AAMA Nov 2011

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, and
current situations and how the AFMS mission/strategy tie into Joint healthcare

Format: Unclassified

Sources: SLW Brief, iEHR brief, MHS Capstone

Integrity - Service - Excellence 1

Headquarters U.S. Air Force
Integrity - Service - Excellence

Air Force Strategies for
Future Healthcare

Lt Gen C. Bruce Green
Surgeon General
17 November 2011

2

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


AFMS Framework Provides
Focus and Alignment(
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


Global Operations:
~ 1,400 Total Force Medics Deployed

Distribution of Current
Total Force Deployments by Corps
MC
14%
Building Partnerships DC Major Conflicts
& Partner Capacity Irregular Warfare
0.51%
NC
Enlisted
16%
60%
MSC
4%
Humanitarian
Natural Disasters & BSC Response
Homeland Response 5.8%
a/o 2010 a/o 2011
0 41% 29%
MSC 1 38% 52%
Deployment 2 15% 15%
Frequency 3 4% 3%
(AD Only) 4 1% 0.75%
I n t e 5+ i t y - S e r v i c e - E x c0.29% n c e
gr 1% elle

CAF/MAF Improvement
Immediate
< 20 min
ER
< 2 hrs
T+0 hrs T+3 hrs
OR & ICU
< 3 hrs
EMEDS Health Response Team (HRT) 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

Evolving Expeditionary Operations( SavingcLives Globally!
Integrity - Service - Excellen e

In Pursuit of Lighter &
Leaner Medical Response
Humanitarian Assistance 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 Transition from Alaska Shelters to Utilis
AK Shelter Compatible; Decreased Build Time
Joint Program Testing w/ Collective Protection

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

MSC/Technician Role: Plans, Logistics, & Development

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 Capability...Expanding Services(Improving Currency

Innovation & Insight to
Recapture Care

Specialty Hospitals Focused on Currency and Recapture
9

AF Medical Home
MSC and 4A Team’s Role Critical

Goal:
>1M Enrolled

Process Balance Decision Support Medical Health
Practice RSV Knowledge Mgmt Supply & Plan
Variation Training Tools Equipment Mgmt
(GPM) (Readiness) (IM/IT) (Logistics) (TOPA)

Healthcare Foundation – Every Team Must Improve Their Care

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

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

Electronic Health Initiatives
Project (eHIP)


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

Leveraging Medical Informatics
DATA INFORMATION KNOWLEDGE WISDOM CHANGE

Better Care
TMDS Clinical
Through
Practice
Evidence Based
Guidelines
DEERS Practice

CarePoint Medication Better Health
PDTS Health
Alerts Enhanced Patient
Services Registries
Data Safety
$ / M2 Warehouse
User Home Best Value
(HSDW)
Interfaces Sensors Healthy Behavior
DMHRS
i Better Care
Expedited
EHR Test Results Improved Patient
Experience

Accelerating Information Exchange with Patient Activation

Investing In Education,
Training, & Research

Open for Business

Joint Capabilities are Greater Than Any Single Service Capability

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 – Critical Step Toward
Building & Sustaining Medical Services

Generating Knowledge(
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

AHLTA on the(
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


Sec Def/Sec VA Decision

Combined Efforts Provide the Best Future EHR

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


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

CLOUD COMPUTING
Data Center Akamai Network End Users End Users
Web 100,000+ Servers
Servers
1900+ Locations
Fire 1000+ Networks
700+ Cities Edge
Database Wall Servers
80+ Countries WAF
Load Edge EDNS
Balancer Servers EDNS
Edge
Transaction
Servers
Server Akamai EDNS
Network Site Shield
Storage
Edge
Servers
Directory/
Policy Server Edge
Servers
Edge
Servers Edge
Servers
Legacy App DNS End Users
Systems Servers Server
WAF

4,000+ customers
15+ million hits per second
Back-Up Site or Load End Users
4+ Tbps normal traffic
Balanced Multi-Data Center Peaks of 7+ Tbps Akamai Architecture
Operational View – OV-1

Better Access, iInnovation, eand xCare e n c ePatients
I n t e g r t y - S e r v i c - E c e l l For

Integrating New Technology

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

From Force Health Protection To Logistics To Portable Surgical Tools
Automated
Directed Information
Energy & Data
Sensors Collection
(AIDC) Future CCATT Mission -
Current CCATT Mission
Wireless

Reaching Beyond with Evolutionary Advances and Concepts

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

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!

“TRUSTED CARE ANYWHERE”

27

AAMA Nov 2011

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