My HealtheVet: VADoD Collaboration Session 172

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My HealtheVet VA-DoD CollaborationSession 172

• Theresa Hancock
• Acting Director, My HealtheVet Strategic Program
  Office
• Major Michael Whitaker
• Information Manager, TRICARE Mgt Activity,
• U.S. Military Health System

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Agenda

• Background
• Key Goals
• Methodology
• Common Portal Audience
• JIF Collaboration Plan Strategy
• Results- Education Sub Group
• Demonstration
• Lessons Learned
• Next Steps

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VA/DoD Background

• The VA portal, My HealtheVet (MHV) and the DoD
  portal, TriCare Online (TOL), were both initiated
  around 2000.
• Focused in different directions
• MHV was created as a Proof of Concept to
  demonstrate that veterans and delegates could be
  provided with copies of key portions of their
  health record.
• TOL concentrated on providing electronic services
  to beneficiaries and providers.
• Six years later
• Both organizations are coming to the point in
  their development life cycle where they are ready
  to provide all the functionality of a robust
  portal. They want to move to a model where they
  can align architectures and jointly develop
  Standards and Requirements, Patient Education
  Objects, and shared portlets.

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Key Goals
Position TOL And MHV To Collaborate

• Define business requirements architectural
  direction
• Establish policy and standards
• Identify areas that will result in shared
  projects producing economies of scale and cost
  avoidance to both agencies in the future

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Common Portal Audience

• Primary MHV And TOL User Groups Overlap

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Methodology

• Document the AS IS state for TOL and MHV
• Perform a gap analysis between the two portals
• Provide recommendations

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JIF Project Collaboration Plan Strategy
Goals

• Leverage Economies of Scale
• Reduce Costs

Ensure Unified And Sustainable Communication
Between VA And DOD Regarding Business And
Technical Aspects Of The MHV And TOL Portals
Personal Health Record Subgroup
Usability Accessibility Subgroup
Business Needs Requirements Subgroup
Technical Subgroup
Training Communication Subgroup
Recommendations
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Roles

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• MHV TOL Management Teams
• Contract Team
• Subgroup Committees with Representatives from
  TOL/DoD and MHV/VA

MHV Management Team
TOL Management Team
Personal Health Record Subgroup
Usability Accessibility Subgroup
Technical Subgroup
Business Needs Requirements Subgroup
Training Communication Subgroup
Contract Team
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Subgroup Committees

• Training Communication SubgroupCommittee
• Educational Objects
• Training
• Communication
• Change Management

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Subgroup Committees

• Personal Health Record Subgroup Committee
• Personal Health Record

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Subgroup Committees

• Business Needs Requirements
• Functional Requirements
• Business Requirements
• Performance Measures

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Subgroup Committees

• Usability Accessibility
• Section 508
• Usability
• Style Guide
• Accessibility
• Testing

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Subgroup Committees

• Technical
• Architecture
• Security
• Portal Site Map

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Training Communication Sub Group Results

• Defined collaborative process to share joint
  educational object content approval
• Developed (3) shared joint pilot
  educationalobjects on PTSD Managing Stress,
  Triggers and Work
• Identified the existing programs which can be
  readily shared
• Developing Joint User Focus Groups for reality
  check

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Initial 3 Topics on PTSD

• Managing your Stress (link to Demo)
• Managing your Triggers
• Managing at Work

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Current Opportunities for Sharing Educational
Programs

• MHV

• DoD/TOL

• Self Paced Training
• Asthma Action Plan
• Diabetes
• Hypertension Monitoring High Blood Pressure
• Virtual CoachUnderstanding A1C

• The five centers available now are
• Diabetes
• Coronary Heart
• Disease
• Heart Failure
• Hypertension
• Stroke

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Future MHV Educational Centers.which can be
shared

• Spirituality
• Hepatitis C
• HIV/AIDS

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Benefits of Shared Program Development

• Decreases duplication
• Time and Human resources
• Reduces Costs
• Increases Efficiency
• Increases number of programs in portfolio
• Increases content quality with breadth of SME
  expertise available

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User Review (focus group)Timeline

• August 2007
• Develop single script for use with both active
  and veteran soldiers
• September 2007
• Identify representatives from around the country
  including acute and non acute care settings and
  all VISNS.
• October 2007
• Hold focus groups and get feedback

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User Review (focus group)Timeline

• November 2007-
• Revise content per feedback
• December 2007 -
• Stress, Triggers and Work PTSD programs on line
  for use by soldiers, vets, providers.

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Highlights from other Subcommittee Efforts

• Performance Evaluation forum for TRICARE and My
  HealtheVet was held, resulting in DoD
  participation in VAs performance measurement
  subcommitee.
• TRICARE has adopted Healthwise for its Health
  content.
• Group is exploring Joint E-Forum structure for
  the vetting of health content requests, to reduce
  redundancy and maximize resources.
• DoD has briefed My HealtheVet on their approach
  to Secure Messaging, in an effort to collaborate
  and share technical strategies.

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Lessons Learned

• Statements of Understanding (which are specific
  outlines of the approach, information to be
  captured, as well as activities to be performed)
  are necessary to baseline expectations for
  deliverables in a transient environment
• Staffing of subgroups needs to be reviewed
  regularly, as organizational changes (contract
  turnover, staff changes) impact subgroup
  membership and participation.
• In a collaborative environment where the focus is
  discovery, project schedule needs to be agile
  enough to take advantage of opportunities as they
  are discovered.

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Lessons Learned(Continued)

• Projects across multiple agencies require a
  considerable amount of time to coordinate and
  meet with subject matter experts and stakeholders
  in each organization. This, coupled with the
  organization structure differences can pose
  significant challenges for time, resources, and
  delivery within short timeframes.

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Next Steps

• Documenting Sustainable and Repeatable
  Communication Processes
• Identifying and documenting timelines and
  strategies for leveraging resources and
  opportunities for sharing
• Focus Groups Launched
• Inclusion of Users for testing satisfaction with
  content and usability
• Explore identifying existing data on returning
  active duty and soon to leave active duty for
  usability criteria.
• Feedback and Revisions

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TRICARE Online (TOL)
Major Michael Whitaker
Information Manager, TRICARE Mgt Activity, U.S.
Military Health System
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Agenda

• eHealth Overview
• Implementation Challenges / Lessons Learned
• Whats New
• Summary

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eHealth - TRICARE Online

• TRICARE Online (TOL), as a Product of TRICARE,
  Provides a Comprehensive Suite of Capabilities to
  Support Consumer Empowerment for MHS
  Beneficiaries
• Empowers beneficiaries to become more involved in
  their own healthcare
• Provides Secure, Role-Based Access to Customized
  Services and Information that Automate and
  Supplement Key MHS Business Processes
• TOL Met and Continues to Meet Identified MHS
  Needs
• MHS Strategic and Optimization Plans

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Overview of MHS eHealth
Log-on to www.TRICARE.mil (TOL), the MHS
HIPAA-compliant secure portal.
TOL
TRICARE
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Overview of MHS eHealth
which provides role-based access
for Beneficiaries, Providers, Support Staff, and
Contractors
Beneficiaries
TOL
TRICARE
Providers
Support Staff
Contractors
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Overview of MHS eHealth
to eHealth applications and services, that
automate and supplement key MHS business
processes.
Capabilities
MTF Pages
Health Content
Appts
Tools
Beneficiaries
TOL
TRICARE
Med Resources
Providers
SPAC
NAS
DRMROL
Support Staff
DRMROL
NAS
SPAC
Contractors
SPAC
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Overview of MHS eHealthUpcoming
The capabilities in blue are functionality coming
later this year
December 2007
Rx Refill
MTF Pages
Health Content
Appts
Tools
PHR
BWE
Beneficiaries
TOL
TRICARE
Med Resources
Providers
SPAC
NAS
DRMROL
Support Staff
DRMROL
NAS
SPAC
Contractors
SPAC
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Implementation ChallengesMHS

• Culture Change
• Power Balance Patient and Provider Relationship
• Territorialism Home-Grown Programs

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Implementation Challenges Patient

• Internet Proficiency and Access
• Distrust of Electronic Avenue
• Loss of Personal Connection
• Security and Privacy

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Lessons LearnedPatient and Provider Concerns

• Enable Timely Program Customization
• Usability
• Understand Existing Business Processes Before
  Web-Enabling Them
• System Availability

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Lessons Learned Navigating Culture Changes

• Patient Empowerment
• Patients as partners more responsible and
  involved in their own healthcare
• Patients as consumers

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Lessons Learned Navigating Culture Changes

• Territorialism
• Loss of autonomy homegrown programs
• Mandates and regulations
• Communications with stakeholders

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Lessons Learned Marketing

• Need Support from Top Down
• Spokesperson or Advocate is Helpful
• Communicate Potential of eHealth Programs
• Expect Slow and Steady Progress
• Counter Negative Word-of-Mouth

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Definitions

• Electronic Health Record (EHR)
• Electronic repository of health information
  retained on behalf of beneficiary
  provider-entered data only

• Personal Health Record (PHR)
• Set of electronic tools that enables
  beneficiaries to access and manage their health
  information, to obtain personalized health
  education and risk assessments, and to co-manage
  their medical conditions along with the
  healthcare care team

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PHR Functionality Overview
Phase I
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PHR Functionality

• Components of PHR Phase I
• Read-only access to Beneficiary EHR data
• Demographics
• Allergies
• Pharmacy
• (DoD, VA, TRICARE Mail Order Pharmacy,
  Civilian Prescriptions)

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PHR Functionality

• Personal Health Manager
• Self-entered Health History
• Personal Health Summary

Printable Report
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Additional Capabilities2007

• Web-Based Pharmacy Refill
• Web-Based Health Assessments
• Beneficiary Web Enrollment

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Future PHR FunctionalityUnder Consideration

• Remainder of EHR data not Included in Phase 1
  (Other Data Elements)
• Hematology, Chemistry, Lab Reports (VA
  Collaboration)
• Beneficiary Data Interactive with Health Content
  (Based upon Problem List)
• Beneficiary Data Incorporated into EHR
• Third-Party Access

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Summary

• TRICARE Online, as a Product of TRICARE, Empowers
  Beneficiaries to Become More Involved in Their
  Own Healthcare
• TOL Met and Continues to Meet Identified MHS
  Needs
• Human Process Needs Patience and Understanding
• Lessons Learned Communicate, Educate,
  Demonstrate Then Market
• eHealth has to Prove Itself Everyday to Everyone

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• Questions?

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• QA

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Thank Yourfor Your Time and Attention!