The document provides an overview of efforts to advance continuum of care for military members through health information technology. It discusses integrating federal and state healthcare, patient-centered care, precision healthcare, technology integration, and working together to achieve success through a common vision of integrity, service, and excellence.

1. Headquarters U.S. Air Force
Integrity - Service - Excellence
Advancing Continuum of Care for
Military Members through Health IT
Lt Gen C. Bruce Green
Surgeon General
11 October 2011
1

2. Shaping the Future of Federal Healthcare
Synergy- Patient-Centered
Federal and State Care
Organizational Precision
Agility Healthcare
Technology
Integration
Working Together, Achieving Success Through A Common Vision
Integrity - Service - Excellence

3. Health & Human Services (HHS)
IT Strategic Plan
Integrity - Service - Excellence 3

4. AHLTA on the'
Information Highway
Peak of Inflated
Opportunity!
Expectations
Plateau of Swamp of
Productivity Diminishing
Vehicle of Returns
Opportunity!
Innovation
Trigger Slope of
Enlightenment
Cliff of
Obsolescence
Trough of
Disillusionment
Time
* Gartner Inc., chart from Mastering the HYPE CYCLE by Jackie Fenn and Mark Raskino
Integrity - Service - Excellence

5. Aligning with the Quadruple Aim
(Variation of Triple Aim)
READY: BETTER HEALTH:
Readiness
BETTER CARE: BEST VALUE:
AFMS Inpatient Measures
CY10 CY10 CY10 CY10
Annual Comparative
Synergy
Q1 Q2 Q3 Q4
MTF's
Reported Events 3911 2618 2908 2769 12206
and
Near Miss(%) 69.4 64.1 64.4 75.6
20.2
68.4 >72% Balance
27.8 <28%
P a t ie n t S a f e t y M e a s u r e m e n t s
No Harm(%) 28.6 30.8 31.5
Harm(%) 2.0 5.1 4.1 4.2 3.8 0
Serious Reportable Events*
Wrong Site Surgery (WSS) 1 2 2 2 7 0
Retained Foreign Objects 0 2 3 1 6 0
Pressure Ulcers (Stage III and IV) 0 0 0 0 0 0
Falls 0 0 0 0 0 0
Fall rate (per 1,000 OBD's) 0.1 0.3 0.3 0.4 0.4 2.1-3.1*
Common Ground and Focus Required to Avoid Extinction
Integrity - Service - Excellence
Quadruple Aim is based on the Institute
for Healthcare Improvement’s Triple Aim

6. Leveraging Medical Informatics
DATA INFORMATION KNOWLEDGE WISDOM CHANGE
Better Care
TMDS Clinical
Through
Practice
Evidence Based
Guidelines
DEERS Practice
CarePoint Medication Better Health
PDTS Health
Alerts Enhanced Patient
Services Registries
Data Safety
$ / M2 Warehouse
User Home Best Value
(HSDW)
Interfaces Sensors Healthy Behavior
DMHRS
i Better Care
Expedited
EHR Test Results Improved Patient
Experience
Accelerating Information Exchange with Patient Activation
Integrity - Service - Excellence

7. Meeting the Stakeholder’s Needs
Individual Med
Readiness
Patient
Health Employer
Rating (HER)
Prev Health
Assessment
Employer
Ultimate
Deployment
Assessment
Health
Outside
Provider
Visit Provider
HSDW Transforms Healthcare Delivery to Health
Integrity - Service - Excellence 7

8. Tri-Service Workflow:
Improves Practice Management
AHLTA-based workflow tool to help healthcare teams personalize
care with standardized tools and templates
Improves readability of providers notes
Automatically captures credit for accurate coding
Tracks preventive services at point of care w/ Electronic-2766
Starts with Info to Provider at Point of Care; Clinical Practice Guidelines Now in AHLTA
Integrity - Service - Excellence

9. Transforming Data Into
Knowledge
Ready Better Health Better Care
Patients receiving Diabetic patient
massive transfusions educated on
experienced 65% “remote
mortality monitoring”
glucometer
Massive JTTR
transfusion Database Readings
MTF calls
mortality analyzed automatically
patient to
drops to to identify sent to
discuss
17% trends healthcare
management
team
Clinical Practice
Guideline developed
Uncontrolled sugar
for 1:1 transfusion
levels Identified
protocol
Empowering Patients & Staff with Tools to Improve Healthcare Delivery
Integrity - Service - Excellence 9

10. Create The Setting
For “Right” Behaviors
Percent of Patients Satisfied* Continuity of Care
Family Health Providers at PCMH Sites MTF Primary Care Visit Distribution* Other Provider
100% Family Health / PCMH Patients
100%
95% 90%
21471
PCMH Team
% Satisfied
80% 64954
90% UP is 70%
42400
85% Good 60%
PCMH PCM
50%
PCMH TEAM
40%
80% 30% 123681 121580 Continuity
20% Other Provider
75% (Family Health
10%
Jan-11 Mar-11 May-11 Jan-11 Mar-11 May-11 Clinic)
0%
Non-PCMH Sites (41/322163) PCMH Sites (34/351952) PCM
PCMH Aggregate Non-PCMH Aggregate
(Non-PCMH
Dec 2010 - May 2011 Sites)
Satisfaction: Goal > 95% Continuity: Goal > 90%
Plan: Provide both monetary + non-monetary incentives to high performers
Monthly Emergency Department and Urgent Care Utilization* HEDIS Measures - Patients Enrolled to PCMH Clinics
Per 100 PCMH Patients
10 40
Average Monthly Visit Rate (per 100)
8 30
6
Score
20
4
2 DOWN 10 UP is
is Good
0 Good 0
Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11
PCMH Aggregate Non PCMH Aggregate PCMH Aggregate Non-PCMH Aggregate
ED/Urgent Care Rate: Goal < 3/100 HEDIS Aggregate: Goal > 40
Inspiring Trust & Confidence by Measuring and Rewarding Outcomes
Integrity - Service - Excellence 10

11. Getting Info to Patients
for Shared Decision Making
Patient Centered Medical Home
HIDDEN SLIDE
For Printing Purposes Linking Individual Patients &
Due To Animation Providers To Health Information
Maximizing Use
Of Teams To
Enhance Care
Building Capacity & Transforming Data into Actionable Info
Improving Currency To Advance Practice
Training, Education & Recapture Provider Decision Support
Deliver Best
Improving Relations, Evidence-Based
Empowering Patients, & Medicine To Patients
Changing Behaviors & Staff
Patient Decision Support Applied Clinical Epidemiology
Integrity - Service - Excellence 11

12. Putting It All Together'
Air Force Medical Home
MHS
Linking Individual Patients &
Quadruple Aim
Providers To Health Information
Maximizing Use
Of Teams To
Enhance Care
Ready Better Health
Building Capacity & Transforming Data into Actionable Info
Improving Currency
“Population Health”
To Advance Practice
Training, Education & Recapture Provider Decision Support
Deliver Best
Better Care &
Improving Relations, Best Value
Evidence-Based
Medicine To Patients
Empowering Patients,
“Experience Of Behaviors
Changing Care”
“Per Capita Cost”
& Staff
Patient Decision Support 12 Applied Clinical Epidemiology

13. Activating Patients & Care Teams
Health
Team Patient
Decision Patient Decision
Support Support
Centered
PCMH Provides Improved Decision Support- For Patients c eHealthcare Teams
Integrity - Service Excellen &

14. Electronic Health Initiatives
Project (eHIP)
Integrity - Service - Excellence 14

15. Developing The US Air Force
Virtual Medical Center

16. Social Networking Needs To Be
Integrated Into Common Practice
PHR
Enhancing and Complimenting The Health Team’s Practice of Care
Integrity - Service - Excellence

17. Sec Def/Sec VA Decision
Combined Efforts Provide the Best Future EHR
Integrity - Service - Excellence

18. DoD-VA “To-Be” iEHR Architecture
Common DoD-VA Requirements: HL7 EHR-S Functional Model with DoD and VA vetted Extensions (SV-4)
Common DoD-VA Integrated Health Business Reference Model (OV-5)
Common DoD-VA “To Be” Process Flow Model (OV-6C)
Presentation
Presentation (Common GUI)
Layer Team
Applications and Services
DoD Unique (16) Common (Joint) Applications & Services (30) VA Unique (6)
Systems Battlefield
Pediatrics Pharmacy
Personal
Laboratory Blood Mgmt
Nursing Long Term
Mission Capabilities Care Health Record Home Care
Requirements Disability Inpatient Emergency Document
Team Military
Obstetrics Evaluation Orders Mgmt Dept Care Mgmt
Rehabilitative Transient
& Performance Readiness Care Outreach
Consult & Operating
Outcomes Enroute
Veterinary Dental Care
Referral Mgmt
Immunization
Room Mgmt
Pharmacy Occupational
Care Mail Order Health (VA)
Team
Common Interface Standards
Business Enterprise Common Services Broker
Process Architecture (includes Enterprise Service Bus (ESB) and Infrastructure Services)
Team Team Common Interface Standards
Common Data Centers
Data Inter- Common Information Interoperability Framework (CIIF)
operability Common Information Model, Common Terminology Model,
Team Information Exchange Specifications, Translation Service
Common Data Standards: SNOMED CT and Extensions, LOINC and RxNorm
Common DoD-VA Measures of Effectiveness, Measures of Performance and key Performance Parameters
Joint DoD/VA DoD Only VA Only
Integrity - Service - Excellence 18

19. Federal Health System
Integration
HOSPITAL
PHARMACY
VISIT
Electronic
Electronic PROVIDER
RADIOLOGY Health Record
Health Record OFFICE
VISIT
Common
Logistics
PUBLIC
LAB SYSTEM HEALTH
SERVICE
Open-Source Provides Integration Without Barriers
Integrity - Service - Excellence 19

20. Federal Agencies Leading the
Way with Open Source
Auto-Generated
Documentation – Doxygen
Code Repository – Git
Cross-Platform Build Tools –
CMake
Bug/Feature Tracker – Mantis
Documents/Resources – Wiki
Mailing Lists
Code Reviewer – Gerrit
Software Quality Dashboard –
CDash
Technical Journal – Insight
Journal
Source: Rick Avilo
Integrity - Service - Excellence 20

21. Synergy Accelerates
Transformation
Leverage Federal expertise through “open” partnerships
Unleash the power of mass collaboration
Improve trust through transparency
Explore new avenues of development
www.max.gov
Generating & Sharing Open-Source Knowledge Accelerates Innovation
Integrity - Service - Excellence

22. PPC Roadmap
Complete
Strategy
IMS Document
Base-lined Complete Idea
Change Factory
Readiness Concept
INTEGRATED
Training
Planning Office Stakeholder
Charter Complete Analysis
Strategic Leadership
ROADMAP
Comms Engagement
Integrated Plan Resource
Roadmap Complete EHR Tri-Fold Library
Complete
Risk/Issues Press Clips &
Base-lined Newsletters
Website
Program Mgmt Content
Mission/Vision
Plan Statements
Tech. Gov.
Lifecycle Policies & Acronym Biographies
Procedures List Complete
CMM Interactive EHRWA
Deliverables Presentations Style Guide
Document
Templates
Acquisition
Strategy
Acquisition IA
Strategy
Systems
Engineering Plan
Industry Days
Held
Final PESHE
TEMP
IA Strategy Capability Develop.
Document
Information AoA Phase II
Support Plan
CARD
Data Mgmt
Strategy
RFI-I / RFI-II
Released
Engineering Action
Plan From, “EHR Way Ahead,” Aug 2011
Paula Friedman, Director, EHRWA, DoD MHS ADM
Complete
I n t e LEGEND: t SCHEDULED e IN PROGRESS - COMPLETEc e l l e n c e
gri y - S rvice Ex

23. Patient as the Decision Maker
Ready: Reassure patient that you “know them”
Accessible: Be there when the patient needs you
Prepared: Respect patient and their time
Precise: Clarify all treatment and follow-up
Organized: Don’t ask patient what you should know or have
available in their medical record
Respectful: Always answer phone calls/resolve patient concerns
Thorough: Tell patient what to do if they feel worse
The Ultimate Outcome of Integration & IT Initiatives is Better Patient Care
Source: Integrity - Service - Excellence 23

24. “TRUSTED CARE ANYWHERE”
Integrity - Service - Excellence