101 - pete marks - dha it overview briefing - fedinsider · pdf...

“Medically Ready Force…Ready Medical Force”“Medically Ready Force…Ready Medical Force” 1

Desktop to Datacenter (D2D) Overview:A converged infrastructure for DoD health care integration

Peter V. Marks, PhDCOO, Defense Health Agency Infrastructure and Operations

Defense Health Agency

“Medically Ready Force…Ready Medical Force”“Medically Ready Force…Ready Medical Force”

∎ The MHS Genesis deployment∎ The value proposition for infrastructure consolidation∎ How complex is the environment?∎ What IT services will be consolidated?∎ Focused on metrics for the business

Agenda

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“Medically Ready Force…Ready Medical Force”“Medically Ready Force…Ready Medical Force”3

To efficiently improve healthcare for the active duty military, veterans and beneficiaries by:

• Establishing seamless medical data sharing between DoD, the VA and the private sector

• Modernizing the Electronic Health Record (EHR) for the Military Health System (MHS Genesis)

Defense Healthcare Management Systems (DHMS) Mission:


Modernization History

2009EHR Way Ahead

2010iEHR

2013DHMSM Kick-‐Off

2015Contract Awardfor MHS Genesis

2006AHLTA Fielding Complete

“I walk slowly, but I never walk backward.”-‐ President Abraham Lincoln

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Why Modernize?

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EHR Modernization Guiding Principles

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Standardization of clinical and business processes across the Services and the MHS

Design a patient-‐centric system focusing on quality, safety, and patient outcomes that meet readiness objectives

Flexible and open, single enterprise solution that addresses both garrison and operational healthcare

Clinical business process reengineering, adoption, and implementation over technology

Configure not customize

Decisions shall be based on doing what is best for the MHS as a whole – not a single individual area

Decision-‐making and design will be driven by frontline care delivery professionals

Drive toward rapid decision making to keep the program on time and on budget

Provide timely and complete communication, training, and tools to ensure a successful deployment

Build collaborative partnerships outside the MHS to advance national interoperability

Enable full patient engagement in their health


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Single DoD Electronic Health RecordGuiding Principle: A flexible and open, single enterprise solution for

both garrison and operational healthcare.

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DHMSM Initial Operational Capability Sites

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Washington

92ND Medical Group &

Aeromedical DEN SQ/SGD

Naval Hospital Oak Harbor

NHCL Everett

Naval Hospital Bremerton

NBHC Sub-‐base Bangor

Puyallup Medical Home

Madigan AMC


Value Proposition: The D2D Solution

Standardization

D2D is vital to removing sources of variance that undermine efforts to implement standard clinical capabilities and workflows . Through standardization of the desktop, end-‐to-‐end control of the network, and centralization of a supporting infrastructure, D2D will achieve the operational efficiency required to support DHMSM.

Operational Efficiency

Through selection of the appropriate architecture, reduction in unused or duplicative resources and the leveraging of economies of scale across enterprise procurement D2D will achieve improved service levels and reduced costs for IT infrastructure.

Achievement of Medical Mission

D2D will provide a platform that allows providers and beneficiaries to access health records, move seamlessly, and exchange health information across the enterprise.

D2D enables the medical mission to be achieved through a platform that allows providers to access systems, moveseamlessly, and exchangehealth information andmedical records across theenterprise.D2D provides the programmatic and architectural detail to support the key HIT objectives in support of the ITinfrastructure readiness: cost savings, operationalefficiency, and achievement of themedical mission.

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Army Navy Air Force Marines

The Complexity (CONUS only)

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Large Organizations Standardize…

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Standardization Supports:

Effectiveness

Agility

Cost Efficiency

Quality


Health IT Standardization: Proven Successes

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Size 177,445 employees, 38 hospitals, serving 10.1 million members

16,500 employees, 5 hospitals, serving 2 million patients

40,000 employees, 22 hospitals, 185 clinics serving 750,000 SelectHealthmembers and over 1.5 million patients

eHR Deployment

Completed 10-‐year roll-‐out of largest civilian eHR in US history, using EPIC-‐based system KP HealthConnect. Encompasses desktop standardization, datacenter management and network integration*

Completed two-‐year, multi-‐phase go-‐live of the completed EPIC eHR suite in 2012, EpicCare, across hospitalnetwork to include a standard desktop and centrally managed network

iCentra rollout began in January 2015 and continued in October. Tool integrates 350 custom products, data center management, eHRmanagement, and revenue cycle system*

Results

Credited with:• Financial savings across

infrastructurenetwork, one region saved over $1.4m on printexpenses alone

• 54% reduction in archival storage space translated to $200,000 savings in one year**

• Awarded HIMSS Analytics Stage 7 Award in 2011+

2014 financial statements show:• .1% decrease in operating costs in

first six months of financial year• A decrease in Epic-‐supported eHR

IT staff• Increase in end-‐user satisfaction**

By the end of 2015, rollout using Agile methodology tool was complete at 4 hospitals and over 60 clinics. Further rollouts by region are planned throughout 2016.

*Case Study: Inova Health System relies CTG Post-‐implementation helpdesk solution**Modern HealthCare.com

*Kaiser Permanente: It takes more than an eHR to be most wired**HIMSS Analytics: Case Studies+PR Newswire: Kaiser Permanente Honored for eHRimplementation

*Sloan Review:Case Study: When healthcare gets a healthy dose of data**Intermountain Physician: Med Staff News: Dec 2015


Gartner: The Vital Role of Standardized Infrastructure for Healthcare Organizations

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“Gartner IT Key Metrics Data (ITKMD) demonstrate that IT staff productivity clearly increases as the variability of infrastructure in an organization decreases. As such, most healthcare organizations are standardizing their infrastructure environment to support not only cost savings but, also, IT efficiency for organizations.”

“Gartner’s analysis strongly suggests that through 2018, at least 70 percent of large-‐scale enterprises can reduce I&O “run” total cost-‐of-‐ownership by 25 percent or more.”


D2D Program Overview

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D2D Core Capabilities

Desktop as a Service (DaaS)

Improving Desktop Capabilities and Clinical Workflows

Network Security Management Service

(NSMS)Securely Interconnecting People and Information

Compute and Storage Management Service

(CSMS)Delivering Mission Agility and

Driving Efficiencies

Directory Services (DS) / EnterpriseManagement (EM)

Information Sharing and Access to Care Across Service Lines

The D2D Program consists of core capabilities that collectively enable a centralized, standardized infrastructure

Global Service Center (GSC)

Providing Global Technical and Functional IT Support

Infrastructure and

Application Performance Management

Computer Network

Defense (CND)

A Single Place for all Performance Management Data

A Single Approval for all IT in the MHS


DHA Footprint -‐ Infrastructure Management

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Summary

• The tables above represent the responsible parties managing components of IT Infrastructure

• Current DHA accounts for 48% of the enterprise

• Including both DHA and locally managed components, DHA accounts for 65% of the enterprise

• In the To-‐Be state, DHA will account for 87% of the enterprise

Program Function ARMY NAVY AF TMA NCR

CSMSApplication Mgmt.Hosting

NSMSWideAreaNetwork (WAN)Local Area Network (LAN)Wireless LAN

DaaS

Tier 2 Touch LaborTier 3 Desktop Support

Infrastructure Mgmt.

GSCTechnical Service DeskFunctional Service Desk

DSEMDirectory Services

Enterprise Management

Program Function ARMY NAVY AF TMA NCR

CSMSApplication Mgmt.

Hosting

NSMSWideAreaNetwork (WAN)

Local Area Network (LAN)

Wireless LAN

DaaSTier 2 Touch Labor

Tier 3 Desktop Support

Infrastructure Mgmt.

GSCTechnical Service Desk

Functional Service Desk

DSEMDirectory ServicesEnterprise Management

48%

17%

23%

12%DHA Enterprise ManagementDHA and Local ManagementLocal ManagementLine Management

DHA Enterprise Management DHA & Local Management Local Management Line Management

As Is To Be


Measures of Success

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Metric Description Industry Benchmark

Baseline Threshold Objective

Operational Availability

The overall availabilityof IT services to the end user irrespective of the source of downtime

99.99% 98.4% 99.0% 99.5%

Customer Support

First Contact Resolution: % of tickets resolved on the first call to the help desk

65% 78% (1 Hour)

65% 78%

Average Resolution Time of Incidents and Service Requests (Non-‐GSC): How long it takes to get a ticket resolved when Help Desk cannot resolve on first contact

NA90%

10 Days or Less

90% 7 Days or Less

90% 3Days or Less

Cost SavingsCost Per Agent Handled Contact $19.07 $16.89 $19.07 $16.64

Annual End-‐User Computing Cost per EUD $1,015 $1,218 $1,015 $947

IT Value is an expression of Availability and Responsiveness over CostIT Value

% Service Improvement

% Baseline Spending

Availability% Decrease in Monthly Downtime

% of Baseline IT Budget

Responsiveness% Decrease in End User Resolution Time

% Baseline End User Computing Costs

D2D will improve IT response to the End User by 70%, while reducing End User IT costs by 22%.

D2D will increase operational availability while reducing downtime per month across the enterprise achieving an end-‐state IT operating cost that is 22% lower from the status quo baseline.


Conclusion

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D2D will provide infrastructure standardization to effectively and rapidly deploy capabilities to improve the survivability and medical readiness of the warfighter

Business

Financial

Schedule

Standards

DriversCurrent Environment DHA D2D Environment

D2D enables the medical mission to be achieved through a platform that allows providers to access systems, moveseamlessly, and exchange health information and medical records across the enterprise. D2D provides the programmatic and architectural detail to support the key HIT objectives in support of the IT infrastructure readiness: cost savings, operational efficiency, and achievement of the medical mission.

The current infrastructure environment is fragmented and inconsistent across the Medical Treatment Facilities (MTFs).

Inefficiencies and inconsistencies within site service levels lead to unequal distribution of staff across the MTFs. This inequality results in duplicative cost requirements and varying service levels is the lead cause for challenges in managing information across our health care environment.


Backup Charts

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Pre-‐Decisional Briefing

DHA IT Infrastructure Plan (1 OF 2)IT SERVICE CAPABILITY BUSINESS IMPACT

Network Security Management Service (NSMS)

Seamless integrated Wide, Local, and Wireless NetworkCapabilities include a Single Security Architecture and centralized Designated Accrediting Authority (DAA), standardized monitoring/ management, and improved provider mobility

Systems and applications will be accessible across the entire DoD health care environment allowing complete access to all patient information regardless of health care location.

Directory Services (DS)/ Enterprise Management (EM)

Centralized and secure access and authentication capability to network resourcesLeverages ability to centrally manage DS infrastructure throughout the enterprise

Health care providers and staff will be able to move from hospital to hospital and be able to authenticate to all IT services without needing new accounts.

Desktop as a Service (DaaS)

Desktop design standardization service across the application, desktop and server environments Includes standardized desktop configuration and application virtualization capabilities across physical and virtual desktops

All desktops will be standardized so providers and staff will be able to move within the medical facility and have access to their information resources.

Compute and Storage Management Service (CSMS)

Centrally managed, integrated, and robust computing: infrastructureGeographically-‐distributed infrastructure designed todeliver low-‐latency services close to the point of careor point of need

Provides a standard method to host applications and the ability for the DoD health care system to use single applications to support all care encounters.

Global ServiceCenter (GSC)

Consolidated MHS enterprise IT service desk Provides a single point of contact for all customers to obtain support for all systems regardless of physical location.


IT SERVICE CAPABILITY BUSINESS IMPACT

Infrastructure and Application Performance Management

Integrate capacity planning and performance monitoring seamlessly through use of integrated tools and processes to monitor the end to end performance of all technology solutionsCapabilities include one set of tools and processes to monitor all technology solutions for all customers.

Will support the business by having a single organization support all elements of systems, network and performance.Will save money by consolidating all tools and processes for monitoring all aspects of technology solutions

Computer Network Defense (CND)

A computer network defense program provides protection, detection, response and sustainment activities for network incidents through a tiered support process. Provide various enclave protection countermeasures which include host intrusion protection and prevention, network configuration management, anti-‐virus/anti-‐spyware, mitigate Information Assurance Vulnerability Management (IAVM) issuances.

Will support the business by having a single CND provider to ensure an enterprise-‐wide computer network defense program that provides protection measures to mitigate the risk to DoD beneficiary information, safety and life issues in the delivery of medical care. Will save money by consolidating all tools and processes for monitoring all aspects of technology defensive protection suites.

Draft slides for January D2D Update

DHA IT Infrastructure Plan (2 OF 2)


Notes on Metrics

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Operational AvailabilityHealthcare Industry has 99.99% availability. Baseline data represents AHLTA operational availability for FY15. Threshold and Objectives are based on maintaining and expanding redundant circuits, adding redundancy to the architecture under MEDCOI, and improving resiliency in power outages through LAN UPS upgrades.

Customer Support First Contact Resolution

Industry benchmark comes from Gartner IT Key Metrics Data 2016: Key Infrastructure Measures: IT Service Desk Analysis: Current Year; Baseline comes from GSC data for Technical Service Desk support to Army for FY15; Threshold is based on industry benchmark, Objective based on standard currently achieved for Army users.

Customer Support Average Resolution Time

Baseline comes from GSC data for Technical Service Desk support to Army for FY15; Threshold and Objectives are based on projected improvements from standard processes and support model put in place under centralized management of help desk/customer support functions.

Cost Savings Cost Per Agent Handled Contact

Benchmark comes from Gartner IT Key Metrics Data 2016: Key Infrastructure Measures: IT Service Desk Analysis: Current Year; Baseline comes from GSC data for Technical Service Desk support to Army for FY15; Threshold is based on industry benchmark, Objective based on Industry average for large help desks.

Cost Savings Annual End-‐User Computing Cost per EUD

Benchmark comes from Gartner IT Key Metrics Data 2016: Key Infrastructure Measures: End-‐User Computing Analysis: Current Year; Baseline comes from analysis of ZBR data for EUD spend and local help desk staffing plus industry averages for software, occupancy and overhead; Threshold is based on industry benchmark, Objective based on Industry average for large enterprises based on hardware volume discounts.

101 - pete marks - dha it overview briefing - fedinsider · pdf...

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