Innovative Thinkers Veteran Health Administration Innovation by hcj

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									 Innovative Thinkers
Veteran Health Administration
     Innovation Program

        Session 188
     August 12, 2010
   1:30 p.m. – 2:59 p.m.
Introduction – Chuck Brown

    • Housekeeping
    • Faculty for today
    • Objectives
    • Program overview
    • Governing
      principles
    • Program portfolios
    • Looking forward
                             2
    Introduction - Housekeeping

• Cell Phone Reminder
  – Please turn off or change your cell phones
   to vibrate

  – If you must answer a call or text message,
   please leave the room




                                                 3
        Housekeeping (Cont.)

• Please, no questions during the
  presentation
  – Questions can be written on a 3x5 card &
    will be answered at the conclusion of the
    presentation, time permitting
  – All questions and answers will be posted
    on the Web including those not answered
    during class

                                                4
    Faculty for Today’s Session

Innovation Program Team Members:
  – Chuck Brown, Director Innovation
   Program

  – Jason Carley, Management Analyst

  – Gail Johnson, MS, PMP (HPTi)

  – William Cerniuk, Technology Director

  – Joe Tastrom, Management Analyst
                                           5
               Objectives
• Introduce the Veterans Health
  Administration (VHA) Innovation Program
• Describe the various VHA Innovation
  portfolios
• Elaborate on collaboration tooling and the
  Sandbox development environment
• Discuss the VHA Office of Information
  and Technology (OI&T) Innovation
  Initiative
• Exchange knowledge and encourage
  networking among potential field
  Innovators                                   6
Innovation Program - Overview
• 2008: Collaboration initiated between
  the Veterans Health Administration
  (VHA), Office of Health Information
  (OHI) and the Department of Veterans
  Affairs (VA) Office of Information and
  Technology (OI&T)
• 2010: As part of the VA Secretary’s
  transformation of VA to a 21st century
  organization, the VA Innovation
  Initiative (VAi2) was born
• Current: All VHA, Veterans Benefits
  Administration (VBA) and OI&T
  innovation efforts are now coordinated
  under VAi2 to promote collaboration      7
          Governing Principles
• Allows critical health care innovations
  reliant on Information Technology (IT)
  to:
– Emerge from the field
– Evolve based on constructive and
  collaborative review
– Solicit commercial/private sector knowledge
  and alternatives
– Be piloted in a safe harbor environment
– Business driven
– Build projects start to finish in a transparent
  environment                                       8
    Governing Principles (Cont.)
• Low bar for Entry:
  – Anyone can participate
  – Invites innovative ideas from the field and
    from other sources such as vendors, open
    sources, and academic organizations
• High bar for Exit:
  – Promotes standardization, ensures security
    and operating performance
  – Mitigates risk to mission critical systems
  – Encourages solutions to emerge ‘close-to’
    Class I
                                                  9
Innovation Program Portfolios

• Bottom up

• Top down

• Laboratory




                                10
       Innovation Program Portfolios
•   Bottom Up: Field innovators identify
    clinical and business opportunities,
    propose innovative solutions, and
    compete for resources to develop those
    solutions
•   Top Down: Targeted VHA business
    opportunities needing solutions are
    identified by VA leadership; industry
    competition to develop enterprise
    solutions with input of field subject matter
    experts                                    11
  Innovation Program Portfolios
             (Cont.)

• Laboratory: Collaboration tools,
  technologies, and services used to
  advance innovation and encourage
  the building of communities of
  interest and Innovation Sandbox
  Virtual software development
  environment

                                       12
   Innovation - Looking Forward

• Workforce Development: Activities
  undertaken to build a culture of
  innovation and a knowledgeable
  workforce

• Innovation Diffusion: Evaluation of the
  quality of products and how products
  work in the health care delivery
  process
                                            13
   Bottom Up Innovation – Jason
             Carley
• Portfolio Overview
• Greenfield Incubation
• VHA/OI&T Innovation Initiative
• Status




                                   14
  Bottom Up Innovation - Overview
• Field innovators identify clinical and business
  opportunities, propose innovative solutions, and
  compete for resources to develop those solutions
• Greenfield Incubation - 2009 Competition:
                                                                 Proposals
      Innovator        LOIs Reviewed         Innovator
                                                                Reviewed by
   Submits Letter of   by Cross-cutting     Submits Full                        Approvals   Execution
                                                                Cross-cutting
     Intent (LOI)        Committee           Proposal
                                                                 Committee




• VHA/OI&T Innovation Initiative (VHA/OI&T II) -
  2010 Competition

                          Top 75 Ideas
                           from Idea
     Innovator
                          Management         Innovator          Review Panel
   Submits Ideas,
                          Tool and 25       Submits Full        Recommends      Approvals   Execution
   Comments, and
                        Ideas from USH       Proposal            Innovations
      Ratings
                       Invited to Submit
                         Full Proposals


                              USH= Under Secretary for Health                                           15
Bottom Up Innovation – Greenfield
                                                           Proposals
   Innovator        LOsI Reviewed          Innovator
                                                          Reviewed by
Submits Letter of   by Cross-cutting      Submits Full                    Approvals          Execution
                                                          Cross-cutting
  Intent(LOI)         Committee            Proposal
                                                           Committee




                               LOI                        Proposal
                            Submissions                  Invitations                  Awards

        Projects                       179                      57                      44

              Max $              250,000                  250,000                     400,000

               Min $                   3,200                 3,200                    30,000

       Median $                  100,680                  125,000                     211,101

    Average $                    125,013                  123,082                     195,006

           Total $            22,388,270                 7,015,680                8,580,269
                                                                                                         16
          Bottom Up Innovation – II
 Web-based Idea Management Software                        Innovator
                                                          Submits Ideas,
                                                          Comments, and

   • Site launched on Feb. 5th and closed on Feb. 28th       Ratings



   • Easy, convenient, electronically safe                   Top 75 Ideas

   • Encourages participation and enables                     from Idea
                                                             Management
                                                             Tool and 25

     collaboration                                         Ideas from USH
                                                          Invited to Submit
                                                            Full Proposals

 Six Categories for Idea Submission
   • Engage Veterans                                         Innovator

   • Aid Providers
                                                            Submits Full
                                                             Proposal


   • Increase Transparency
   • Improve Workflow
                                                           Review Panel
   • Continuous Improvement                                Recommends
                                                            Innovations

   • The Babe Ruth Category
 VHA and OI&T:
   • Submit ideas to improve the current process             Approvals


   • Strengthen and challenge others’ ideas by posting
     comments
   • Vote for ideas they believe will have the greatest      Execution

     impact
                                                                              17
   • Recruit other employees to participate
Bottom Up Innovation – VHA/OI&T II



Screen Shot




                                 18
                                                     Ideas




                                1000
                                       2000
                                              3000
                                                             4000
                                                                    5000
                                                                           6000
                                                                                              7000




                            0
                            1
                           11
                           21
                           31
                           41
                           51
                           61
                           71
                           81
                           91
                          101
                          111
                          121
                          131
                          141
                          151
                          161
                          171
                          181
                          191
                          201
                          211
                          221
                          231
                          241
                          251
                          261
                          271
                          281
                          291
                          301
                          311




     Hours since launch
                                                                                  Ideas Entered




                          321
                          331
                          341
                          351
                          361
                          371
                          381
                          391
                          401
                          411
                          421
                          431
                          441
                          451
                          461
                          471
                          481
                          491
                          501
                          511
                                                                                                           Usage Statistics 2/5/10 – 2/28/10




                          521
                          531
                                                                                                                                               Bottom Up Innovation – II (Cont.)




                          541
                          551
                                                                                                   Over
                                                                                                  6,500!




19
                                                            Comments




                                    1000
                                           2000
                                                         4000
                                                                5000
                                                                       6000
                                                                                     8000
                                                                                            9000




                                                  3000
                                                                              7000
                                                                                                   10000




                                0
                            1
                           11
                           21
                           31
                           41
                           51
                           61
                           71
                           81
                           91
                          101
                          111
                          121
                          131
                          141
                          151
                          161
                          171
                          181
                          191
                          201
                          211
                          221
                          231
                          241
                          251
                          261
                          271
                          281
                          291
                          301
                          311




     Hours since launch
                          321
                                                                                                           Comments Entered




                          331
                          341
                          351
                          361
                          371
                          381
                          391
                          401
                          411
                          421
                          431
                          441
                          451
                          461
                          471
                          481
                          491
                                                                                                                              Usage Statistics 2/5/10 – 2/28/10




                          501
                          511
                          521
                                                                                                                                                                  Bottom Up Innovation – II (Cont.)




                          531
                          541
                          551
                                                                                                               Over
                                                                                                              9,000!




20
    Bottom Up Innovation – II (Cont.)
• Thousands of ideas to 100 full proposals
    – Crowdsourcing results used to identify the 75
      most popular ideas
       • Ideas voted up, voted down or commented on
       • Incentives offered for top participants
    – Under Secretary for Health (USH) designees
      selected 25 additional “gems” that were not
      identified by the voting process
    – Proposal invitations released on March 23rd
•   Full proposals to funded ideas
    – 67 full proposals were received by April 16th
    – Proposals were randomly distributed among 6
      panels
    – Each panel consisted of a: Physician, Nurse,
      Administrator, Informaticists, and Distinguished   21
  Bottom Up Innovation – II (Cont.)

• 26 proposals approved for funding on
  May 14th
  – 20 proposals in both the normalized and
    raw top 25
  – 6 additional highly ranked proposals
    recommended by the panels for funding
  – 17 (65%) crowd nominated, 9 (35%)
    executive picks
  – ~$15M required for execution

                                              22
                            Bottom Up Innovation – II (Cont.)

                                                                                                                                                                       Raw Proposal Score
                                                                                                                                                                          Distribution
                                Normalized Score                                                                                                              16
Number of Proposals




                                  Distribution                                                                                                                14

                                                                                                                                                              12




                                                                                                                                        Number of Proposals
                      12                                                                                                                                      10
                      10
                                                                                                                                                              8
                       8
                       6                                                                                                                                      6
                       4
                                                                                                                                                              4
                       2
                       0                                                                                                                                      2
                           -2




                                                       -1




                                                                                    0




                                                                                                            1




                                                                                                                                    2
                                -1.75
                                        -1.5
                                               -1.25


                                                            -0.75
                                                                     -0.5
                                                                            -0.25


                                                                                        0.25
                                                                                               0.5
                                                                                                     0.75


                                                                                                                1.25


                                                                                                                             1.75
                                                                                                                       1.5




                                                                                                                                                              0
                                                                                                                                                                   1   1.25   1.5   1.75   2   2.25   2.5   2.75   3
                                                                    Normalized Score
                                                                                                                                                                                       Raw Score




                                                                                                                                                                                                                   23
                               Bottom Up Innovation – II (Cont.)
                                                            Proposals by VISN
                      10
                      9
                      8
Number of Proposals




                      7
                      6
                      5
                      4
                      3
                      2
                      1
                      0
                           1   2   3   4    5   6   7   8   9     10    11    12     15   16   17   18   19   20   21   22   23   CO   OIT
                                                                             VISN

                                                            Invites    Submissions    Top 26




                                           VISN = Veterans Integrated Service Networks
                                                                                                                                   24
   Bottom Up Innovation - Status

• Many exciting Bottom Up Innovations
  are moving forward and are in various
  stages of maturity
• We look forward to many successful
  Innovations and soliciting more
  innovative ideas in the future




                                          25
Top Down Innovation – Gail Johnson

•   Definition
•   Approaches
•   Results
•   Current status of projects




                                 26
 Top Down Innovation – Definition
• Top Down Projects:
  – Are problematic areas or improvements
    needed to advance VHA patient care
    efforts
  – In need of innovative solution definition
    and development
  – Tend to be larger in scope and cost than
    Bottom Up project
  – Are intended to ultimately be enterprise-
    wide solutions

                                                27
    Top Down Innovation - Approaches
•   Three different approaches
    1) Conduct field developed solutions “bake-off”
       of existing VHA innovations to address a VHA
       Strategic Goal
    2) Solicit ideas from VHA Leadership, e.g. VISN
       Directors and VHA Chief Officers
      •   Accelerated user-centered design requirements
          and agile development methodologies applied by
          the Innovation PMO in close collaboration with
          VHA clinical sponsor and field personnel
    3) Conduct an Industry Innovation Competition
      •   VA Leadership topics selected
      •   Release to private sector for solution proposals

                                                             28
  Top Down – Results: Approach 1
• Bake Off
  – Joint Commission National Patient Safety
    Goal for Standardized Anticoagulation
    Therapy Management chosen for focus
  – Working group formed
  – 10 field developed Class 3 software
    solutions reviewed by cross Network and
    VA medical center innovators
  – Portland Veterans Affairs Medical Center
    solution chosen and approved by the
    National Leadership Board (NLB) in
    September 2008
                                               29
  Top Down – Results: Approach 2
• Leadership Solicitation
  – January 2009 solicitation
     • 49 submissions received
     • 12 from Veterans Integrated Service Networks
       (VISNs), 5 Central Office programs
  – 15 peer reviewers
     • Mix of field and VHA Central Office staff, clinical,
       business and technical staff
     • Blinded independent review which assessed each
       Innovation Criteria on a 1-5 scale
     • Potential conflicts of interest addressed
     • Group discussion and final scoring at face-to-face
       meeting in March 2009
                                                              30
Top Down – Results: Approach 2 (Cont.)
• Evaluation Criteria Addressed*                         * As determined by
                                                         submitter
                                                                   Of
                               Criteria                            49
       1. Improves patient care e.g., safety, quality or                      87.8
          access                                                   43           %
       2. Improves efficiency e.g., clinical workflow,                        89.8
          cost/benefit                                             44           %
       3. Impacts numerous Veterans, staff or other stake –                   91.8
          holders                                                  45           %
       4. Addresses an unmet need rather than                                 69.4
          incrementally improve existing methods                   34           %
• VHA Communities Impacted*
    5. Helps meet an organizational requirement e.g.,                    53.1
                Commission or
          Joint Administrative Congressional mandate 44            26 89.8%%

               Clinical                                    45           91.8%
               Veteran - Direct Impact                     39           79.6%
               Other                                       12           24.5%        31
Top Down – Results: Approach 2 (Cont.)
• 49 strategic submissions ranked
   – Full descriptions of all submissions
     • http://vaww.innovations.va.gov
                             SUBMISSIONS BY OFFICE
        WORKFORCE MANAGEMENT & CONSULTING             2
      PUBLIC HEALTH & ENVIRONMENTAL HAZARDS…          2
                 PATIENT CARE SERVICES OFFICE                                      14
                          PCS - TOP 2 PROJECTS        2
                           INFORMATION OFFICE     1
                               BUSINESS OFFICE            3
                                        VISN 23   1
                                        VISN 22               4
                        OFFICES         VISN 21   1
                                        VISN 20       2
                                        VISN 18               4
                                        VISN 17           3
                                        VISN 11       2
                                         VISN 8       2
                                         VISN 7   1
                                         VISN 5               4
                                         VISN 3   1
                                         VISN 2       2
                                              0                   5           10   15
                                                                      COUNT
                                                                                        32
Top Down – Results: Approach 2 (Cont.)
• Top 10 identified by review team in March 2009
 Rank   ID                                   Title                                Score
  1.    28   Chemotherapy ordering                                                4.43
  2.    18   Point of care support of clinical decision making and just-in-time   4.13
             provider education
  3.    34   Clinical reminders that operate on multi-site data                   4.07
  4.    21   Remote medication administration management                          3.93
  5.    36   Comprehensive problem specific databases and tracking systems        3.86
  6.    44   Comprehensive management of patient flow in the in-patient setting   3.86
  7.    23   Capture of data from specialty procedure support systems             3.73
  8.    27   Problem oriented views of the Electronic Health Record               3.73
  9.    25   Collaborative healthcare management                                  3.67
  10.   19   Care management through a Computerized Patient Record System         3.67
             (CPRS)-based flexible but durable plan of care


                                                                                     33
  Top Down – Results: Approach 3

• VAi2 Industry Innovation Competition
  – Solicitation for private sector ideas for solutions
    released
  – Broad Agency Announcement (BAA) on 6/07/10
    from the Department of Veterans Affairs (VA)
    Secretary – open through September 2010
  – Six key areas for substantial advancement
    selected
     • Innovative Housing Technologies to Address Veteran
       Homelessness
     • Telehealth
     • New Models of Dialysis and Renal Disease Prevention
     • Improvement of Polytrauma Care
     • Reducing Adverse Drug Events
     • Integrated Business Accelerator                       34
     Top Down – Current Status
• Anticoagulation Management Project
  – Sept. 2008: Portland product began upgrade to
    Class 1
  – Sept. 2008: Joint field developer, stakeholder,
    and Office of Enterprise Development (OED)
    project team formed
  – Oct. 2008: Product underwent technical review
    and revisions analysis
  – March 2010: Product released nationally;
    implementation paused until patch correcting
    production issues tested and released
  – Current: Final production release pending
    changes

    Visit VHA Innovation Booth for a demonstration.
                                                      35
 Top Down – Current Status (Cont.)
• Chemotherapy Ordering Project
  – Nov. 2009: First Chemotherapy Ordering
    Workshop (Analysis Phase) held and
    conducted by the Vanderbilt Center for
    Better Health (VCBH)
    • Start of user requirements definition
  – Feb. 2010: Second Chemotherapy Workshop
    (Design Phase) held with VCBH
    • User requirements refined and screen shot
      developed
  – July 2010: Innovator project team formed
  – Aug. 2010: Agile methodologies software
    development contract awarded
                                                  36
 Top Down – Current Status (Cont.)

• Chemotherapy Ordering Project
  – Since August 2010:
     • Agile development and prototypes produced

     • Shared with project team to refine solution

 Please visit VHA Innovation Booth to see the current
               prototype demonstration.



                                                        37
Top Down – Current Status (Cont.)
• Point of Care Support of Clinical Decision
  Making Project
  – Jan 2010: First Point of POC of CDM Workshop
    (Analysis Phase) held and conducted by the
    Vanderbilt Center for Better Health (VCBH)
     • Start of user requirements definition
  – June 2010: Second POC CDM Workshop (Design
    Phase) held with VCBH
     • User requirements refined and screen shot developed
  – July 2010: Innovator project team formed
  – Aug 2010: Agile methodologies software
    development contract awarded

                                                             38
 Top Down – Current Status (Cont.)
• Point of Care Support of Clinical
  Decision Making Project Since August
  2010:
  – Agile development and prototypes
    produced
  – Shared with Project Team to refine
    solution



Please visit VHA Innovation Booth to see the current   39
                   prototype demo!
   Top Down – Current Status (Cont.)



• Six Leadership Solicitation Projects
  – Solicitations of private sector proposals for
   Innovative solutions
  – Industry responses coming in now




                                               40
Laboratory – William Cerniuk


   • Laboratory Components

   • Collaboration

   • Innovation Sandbox




                               41
         Laboratory – Components (Cont.)
    Laboratory
•   Collaboration Tools:
    Technologies and services used to
    advance innovation and encourage
    the building of communities of
    interest

• Innovation Sandbox:
    Virtual software
    development
    environment
                                           42
Laboratory – Collaboration Tools




                  Technologies and services
                  used to advance innovation
                  and encourage the building
                  of communities of interest

                                           43
  Laboratory – Collaboration Tools
               (Cont.)
• collaboration \kə-′la-bə-′rā-shən\
  – noun
  – 1 the action of working with someone to produce or create
    something.


  – 2 traitorous cooperation with an enemy : he faces charges of
    collaboration.
  – DERIVATIVES

  – collaborationist |-nist| noun & adjective (sense 2).
  – ORIGIN mid 19th cent.: from Latin collaboration(n-), from
    collaborare ‘work together.’

                                                                   44
   Laboratory – Collaboration Tools
                (Cont.)
Collaboration
• Software Products and
  Services - To share ideas
  freely and accelerate       • Bottom Up Innovation
  innovation                    Support - Executive
• Forming Communities -         management “innovation
  Enabling groups of            challenges”
  individuals with similar    • Future Technology Support -
  interests to dynamically      Identifying technologies of
  emerge                        interest
  (birds of a feather)        • Sandbox Support -
• Top Down Innovation           Sharing code, engineering
  Support -                     techniques, connecting
  Idea proposal, idea           innovators to technical
  refinement, idea maturation   resources                   45
  Laboratory – Collaboration Tools
               (Cont.)
Principles of Operation            The only failure is
                                   the failure to
                                   collaborate

 • Easy access,
 • Available to all innovators
 • Transparent to the enterprise
 • Share, share, share
 • Light touch governance to promote
   consistency and simplicity
                                                     46
 Laboratory – Collaboration Tools
              (Cont.)
                                        Lessons learned are
• Goals:                                the currency of the
                                        innovation program

  – Foster a Social Network of Innovation
  – Cultivate Communities of Interest
  – Reduce unnecessary redundancy
  – Accelerate the innovation process
  – Inspire innovators
  – Propagate lessons learned


                                                       47
 Laboratory – Collaboration Tools
              (Cont.)
• On the Horizon

  – Idea management
   collection, assessment,
   workflow, promotion

  – Knowledge management
   search and browse innovation knowledge base

  – Source code management
   configuration management, assignment tracking
   and bug reporting

                                                   48
Laboratory - Innovation Sandbox
          Joe Tastrom




                                  49
 Laboratory - Innovation Sandbox
             (Cont.)
• Principles of Operation
  – Easy access
  – Available to all innovators     The only failure is the
                                    failure to collaborate

  – Transparent to the enterprise
  – Share, share, share
  – Light touch governance to promote
   consistency and simplicity


                                                        50
 Laboratory - Innovation Sandbox
             (Cont.)
• Sandbox Overview
  – Software development and systems
   engineering
  – Virtual workspace with virtual workstations
  – Available enterprise-wide
  – Joint effort between the Office of Health
   Information (OHI) and the Office of
   Information and Technology (OI&T)
  – Open to all code warriors                     51
Laboratory - Innovation Sandbox
            (Cont.)
        Sandbox Network




                                  52
Laboratory - Innovation Sandbox
            (Cont.)
            Access


                     Developers use any
                     workstation that can
                     run the Citrix client
                     software to access the
                     Sandbox Network




                                        53
Laboratory - Innovation Sandbox
            (Cont.)
       Protecting Production


                An internal firewall protects
                the VA production network
                from "prototypes gone wild"
                in the Sandbox Network




                                                54
Laboratory - Innovation Sandbox
            (Cont.)
      Environment & Services

                Software development and
                systems engineering is fully
                supported with simulated
                production services




                                           55
Laboratory - Innovation Sandbox
            (Cont.)
        Internet Gateway


               An external firewall provides
               extended internet access to
               innovative commercial
               technologies




                                               56
Laboratory - Innovation Sandbox
            (Cont.)
    Internet and Partner Access

                Connections for the
                Innovation Sandbox
                Network to both external
                Innovation partners and
                external services




                                           57
Laboratory - Innovation Sandbox
            (Cont.)
            Network


              Connections for the
              Innovation Sandbox
              Network to both external
              Innovation partners and
              external services




                                         58
Laboratory - Innovation Sandbox
            (Cont.)
            Network




                                  59
   Closing – Chuck Brown

• Culture of innovation

• Goals and objectives

• Innovation program vision




                              60
         Culture of Innovation

• Ignite the spark of innovation in the VHA
  once again
• Those closest to the issues know best
  how to correct them
• Foster collaboration with field
  development and national developers
• Embrace unsuccessful prototypes for the
  lessons learned and knowledge gained,
  which ultimately improves the
  organization
                                              61
    Culture of Innovation (Cont.)
• Business Focus Group Results: How to
  Value Innovations
  – Improve patient care (e.g., safety, quality, or
    access)
  – Improve efficiency (e.g., clinical workflow,
    cost/benefit)
  – Affect numerous Veterans, staff, or other
    stakeholders
  – Address an unmet need rather than
    incrementally improve existing methods
  – Help meet an organizational requirement (e.g.
    Joint Commission or congressional mandate)
                                                  62
         Goals and Objectives
• Full Transparency:
  – Make all work, lessons learned, and
    documentation readily accessible to any
    member of the organization
  – Ensures consistent and ongoing
    coordination with customers and
    continuous assessments of potential
    innovative solutions
  – Promote knowledge transfer from
    innovator to production systems           63
      Innovation Program Vision
• Transition the local VHA innovation
  environment of the past to a virtual innovation
  community of the future
• Establish innovation partnerships with OI&T,
  VBA, and private industry
• Foster innovation lifecycle from incubation to
  bedside
• Recognize innovation as a critical element of
  the workforce
• Create, connect, and empower innovators


       We are already successful!                   64

								
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