My HealtheVet: VA-DoD Collaboration Session 172 Theresa Hancock Acting Director, My HealtheVet Strategic Program Office Major Michael Whitaker Information Manager, TRICARE Mgt Activity, U.S. Military Health System Agenda • Background • Key Goals • Methodology • Common Portal Audience • JIF Collaboration Plan & Strategy • Results- Education Sub Group – Demonstration • Lessons Learned • Next Steps VA/DoD Background •The VA portal, My HealtheVet (MHV) and the DoD portal, TriCare Online (TOL), were both initiated around 2000. •Focused in different directions –MHV was created as a Proof of Concept to demonstrate that veterans and delegates could be provided with copies of key portions of their health record. –TOL concentrated on providing electronic services to beneficiaries and providers. •Six years later –Both organizations are coming to the point in their development life cycle where they are ready to provide all the functionality of a robust portal. They want to move to a model where they can align architectures and jointly develop Standards and Requirements, Patient Education Objects, and shared portlets. Key Goals Position TOL And MHV To Collaborate Define business requirements & architectural direction Establish policy and standards Identify areas that will result in shared projects producing economies of scale and cost avoidance to both agencies in the future Common Portal Audience Primary MHV And TOL User Groups Overlap Medical Support VA Employee Personnel VA TOL Patient Beneficiary TOL Veteran External Support Contractor VA TOL Veteran Advocate/ Health Care Health Care Family Member/ Provider Provider Friend TOL Manager Other Methodology Document the “AS IS” state for TOL and MHV Perform a gap analysis between the two portals Provide recommendations JIF Project Collaboration Plan & Strategy Goals •Leverage Economies of Scale •Reduce Costs Ensure Unified And Sustainable Communication Personal Health Record Usability & Accessibility Between VA And DOD Subgroup Subgroup Regarding Business And Technical Aspects Of The MHV And TOL Business Needs & Requirements Subgroup Technical Subgroup Training & Communication Subgroup Portals Recommendations Roles • MHV & TOL MHV TOL Management Management Team Management Team Teams • Contract Team Personal Health Record Subgroup Usability & Accessibility Subgroup • Subgroup Committees with Representatives Business Needs & Technical Subgroup Training & Communication Requirements Subgroup Subgroup from TOL/DoD and MHV/VA Contract Team Subgroup Committees Training & Communication Subgroup Committee • Educational Objects • Training • Communication • Change Management Subgroup Committees Personal Health Record Subgroup Committee • Personal Health Record Subgroup Committees Business Needs & Requirements • Functional Requirements • Business Requirements • Performance Measures Subgroup Committees Usability & Accessibility • Section 508 • Usability • Style Guide • Accessibility • Testing Subgroup Committees Technical • Architecture • Security • Portal Site Map Training & Communication Sub Group Results 1. Defined collaborative process to share joint educational object content approval 2. Developed (3) shared joint pilot educational objects on PTSD Managing Stress, Triggers and Work 3. Identified the existing programs which can be readily shared 4. Developing Joint User Focus Groups for “reality check” Initial 3 Topics on PTSD • Managing your Stress (link to Demo) • Managing your Triggers • Managing at Work Current Opportunities for Sharing Educational Programs MHV DoD/TOL The five centers available Self Paced Training now are: • Diabetes • Asthma Action Plan • Coronary Heart • Diabetes • Disease • Hypertension Monitoring • Heart Failure High Blood Pressure • Hypertension • Stroke • Virtual Coach Understanding A1C Future MHV Educational Centers ….which can be shared • Spirituality • Hepatitis C • HIV/AIDS Benefits of Shared Program Development • Decreases duplication – Time and Human resources • Reduces Costs • Increases Efficiency • Increases number of programs in portfolio • Increases content quality with breadth of SME expertise available User Review (focus group) Timeline • August 2007 – Develop single script for use with both active and veteran soldiers • September 2007 – Identify representatives from around the country including acute and non acute care settings and all VISNS. • October 2007 – Hold focus groups and get feedback User Review (focus group) Timeline • November 2007- – Revise content per feedback • December 2007 - – Stress, Triggers and Work PTSD programs on line for use by soldiers, vets, providers. Highlights from other Subcommittee Efforts • Performance Evaluation forum for TRICARE and My HealtheVet was held, resulting in DoD participation in VA’s performance measurement subcommitee. • TRICARE has adopted Healthwise for its Health content. • Group is exploring Joint E-Forum structure for the vetting of health content requests, to reduce redundancy and maximize resources. • DoD has briefed My HealtheVet on their approach to Secure Messaging, in an effort to collaborate and share technical strategies. Lessons Learned • Statements of Understanding (which are specific outlines of the approach, information to be captured, as well as activities to be performed) are necessary to baseline expectations for deliverables in a transient environment • Staffing of subgroups needs to be reviewed regularly, as organizational changes (contract turnover, staff changes) impact subgroup membership and participation. • In a collaborative environment where the focus is discovery, project schedule needs to be agile enough to take advantage of opportunities as they are discovered. Lessons Learned (Continued) • Projects across multiple agencies require a considerable amount of time to coordinate and meet with subject matter experts and stakeholders in each organization. This, coupled with the organization structure differences can pose significant challenges for time, resources, and delivery within short timeframes. Next Steps • Documenting Sustainable and Repeatable Communication Processes • Identifying and documenting timelines and strategies for leveraging resources and opportunities for sharing • Focus Groups Launched – Inclusion of Users for testing satisfaction with content and usability – Explore identifying existing data on returning active duty and soon to leave active duty for usability criteria. • Feedback and Revisions TRICARE Online (TOL) Major Michael Whitaker Information Manager, TRICARE Mgt Activity, U.S. Military Health System Agenda • eHealth Overview • Implementation Challenges / Lessons Learned • What’s New • Summary eHealth - TRICARE Online • TRICARE Online (TOL), as a Product of TRICARE, Provides a Comprehensive Suite of Capabilities to Support Consumer Empowerment for MHS Beneficiaries – Empowers beneficiaries to become more involved in their own healthcare • Provides Secure, Role-Based Access to Customized Services and Information that Automate and Supplement Key MHS Business Processes • TOL Met and Continues to Meet Identified MHS Needs – MHS Strategic and Optimization Plans Overview of MHS eHealth Log-on to www.TRICARE.mil (TOL), the MHS HIPAA- compliant secure portal…. TRICARE TOL Overview of MHS eHealth which provides role-based access for Beneficiaries, Providers, Support Staff, and Contractors… Beneficiaries TRICARE Providers TOL Support Staff Contractors Overview of MHS eHealth to eHealth applications and services, that automate and supplement key MHS business processes. Capabilities Appts Tools MTF Health Pages Content Beneficiaries TRICARE Med Providers SPAC DRMROL NAS Resources TOL Support Staff DRMROL NAS SPAC Contractors SPAC Overview of MHS eHealth… Upcoming The capabilities in blue are functionality coming later this year December 2007 Health Rx Appts Tools MTF Refill PHR BWE Pages Content Beneficiaries TRICARE Med Providers SPAC DRMROL NAS Resources TOL Support Staff DRMROL NAS SPAC Contractors SPAC Implementation Challenges MHS • Culture Change • Power Balance – Patient and Provider Relationship • Territorialism – Home-Grown Programs Implementation Challenges Patient • Internet Proficiency and Access • Distrust of Electronic Avenue • Loss of Personal Connection • Security and Privacy Lessons Learned Patient and Provider Concerns • Enable Timely Program Customization • Usability • Understand Existing Business Processes Before Web-Enabling Them • System Availability Lessons Learned Navigating Culture Changes Patient Empowerment • Patients as partners: more responsible and involved in their own healthcare • Patients as consumers Lessons Learned Navigating Culture Changes Territorialism • Loss of autonomy – homegrown programs • Mandates and regulations • Communications with stakeholders Lessons Learned Marketing • Need Support from Top Down • Spokesperson or Advocate is Helpful • Communicate Potential of eHealth Programs • Expect Slow and Steady Progress • Counter Negative Word-of-Mouth Definitions • Electronic Health Record (EHR) Electronic repository of health information retained on behalf of beneficiary – provider- entered data only • Personal Health Record (PHR) Set of electronic tools that enables beneficiaries to access and manage their health information, to obtain personalized health education and risk assessments, and to co-manage their medical conditions along with the healthcare care team PHR Functionality Overview DISA SATX Phase I TOL Central TOL Registered Beneficiary Appointing DISA Montgomery MHS Med Profile Medication Profile VA Med Profile VA Medication Profile PHR Secure Access MHS SSO Authentication CDR Allergy Profile Allergy Profile Demographic Profile Demographics Profile Personal Health Journal Existing PHR application and data (self-entered info) Future PHR Functionality • Components of PHR Phase I – Read-only access to Beneficiary EHR data Demographics Allergies Pharmacy (DoD, VA, TRICARE Mail Order Pharmacy, & Civilian Prescriptions) PHR Functionality • Personal Health Manager Printable Report – Self-entered Health History • Personal Health Summary Additional Capabilities 2007 • Web-Based Pharmacy Refill • Web-Based Health Assessments • Beneficiary Web Enrollment Future PHR Functionality Under Consideration • Remainder of EHR data not Included in Phase 1 (Other Data Elements) • Hematology, Chemistry, Lab Reports (VA Collaboration) • Beneficiary Data Interactive with Health Content (Based upon Problem List) • Beneficiary Data Incorporated into EHR • Third-Party Access Summary • TRICARE Online, as a Product of TRICARE, Empowers Beneficiaries to Become More Involved in Their Own Healthcare • TOL Met and Continues to Meet Identified MHS Needs • Human Process – Needs Patience and Understanding • Lessons Learned – Communicate, Educate, Demonstrate … Then Market • eHealth has to Prove Itself Everyday to Everyone Questions? Q&A Thank Your for Your Time and Attention!
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