The Current Process for VA Pharmacy Information Systems Improvements and Enhancements

1. The Current Process for VA Pharmacy Information Systems Improvements and Enhancements Lynn Sanders VA Pharmacy Informatics Conference April 2010

2. Today’s Discussion • Idea • Process to submit an idea • RAEM and Class 3 • Program Office Role • Request for business owner support • Approval, prioritization, funding • Project Development • Project Oversight and Governance • The Next Big Thing

3. It Starts with the Idea and Need • Ideas Usually come from a medical center as a result of a Need • Needs come from an issue, such as a patient safety incident or a legislative review. • Once a need is identified – some one needs an idea.

4. Ideas • Ideas are developed in a number of ways • At the medical center by a person or group that designs something locally. • In many cases this may simply be a tool used locally such as a template or file man report • In some cases the design is shared and its believed that other medical centers might benefit. • Ideas may also come from outside VA, other hospitals and vendors

5. From Idea to Development • There are a few ways that a idea for system improvements to be developed • New Service Requests • Class III Conversions • Innovations Program • Local Development

6. The Process to Have an Idea or Need Developed

7. PBM Program Office Role Request for Approval, Prioritization

8. Improving Pharmacy Systems • Pharmacy Re-engineering • New Service Requests • Class III Development • Innovations • Local Development • Incorporating Commercial Systems

9. ESM AND THE RAEM PROCESS

10. Enterprise Systems Management Office (ESM) • The Enterprise Systems Management (ESM) Office is part of the Veterans Health Administration (VHA) Office of Health Information (OHI) within the Department of Veterans Affairs (VA).  The ESM Office serves as a VHA advocate and facilitator in the advancement of Information Technology (IT) and innovative health information strategies that improve the services provided to our nation’s Veterans. • The Office also serves as a liaison among clinical, business, and IT communities to ensure technology enhancements and strategy requirements are: • Identified • Communicated • Understood • Prioritized • Translated into IT investments that meet clinical, business, and Veterans’ needs

11. Requirements Analysis & Engineering Management (RAEM) is part of the ESM organization of the VHA Office of Health Information (OHI) • Our primary goals are: • Gathers, documents, analyzes, and evaluates clinical and business requirements. • Analyzes and evaluates projects and programs designed to meet VHA clinical and business requirements, including analysis of costs, benefits, return on investment, cost effectiveness and suitability for meeting the stated requirements. • Interprets and assesses the impact of new or proposed Congressional legislation or Administration proposals on VHA user requirements. • Provides business intelligence to support executive decision making during all stages of project and program planning, policy formulation, and decision making. • Translates user requirements into functional requirements through coordination with technical resources, documents system Concepts of Operations, and defines requirements for VHA enterprise architecture and compliance. • Facilitates collaboration among various teams to address process improvement.

12. New Service Requests VHA utilizes a rigorous, seven-phase process to evaluate NSRs: • Request Initiation • Assessment of Request • Analysis of Requirements • Technical Assessment of Request • Prioritization of Requests • Approval of Concept • Funding and Activation of Project.

13. New Service Requests

16. Prioritization By VHA HSIEB, Patient Safety

17. Five Health Information Systems Executive Boards (HISEBs) have been • formed under the authority and guidance of the Informatics and Data Management Committee (IDMC). Each HISEB provides senior VHA management, leadership, and oversight to facilitate and advance the functionality and operation of an IT portfolio in the Office of Health Information. • Responsibilities include: • Ensuring that the portfolio meets current and future needs of VHA customers. • Ensuring effective resource utilization. • Ensuring that the portfolios are managed in compliance with VA and VHA plans, policies, standards, infrastructure and architecture. • Establishing project specific sub-groups. • Overseeing the performance, planning and execution of systems within each portfolio to ensure successful development and operation throughout the system's lifecycle. Health Information Systems Executive Boards (HISEBs)

18. Health Provider SystemsHISEB Review Process

19. Health Provider Systems Portfolio • Health Provider Systems (HPS) provides IT tools that support clinical care activities, both for direct care givers as well as ancillary service departments. Health Provider Systems are information systems that help healthcare providers care for Veterans by supplying information to main systems, such as VistA. • The HPS portfolio focuses on: • Electronic Healthcare Record (CPRS) • Clinical flow sheets • Laboratory, Pharmacy, Radiology, and Surgery departmental systems • Clinical Image Management services • The Enterprise Systems Managers (ESMs), in conjunction with the Health Provider Systems Health Information Systems Executive Board (HISEB), will manage and oversee the HPS portfolio.

20. Health Provider Systems – Active Projects BCE – Positive Patient Identification Blood Bank - VBECS v1.0 Updates Blood Bank Application Maintenance Blood Bank System Anticoagulation Management Program Mandatory Field in Consult Request Software “soonest appropriate date for this service to be provided” CLIO v1 CPRS - Display Polytrauma Markers CPRS GUI Development Version 28 EDIS v1 VistaWeb v11 Radiology HL7 Interface Update Radiology Safety & Reporting Enhancements (previously known as Radiology Maintenance & Enhancements- Radiology) RAI/MDS Maintenance BCMA - Inpatient Medications Requests for SFG IRA - Phase 3 and Phase 4 FY 10 Annual Surgery Updates FY10 Pharmacy NDF Maint and Data Updates Document and Ancillary Imaging Filmless Radiology (VHA will determine Leg. mandate) VistA Imaging Core VistA Imaging Storage Laboratory System Reengeering Project (LSRP) FDA Medication Guides Updates - Just approved to activate, project in startup Ward Drug Dispensing Equipment (WDDE) Interface Pharmacy Legacy QTR Enhancements Pharmacy Re-Engineering (PRE) .5 National Teleradiology Program VA/DoD Imaging Paused – Blind Rehabilitation v5.1 (need to replace a contract lost in December) Paused – Spinal Cord Injury v3.0 (need to replace a contract lost in December) Paused - Mental Health Enhancements phase I (this defect repair effort requires two OI&T resources)

21. New Service Requests PBM is asked to Prioritize • Teratogenic Drugs • Supratherapeutic Dosages • Allergy Checks using COTS • CCHIT • Transfer In/Out/NVA • Order Checking Improvements • Complex Order Edit

22. Patient Safety Reviews of NSRs

23. Funding By VA IT Subsequent to Prioritization and Cost Assessment

24. What Drives Funding? • Sustainment • Core • Critical Patient Safety • Transitional – T 13 Initiative • Mission Critical • Other Mission Critical • Discretionary Mission Critical

25. Funding Prioritization

27. VA INITIATIVES/PROGRAMS 2010

28. Project Development Example of PRE as a Project

29. Pharmacy Re-engineering Functionality Project Plan Before PMAS

30. PM Name: Mike Mims VHA Biz Rep: VHA Biz Owner: Lynn Sanders Jeff Ramirez Pharmacy Reengineering Project – Business Case The Pharmacy Reengineering (PRE) project will replace all pharmacy applications with a system that better meets the current and expected business needs for the VA. This product will deliver enhanced order checking functionality utilizing HealtheVet (HeV) compatible architecture to the field with our first iteration addressing known patient safety issues. Other enhancements will include Dispense and Administration, Activate, Inventory, Clinical Monitoring, and functions with final migration to the HeV environment. Program Summary: Current Pharmacy functionality is not patient centric and does not include adequate decision support capabilities required for a modern healthcare system. Approximately 124 requests for system improvement have been referred to Pharmacy Reengineering and are deemed not feasible to be implemented in Legacy. The Pharmacy Reengineering project will provide the ability to respond to the ever-changing patient safety issues, medication treatment cost reduction and containment, beneficiary service requests, and will provide the clinician with an improved work flow and process utilizing a scalable HDR/HealtheVet platform and realization of One VA. Justification: Business Value Version Number: 1.0

31. Business Value Continued

32. Business Value Continued

33. What is the Project Management Accountability System (PMAS) and what role does it play in the IT projects that are being stopped or continued? • PMAS is the rigorous management approach VA instituted to address IT development project performance shortcomings.  PMAS delivers smaller, more frequent releases of new functionality to customers, ensuring that customers, project staff, and vendors working on a project are aligned, accountable, and have access to all necessary resources to successfully complete the project’s goals and objectives. PMAS mandates that specific project resources and documentation be in place before development begins and mandates that approval processes be used during the system development life cycle. It also ensures that development projects are outcome-based by institutionalizing the use of standard, end-to-end repeatable processes.

34. Pharmacy Reengineering Plan/Progress PMAS Re-planning Objectives • Support delivery (IOC) of PRE components in manageable increments not to exceed 6 months.  • Increments must provide functionality to business owners • Accelerate delivery of increments to field testing • Reduce duration of lab testing processes • Increase reliance on internal SQA and test accounts at field sites for feature testing • Beat schedule for FOC delivery outlined in approved June 2009 schedule

35. Pharmacy Re-engineering Plan After PMAS

36. PMAS Integrated Project Teams

37. Pharmacy Reengineering Update (M. Mims) COMPLETE COMPLETE 37 37

38. Pharmacy Reengineering Update (M. Mims)Status YELLOW Current PRE Status. IOC for PECS (Increment 2) completed 3/5/10 as scheduled. National Hardware Solicitation bids received 3/12/2010. Reviews start 3/15/2010. Setup of Beta sites for Increments 3 and 4 completed as scheduled by 3/15/10. UAT for Increment 4 is planned for the week of 4/12/2010. Issues Existing SQA testing and Project Planner contracts supporting PRE expire on 3/31/10. If coverage in these areas is not maintained, PRE schedule may be impacted. Indications are that these contracts will not be renewed. 38 38

39. Other Major Projects • Pharmacy Legacy Quarterly Enhancements • CPRS • Inpatient Medication Orders • BCMA • BCRO • Lab Re-engineering • e-Pharmacy Claims

40. My HealtheVet Secure Messaging • SM enables Veterans and their healthcare teams to exchange non-urgent health-related information, attend to administrative needs, and in some cases communicate in lieu of an office visit or telephone call. SM is a patient-professional communication toolthat enables: 1) patient-clinician communication management; 2) healthcare team management; 3) message management; and 4) patient services/clinical operations management. This e-health service, provided through MHV, is the authorized means for VA staff and patients to communicate electronically with one another. • Expansion of virtual medicine for Veterans is a critical component of the Veteran Centered Medical Home model transformation. SM through MHV is considered an essential element of the Veteran Centered Medical model enhancing virtual medicine activities and providing patients with access to the care they need in a manner they desire.

41. BCRO Share Point SiteAccess and Management of Information

42. Innovations

43. GREENFIELD INNOVATIONS

45. Local Development – Beating The System

46. Local Medical Center DevelopmentAlerts, Progress Notes, Reminders, Templates, Consults

47. Project Oversight and Governance PBM, Patient Safety, ESM

48. The Business Relationship MeetingVHA & VA IT • Purpose • The Business Relationship Meetings between Under Secretary of Health and VA Chief Information Officer provide a forum for weekly status reports on various projects and activities.  The primary meeting activities are as follows: • •     The review and discussion of status of agenda items as determined by VHA • •     Discussion of various joint activities and projects between VHA and OI&T • •     Focus on development and operational issues

49. PBM Clinical Informatics Role in the Development and Deployment of a Project Approval of Project Phases Issue Brief and Concurrence • ESM, VA IT, PBM, Patient Safety Advisories to Leadership and Medical Centers Compliance Monitoring Report of Contact for Problems Workgroup Participation and Subject Matter Experts with VA IT Project Leaders and Developers Knowledge Experts Training and Education Communications

50. VHA Software Patch Issue Brief • SUMMARY OF TESTING: •  Testing Process: • Peripheral devices affected: • Outstanding Issues: • Exceptions to Testing: • Communications: •  Proposed IOC Test Sites • IMPLEMENTATION ISSUES: • Recommend Approval/ Do Not Recommend Approval • ECOMMENDATION: • BASIS OF RECOMMENDATION AND EFFECTS ON EXISTING PROGRAMS AND/OR FACILITIES: •  CONCURRENCES: • VHA OHI IT Patient Safety: • Recommend Approval/ Do Not Recommend Approval/ No review required • Business Owners/Stakeholders Signature: • Issue: •  Date of Report: •  Point of Contact: • Desired Release Date: •  Emergency Release: •  Application Name(s): • Software Product Description: •  Patch Release Dependencies •  STATEMENT OF ISSUE: • SUMMARY OF FACTS / BACKGROUND: • Impacts to Healthcare: • Impacts to Business Flow: • Solutions: • CURRENT ACTIONS: