The Electronic Health Record in Theater by broverya78

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									AHLTA Users’ Conference 2008




          The Electronic Health Record in Theater


   Major Michael Holmes, USAF, MSC, Chief, Theater Products Division
                                                            June 2008
Theater Operational View OV-1




                                2
Integration

 Clinical Information Telemedicine &        Theater Medical    Resource Information Defense Medical      United States  Other
                                                                                                        Transportation Partners
Technology Program Advanced Technology   Information Program   Technology Program Logistics Standard
                      Research Center       - Joint (TMIP-J)      Office (RITPO)    Support (DMLSS)       Command
    Office (CITPO)
                         (TATRC)                                                                       (USTRANSCOM)

                       AHLTA-Mobile            JMeWS             TMIP CHCS Caché        DMLSS OTR      TRAC2ES Mobile    SAMS
   AHLTA-Theater        TeleHealth              JMAT              DOEHRS-IH/EH            TEWLS                          GEMS
                         TRAVAX                 TMDS                                      DCAM                           MEDIC
   AHLTA Warrior
                           EIC                 - JTTR                                     PMITS                          GCSS
                                               - JPTA
                                                                                          BLOOD
                                               - BHIE-T
                                                                                           JMAR




  Electronic                                                                                                             Patient
 Health Record                                                                                                          Movement

                       Command                                                                    Medical
                       & Control                                                                 Logistics




                   Theater Medical Information Program - Joint                                                                     3
Service Infrastructure Program Offices




                             CONOPS
                             Hardware
                   Communications Infrastructure
                         Fielding/Training         4
Current Clinical Capabilities (Block 1)


                                  AHLTA-Theater
                                  Version 301.3
                                    Outpatient Treatment
AHLTA-Mobile                        Documentation
Version 1.9.8
  First Responder Application     Joint Medical Work
  Electronic Field Medical Card   Station (JMeWS)
                                  Version 2.2.3.4
                                    Command and Control
                                    Medical Surveillance
TMIP CHCS Caché (TC2)               Classified
Version 1.0.0.0                   Theater Medical Data
 Inpatient Treatment
 Documentation                    Store (TMDS)
 Pharmacy, Laboratory, and        Version 2.2.4.0
 Radiology Support                  Individual Theater
                                     Medical Encounters
                                    BHIE-T Interface
                                    JPTA Capability
                                    Unclassified
                                                           5
Current Logistics Capabilities in Theater


DMLSS Customer Assistance Module (DCAM) Version 1.1.39.0
  Stand alone MEDLOG application that enables users to electronically
  download catalog data, place orders, and obtain status information from
  their supply activity
      Can be used by all medical personnel
  Operates in austere communication environments
  Capability to feed data to Joint Medical Asset Repository (JMAR)



Patient Movement Item Tracking System (PMITS) PlexusD Version 1.0.2.0
 Tracks air certifiable medical equipment evacuated with the patient
 Facilitates the management and distribution of PMI assets
 Stand-alone application which requires a modem to communicate
 Utilizes bar-coding and scanning technologies




                                                                            6
Joint Patient Tracking Application (JPTA)
Merge into TMDS

» Merged JPTA into TMDS
   ▫   Allows authorized users to view patient data from Theater clinical systems
       (AHLTA-Theater, AHLTA-Mobile, GEMS, SAMS and TC2)
   ▫   Provides Theater patient visibility and tracking
        • TRAC2ES Patient Movement Request (PMR)

   ▫   One Theater database

» Data interfaces
   ▫   CHCS Patient Data Import (visibility of SI and VSI patients)
   ▫   DEERS
   ▫   Veterans Tracking Application (VTA)
   ▫   DFAS (combat injury pay)
   ▫   Medical Operational Data System (MODS)

» Activated 1 March 2008
                                                                                    7
TMDS Update

» Communicating directly with Theater community
   ▫   Visited LRMC
   ▫   Conducting weekly teleconferences
   ▫   Conducting virtual training
   ▫   Senior TMIP leadership visited theater

» Seven major issues
   ▫   Patient search, patient registration update, duplicate patients, reports,
       application speed, roles/privileges, and interfaces

» Current Ops Support
   ▫   Rapidly developing capability shortfalls and enhancements
   ▫   Team in Theater to help address functional, technical, and training issues
   ▫   Implementing forward deployed servers to increase application speed
   ▫   Changed system name from JPTA to TMDS and merged accounts (1 May 08)
   ▫   Expect major issues to be resolved by mid June                               8
Theater Medical Data Integration (TMDI): Today




                                                 9
Theater Data viewable in
  Garrison MTF / VA




                           10
TMDS-BHIE View
Lab Data Sharing



                           TMDS View




AHLTA - BHIE Data Viewer
                                       11
TMDS-BHIE
Radiology Data Sharing



                           TMDS View




AHLTA - BHIE Data Viewer
                                       12
TMDS-BHIE
Medication Data Sharing



                           TMDS View




AHLTA - BHIE Data Viewer
                                       13
TMDS-BHIE
Inpatient Data Sharing



                           TMDS View




AHLTA - BHIE Data Viewer
                                       14
TMDS-AHLTA View
CDR Records



                  TMDS View




AHLTA CDR view
                              15
TMDS-VTA
Tracking and Treatment Data Sharing



                                      TMDS View




VTA
                                                  16
TMDS-VISTA CPRS BHIE
Theater Clinical Data Sharing



                                TMDS View




VISTA CPRS BHIE
                                            17
TMDS-TRAC2ES Interface
Patient Movement Data



                         TMDS View




TRAC2ES PMR
                                     18
TMIP TC2 Statistics
                                        TC2 Statistics
                                    (June07 – 30 Apr 08)
                  798,919         2,101,965 Total Workload
      800,000
                            711,155

      700,000


      600,000


      500,000


      400,000

                                      292,641
      300,000
                                                216,064
                                                                                              NOTE: As of 15 May,
      200,000                                                                                 all inpatient data is
                                                                                              collected through TC2

      100,000                                             52,653
                                                                   17,244     9,083   4,206

           0
                Out Pt Pharm              In Pt Pharm / IV                  Out Pt Lab
                In Pt Lab                 Pts Registered                    Admissions
                Out Pt X-Ray              In Pt X-Ray
                                                                                                              19
TMIP Outpatient Statistics

                          Outpatient Statistics
                         (1 Jan 05 – 30 Apr 08)
                      1,748,051 Total Encounters




                              4
                            16
                          8,
    1,600,000




                         42
                       1,
    1,400,000

    1,200,000

    1,000,000

      800,000

      600,000

                                         0
                                        57
      400,000
                                      9,




                                                        7
                                                      31
                                    20




                                                    0,
      200,000

           0                                       11

                      AHLTA-T       SAMS     GEMS
                                                            20
Block 2 Release FY07 (formerly B2R1)

  Originally                      Development
  Planned:                        Added to Block 1:                Other Products:
    AHLTA-Mobile 1.9.8*             TMIP Composite Health Care      Patient Movement Items
    AHLTA-Theater 301.9*            System Caché (TC2) 1.0.0.0      Tracking System (PMITS)
                                    TMDS with JPTA functionality    1.0.2.0
    JMeWS 2.2.3.4*
                                    2.2.4.0                         Shipboard Non-tactical
    Business Objects (Ad            DMLSS Customer Assistance       Automated Data Processing
    Hoc Reporting) 6.5.1            Module (DCAM) 1.1.106.0         Program (SNAP) Automated
  * Newer Version Than Planned
                                    TRANSCOM Regulating and         Medical System (SAMS)
                                    Command & Control Evacuation    9.02.00
                                    System (TRAC2ES) Interface

               Environment: Windows XP Professional/Server 2003 Oracle 10g

                        Sustain Block 1 until the Services migrate to Block 2

               Released to Service Infrastructure Program Offices October 2006
                OT completed 5 February 2008/ FDDR planned for August 2008


                                                                                                21
Block 2 Release FY07 Highlights

» AHLTA-Theater
   ▫   Alternate Input Methods (AIMS) Forms
        • Includes 111 standard templates
   ▫   MACE Forms
   ▫   SAMS demographic interface
   ▫   Limited inpatient capability for Forward Resuscitative (Level II)
   ▫   Off-line demographic verification
» AHLTA Warrior (Phase 2)
   ▫   Reachback to the CDR for Patient History
        • Clinical Encounter
        • Allergies
        • Laboratory
        • Radiology
        • Pharmacy
   ▫   Single Sign On (SSO) with TMDS
        • Eliminates multiple passwords
        • Reduces multiple login screens to one

                                                                           22
Near Term Initiatives

» Accelerate Sunseting GEMS and SAMS
   ▫   GEMS and SAMS PEM functionality will be replaced with
       AHLTA-T
   ▫   EH & OH will be replaced by DOERHS-EH and AHLTA-T AIMs Forms
   ▫   Rad Health will continue

» Clinical Context Management
   ▫   Automatically references the same patient across multiple applications
   ▫   Extends Single Sign On across the TMIP Suite of software

» NeuroCognitive Assessment Tool (NCAT)
   ▫   Conduct an Joint Service Analysis of Alternatives (AoA) to identify the best
       technology to support the Theater business practice for Psychological
       Health and Traumatic Brain Injury
        • First meeting was held 17 April 2008




                                                                                      23
Theater Deployable Tele-Radiology Systems (DTRS)

» TMIP is the new Program of Record for Theater DTRS

» Coordinating with Integrated Clinical Systems (ICS) staff at the
  US Army Medical Research and Materiel Command (MRMC) for
  a seamless handoff
   ▫ Transitioning current Theater solution (Medweb) to TMIP

» Developing the Theater DTRS support plan
   ▫ Assessing the current status of equipment

» Functional CONOPS aligns with CENTCOM’s Joint Urgent
  Operational Needs Statement (JUONS) for bandwidth




                                                                 24
Proposed Theater DTRS Concept




                                25
Joint Medical Analysis Tool (JMAT)

» JMAT is a critical Force Health Protection (FHP) component as
    outlined in the Chairman, Joint Chiefs of Staff (CJCS) Joint
    Publication 4-02, Health Service Support

»   JMAT is a Joint Staff approved automated tool supporting:
    ▫ Medical Support Requirements Estimation (RE)
    ▫ Course of Action Analysis (COAA)
    ▫ Scenario Building
    ▫ Risk Assessment

» JMAT v1.0.1.0
    ▫ Stand-alone medical planner tool/application
    ▫ Released 19 December 2007
    ▫ Replaced MAT v2.0.5.2

» JMAT v2.0 (Web-based version) - Currently in development
                                                                   26
JMAT Development: JMAT v2.0 (Web-based)

» Transforms the current JMAT v1.0.1.0 into a dynamic web-
  based collaborative planning tool
» Two phase development plan:
      • Phase I (FY08):
          ◦ Graphic User Interface (GUI)- Interactive and Icon based
          ◦ Geo-spatial Information System (GIS) Capability- “smart map
            feature” will have the same look and feel as MSAT
          ◦ Scenario Building Functionality- ability to use empirical data
          ◦ Concludes with an Early User Evaluation (EUE)
      • Phase II (FY09):
          ◦ Interfaces with external data sources
              – Common User Database (CUD)
              – Joint Data Logistics Model (JDLM)
          ◦ Simulation functionality- to execute COAA and RE
» Stand-alone version for austere communications environments
» Interoperable with JMeWS and MSAT
                                                                             27
Medical Situational Awareness in the Theater (MSAT)

 Provide commanders and their staffs actionable knowledge
 and enhanced medical situational awareness to enable
 critical decision making




                       • Joint Medical Information Systems   • Services Oriented
     Medical                                                   Architecture
                       • Global Combat Support System
    Situational        • Net-Centric Enterprise Services     • Mapping Tools
    Awareness          • Net-Enabled Command and Control     • Decision Support /
                                                               Business Intelligence


 Support Decision by   Leveraging existing success to   Empower commanders
     Making             and emerging capabilities     with Actionable Knowledge


                                                                                       28
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TMDI: Mid Term (FY10)




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Questions?




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