Defense Heath Information

System

A Case Study for National HIT

Seong K. Mun, PhDMedical Research Fellow

Institute of Advanced StudyVirginia TechAlexandria, VA

The Military Health System (MHS)The Military Health System (MHS)

9.1 million eligible beneficiaries Active duty military Family members (spouses & children) Retirees Other eligible populations

65 hospitals & medical centers

412 medical clinics & 414 dental clinics

132,700 personnel 86,400 military

46,300 civilian

Approximately 200,000 network providers at 2,800 network facilities under our purchased care

MHS Environment

Key data points

INDUCTINGINDUCTING

MOBILIZINGMOBILIZING

CASUALTYCASUALTYCASUALTYPREVENTIONPREVENTIONPREVENTION

SEPARATIONSEPARATIONPROCESSINGPROCESSING

THEATERTHEATER

REMAINSREMAINSPROCESSINGPROCESSING

DEFINITIVECARE

TRAININGTRAININGDEPLOYINGDEPLOYINGDEPLOYING

ENROUTE CAREENROUTE CARE

Military Military Electronic HealthElectronic HealthRecordRecord

EMPLOYING

COULD20/12345

ISSUED19960816EXPIRES19970627DATE OFBIRTH19491215

MARC

Common Access CardCommon Access Card

HEALTHY & FITHEALTHY & FITHEALTHY & FITFORCEFORCEFORCE

FIRST

RESPONDER

FORWARDFORWARDRESUSCITATIVERESUSCITATIVE

SURGERYSURGERYTHEATER

HOSPITALIZATION ECT-130

UNITED STATES ARMY

SUSTAININGSUSTAININGBASEBASE

Longitudinal Health Longitudinal Health RecordRecord

1991 Gulf War Syndrome Controversy

Longitudinal Health Record

To Enhance Force Health Protection

Before, During and After Deployment

System of Systems

System of SystemsSystem of Systems disease surveillance, battlefield assessment, and patient care - Get’s the most attention

occupational health, preventive medicine, medical strategic planning, and longitudinal patient health care

National ForumNational Forum Washington DC, March, 2008

DoD with active participation of VA

Review the Progress and Facilitate Strategic Discussion

This Presentation Major Themes Emerging Concepts New Developments Lessons for National Heath IT

Major Themes (I)Major Themes (I) Longitudinal Health Record

Computer Based Patient Record – To replace paper Electronic Medical Record - Connectivity Electronic Health Record – Integration of

Records Longitudinal Health Record – Continuity of Care Personal Health Record – Comprehensive Med/Beh

Record

Interoperability and National Health IT Very little concern at the beginning Limited to Departmental and Institutional

Interests Expanding Enterprise DoD with VA then Civilian (Ways to go) DoD-VA-National IT70%

Major Themes (II)Major Themes (II) Knowledge Discovery and Management

Key Promised Benefits – Yet To Be Achieved Computable Data – Structured and Natural

Language Burdens and Cost of Structured Data Ownership and Access of Certain Data Practice Guidelines and It’s Usability

Needs for Architecture Strategy Evolving Congressional Guidance Evolving Definition of LHR “High Priority” Tactical Issues Long Term Architectural Strategy

Major Themes (III)Major Themes (III)

Software Engineering and Project Management

Driven as a traditional acquisition activity

Requirement – Budgeting – RFP – Delivery

Rapid Technology Changes Designed to be obsolete No ways to accept

innovation Development in Isolation No accumulated knowledge

within DoD Unprecedented Open

Discussion at All LevelsSource Requirements

Information Management

PEO

Program Managers

Contractors

Requirements

Capability Gap

Interoperability Gap

Architecture

After-the-fact

documentation

10

Storing & Accessing the Data

Not a CompleteEHR

Architecture &Networks

Mining the Data

Catching the Data

Five Greatest Five Greatest ChallengesChallenges

Taylor- Grumann

Emerging Concepts Emerging Concepts (I) (I)

Personal Health Record Possible Solution for Interoperability? Accuracy, Completeness, Privacy and

Confidentiality Start with minimum set of data – Lindberg –

Trust the Patients New Players Possibly with New Business Models Trust Patients

Physician Groups, Employers, Insurers, IT Companies

Emerging Concepts Emerging Concepts (II)(II)

Predictive Genetic make-up – disease prediction Protein makers – health status

Preventive Probability of disease Response to treatment Preventive treatment

Personalized Optimized and targeted

Participatory Personal choices of illness and

wellbeing

Emerging Concepts Emerging Concepts (III)(III)

Decision Support Required for Evidence Based Medicine Sophistication is Growing Physician Adoption is a Challenge

Health Services Research – Data Driven What works and What does not Work? How to improve quality? How to reduce whose costs?

More Recent Policy More Recent Policy DirectionsDirections

Develop MHS Architecture Blue Print in partnership with VA, Industry and Civilian Sector

Design the Architecture to take advantage of advances in technology

Support Personal Health Record Approach

Adopt Service Oriented Architecture (SOA)

Regionalize computing infrastructure

Enhance Information Sharing with VA and Private Sector via NHIN

-- Work with Other Entities

ConclusionConclusion IT issues has emerged as a strategic center for policy

Informed leadership and active participation of users

IT is the primary process of business

IT development has to remain open and nimble

Data sharing and Interoperability

The Promise of Knowledge Discovery and System Research – Easy of Data Generation Vs. Computablility

New Workflow models required for the success of IT

Thank you.Thank you. Ward S. Cassells, MD,

LTC. Hon Pak, MD and COL. David Gilbrtson

Jeff Collmann, PhD, Walid Tohme, PhD, Ron Gimble, PhD, Betty Levin, MS, Fred Prior, PhD, Chunhua Weng, PhD, Kenneth Wong, PhD, Leigh Jerome, PhD, Conrad Clyburn, MS, and Stephen Hufnagel, PhD.