1. CSPAR (3 Dec 2011)
Lt Gen Green/CMSgt Cole (60-Minute)
Meeting: CSPAR, 3 December 2011, 0800 (60 minutes includes Q&A)
Theme: “Transformational Pathways to Global Healthcare”
Audience: ~ 100 Airmen including Consultants and Enlisted Functionals
Purpose: Future of the AFMS
Design: AFMS future updates, AFMS mission/strategy
Format: Unclassified
Sources: AMSUS brief, SLW brief, iEHR brief
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2. Headquarters U.S. Air Force
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CSPAR: The Future is Now
Lt Gen C. Bruce Green CMSgt Charlie Cole
Surgeon General CMEF
3 Dec 2011
2

3. We’re All In
AF Mission
The mission of the
United States Air Force is
to fly, fight and win&in air,
space and cyberspace
AFMS Mission AFMS Vision
Seamless Health Service World-Class Healthcare
Support to USAF and for Our Beneficiaries
Combatant Commanders Anywhere, Anytime
Through Global Vigilance, Reach, and Power!
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4. 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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5. Focus and Alignment6
Through the AFMS Framework
Strategies
Overlapping
Mission Areas Transform Deployable Capability
Rapid Response to Any Worldwide Contingency
Fit
Force Build Patient-Centered Care
Continuity & Prevention to Optimize Health
Invest in Education, Training & Research
Sustain Our Future Capabilities
Strategy Common Practice Culture
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6. In Pursuit of Lighter &
Leaner Medical Response
Humanitarian Assistance EMEDS Health Response Team (HRT)
Rapid Response Team (HARRT)
Airlift Deployment Requirements:
Earthquakes
Indonesia < 24 HRS +
C-17’s
Rapid Response Medical Capabilities:
Emergency, Resuscitative, & Surgical Care
Earthquakes
Chile T+0 hrs Operational
Results:
Immediate Care
< 20 min
ER
Earthquakes < 2 hrs
Haiti OR & ICU
< 3 hrs
T+3 hrs
Pursuing Perfection in Medical Response Capability
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7. Continuous Advances in
Casualty Care
WWII
30% Learning From Coalition Partners, We
Leveraged Trauma Registry Data To
Build Innovative Solutions
> 80 Patients Moved as of Nov 11
Combat Mortality Rate
Korea
25% Tactical Critical Care Evacuation Team (TCCET)
Vietnam
24%
INTERFLY AGREEMENT
Applying Lessons Learned From the C-17
*AeroSpace Interoperability Council
Persian
Gulf
24% Creating a “patient staging” continuum
Modular Aeromedical Staging Capability (MASC)
OIF/OEF New CASF Activated at SAMMC
<10%
Re-engineering Global Patient Staging
Expeditionaryt OperationseEvolving tocSave n c e Globally
I n e g r i t y - S r v i c e - E x e l l e Lives

8. Global Operations:
~ 1,362 Total Force Medics Deployed
Distribution of Current
Total Force Deployments by Corps
MC
14%
DC
Building Partnerships 0.5% Major Conflicts
& Partner Capacity Irregular Warfare
NC
Enlisted 16%
60%
MSC
4%
BSC
Natural Disasters & 5.5%
Humanitarian
Homeland Response Response
As Missions Transform, Readiness is Still Priority #1
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9. Innovation & Insight to
Recapture Care
Delivering Patient-Centered Care To Our
Beneficiaries
Creating Currency Opportunities To Support Travis AFB, CA Langley AFB, VA
Readiness
Allowing Medics To Practice Full Scope Of
Care
Tackling Per Capita Cost Through Targeted Nellis AFB, NV Elmendorf AFB, AK
Investments
Eglin AFB, FL Keesler AFB, MS
WPAFB, OH
Specialty Hospitals Focused on Currency and Recapture
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10. Just Say Yes6
Nellis Success
Know the Population
-Cardiovascular Catheter #1 Patient
Referral at Nellis
Implement Advanced Services
-Comprehensive Internal Medicine
-Care Now for DoD Beneficiaries > 65 y/o
Expanding Services to Recapture More DoD Beneficiaries
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11. Transforming Focus from
Healthcare To Health
Healthcare Is A FH Clinics Started- 69
Team Sport Ped Clinics Started- 35
Clinic Health
Management Management
HEALTHCARE HEALTH
Right Patient9 Right Prevention9
Right Time9 Right Outcome9
Maximize Teamwork/Skill Set s to Deliver Better Health & Better Care
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12. Create The Setting
For “Right” Behaviors
Percent of Patients Satisfied* Continuity of Care
Other Provider
$
Family Health Providers at PCMH Sites MTF Primary Care Visit Distribution*
100% Family Health / PCMH Patients
100%
21471
95% 90% PCMH Team
64954
% Satisfied
80% 42400
90% UP is 70%
Good 60%
85% PCMH PCM
50%
PCMH TEAM
40%
80% 30% 123681 121580 Continuity
20% Other Provider
75% 10% (Family Health
Jan-11 Mar-11 May-11 Jan-11 Mar-11 May-11 0% Clinic)
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%
$ $
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
DOWN 10 UP is
2 is Good
$
Good
0 0
Dec-10 Feb-11 Apr-11 Dec-10 Feb-11 Apr-11 Dec-10 Feb-11 Apr-11 Dec-10 Feb-11 Apr-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
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13. Leveraging Medical Informatics
DATA INFORMATION KNOWLEDGE WISDOM CHANGE
Better Care
TMDS Clinical
Through
Practice
Evidence Based
Guidelines
DEERS Practice
CarePoint Medication Better Health
PDTS Alerts Enhanced Patient
Registries Safety
$ / M2 User Home Best Value
Interfaces Sensors Healthy Behavior
DMHRSi
Expedited Better Care
EHR Test Results Improved Patient
Experience
Decision Support Is No Longer Just For Our Providers
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14. Transforming Data Into
Knowledge
Ready Better Health Better Care
Patients receiving Diabetic patient
massive infusions of > educated on
10 pints experienced “remote
mortality of 33% monitoring”
glucometer
Clinical Study
Readings
Practice registry MTF calls
automatically
Guideline to identify patient to
sent to
developed trends discuss
healthcare
management
team
Conclude infusing
whole blood
Uncontrolled sugar
reduced mortality
levels Identified
to less than 20%
Using Informatics to Accelerate Change in Practice Patterns & Behavior
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15. Generating Skills/Knowledge
Through Medical Simulation
Maximizing the skills of our entire healthcare team
New “DoD Center of Excellence”
Phase 1 Under Development
METC Training Gaming Simulations
Synthetic tissue to augment/replace live tissue
Mobile Lightweight Simulator
Improving Healthcare Capabilities Through Realistic Scenarios
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16. Activating Patients & Care Teams
Health
Team Patient
Decision Patient Decision
Support Support
Centered
PCMH Provides Improved Decision Support- For Patients c eHealthcare Teams
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17. Electronic Health Initiatives
Project (eHIP)
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18. Investing In Education,
Training, & Research
*METC Awarded Institute for Credentialing
Excellence’s Presidential Citation 2011!
Keeping Medics Ready Through Joint & Civilian Partnerships
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19. Establishing Partnerships to
Enhance Capabilities
Physician/Dentist Education (GME/DME)
Stand alone programs
Masters with civilian universities
Integrated/affiliated with Federal partners
Nurse Education (Transition Program)
New sites include: Cincinnati, OH & Scottsdale, AZ
Nurse Enlisted Commissioning Program (NECP)
USAF Dental Hygiene Program
Research
Partnerships are Vital Tools to Build & Sustain Medical Services
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20. DoD-VA Sec Def/Sec VA Decision
“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
Health Record
Capabilities Care Home Care
Mission Military Disability Inpatient Emergency Document
Requirements
Team Readines Obstetrics Evaluation Orders Mgmt Dept Care Mgmt
Rehabilitative
Care
Transient
Outreach
s
& Performance Enroute Veterinar Dental Care
Consult &
Immunization
Operating Pharmacy Occupational
Referral Mgmt Room Mgmt
Outcomes Team Care y Mail Order Health (VA)
Common Interface Standards
Business
Process Team Enterprise Common Services Broker
Architecture (includes Enterprise Service Bus (ESB) and Infrastructure Services)
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
Combined Efforts Provide theOnly
Joint DoD/VA DoD Best Future EHR
VA Only
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21. Leading the Way
with Open Source
HOSPITAL
PHARMACY
VISIT
Electronic
Electronic PROVIDER
RADIOLOGY Health Record
Health Record OFFICE
VISIT
PUBLIC
LAB SYSTEM HEALTH
SERVICE
Open-Source Provides Integration Without Barriers
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22. Shaping the Future of Federal Healthcare
Synergy- Patient-Centered
Joint and Coalition Care
Organizational Precision
Agility Healthcare
Technology
Integration
Working Together, Achieving Success Through A Common Vision
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23. Generating Knowledge6
PRIMARY CARE 2025: A Scenario Exploration of Forces,
Challenges, and Opportunities Shaping Primary Care in the U.S.
GENOMIC MEDICINE: An Active Consortium of Government,
Academic, and Industry Leaders in the Field of Genomic
Medicine Providing Expert Direction for PC2Z Program
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
USU-HJF Military Medicine Symposium:
The TBI Spectrum, Challenges, Initiatives, & Prevention
Innovative Collaboration to Shape the Future of Healthcare
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24. 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
Patient-Centered Care Begins with Access to Earn Trust!
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25. “TRUSTED CARE ANYWHERE”
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