet (E, C, W) Facilities VISN CIO Council HRC Architecture Planning Workgroup Cyber & Info Sec Major Organizations IT Business Permanent Organizations Boards, Committees, Working Groups Coordination Direction P/D CHIO Auto-mation Center Health Data & Informatics Domain Prioritization Workgroup HSD&D Data Standard-ization Oversight Board ESMs HPMO Domain Action Teams Collaborative Health Information Partners (CHIP) HISEB

9. IDMC SC Membership Renee Oshinski (Chair) Deputy Network Director, VISN 12 William H. Beer, MD CIO, San Antonio VAMC Cynthia Breyfogle Chief Business Officer, VISN 23 Kathryn Corrigan, MD Interim ACOS Amb Care Tampa VAMC David Douglas, MD Assoc Dir Information Portland VAMC Brian Heckert Director, VAMC Columbia Peter Henry Director, Black Hills VAMC James Laub Chief Information Officer (CIO), VISN 18 Michael Simberkoff, MD COS, NY Harbor Health VAMC

10. NLB’s Informatics & Data Management Committee IDMC Screening Committee • Initial Assessment & Briefings (IABs) prepared by • Office of Information’s • Health Systems Design & Development - Planning & Analysis • With input from Office of Information’s • Enterprise Systems Management HISEBs (Executive Boards) HISEB Health Data Systems HISEB Veterans Programs HISEB Health Provider Systems HISEB Management & Financial Systems HISEB Infrastructure HISEB Common Services

11. Executive Board input to IDMC SC Health Provider Systems (HPS) • Supports health care providers in the care of veterans. Key HPS systems include BCMA, CPRS, Lab, Nursing, Pharmacy, and VistA Imaging. • Primary Stakeholders: Clinical Providers Health Data Systems (HDS) • The storage and use of dataand related efforts for interoperability and standardization of information. Key HDS systems include data standardization, information sharing, clinical data repositories, warehouses, and data marts. • Primary Stakeholders: Groups who use clinical data, external users. (Patient care, research, epidemiology, biostatistics, patient safety, decision support, quality/ performance improvement, clinical and administrative management) Management, Enrollment & Financial Systems (MEFS) • Management, financial, and business aspects of VHA.   Includes financial systems, logistics systems, pay, enrollment and eligibility, scheduling and billing. • Primary Stakeholders: Chief Business Officer, Chief Logistics Officer, Chief Financial Officer

12. Executive Board input to IDMC SC Veteran Programs (Under discussion, may leave with HPS) • Systems used directly by veterans, their families, veteran advocates, and designated VA and non-VA health providers. Included are MyHealtheVet (MHV) and Home Telehealth. • Primary Stakeholders: Veteran Representatives Systems for External Information Exchange (Under discussion) • An outward looking portfolio for information exchange with users outside VA/VHA, to include CDC, IHS, DOD, RHIO’s. • Primary Stakeholders: External Users Infrastructure, Common Services, Foundations (may be renamed) • Common requirements of the primary programs, such as hardware, platforms, and software infrastructure. • Primary Stakeholders: Internal to OI

13. New Service Requests (NSR) • NSR process initiated via Planning and Analysis Service (PAS) Webpage • NSRs must be authorized by an approving authority • Submit Request • View Request • Guidance Policy

14. Approved List of Endorsers Secretary of Veterans Affairs Deputy Secretary for Veterans Affairs Under Secretary for Veterans Benefits Veterans Benefits Administration CIO Director, C&P Service Associate Deputy Under Secretary for Programs & Policy (VBA) Under Secretary for National Cemetery National Cemetery Administration CIO Director, Office of Financial Management Deputy Assistant Secretary, Acquisition and Materiel Management Assistant Secretary, Human Resources and Administration Assistant Secretary, Information and Technology Assistant Secretary, Public and Intergovernmental Affairs Assistant Secretary, Congressional and Legislative Affairs Assistant Secretary, Policy and Planning Assistant Secretary, Management a. VHA Board of Directors Under Secretary for Health Principal Deputy Under Secretary for Health Chief of Staff (USH) Chief Compliance & Business Integrity Officer Chief Management Support Officer Deputy USH for Operations & Management Deputy USH for Health Policy Coordination Medical Inspector Chief Quality and Performance Officer Director, Office of Research Oversight Chief Patient Safety Officer Assistant Deputy USH for Policy & Planning Director, Strategic Initiatives Office Chief Communications Officer Director, National Center for Ethics in Health Care Chief Prosthetics and Clinical Logistics Officer Chief Patient Care Services Officer Chief Research and Development Officer Chief Public Health and Environmental Hazards Officer Chief Academic Affiliations Officer Chief Readjustment Counseling Officer Chief Business Officer Chief Financial Officer Chief Facilities Management Officer Chief Information Officer Chief Health Informatics Officer Chief Employee Education System Officer Director, Veterans Canteen Service Chief Nursing Officer b. All VISN Directors c. All VISN Chief Information Officers d. Office of the Chief Information Officer Director, Health Enterprise Strategy Director, Enterprise Systems Management Enterprise System Managers Director, Health System Implementation, Training and Enterprise Support Director, Health Systems Design & Development Director, Health Data and Informatics Authorized Approving Authorities

15. NCT Requests • NCT requests require two key endorsers: VISN Chief Information Officer (CIO) and Medical Facility Chief of Staff (COS)/Director. • NCT requests require that the product must be entered in the Commercial Products Registry • NCT requests require a Vendor Product Evaluation Packet

16. What are the steps in the Process? • Once the request is submitted, Planning and Analysis (P&A) team members will begin the analysis process.  • The initial steps include: assigning of a functional and business analyst, contacting the appropriate development team(s), verifying endorsement and contacting the requestor.  • P&A determine whether the request will need to be submitted to the Screening Committee for approval. If so, the functional analyst and business analyst will contact the requestor and subject matter experts to gather information to support the request. The development teams are also asked for impact information. • Once the necessary information is gathered, the completed packet is submitted up for approval.  

17. How do New Service or New Technology Requests get screened? • After requests have been submitted to the website, P&A staff create a document which serves as the basis for screening by the committee. The document comes to the IDMC SC in 2 forms • Intent to Proceed • Initial Assessment and Briefing

18. ITP: Intent to Proceed • Projects with legal, political, or financial implications so compelling that they come to the SC basically as a fait accompli • SC asked to provide input but not asked to approve or prioritize

19. Decision Support Memo to SC Overview Description of Request Background Description of Project Legacy Vista Changes HeV Vista Enhancements High Level Impacts Resources Needed Project Schedule Considerations/ Recommendations AS-IS vs. TO-BE flowcharts IAB: Initial Assessment and Briefing SC reviews IAB and then recommends disposition to IDMC

20. SC Meeting Agenda • VANTS call 4th Thurs 2-4PM Eastern • ITP review • IAB review/discussion/disposition • Weekly summary of new IT service requests (is Fast Track warranted?) • Quarterly Review of Parking Lot Items

21. Disposition • IDMC reviews/approves SC recommendations • “Approved” projects may be parked or put on hold and might be subject to lengthy delays due to competing projects/ scarce resources • SC/IDMC Approved Projects • Decision memos sent to requestors via Outlook • Decisions can be appealed

22. Parking Lot items AKA Parked Projects • These projects have been approved but are parked awaiting funding or are dependent on another application under development before work can start. • Parked projects are reviewed quarterly to determine the need for re-prioritization, deletion, or acceleration based on current VHA strategic initiatives, performance goals, and/or business drivers

23. Common Reasons for Disapproval • Insufficient business case • Enhancements to legacy Vista would not be complete until after anticipated release of HeV • Project would cause unacceptable delays in other high priority projects • Limited national applicability (one facility or only one VISN affected)

24. Recent Enhancements to NSR/NCT Process • SC to ask for IDMC review/approval of items in the Parking Lot • SC to develop a Fast Track Process • SC to revisit/propose process for evaluation of New Commercial Technologies • Promote/Improve input from HISEBs • Publicize the NSR and Fast Track Processes

25. Fast Track • Process clarified and enhanced after August NLB meeting • SC and IDMC review items in the Parking Lot quarterly • Business Owners/Requestor and OI ESMs invited to directly participate in SC meetings • SC will review weekly summaries of NSRs to identify projects which should be Fast Tracked

26. Fast Track, cont’d • HISEB input sought earlier in the process so as to be included in the IABs referred to the SC • HISEB review and response time shortened from 2 weeks to 1 • Fast Track projects will have an expedited review

27. VHA Fast Track IT Service Request Patient Safety Initiative or a Legislative/Strategic Initiative endorsed by USH/PDUSH New IT Service Request Must be endorsed by NLB Member (VISN Director or Program Officer) http://vista.med.va.gov/pas/NewITRequestForm.asp Endorsed by Facility/VISN Leadership Development Teams and SME’s/User Groups HSD&D Conducts Initial Planning & Analysis Functions 5 - 7 DAYS 3 - 4 MONTHS Preparation of Intent to Proceed (ITP) “Must Do Work” Preparation of Initial Assessment and Briefing (IAB) OI Leadership Review Period HISEB Review Period 1-2 Weeks Screening Committee Review ALL Feedback is forwarded for review process. Multidisciplinary SC Membership IDMC Review of Screening Committee’s Recommendations Multidisciplinary IDMC Membership Notification sent to Requestor Indicating IDMC Decision APPROVED Entered OI Technical Service Project Repository DISAPPROVED Requestor may re-submit request or ask for appeal through IDMC Manager Notification Sent to Appropriate HISEB

29. Scenario 1: NSR for a change to a VistA package to roll data up nationally • Researcher submits NSR after obtaining endorsement • NSR indicates national rollup of data is needed • Planning and Analysis staff assist in solidifying requirements which includes setting up Kick-Off Call • Packet workup then begins to assemble the documentation to support further discussion and decision making • IAB (or ITP) sent to HISEBs for comment • IAB AND HISEB feedback sent to IDMC SC members prior to monthly call where requestor will participate • IDMC SC makes recommendation to IDMC • IDMC approves, disapproves, requests further analysis • Requestor notified

30. Scenario 2: NCT for a clinical decision support system • Researcher enters product into registry, completes paperwork, obtains endorsement and submits NCT • Planning and Analysis staff request security and architecture review • Packet workup then begins to assemble the documentation to serve as the basis for discussion and decision making • IAB sent to HISEBs for comment • IAB and HISEB feedback sent to IDMC SC members prior to monthly call where requestor will participate in the discussion • IDMC SC makes recommendation to IDMC • IDMC approves, disapproves, requests further analysis • Requestor notified

31. New Commercial Technology Process will be re-engineered 5 aspects of NCT process reviewed at special February meeting of SC 1) Governance 2) Funding to Maintain Innovation 3) NCT Review Process Timelines 4) Procurement for Testing Products 5) Market Analysis

32. NSR Process Clarified Insufficient resources and competing projects mean that many worthwhile projects will be delayed Centralization, IT Reorg and Budget cuts cast further uncertainty on the process HISEB and field input essential but not well operationalized NCT process will be re-engineered later this year Summary and Forecast

33. Questions?