2 4 6 8 VHA Can Innovate VeHU Class 265

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2 4 6 8 VHA Can InnovateVeHU Class 265

• Linda Fischetti, RN MS
• Paul Tibbits, MD
• Ray Sullivan

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Innovation Opportunity

• VHA
• Remarkable Transformation of the Department of
  Veterans Affairs Health Care System
• The culture of quality depended on the
  successful implementation of several
  innovations a uniform data collection system
  facilitated by nationwide implementation of an
  electronic medical record system, systematic
  application of quality standards, and externally
  monitored local area networks to monitor
  quality.
• Annals of Internal Medicine August 17, 2004
• VA
• Commitment
• 8M in FY 2008-09 IT funds have been identified
  as available for innovation projects in VHA

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Program Description

• Innovation will allow innovative ideas to emerge
  from the field, and enable the field to build
  communities of interest to identify and promote
  the ideas that have the most promise.
• The program will use innovation IT dollars to
  attain hardware, software and contract
  development resources for field based
  development, and Medical Care dollars for program
  management, stakeholder interaction, encouraging
  innovators, and evaluation.

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Program Construction

• Maximize Resources VHA Innovation will require
  a mix of Medical Care and IT funding
• VHA (Medical Care Dollars)
• Program management (light touch)
• Clinical and business guidance
• Training for VHA employees
• OIT (IT Dollars)
• Hardware
• Software
• Contract Labor to (possibly) backfill field 2210
  resources

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How Innovation Works

• Governing Principles
• Driven by Business Needs
• Field-based
• Strategically directed
• Will eventually replace traditional Class III
  development
• A process is already in place to promote existing
  class III applications
• Full Transparency
• Low Bar for Entry
• Anyone can play
• High Bar for Exit
• VistA solutions will emerge as close-to-Class I

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Keys to Success

• Align with VHA Strategic goals
• http//vaww.ush.va.gov/
• Align with VA IT goals
• http//vaww.itsegov.oit.va.gov/docs/it_strat_plan.
  pdf
• Empower field innovators
• Provide innovation environments to
• Encourage innovators
• Protect VistA system access and health data
• Incent for VHA strategic incubation
• Promote VHA / OIT partnerships
• Encourage / reward a culture of innovation

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A Diversified Approach

• The VHA / VA Innovation Program will provide a
  way to invest across the entire innovation
  lifecycle.
• The program will be phased in over time, in
  accordance with available resources.
• The Program has five initiatives
• Innovation Initiatives
• 1 Green field Incubation
• 2 Strategic Incubation
• 3 Innovation Diffusion
• Enabling Initiatives
• 4 Collaboration Tools
• 5 Workforce Investment

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Initiative 1 Greenfield Incubation

• Definitions
• A greenfield opportunity refers to a marketplace
  that is completely untapped and free for the
  taking, lacking any constraints imposed by prior
  work.
• Incubation refers to cultivating an innovation in
  a protected environment to see what grows.
• Greenfield Incubation
• Provide a mechanism for field innovators to
  propose new opportunities
• Provide visibility of all suggested innovation
  activities to the field
• Encourage the field to select the most promising
  candidates
• Provide assistance / guidance, innovation
  accounts and policy

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Initiative 1 Greenfield Incubation (cont)

• Key Actions
• Develop an open collaboration environment
• Promote field-driven innovation
• Develop partnership road map
• Roles and Responsibilities
• Policy
• Accountability
• Track innovation activities
• Evaluate value
• Establish easily accessible, protected innovation
  environments

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Initiative 1 Greenfield Incubation (cont)

• We will be successful when we have
• Established Innovation Accounts
• Defined Innovation Lifecycle / roles and
  responsibilities
• Established Innovation Sandbox Technical
  Support to answer questions and guide innovators
  
• Subject Matter Expertise (OIT)
• Standing Technical Team (Virtual)
• Enterprise Standards
• Architecture
• Security Privacy
• Patient Safety, Information Management Policy,
  508, Human Factors, Coding, etc.
• Developed methodology to pair VHA innovators with
  IT resources (coders, environments, etc.)
• Established a mechanism to track innovation
  activities and gauge value

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Initiative 1 Greenfield Incubation (cont)

• Joint VHA and OIT Activities FY 08-09
• Define process and policy for access to
  innovation accounts / environments
• Establish Innovation Registry and process to
  allow access to innovation environments
• Communicate and manage expectation for activities
  and appropriate access
• Create Innovation Accounts
• Dummy Data / Low bar for entry
• Migrate vetted software from innovation account
  to VAMC test account for more disciplined
  assessment
• Real Data / OIT specifies demonstrated level of
  competency prior to entry
• OIT gates and monitors Real Data / Staging area
  for live / Authorized personnel with proven
  competency
• Develop strategy to migrate from Test Accounts to
  Innovation Accounts with minimal disruption
• Safeguard clinical environment from potential
  damage to data/systems/network
• Iteratively refine Innovation Account to meet
  innovator requirements

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Initiative 2 Strategic Incubation

• Definitions
• Strategic refers to activities that enable an
  organization to meet predefined goals.
• Incubation refers to cultivating an innovation in
  a protected environment to see what grows.
• Strategic incubation involves engaging VHA
  leadership in articulating strategic targets for
  innovative development and allowing field based
  developers to compete for award.
• Strategic Incubation
• Establish annual process to engage leadership in
  identifying opportunities where innovative IT
  solutions are needed
• Provide a mechanism for field innovators to
  propose approach to satisfy the strategic need
  and to choose the best solution
• Pair VHA and virtual technical teams to support
  targeted efforts
• Monitor progress, and provide transparency to VHA
  community
• Measure and evaluate impact

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Initiative 2 Strategic Incubation (cont)

• First Target Address Joint Commission future
  needs that
• require IT response
• Recruit a Clinical Leader to define VHA
  requirements and selection criteria
• Establish policy and process
• Develop Methodology and Evaluate Product and
  Process
• Determine areas to be addressed in FY 08/09

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Initiative 3 Innovation Diffusion

• Definition
• The diffusion of innovation is the study of how,
  why, and at what rate new ideas and technology
  spread through cultures. The intent is to
  anticipate the culture and maximize the chance of
  the acceptance and integration of new
  technological products into the workplace.
• In other words How do we get to the tipping
  point?
• And how do we get the best reception when we get
  there?
• Innovation Diffusion
• Build on success
• Diffuse innovation to a larger field segment
• Test and measure effect / innovation in business
  practice
• Use results to inform selection and deployment

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Initiative 3 Innovation Diffusion (cont)

• Innovation Diffusion evaluates both the quality
  of the IT product and how the product works in
  the care delivery process
• Diffusion is a core competence of VHA, and will
  be a key part of the Innovation program. Process
  re-engineering and assessment will be
  accomplished with Medical Care funds.
• Begins with choosing a proven innovative
  technology
• Chosen / endorsed by field clinical community
• Works with OIT-defined technical architecture
• Low risk (due to proximity to clinical
  environment)
• Involves a close partnership / negotiation
  between business practice (VHA) and technical
  implementation (OIT) to identify best solution
  and implementation methodology
• Provides business impact assessment and
  evaluation

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Initiative 4 Collaboration Tools

• Definition
• Collaborative software is software designed to
  help people involved in a common task achieve
  their goals.
• Such social software systems as email,
  calendaring, text chat, and wiki belong in this
  category. It has been suggested that Metcalfes
  law the more people who use something, the more
  valuable it becomes applies to such software.
• Collaboration Tools
• Build a set of technologies and collaboration
  tools to advance innovation
• Encourage the building of communities of interest
  and gradually build a connection with innovation
  environments and other technologies such as
  project management.

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Initiative 4 Collaboration Tools (cont)
Collective Innovation Shared Knowledge Work
Functions Communications

• Benefits
• Assists in building communities of interest
• Promotes collaborative refinement of innovative
  ideas
• Enables identification, tracking, merging and
  support for widespread field innovation projects
• Gathers field input to inform Innovation Program
• Provides support for field-based innovators as
  they move forward

Innovation Dissemination of Innovation is
Social Knowledge Persuasion Decision
Rogers
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Initiative 4 Collaboration Tools (cont)
Short Term Solution Kick Start Team Collaboration
- Start Small

• Innovation Web Site
• Announces Presence
• What Is Coming / Stay Tuned
• Goal Transparency Communication
• Initial Collaboration Environment
• Low Cost, High Yield, Near Zero Management
• Base Collaboration Tools
• Listserv
• Wiki
• Blog
• Podcast
• Team Calendar

Innovation Dissemination of Innovation is
Social Knowledge Persuasion Decision
Rogers
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Initiative 4 Collaboration Tools (cont)

• Long Term Solution Innovation Sandbox Pilot
• Major feature categories
• Collaboration tools
• Content management
• Communication tools
• Innovation project management
• Development environments
• Progress
• Joint VHA and OIT technical team produced CONOPS
  
• IDMC endorsed pilot of innovation collaboration
  tools
• Market survey discovered wide range of offerings
• Next steps
• Validate top contender features
• Partner with OIT to
• Pilot Innovation Sandbox tools
• Develop Recommendations for deployment

Innovation Dissemination of Innovation is
Social Knowledge Persuasion Decision
Rogers
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Initiative 4 Collaboration Tools (cont)

• Innovation Sandbox Pilot
• Progress
• Joint VHA and OIT technical team produced CONOPS
  
• IDMC endorsed pilot of innovation collaboration
  tools
• Market survey discovered wide range of offerings
• Next steps
• Validate top contender features
• Partner with OIT to
• Pilot Innovation Sandbox tools
• Develop Recommendations for Deployment

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Initiative 5 Workforce Investment

• Definition
• Workforce investment is a set of activities
  undertaken to build a culture of innovation and a
  knowledgeable workforce
• Workforce Investment
• VHA has a long history of pairing IT developers
  and implementers with front line clinicians and
  business people
• A considered investment in socializing and
  sharing of innovation techniques and successes
  will keep VHA at the forefront of innovation

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Initiative 5 Workforce Investment (cont)

• Combination of Medical Care and IT Funds
• Provide Scholarships for field based innovators
  to attend leading edge health care technical
  symposiums or other forums
• Create training materials to build skill set
  needed for success in innovation environments
• Publish Innovation newsletters to showcase field
  work, emerging health technologies, etc
• Build and field technical training library
• Promote joint innovation exploration with
  collaboration partners (e.g., DoD, Indian Health
  Service) and the private sector (e.g., KP, Mayo
  Clinic)

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Summary

• Transition the local VHA innovation environment
  of the past to a virtual innovation community of
  the future
• Establish VHA / OIT Innovation Partnerships
• Foster lifecycle innovation from Incubation to
  Bedside
• Recognize innovation as a critical element of the
  workforce
• Create and recognize innovators
• Next Steps
• Form teams / leads
• Develop governance / milestones / project plans
• Establish process and performance measures
• Execute

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For More Information

• Linda Fischetti, RN MS
• Chief Health Informatics Officer (Acting)
• linda.fischetti_at_va.gov
• 301-734-0417
• Ray Sullivan
• Executive Director, OIT Field Operations
• ray.sullivan_at_va.gov
• 202-461-5936
• Paul Tibbits, MD
• Deputy CIO for Enterprise Development
• paul.tibbits_at_va.gov
• 202-461-6931

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For More Information

• Subscribe to the Innovation ListServ
• Send subscribe Innovators-L (do not include the
  quotes) in the message body to listserv_at_www.listse
  rv.va.gov

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Innovation Sandbox

• Jim Demetriades
• Emerging Health Technologies

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Sandbox Description

• The Innovation Sandbox is much more than a
  software development environment. It is also a
  virtual space for people to collaborate,
  innovate, and develop ideas and requirements.
• The Sandbox is a geographically limitless
  solution to the historic challenge of locally
  bound development efforts.
• The Sandbox is intended for anyone who
  contributes interest and ideas to VistA.

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Initial Accomplishments

• IDMC charge
• Early 2007
• Propose a way to preserve innovation, minimizing
  IT re-organization challenges
• Cross organizational workgroup
• Chartered May 2007
• Stakeholders from field, OIT and OI
• Innovation CONOPS
• Presented and approved for pilot by IDMC Sept
  2007
• Industry review and comment Gartner, Perot
  Systems, EDS, Microsoft, IBM

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Goals

• Perpetuate local innovation in support of mission
  needs
• Strengthen early idea sharing
• Encourage communities of interest
• Increase collaboration
• Eliminate redundancy
• Rapidly deploy innovative software which adheres
  to national development standards

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Principles

• Access is easy and open to all.
• The Sandbox is structured to allow ideas and work
  products to be freely shared.
• There is a well-defined path for mainstreaming
  innovative creations into production.
• Failures are expected and accepted as a cost of
  being innovative.
• Sandbox governance promotes process consistency,
  simplicity, and reuse.

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Features

• Community forums
• Idea development
• Requirements formulation
• Community feedback (voting, comment, etc)
• Content management
• Design creation
• Software project management
• Software development environments
• Application sharing

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User Experience

• Receive general innovation news.
• Access resource libraries.
• Discover or create birds of a feather
  communities.
• Contribute ideas and collaborate in shaping
  business requirements.
• The more technically inclined can initiate
  software projects.
• Innovation ideas or requirements may be submitted
  to the New Service Request (NSR) process.
• Applications that meet high-bar exit criteria
  for national business value, OIT programming
  standards and infrastructure capacity may be
  fast-tracked within the NSR process.

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Conceptual Architecture
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Benefits

• Makes innovation visible and easily managed.
• Puts users at the center of application design.
• Quickens the historical pace of field-based
  innovation.
• Fosters the emergence of group-forming networks
  that spawn innovative solutions.
• Open participation and access to innovation
  resources regardless of location.

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Intended Solution

• Contract awarded to survey market for toolset
• final recommendations received May 2008
• The market is clearly emerging and volatile
• No single solution meets our wants
• Propose bridging two commercial products
• one strong in collaboration and idea management
• the other a solid software project management and
  development environment

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Current and Future Plans

• In progress now
• Bench validation of recommended solution
• Deployment alternatives analysis (in-house,
  hosted)
• In the queue
• Pilot approach decision
• Acquisition/installation
• Initial live testing (pilot)
• Transition planning

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Discussion
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