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Document Sample
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
