Defense Heath Information System A Case Study for National HIT

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Defense Heath Information SystemA Case Study for
National HIT
Seong K. Mun, PhD Medical Research
Fellow Institute of Advanced Study Virginia
Tech Alexandria, VA
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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

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MHS Environment
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Longitudinal Health Record

• 1991 Gulf War Syndrome Controversy
• Longitudinal Health Record
• To Enhance Force Health Protection
• Before, During and After Deployment
• System of Systems

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System of Systems

• disease surveillance,
• battlefield assessment, and
• patient care - Gets the most attention
• occupational health,
• preventive medicine,
• medical strategic planning, and
• longitudinal patient health care

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National 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

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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 IT

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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 Its Usability
• Needs for Architecture Strategy
• Evolving Congressional Guidance
• Evolving Definition of LHR
• High Priority Tactical Issues
• Long Term Architectural Strategy

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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 Levels

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Five Greatest Challenges
Not a Complete EHR
Catching the Data
Storing Accessing the Data
Mining the Data
Architecture Networks
Taylor- Grumann
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Emerging Concepts (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

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Emerging Concepts (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

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Emerging Concepts (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?

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More Recent Policy Directions

• 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

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Conclusion

• 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

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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.