1. MHS Capstone (27 Oct 2011)
Lt Gen Green (1-Hour)
Meeting: MHS Capstone, 27 October 2011, 1045
Theme: “Partnerships Among the Services”
Audience: ~ Senior Leaders in MHS, OSD, VA
Purpose: Updates on AFMS hot topic health issues
Design: AFMS hot-topic issues: JUMC, mission and strategy, advances, and
current situations and how the AFMS mission/strategy tie into Joint healthcare
Format: Unclassified
Sources: NIH/CTSA brief, Emergency Medicine Conference brief, Army
Strategic message
Integrity - Service - Excellence 1

2. Headquarters U.S. Air Force
Integrity - Service - Excellence
Capturing Care at Specialty Hospitals
Lt Gen C. Bruce Green
Surgeon General
27 Oct 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!
Integrity - Service - Excellence

4. Our Focus and Alignment2
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
Integrity - Service - Excellence

5. Continuous Learning2
Guarantees Success
Continuous Increase In Level of Care Provided
Level of Care
Lvl-III/CSH, Definitive
Lvl-II/Forward EMEDS, EMF Care
BAS Surgical Teams
En Route
Wounded Time Critical Care
Rotary Transport
Learning From Coalition Partners, Single Intensivist
We Leveraged Trauma Registry Augmentation
Data To Build Innovative Solutions -Two TCCET Teams
- 1st Deployed June 2011
Tactical Critical Care Evacuation Team - 77 Critical Patients Moved
as of Oct 11
Capability Must Constantly Evolve to Meet Mission Requirements
Integrity - Service - Excellence

6. Constant Improvement of Capability
Immediate
< 20 min
ER
< 2 hrs
T+0 hrs T+3 hrs
OR & ICU
< 3 hrs
EMEDS Health Response Team a Reality!
Self-Aid Combat Medics Forward In Theater Care Definitive Care
Buddy Care Navy Corpsmen Resuscitative Rehab/Recovery Home w/Family
Care AF Theater Hosp SAMMC
Expeditionary g r i t y - S e r v i c e - E x c e l l to Save Lives!
I n t e Operations2 Evolving e n c e

7. Recapturing Care Together
Where It Makes Sense
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 Wright –Patterson
AFB, OH Langley AFB, VA
Nellis AFB, NV
Keesler AFB, MS
Systems-Based Approach
Required To Optimize Our
Integrated Delivery System Eglin AFB, FL
Elmendorf AFB, AK
Building Joint Capability...Expanding Services2Improving Currency
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8. AFMS Strategies – Medical Home
Family Health Clinics Implemented – 61
DATE MAJCOM MTF Purpose
Enrolled FH Population – 622,224 Seymour
01 Oct ACC PCMH Sr Consultant visit
Johnson
Pediatric Clinics Implemented – 11 3-5 Oct PACAF Eielson PCMH visit #2
Enrolled Population – 26,531 4-6 Oct AMC Dover PCMH Sr Consultant visit
10-12 Oct AETC Vance PCMH visit #1
Total Population Enrolled – 648,755 Altus
12-13 Oct AETC PCMH Sr Consultant visit
57% of AFMS Enrollment 13-15 Oct AFMC
Tinker
PCMH Sr Consultant visit
83% FH Enrollment 18-20 Oct AFGSC Whiteman PCMH Sr Consultant visit
11% Pediatric Enrollment 24-26 Oct USAFA USAFA PCMH visit #2
26-Oct ACC -ellis PCMH Sr Consultant Visit
1- 5 -ov PACAF Anderson PCMH visit #2
1 -5 -ov PACAF Kadena PCMH visit #2
1-5 -ov PACAF Osan PCMH visit #2
2 -ov AFSPC Peterson PCMH Sr Consultant visit
2 -ov ACC Dyess PCMH visit #1
11/10/2011 Integrity - Service - Excellence Data effective 1 Oct 11 from DSS
enrollment numbers Sep 2011
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9. 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
Integrity - Service - Excellence 9

10. 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
Integrity - Service - Excellence

11. 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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12. Activating Patients & Care Teams
Health
Team Patient
Decision Patient Decision
Support Support
Centered
PCMH Is The LynchpineTorBetter Decision Support ForlPatients & Health Teams
Int g ity - Service - Excel ence

13. Electronic Health Initiatives
Project (eHIP)
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14. Consumer Driven Health Begins
With Information & Transparency
Cost
Access to Info Safety
Alternatives For A
Quality Sustainable Future?
On-line Resources Hospital
Find It Fast! Compare Risk Pay For Health
HHS.gov
Diseases & Conditions & Readiness
A–Z
- Health Savings Account
Benefits - Selective Co-pays
Concierge Care
Self-Care Apps
(PMPM)
- Wounded Warriors
- Chronic Conditions
Motivating patients to be proactive2
We Must Drive Informed Decisions
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15. Investing In Education,
Training, & Research
Opened June 1st
Joint Capability is Greater Than Any Single Service Capability
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16. 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
Nurse Education (Transition Program)
Increasing to 241 enrolled students in FY10
New sites include: Cincinnati, OH & Scottsdale Healthcare, AZ
Nurse Enlisted Commissioning Program (NECP)
50 per year with school of their choice
Research USAF Dental Hygiene Program
Diabetes 10 scholarships per year
Telepathology Trident Technical College (SC)
Teleradiology St. Petersburg College (FL)
Education & Research – Absolutely Critical to
Building & Sustaining Medical Services
Integrity - Service - Excellence

17. AHLTA on the2
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

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

19. 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 19

20. 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
Integrity - Service - Excellence 20

21. 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 21

22. PPC Roadmap
Complete
Strategy
IMS Document
Base-lined Complete Idea
Factory
Headquarters U.S. Air Force
Change
Readiness Concept
INTEGRATED
Training
Planning Office Stakeholder
Charter Complete Analysis
Strategic Leadership
ROADMAP
Comms Engagement
Integrated Plan Resource
Integrity - Service - Excellence
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
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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
LEGEND: SCHEDULED IN PROGRESS COMPLETE

23. Integrating New Technology
Current CCATT mission Future CCATT mission - Wireless
From Force Health Protection To Logistics To Portable Surgical Tools
Automated
Directed Information Hand-held,
Energy & Data Battery-powered,
Sensors Collection Laser Cautery &
Video
(AIDC) Ablation Tool
Assisted
Intubation
Improving Our Environment Of Care To Deliver Better Outcomes
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24. Shaping the Future
of Military Healthcare
AMEDD Futures 2039 AFMS Futures 2045
Planning Factors Planning Factors
Joint Organization
Patient-Centered Care
MILHEALTH
Military-Civilian Synergy
Synergy-Joint & Coalition
(Education & Currency)
Cultural Adaptability
Organizational Agility
Personnel Interoperability
Global Engagement
Precision Healthcare
Surveillance/Public Health
Technology Integration Technology Integration
Working Together, Achieving Success Through Common Vision
Integrity - Service - Excellence

25. The Focus is on Us
Walter Reed National San Antonio
Military Medical Center Military Medical Center
(WRNMMC)
Walter Reed National San Antonio
Military Medical Center Military Medical Center
(WRNMMC)
Joint Healthcare
San Antonio Military
Health System
SAMHS
San Antonio Military
Health System
Ft Belvoir Community SAMHS
Hospital (FBCH)
Ft Belvoir Community
Hospital (FBCH)
AF Theater Hospital, Craig Joint Theater
Wilford Hall Theater
Andrews Ambulatory JointJoint BaseHospital,
AF Theater
Base- Balad- Balad
Andrews Ambulatory
Craig Joint
Hospital Center
Hospital - - Bagram
Ambulatory SurgeryBagram
Wilford Hall
Ambulatory Surgery Center
Care Ctr Care Center
Improving eSynergy Through E xCommon Vision
Int grity - Service - a cellence

26. “TRUSTED CARE ANYWHERE”
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