Maximizing Best Practices for Innovation Leveraging Technology to Take Healthcare to the Next Level

Transcription

1 Maximizing Best Practices for Innovation Leveraging Technology to Take Healthcare to the Next Level Paul Tibbits Deputy CIO for Enterprise Development Department of Veterans Affairs November 9, 2009

2 Topics Accountability VA/DoD Interoperability Nationwide Health Network Architecture: SOA Overview Architecture: SOA at VA Innovation Philosophical Views and Challenges

3 PMAS: Introduction Program Management Accountability System (PMAS) introduced on 15 June 2009 All projects will utilize incremental delivery (smaller, more frequent delivery of functionality) Rigorous management to committed schedule milestones (3 misses cause project stop) Provides near-term visibility into troubled projects to eliminate big bang project failures Initial 45 projects paused on July 17, 2009 Worst performing projects in the portfolio Most were over one year behind schedule All VA IT projects will be PMAS compliant by June 2010.

4 Incremental Development All new VA IT projects/programs must use an incremental development approach Frequent customer delivery milestones; at most every six months Customer must test and accept functionality To be approved for investment, a program or project must have: An identified customer sponsor An established integrated project team Program plan that documents frequent delivery milestones Documented, agreed to requirements for initial milestones Clear plan for necessary program disciplines Clear access to necessary program resources Customer, program, and vendor acceptance of PMAS Jointly established success criteria

5 VA/DoD Interoperability

6 Current State Pharmacy Data Theater Clinical Data Inpatient Consults Social History Sep 09 Sep 09 Sep 09 Sep 09 Oct 09 HEC IM/IT WORK GROUP Allergy Data Radiology Reports Operative Reports Other History Inpatient Documentation Expansion Gateways - Data Migration Document Scanning (initial) Expansion of Questionnaires Lab Results (computable) Lab Results Pre-Deploy Assessment Provider Notes Family History Questionnaires DoD and VA Shared Health Data Discharge Summaries Post-Deploy Assessment Procedures Vital Signs Std Ambulatory Data Record Post-Deploy Reassessment Problem Lists Additional Inpatient Data Plan Completed Jun 08 Images (Enterprise-Wide) Add l Data Elements (Viewable) Add l Data Elements (Computable) Interoperability Plan, V 1.0 Completed Sep 08 Combat Military Pay MGIB Eligibility BEC IS/IT WORK GROUP Compensation & Pension Data Plan Completed Jun 08 Images (Enterprise-Wide) Add l Data Elements (Viewable) Add l Data Elements (Computable) Interoperability Plan, V 1.0 Completed Sep 08 Accessions & Separations Add l Education Benefit Data MGIB Program Usage Data Activation / Mobilization UIC Mailing Address Data Military Pay Insurance/ Benefit Eligibility Military Imaged Record via DPRIS Member / Veteran Family Member for Insurance and Cemetery Benefits DoD and VA Shared Personnel / Administrative Data Cognitive Assessment Tool (LOA2) Web-Based Training (LOA2) TBI / PTSD Telehealth Consult (LOA2) Document Mgmt. System (LOA1) VA Disability Exam Templates (LOA1) Dis Eval Sys Pilot - VTA Tracking (LOA1) Wounded Warrior Indicators (LOA4) ebenefits Portal (LOA4) Imaging - Theater (LOA4) Reserve Health Records Access (LOA4) TBI Extender Codes (LOA2) Behavioral Health Notes (LOA2) Research Clearing / Datamart (LOA2) TBI Patient Registry (LOA2) Clinical Case Mgmt. (LOA3) ADT to DFAS (LOA8) Web-Based FIRP (LOA3) Non-Clinical Case Mgmt. (LOA3) KEY Current Sharing (Viewable) Current Sharing (Computable) Planned Sharing (funded) Potential Sharing (unfunded & uncosted) Clinical Enhancements Defense Center of Excellence (DCOE) Phase 1 of Common s Initiative Phase 2 of Common s Initiative Potential Sharing (DoD funded) Potential Sharing (VA funded; DoD identified funding requirements FY09 supplemental) On Contract 6

7 North Chicago Captain James A. Lovell Federal Health Care Center First FHCC managed jointly by VA and DoD Opening Day October 2010 Ambulatory Care Center site On Schedule Provide Management/ Technology Key to establishing VA/DoD electronic health record 7

8 Proposed Future State Other Government Agencies Beneficiary / Stakeholder Managed Care / Fee Private Providers Other Uniformed s Army Marine Corps Navy Air Force JOINT DoD Unique Data Ex: Enrollment, Operational/Theater DoD Pharmacy* Self- Logon Common s Lab* Radiology* Consults Single Sign-On Portable Order Entry Identity Management History Benefits & Eligibility Compensation Education VA VHA VA Unique Data Ex: Extended Care Data, Veteran/Dependent Benefits Virtual Lifetime Electronic Record Health Benefits Personnel * Orders and results 8

9 Nationwide Health Network

10 Nationwide Health Network Health Bank or PHR Support Organization State and Local Gov Community Health Centers Community #1 Mobilizing Health Nationwide CDC VA DoD Labs SSA CMS Integrated Delivery System The Internet Pharmacies Community #2 Standards, Specifications and Agreements for Secure Connections

11 Federal CONNECT Concept of Operation Federal Sector Agency 1 Existing HIT System Agency 1 NHIN Gateway Adapter* Adapter SDK Agency 1 NHIN Gateway Agency 2 Existing HIT System 70 Agency 2 NHIN Gateway Adapter* Adapter SDK Agency 2 NHIN Gateway NHIN Agency n Existing HIT System Agency n NHIN Gateway Adapter* Adapter SDK Agency n NHIN Gateway *Agencies may share some development efforts for the Gateway Adapter Developed by NHIN-C Federal Consortium 11

12 Wounded Warrior Scenario: Key Concepts Continuity of Care for the Wounded Warrior Aggregated View of Retrieved Patient Health Determination of Disability Benefits 12

13 NHIN can Enable VLER (Phase II) Private Providers National Standards NHIN Exchange Standard Administrative Record Standard DoD DoD Apps. Shared s VA Apps. VA NHIN Record Standard 13

14 Architecture: SOA Overview

15 Line of Sight in Action Line of Business (LOB) or Business Process Modeling Center of Excellence (PMCE) Performance Reference Model (PRM)/Strategy Documents Strategy PRM Business Process Models Business BRM SE & Data Data DRM Systems Engineering (SE)/Architecture and Engineering Processes Applications & s SRM SE Artifacts Technology Infrastructure TRM System Development Life Cycle (SDLC) Process IT Products IT Products IT Products IT Products

16 FEA PRM BRM DRM SRM TRM Strategic Goals & Objectives Business Components (Functions, Subfunctions, and Capabilities & Data Applications s Infrastructure Components Medical Care Sub- Function 1 Element 1 Element 2 1 Composite Apps Care Mgmt Enabling the Business (a FEA Point of View) Employee Health Record VHA Domains of Value Eight for Excellence Medical Research Sub- Function 2 Element 3 VA Pillars Element Medical Educatio n Sub- Function 3 Element s 2 n Sub- Function 4 Messaging Discovery Security Core s Element 6 Technical Standards ESM Strategy Lines of Business Business Area Sub-Functions Element VHA 6 Strategy Lines of Business Business Area Sub-Functions Element 6 Supporting Activities Business Process Modeling Core Data Model Orchestration Enterprise Engineering Enterprise Strategic Goals, Organizational Processes Enterprise Data Strategy Business Specific Extensions E-SOA Core Reference Implementation Security s Discovery Data SPP Mediation s Messaging Measurement & Enforcement Contracts Level Agreements User-Facing s ESM Implementation of Standards, Specifications, Patterns, Practices E-SOA Governance Requirement Framework Organizational Governance Open Community Process Business Process Modeling Data Strategy Metrics Test & Assessment Certification & Authorization Deployment Strategy Education & Training

17 System of Systems (SoS) Software module or i.e. lab, scheduling, identity, etc Software module or i.e. lab, scheduling, identity, etc SOA Stack Software module or i.e. lab, scheduling, identity, etc Software module or i.e. lab, scheduling, identity, etc Software module or i.e. lab, scheduling, identity, etc Software module or i.e. lab, scheduling, identity, etc Common s -Heavy use of Rational Tool Suite (with Jazz enhancement). Some Systems Engineering Tools -Heavy use of a modeled based Systems Engineering Tools Suite and some Rational (with Jazz enhancement) Products Provide boundary conditions and definition of black boxes Software Engineering Management Plan (SEMP) Heavy focus on SoS Architectures/Designs 508 Requirements/Design Disaster Relief (DR) Oriented Architecture (SOA) Etc. SDLC Process Provide processes in the development of individual modules Heavy use of Rational/Jazz Tool Suite although has some need for software engineering tool suites Agile Development Methodology Project/ focused requirements Lab Payment of benefits Etc Business Architecture Artifacts Systems Engineering/Architecture and Engineering Processes

18 Business Architecture Artifacts System of Systems Systems Engineering/Architecture and Engineering Processes Software module or i.e. lab, scheduling, identity, etc Software module or i.e. lab, scheduling, identity, etc SOA Stack Software module or i.e. lab, scheduling, identity, etc Software module or i.e. lab, scheduling, identity, etc Software module or i.e. lab, scheduling, identity, etc Software module or i.e. lab, scheduling, identity, etc Common s Artifacts of SE Process feed into various spots in SDLC Artifacts need be focused on SoS Artifacts need to tie into business architecture SDLC Process Challenge How do artifacts which are updated on a periodic basis fit into a time based (project based) project Sequencing artifact updates to all project schedules not possible SE artifacts must take into account projects at different states in SDLC and be able to account for different life cycle states

19 Architecture: SOA at VA

20 VA SOA Transition Road Map ACTIVITIES Perform Pre-Audit & Assess Readiness Define Guidelines & Constraints Identify Business & IT Stakeholder- Conduct Analysis on Executives, Managers & Executers Conduct Initial Training Define Metrics: Goals, Stakeholder Impacts & Changes Prepare Organization Change Strategy & Framework Training Plan, Materials Training Content, Structured to Complement Other VA Training VA As-Is ACTIVITIES Provide Governance Assessment, Model & Framework Document Requirement Define Roadmap Define Reference Architecture & Security Model Prepare Developers Handbook Center of Excellence Enable Enterprise Framework Deploy & Manage Common, Documented Methodology Facilitate Cross-Organizational Requirements Gathering for Development & Enhancement Activities Implement Governance Strategy & Framework Enforce Common Development, Coding, Documentation & CM Standards Provide Education Outreach & Awareness Initiatives Complement Current Training Provide Plan & Materials, & Conduct Training Integrate VA Business Process Modeling Provide CM Plan, SOA COE Ops Guide Current Status Goal Operational SOA Rollout Planning ACTIVITIES Establish VA SOA Infrastructure Wrap Legacy VA Systems as s Secure Interfaces Design, Procure and Deploy SOA Infrastructure Implement Reference Stack Refine Design and Implement, Policies, Processes, Procedures, Documents, etc Implement the Above Phase 1 Prepare the Business and IT Phase 2 SOA Governance and Management Goal Discoverable Reliable s Phase 2 SOA Governance and Management Goal Loosely Coupled s Phase 3 Legacy Transformation Goal Composable, Reusable s Phase 4 Business Enablement with SOA Oriented Enterprise VA ACTIVITIES Establish VA SOA MetaModel Semantic Integration Across VA VA s and Processes Implementation VA Internal Use Only 20

21 Standards, Specifications, Patterns Data Strategy, Interface Design and Architecture with associated Coding standards are synergistically evolved through BRM/BPM analysis -Orientation is appropriate embedded in each of these based on a business case evaluation of the capabilities being augmented or transformed. Governance Fed by coevolution of technology and BRM/BPM analysis

22 VA Internal Use Only 22 Example: Chapter 33 Tactical Governance Implementing Governance for Chapter 33 Established OED / Chapter 33 Architecture and Engineering Governance Board Established ESOA / Chapter 33 Architecture Integrated Product Team (IPTs) to manage issues in key areas Security, Architecture, Infrastructure Identifying and managing critical gaps in Governance for Chapter 33 Process and artifacts that: Identify connection to systems outside CH33 Determine responsibility for changes to these systems Determine service agreement type Enable CH33 service deployment and certification Developing service-oriented Standards, Specifications, Patterns and Practices (SSPP) and an associated reference implementation of core services Chapter 33 Tactical Governance ESOA / Ch 33 Arch IPT Charter SPAWAR (Chair) Ch 33 Technical Team -SE EIE OED-SE OED / Ch 33 Arch-Eng Governance Board Charter OED-SE (Chair) Architect PM Rep EIE Rep BOIBI Rep Field Ops Security Chapter 33 Governance Model is scalable to the Enterprise level

23 Innovation

24 Health Technology Innovation A partnership between VHA and VA Office of and Technology (OI&T) Objectives: Allow mission critical healthcare innovations reliant on information technology to emerge. Establish processes that ensure investments in innovation are reviewed and prioritized by stakeholders. Ensure that innovations are developed, tested, piloted and deployed with due regard for security, network integrity and privacy. Full Transparency Low Bar for Entry High Bar for Exit 24

25 Innovation Components Greenfield Incubation field innovators propose new opportunities Strategic Incubation* leadership identifies opportunities Innovation Diffusion evaluation of the quality of products and how products work in the healthcare delivery process Collaborative Tools technologies used to advance innovation and encourage the building of communities of interest Workforce Development activities undertaken to build a culture of innovation and a knowledgeable workforce VA OI&T Innovation Advancement Program (IAP) *cross-administration strategic initiatives to be undertaken; points of contacts have been identified 25

26 Conclusions Investment (Cost) vs. Value Consensus of IT Sellers and Buyers on Meeting Business Need Interoperability Is Key Interoperability Is More Important Than Code Re-Use to Meet Business Need

27 Top 10 SOA General Misconceptions 10. Orchestration = dynamic discovery = dynamic consumption 9. Configurable = loosely coupled 8. Identity is Identity, and there is only 1 7. SOA is a Big Bang Theory 6. Granularity of services is easy to define 5. Standards and Specifications compliance is strictly defined 4. WSDL exchange = interoperability 3. Security and auditing can be retrofitted 2. -Oriented Architectures are primarily a technical or management approach And the #1 General misconception is 1. SOA is the answer to interoperability (and you can buy one)

28 Philosophical Views and Challenges

29 PHR

30 Driving Forces Or Obstacles? Improve patient safety Aging population: manage multiple comorbidities Align health care cost with value (= health outcomes) Empowered consumers: use of internet tools Employer-driven consumer models Physician acceptance of technology: reimbursement driven Disease and case management Pay for Performance and value-based purchasing

31 Innovation "The people in the field are the closest to the problem, closest to the situation, therefore, that is where real wisdom is. (Former Secretary of State Colin Powell)

32 Greenfield Incubation Timeline Greenfield LOI Solicitation Issued to Field by DUSHOM Greenfield RFP Invites Greenfield RFP Peer Review Welcome Packages Distributed Off-site Review / Acquisitions Assistance January February March April May June 2009 Greenfield LOL Submission Deadline Greenfield LOL Peer Review Greenfield RFP Submission Deadline Fatal Flaw Confirmatory Reviews 44 Innovative Ideas Kicked-off

33 Greenfield Award Overview Category Reviewed LOI Impacting Category Awards Impacting Category Award Percent Administrative % Clinical % Education % Other % Veteran Direct Impact % 44 TOTAL CONCEPTS SELECTED FOR FUNDING

34 Innovation Evaluation Innovation criteria Improves patient care (e.g., safety, quality or access) Improves efficiency (e.g., clinical workflow or cost/benefit) Impacts numerous Veterans, staff or other stake holders Addresses an unmet need rather than incrementally improves existing methods Helps meet an organizational requirement (e.g., Joint Commission or Congressional mandate) Three review teams, five reviewers per team with multi-discipline and leadership level mix Preliminary Review Process: Addressed Conflicts of Interest Randomly assigned LOI to teams Used blinded independent review with established Innovation Evaluation Criteria on 1-5 scale Group discussed and determined final scoring Final Review Process and Criteria: Same review teams, evaluated full proposals Benefit factors: Quality, Efficiency, Scope, Novelty, Requirement Feasibility factors: Team, Approach, Environment

35 Approaching Orientation Strategic Governance needs to enforce the design by standards approach versus design by product across the Enterprise Critical elements required to scale Tactical Governance Model Enterprise review boards Programmatic Governance Boards: Enterprise Management Processes Functional Governance Boards: portfolio and capability establishment Technical Governance Boards Roadmap for core services utilized by all development efforts Reference Architecture to enable experimentation and development including Standards, Specifications, Patterns and Practices (SSPPs) FEA BRM PRM DRM SRM TRM Strategic Goals & Objective s Business Components (Functions, Sub-functions, and Capabilities & Data Application s s Infrastructur e Components Medical Care Sub- Function 1 Element 1 Element 2 1 Care Mgmt Composite Apps 1 Employee Health Record Messagin g VA Pillars VHA Domains of Value Eight for Excellence Medical Researc h Sub- Function 2 Element 4 Element s 2 Medical Educatio n Sub- Function 3 Discovery Element 5 6 Element 6 n Core s Sub- Function 4 Security Technical Standards VA Internal Use Only 35 Strateg y Lines of Business Business Area Sub-Functions Element VHA 6 ESM Strateg y Lines of Business Business Area Sub-Functions Element 6 Governanc e E-SOA Governance Requirement Framework Organizational Governance Open Community Process Business Process Modeling Data Strategy Metrics Test & Assessment Certification & Accreditation Deployment Strategy Education & Training

36 Current Architecture 36

37 Possible Future Architecture VA Internal Purposes Only 37