Defense Medical Materiel Standardization Program DMMSP Initiative

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• Defense Medical Materiel Standardization Program
  (DMMSP) Initiative

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Overview

• Genesis
• Logistics Key Performance Indicators
• High-level Logistics Attributes
• Current Status
• Way Forward

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DMMSP Origins

• First Principle Clinically Driven Medical
  Supply Chain (CDMSC)
• DASD(FHPR) requests Medical Logistics Proponent
  Committee (MLPC) provide a decision brief on
  how to create/move forward with the development
  of a Defense Medical Materiel Standardization
  Program (DMMSP)
• January 2007 DMMSP Working Group Kickoff

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DMMSP Origins, cont.

• February 2007 Medical Logistics Summit produces
  key attributes of DMMSP
• March - Dec 2007 Progress on several logistics
  aspects of DMMSP processes and databut need for
  greater clinical participation in DMMSP
  governance becomes increasingly urgent

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DASD(FHPR) Informal Guidance for DMMSP

• The MHS will implement a program of medical
  materiel standardization built on commercial
  supportability clinician-driven product
  requirements and seamless integration of
  Medicoeconomic assessments, regional and national
  TRICARE standardization, and Joint or
  Service-level, doctrine, combat development,
  readiness plans and programs. This
  standardization program has five key attributes
  that directly relate to Force Health Protection
  (FHP)

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Key Attributes of DMMSP

• Clinicians will practice in operational settings
  as they train and practice in institutional
  settings. This is a reversal of earlier "do in
  peace as we do in war" or "austere but adequate"
  principles and acknowledges that clinicians will
  be supported by the logistics system that enables
  them, rather than the reverse.
• MTFs and operational medical practices
  constitute two halves of an inseparably
  integrated whole. Providers train and practice in
  one setting and deploy to another. Training,
  credentialing and clinical practice management in
  MTFs must be logistically supported in
  operational settings. If these practices are
  unsupportable, patients should be evacuated to
  locations that do support them.

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Key Attributes of DMMSP, cont.

• 3. Standardization and requirements forecasting
  processes will be built on current institutional
  clinical practice patterns. Deployable materiel
  packages can be developed by Service and Joint
  combat developers that incorporate current
  clinical practices. If this is not possible,
  patients will be evacuated as rapidly as possible
  to definitive care sites where current clinical
  practices are enabled.

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Key Attributes of DMMSP, cont.

• 4. DoD has one program for clinical
  standardization. It incorporates pharmacoeconomic
  assessments, tri-service regional business
  operations and operational standardization. All
  DoD organizations involved in medical materiel
  standardization will create and implement
  business processes that support the seamless
  integration of these standardization processes.
• 5. All DoD standardization processes are
  governed by the overarching premise that medical
  materiel requirements must be supportable by the
  commercial supply chains that also support
  institutional operations of the MHS.
  Environmental, operational and mission-specific
  requirements are important, but must be
  supportable by DoD's commercial partners. Supply
  chain enablers provided by the DoD Executive
  Agent for Medical Materiel must also support this
  premise.

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DMMSP Attributes vs. Potential KPIs
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DMMSP Attributes vs. Potential KPIs, cont.
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The Challenge Deploy Institutional Clinical
Practices
From Unmeasured Perception
To Measurable Reality
Operational Products
Operational Products
Institutional Products
Institutional Products

• Obstacles include
• Fragmented data assets with multiple product
  identification methods and variable data quality
• Limited number of SMEs to cope with high volume
  of items
• Rapid evolution of technologies changing
  operational concepts
• IT systems that do not make data-sharing
  process integration easy
• Consensus on DMMSP Governance is difficult

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High-Level Attributes (Logistics View)

• Linkage Use governance, processes and shared
  data to create linked relationships

• Unified Single governance authority (to guide,
  focus, prevent duplication and overlap)
• Action categories Tailor processes to focus
  standardization resources based on expected
  benefits (clinical outcomes, operational
  effectiveness, economic savings)
• Data-centric Strengthen management of supporting
  data resources to provide authoritative data for
  decision-making

SCD- Service Combat Developer/SMD- Service
Materiel Developer
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Potential Benefits

• Patient Safety / Clinical Efficacy
• Outcome-based product selection when possible
• Continuity from forward edge to definitive care
• Better support for preferred and specialty
  products
• Readiness
• Deployable assemblages outfitted with common,
  up-to-date items improved interoperability
• Easier transition from institutional to
  operational practice
• Reduced variation and inefficiency in theater
  supply chain
• Economic
• Regional and National Discounts for volume
  commitments
• More efficient interface with Regional Prime
  Vendors

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Potential Benefits, cont.

• Civilian sector supply chain improvement
  initiatives generated an average 1.25 annual
  cost reduction
• Healthcare organizations implementing best
  practice processes can save between 15 and 30
  percent
• Greatest opportunity for savings can be achieved
  through standardization
• Focus on clean, comprehensive supply item masters
  to improve ability to evaluate product data
• Increase awareness and understanding of metrics
• To reduce supply costs, physicians must be
  involved stakeholders in standardization and
  utilization efforts
• Information from HFMAs 2005 Supply Chain
  Benchmarking Survey

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Work to Date

• Clinically-Driven Medical Supply Chain Report
  (CDMSC)
• Good stove-piped processes
• Lack of cross-walk on standardization activities
• Need for data sharing tools
• Documentation of as-is standardization-related
  processes in
• DMSB (Defense Medical Standardization Board)
• PEC (Pharmaco-Economic Committee)
• TRBOs (Tri-Service Regional Business Offices)
• Services (partial)

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Work to Date, cont.

• Identification of critical data elements for
  product identification
• Survey of existing logistics data tools (PDB,
  JMAR, UDR)
• Review of statutory and DoD references on
  standardization and cataloging
• Development of proposed logistics-based KPIs to
  measure standardization performance

• PDB-Planning Data Rates, JMAR-Joint Medical
  Asset Repository, UDR-Universal Data Repository

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Next Steps

• To-Be Process Backbone linking standardization
  activities and data required to support
  coordination
• Business rules and criteria for standardization
  and allocating resources according to expected
  benefit
• Identification and evaluation of data
  requirements to support cataloging and
  standardization

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Next Steps, cont.

• Development of surveillance and performance
  monitoring solutions
• Development of proposed DoD policies and
  Governance structures for medical standardization
• Concept under consideration for a governing body
  comprised of tri-service, multi-agency clinical
  representatives
• GO/SES buy-in Force Health Protection Council

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Timeline

• NLT Oct 2007 Review Validate As-Is
• Oct Dec 2007 Develop Validate To-Be
• January 2008 Initial Recommendations
• Jan - April 2008
• Draft Documents (DoDD, DoDI) OPR is FHPR AO is
  DMMSP WG
• Develop Action Plan for Implementation OPR is
  FHPR AO is DMMSP WG

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Timeline, Cont.

• Jan - April 2008, cont
• Drafts worked by AO through team process
• Joint Integrated Process Team (JIPT)
• Expeditionary Sustainment Command (ESC)
• MLPC
• October 2008
• DoDD, DoDI Complete
• Program Initial Operating Capability (IOC)

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Questions?
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BACKUP
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Vision

• A single governing body should be established to
  coordinate and integrate MHS medical materiel
  standardization efforts
• Will be comprised of O-6 level representatives
  from SCDs, TRBOs, PEC, DMSB, DSCP, Joint Staff,
  HA CPP and the MLPC
• Will be accountable to the FHPC for DMMSP and may
  supplant the DMSB Flag Board
• Will guide development and adoption of
  standardized business practices for medical
  materiel standardization for both institutional
  and operational settings within the MHS
• Will provide direction to the DMSB/DML PO staff
  in carrying out DMMSP functions
• Will facilitate information exchange to eliminate
  duplicative clinical evaluation panels
• Will establish and monitor MHS standardization
  metrics with accountability to the FHPC to
  achieve agreed upon goals
• Will act as the authoritative clinical voice in
  review and coordination of all DML issues
  referred from the MLPC
• Will define clinical requirements for development
  of the CUD, JMAT and other modeling tools
• Will act as the FLA under DLA EA for clinical
  issues pertaining to the Class VIII supply chain
• Will explore opportunities for interagency
  standardization with the VA
• Will act as the DoD Commodity Council for
  National DoD medical materiel acquisition
  initiatives and as such will be designated as the
  DoD Joint Standardization Board (JSB)
• Will explore implementation of TARA evaluations
  to standardize medical equipment used throughout
  the MHS

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Governance Alternatives

• Working Group Determining Alternatives for
  Over-arching Governance
• Link all Standardization efforts into one program
• Fit into existing MHS structure
• Options
• Force Health Protection Council
• Clinical Steering Council
• Re-Organize Defense medical Standardization Board
  Structure
• Leave Existing Structure with added
  responsibility
• All share common theme of Clinical Advisory
  Committee

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Clinical Advisory Committee (CAC)

• Suggested Core Composition
• Pharmaco-Economic Committee
• Defense Medical Standardization Board
• Service Clinical Ops (x4)
• Medical Logistics Proponent Committee
• Deputy Chief Medical Officer, TMA
• JSS/JFCOM
• VA Clinical Ops if needed
• Others TBD by CAC