I n t e g r i t y - S e r v i c e - E x c e l l e n c e

AAMA (17 Nov 2011)Lt Gen Green (1-Hour including Q&A)

� Meeting: AAMA, Air Force Breakout, 17 October 2011, 1330

� Theme: “The Future of Healthcare”

� Audience: ~ 150 MSC Officers to include many previous MSC Corp Chiefs

� Purpose: Future of the AFMS

� Design: AFMS hot-topic issues: JUMC, mission and strategy, advances, andcurrent situations and how the AFMS mission/strategy tie into Joint healthcare

� Format: Unclassified

� Sources: SLW Brief, iEHR brief, MHS Capstone

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I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Headquarters U.S. Air Force

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Air Force Strategies forFuture Healthcare

Lt Gen C. Bruce GreenSurgeon General

17 November 2011

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Moving Forward

� 2009: STRATEGIC IMPERATIVES� The Future & Communicating the Vision

� 2010 : EXECUTING THE STRATEGY� Focus on Alignment

� 2011: BREAKTHROUGH PERFORMANCE� Tools, Incentives, and Rewards

� 2012: CULTURE OF ACCESS, INNOVATION & SERVICE� Patient-Centered Care

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I n t e g r i t y - S e r v i c e - E x c e l l e n c e

AFMS Framework ProvidesFocus and Alignment(

Transform Deployable CapabilityRapid Response to Any Worldwide Contingency

Build Patient-Centered CareContinuity & Prevention to Optimize Health

Invest in Education, Training & ResearchSustain Our Future Capabilities

FitForce

OverlappingMission Areas

Strategies

Strategy � Common Practice � Culture

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Global Operations:~ 1,400 Total Force Medics Deployed

MSCDeploymentFrequency

(AD Only)

Building Partnerships& Partner Capacity

Major ConflictsIrregular Warfare

Homeland ResponseNatural Disasters & Humanitarian

Response

a/o 2010 a/o 20110 41% 29%1 38% 52%2 15% 15%3 4% 3%4 1% 0.75%5+ 1% 0.29%

MC14%

DC0.51%

NC16%

MSC4%

BSC5.8%

Enlisted60%

Distribution of CurrentTotal Force Deployments by Corps

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

T+0 hrs

CAF/MAF Improvement

T+3 hrs

EMEDS Health Response Team (HRT) a Reality!

Immediate< 20 min

ER< 2 hrs

OR & ICU< 3 hrs

Evolving Expeditionary Operations( Saving Lives Globally!

ForwardResuscitative

Care

Definitive CareHome w/Family

SAMMC

Self-AidBuddy Care

Combat MedicsNavy Corpsmen

In Theater CareRehab/RecoveryAF Theater Hosp

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

In Pursuit of Lighter &Leaner Medical Response

Humanitarian AssistanceRapid Response Team (HARRT)

MSC/Technician Role: Plans, Logistics, & Development

EarthquakesIndonesia

EarthquakesChile

EarthquakesHaiti

Airlift Deployment Requirements:

< 24 HRS +

Health Response Team (HRT)

Rapid Response Medical Capabilities:Emergency, Resuscitative, & Surgical Care

C-17’s

� Transition from Alaska Shelters to Utilis� AK Shelter Compatible; Decreased Build Time� Joint Program Testing w/ Collective Protection

� Developing “Portable” Functional SupplySystem (ER/OR/ICU/Peds/GYN/etc)� Improved Storage/Shipping�Secure/Weather Proof Versus Triwalls/Ropak�Standardized Packing Portable Drawer Modules

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Recapturing Care TogetherWhere It Makes Sense

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Building Capability...Expanding Services(Improving Currency

� Delivering Patient Centered Care To Our Beneficiaries� Creating Currency Opportunities To Support Readiness� Allowing Medics To Practice Full Scope Of Care� Tackling Per Capita Cost Through Targeted Investments

Travis AFB, CA

Nellis AFB, NV

Eglin AFB, FLElmendorf AFB, AK

Systems-Based ApproachRequired To Optimize OurIntegrated Delivery System

Langley AFB, VA

Keesler AFB, MS

Wright –PattersonAFB, OH

Innovation & Insight toRecapture Care

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Specialty Hospitals Focused on Currency and Recapture

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

AF Medical HomeMSC and 4A Team’s Role Critical

Goal:>1M Enrolled

ProcessPracticeVariation

(GPM)

BalanceRSV

Training(Readiness)

Decision SupportKnowledge Mgmt

Tools(IM/IT)

MedicalSupply &

Equipment(Logistics)

HealthPlan

Mgmt(TOPA)

Healthcare Foundation – Every Team Must Improve Their Care

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

75%

80%

85%

90%

95%

100%

Jan-11 Mar-11 May-11 Jan-11 Mar-11 May-11

PCMH Aggregate Non-PCMH Aggregate

%Sa

tisfie

d

Percent of Patients Satisfied*Family Health Providers at PCMH Sites

UP isGood

Create The SettingFor “Right” Behaviors

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ED/Urgent Care Rate: Goal < 3/100

0

2

4

6

8

10

Dec-10 Feb-11 Apr-11 Dec-10 Feb-11 Apr-11

PCMH Aggregate Non PCMH Aggregate

Aver

age

Mon

thly

Vis

it Ra

te (p

er 1

00)

Monthly Emergency Department and Urgent Care Utilization*Per 100 PCMH Patients

DOWNis

Good

HEDIS Aggregate: Goal > 40

0

10

20

30

40

Dec-10 Feb-11 Apr-11 Dec-10 Feb-11 Apr-11

PCMH Aggregate Non-PCMH Aggregate

Scor

e

HEDIS Measures - Patients Enrolled to PCMH Clinics

UP isGood

Inspiring Trust & Confidence by Measuring and Rewarding Outcomes

123681

64954

121580

42400

21471

0%10%20%30%40%50%60%70%80%90%

100%

Non-PCMH Sites (41/322163) PCMH Sites (34/351952)

Dec 2010 - May 2011

Continuity of CareMTF Primary Care Visit Distribution*

Family Health / PCMH PatientsOther Provider

PCMH Team

PCMH PCM

Other Provider(Family HealthClinic)PCM(Non-PCMHSites)

PCMH TEAMContinuity

Continuity: Goal > 90%Satisfaction: Goal > 95%

$

$

$ $

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

PatientCentered

HealthTeam

DecisionSupport

PatientDecisionSupport

PCMH Is The Lynchpin To Better Decision Support For Patients & Health Teams

Activating Patients & Care Teams

I n t e g r i t y - S e r v i c e - E x c e l l e n c e 13

Electronic Health Initiatives Project (eHIP)

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Transforming Data Into Knowledge

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Diabetic patient educated on

“remote monitoring” glucometer

Readings automatically

sent to healthcare

team

MTF calls patient to discuss

management

Patients receiving massive infusions of > 10 pints experienced

mortality of 33%

Study registry

to identifytrends

Conclude infusing whole blood

reduced mortality to less than 20%

ClinicalPractice

Guidelinedeveloped

Uncontrolled sugar levels Identified

Ready Better Health Better Care

Using Informatics to Accelerate Change in Practice Patterns & Behavior

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

EHR

PDTS

TMDS

DEERS

$ / M2

DMHRSi

Leveraging Medical Informatics

Better Care Through

Evidence Based Practice

Registries

CarePoint

User Interfaces

Better Health Enhanced Patient

Safety

Best ValueHealthy Behavior

Clinical Practice

Guidelines

Medication Alerts

Home Sensors

ExpeditedTest Results

Better CareImproved Patient

Experience

DATA INFORMATION WISDOM CHANGEKNOWLEDGE

Accelerating Information Exchange with Patient Activation

HealthServices

DataWarehouse

(HSDW)

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Investing In Education,Training, & Research

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Open for Business

Joint Capabilities are Greater Than Any Single Service Capability

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Nurse Education (Transition Program)� Increasing to 241 enrolled students in FY10� New sites include: Cincinnati, OH & Scottsdale Healthcare, AZ

Enduring Academic Partnerships

Physician/Dentist Education (GME/DME)� Stand alone programs� Masters with civilian universities� Integrated/affiliated with Federal partners� 84 Advanced Education General Dentistry-1 slots/yr� Dental Specialty certificate/Masters program opportunities

Research� Diabetes� Telepathology� Teleradiology

Education & Research – Critical Step Toward Building & Sustaining Medical Services

Nurse Enlisted Commissioning Program (NECP)� 50 per year with school of their choice

USAF Dental Hygiene Program� 10 scholarships per year� Trident Technical College (SC)� St. Petersburg College (FL)

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Generating Knowledge(

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PRIMARY CARE 2025: A Scenario Exploration of Forces, Challenges, and Opportunities Shaping Primary Care in the U.S.

DOD/VA iEHR and GOVERNMENT HIE SUMMIT: Establishing a Common Roadmap for Today,

Tomorrow, and the Future

OPEN SOURCE SOFTWARE of the MILITARY HEALTH SYSTEM:A Product Lifecycle Management Workshop

VETERANS AFFAIRS ROUNDTABLE: Future Performance Metrics to Assess Population Health, Patient Experience, and Healthcare Value

GENOMIC MEDICINE: An Active Consortium of Government, Academic, and Industry Leaders in the Field of Genomic Medicine Providing Expert Direction for PC2Z Program

Innovative Collaboration to Shape the Future of Healthcare

USU-HJF Military Medicine Symposium: The TBI Spectrum, Challenges, Initiatives, & Prevention

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

AHLTA on the( Information Highway

Exp

ecta

tions

Time

Innovation Trigger

Vehicle ofOpportunity!

Peak of InflatedOpportunity!

Trough of Disillusionment

Slope ofEnlightenment

Plateau ofProductivity

Swamp ofDiminishing

Returns

Cliff ofObsolescence

* Gartner Inc., chart from Mastering the HYPE CYCLE by Jackie Fenn and Mark Raskino

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Sec Def/Sec VA Decision

Combined Efforts Provide the Best Future EHR

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

DoD-VA “To-Be” iEHR Architecture

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MissionRequirements& Performance Outcomes Team

BusinessProcessTeam Common Interface Standards

Common Interface Standards

Presentation(Common GUI)

Common Data Centers

Common Services Broker(includes Enterprise Service Bus (ESB) and Infrastructure Services)

PresentationLayer Team

SystemsCapabilitiesTeam

EnterpriseArchitectureTeam

Data Inter-operabilityTeam

Common Information Interoperability Framework (CIIF)Common Information Model, Common Terminology Model,Information Exchange Specifications, Translation Service

Common Data Standards: SNOMED CT and Extensions, LOINC and RxNorm

DoD Only VA Only Joint DoD/VA

Pharmacy

DisabilityEvaluation

Dental Care

PersonalHealth Record

InpatientOrders Mgmt

Consult &Referral Mgmt Immunization

Laboratory

EmergencyDept Care

Nursing Home

RehabilitativeCare

Long Term Care

TransientOutreach

DoD Unique (16) VA Unique (6)Common (Joint) Applications & Services (30)Battlefield

Care Pediatrics

MilitaryReadiness Obstetrics

Enroute Care Veterinary

OperatingRoom Mgmt

Blood Mgmt

DocumentMgmt

Applications and Services

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)

Common DoD-VA Measures of Effectiveness, Measures of Performance and key Performance Parameters

OccupationalHealth (VA)

PharmacyMail Order

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Leading the Way with Open Source

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PHARMACY

RADIOLOGY

HOSPITALVISIT

LAB SYSTEMPUBLIC HEALTH SERVICE

PROVIDEROFFICE

VISIT

ElectronicHealth Record

ElectronicHealth Record

Open-Source Provides Integration Without Barriers

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

4,000+ customers15+ million hits per second4+ Tbps normal trafficPeaks of 7+ Tbps

CLOUD COMPUTINGAkamai Network100,000+ Servers1900+ Locations1000+ Networks700+ Cities80+ Countries

Back-Up Site or Load Balanced Multi-Data Center

Transaction Server

DNS Server

Directory/Policy Server

LegacySystems

App Servers

Database

Load Balancer

Web Servers

Fire

Wall

Data Center

End Users

EDNS

EDNS

Edge Servers

Edge Servers

Edge Servers

Edge Servers

End Users

Edge Servers

EDNS

AkamaiSite ShieldNetwork

StorageEdge

Servers

End Users

End Users

Edge Servers

WAF

WAF

Better Access, Innovation, and Care For Patients

Akamai Architecture Operational View – OV-1

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Integrating New Technology

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Hand-held, Battery-powered, Laser Cautery & Ablation Tool

Directed Energy Sensors

Automated Information

& Data Collection

(AIDC)Current CCATT Mission

From Force Health Protection To Logistics To Portable Surgical Tools

Future CCATT Mission -Wireless

Reaching Beyond with Evolutionary Advances and Concepts

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Shaping the Future of Federal Healthcare

Patient-Centered Care

Synergy-Joint and Coalition

Organizational Agility

PrecisionHealthcare

Technology Integration

Working Together, Achieving Success Through A Common Vision

I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Patient-Centered Care

� 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 phones/resolve patient concerns� Thorough: Tell patient what to do if they feel worse

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Patient-Centered Care Begins with Access to Earn Trust!

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“TRUSTED CARE ANYWHERE”