electronic health record

 

electronic health record

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Dave Bowen

Thursday, November 7th, 2013 - 12:20
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What is the IT strategy for the Defense Health Agency? How has it enhanced DoD’s IT efforts to delivery care anytime, anywhere? How is the DHA modernizing its technology infrastructure and realizing a robust integrated electronic health record? Join Michael Keegan as he explores these questions and more with Dave Bowen, CIO at the Defense Health Agency.
Radio show date: 
Mon, 11/18/2013
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Intro text: 
What is the IT strategy for the Defense Health Agency? How has it enhanced DoD’s IT efforts to delivery care anytime, anywhere? How is the DHA modernizing its technology infrastructure and realizing a robust integrated electronic health record? Join Michael Keegan as he explores these questions and more with Dave Bown, CIO at the Defense Health Agency.
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Complete transcript: 

 

THE BUSINESS OF GOVERNMENT HOUR

 

 

DAVE BOWEN

CHIEF INFORMATION OFFICER, MILITARY HEALTH SYSTEM

At the U.S. DEPARTMENT OF DEFENSE

 

 

Michael Keegan: Welcome to The Business of Government Hour. I'm Michael Keegan, your host, and Managing Editor of The Business of Government Magazine. The provision of health services is a critical and significant mission within each branch of the U.S. Military, as well as an integral part of the U.S. Department of Defense's Military Health System, MHS.

 

MHS relies on information and technology to carry out its mission and meet DOD's quadruple aim: to achieve medical readiness, improve the health of its people, enhance the experience of care and lower its health care costs. To do this, it depends on the availability of and access to high-quality, timely and reliable information, and the technology that makes all of it possible, advances in technology that are clinically relevant, technically feasible, and financially viable. These are strategic assets to an organization that understands managing resources efficiently and effectively is key to being successful.

 

What is the information technology strategy for DOD's Military Health System? How does the creation of the Defense Health Agency enhance IT efforts to deliver care anytime anywhere? And how is MHS modernizing its technology infrastructure and realizing a robust, integrated electronic health record? We'll explore these questions and so much more with our very special guest, David Bowen, Chief Information Officer at the U.S. Department of Defense's Military Health System.

 

Dave, welcome to the show. It's great to have you back.

 

Dave Bowen: Thanks, Michael. A pleasure to be here.

 

Michael Keegan: Also joining our conversation from IBM is Gio Patterson.

 

Gio, welcome.

 

Gio Patterson: Oh, thank you, Michael.

 

Michael Keegan: So, Dave, before we delve into specific initiatives, perhaps you could give us a brief overview of the history and continuing evolution of DOD's Military Health System and more particularly, the recently established Defense Health Agency.

 

Dave Bowen: Terrific. I'd be happy to. Let me give you some background on the Military Health System, what we'll call MHS. We're really a global health care system and very unique in a number of ways in which I'll discuss. We're comprised of both direct care provided in over 400 military treatment facilities, hospitals, clinics, what have you, and also care purchased through our health plan using civilian providers and institutions.

 

We extend from theater medical care all the way from the battlefield all the way back to our hospitals here, big hospitals, here in D.C.: Walter Reed, Bethesda, etc. So, it's really an integrated system. We strive to provide optimal health care services in support of our nation's military missions anytime anywhere.

 

Our care delivery system is not limited to just our brick-and-mortar facilities. Our personnel are ready to go into harm's way to deliver care. We also build bridges to peace through humanitarian support whenever and wherever needed, notably the care of hospital ships and things like that. And we provide premiere care for our military service members, family of military members, retirees, and their families.

 

Our budget in fiscal '13 is 50 billion. It's the unified medical program and supports the physical and mental health care of over 9.6 million patients worldwide. This budget supports the entirety of military medicine from the policymakers in health affairs, to the insurance-type benefits of our tricare insurance program, and to the heads and -- excuse me -- and to the -- and on the hands of our clinical services provided at anytime, anywhere by our doctors, nurses, medics, corpsmen, paraprofessionals within the Army, Navy, Air Force and medical departments.

 

Today, approximately 230,000 MHS users depend on information technology services delivered through civil defense organizations. These include the tricare management activity, our health plan, and each of the service medical departments. These separate but distinct services currently provide the critical infrastructure and software to bring our integrated health care delivery system into being.

 

Under the current state, it has been challenging for our health IT customers in the services to determine who within the Military Health System governance structure was accountable for health IT performance. Reforming the management of the IT infrastructure will, over time, give us the ability to manage health IT delivery all the way to the desktop. There will be no longer any confusion about who is really accountable for health IT. It will be us.

 

So this month, we stood up the Defense Health Agency. It came into being on October 1. The tricare organization went away, became part of the -- or morphed into the Defense Health Agency. And as a part of the stand up of the DHA, we consolidated a number of sort of back office services, if you will, into shared services models. And they include our facility services, our health plan, operational services, our logistic services, and our IT.

 

So, under the IT directorate, each health IT business process will be aligned to a leader in the directorate reflecting our commitment to ownership and accountability. We're basically consolidating the health IT component of all of the military services.

 

To support the transition of the bulk of health IT services, the service chief information officers and their associated service IT management functions, as I said, have transitioned into the Defense Health Agency and now have been actively involved in all of the planning for providing health IT on a shared-services basis within the HIT. We've been planning for that since January. We've been through the development of business case working on who's going to transition, etc, etc. And all of that sort of came into being on the first of October.

 

The service CIOs actually have a dual role. They will continue to advise their surgeons general on IT matters and guide IT delivery within the services until all of the IT functions transition under the management of the Defense Health Agency. We anticipate that's going to be about a 2-year process. The service CIOs will retain direct authority over their service-specific resources, again, until we reach our full operational capability on somewhere around October 2015.

 

So right now, infrastructure and application services previously provided to the TMA are now provided by the health IT directorate which I head up within the Defense Health Agency. Infrastructure and application services provided by the services will remain in place until they are standardized and transitioned over. So over the next two years, we'll continue the required consolidation of IT functions to fully implement the health IT shared services.

 

Under the direction of the health IT director, which is me, we will take the service CIOs, our chief medical officers and operational service leads, and use them to maintain current operations and delivery to the services, and at the same time, support the stand up of the new health IT organization oversee the stepwise transition of the remaining IT functions. So basically, the end result will be an enterprisewide, integrated IT environment with standardized infrastructure and applications down to the desktop level, basically, to our user fingertips.

 

Michael Keegan: And so, realizing that organizational vision that DHA creates for your specific discipline, could you tell us more about your office, how it has evolved, the size of its budget, number of folks that work for you?

 

Dave Bowen: Sure. Very briefly, we transitioned about -- well, we transitioned 744 people into the office of the CIO basically on October 1. We developed an organization that has six vertical divisions within it, essentially using best of breed, best practices from industry, as well as some advice from the Gaertner folks. Our six vertical organizations are sort of innovation and modern technology is one. Governance and customer relations is the second one. Our infrastructure group is our largest group; that's the third one. The solution delivery group is number four. Our information delivery, information analytics, etc., is the fifth one. And then, the final one is our security and privacy organization.

 

And as I said, there are about 744 government employees that transitioned over on October 1. We also transitioned over about 1,000 contractors so our going in state was about 1,750 people. Budget for this year is somewhere around 2.2 billion across those six verticals in the new organization. So, that gives you sort of the going in numbers. When we finally reach full operating capability, we expect to be somewhere between eight and 9,000 employees and contractors. And we're still researching budget numbers, but certainly the 2.2 billion-dollar number will be at least that and maybe more.

 

Gio Patterson: Dave, now that you've provided us with a sense of a larger organization and the mission of your office, perhaps you could tell us more about your specific responsibilities and duties as the DHA Military Health System's CIO, and how do your efforts support the department's overall mission?

 

Dave Bowen: Well, let's talk about the mission, Gio, because that's a terrific question. We operate on an overall mission for the Military Health System that we call quadruple aim. Basically, there're four pillars to the mission. The quadruple aim was developed in 2009, and it still remains relevant today. During fiscal year 2012, our senior Military Health System leadership agreed to begin fiscal 2013 by explicitly emphasizing the quadruple aim as beginning our desired direction for improvement. And the four pillars of the quadruple aim include readiness, which means being able to field what we call a medically ready force and be able to deliver health care anytime anywhere in the world in support of the full range of military operations and including humanitarian mission. So, that's the readiness component.

 

The second component of the strategy is better health, and we want to reduce the number of health care visits to our direct care system by our service members by encouraging them to promote better health: things like smoking cessation, weight control, these things. And we have this tag line we kind of use to describe that that says we're moving from health care to health. And so we're talking more about preventative activities that will certainly reduce service members' need to seek more acute health care.

 

The third component of the strategy is better care. And that is basically making sure the care that we do provide our members is the finest in the world, a care experience that's safe, timely, effective, efficient, equitable and patient- and family-centered so basically focusing on care that we provide to the service member and provide to the family.

 

And then finally, which is where we're focusing a lot of our attention, better efficiencies and lower cost. We need to create value by focusing on quality, eliminating waste and reducing unwanted variation. We're going to consider the total care, cost of care go over time, not just the cost of an individual health care activity. We have both near- and long-term objectives in this area to become more agile in our decision making and maximize longer-term opportunities to change -- excuse me -- to change the trajectory of our cost growth through a healthier population. And certainly in the IT area with a budget the size of ours, cost is a focus, and we'll talk about that probably a little bit later.

 

Michael Keegan: Yeah, might get into it now. I was wondering, given your responsibilities and duties to make the quadruple aim reality from at least a mission support perspective, what are the three -- top three management challenges you face, and how have you sought to address them?

 

Dave Bowen: Well, in sort of about this question, I mean, I -- we're sitting here, what, 18 days into the stand up of the Defense Health Agency, two days into the operation now of our federal government so certainly, a lot of challenges came to mind. But let me talk about a couple. Certainly, between -- again back to the cost element, we've got -- we run a very high budget. Our budget is almost about ten percent of the total budget of the Department of Defense. So that is the total defense health program and all the care that we provide so very, very strong emphasis on cost control and cost reduction.

 

We've got a disparity between the cost to support and maintain our current systems and sort of have a problem because we're stuck in this conundrum of the high cost to support and maintain our current systems, and yet, we need to transition away from them into new, more modern systems to reduce our costs, but certainly there are up-front dollars involved do that. So, we've got sort of this push-pull around the high current costs and some need to fund the future development.

 

Our sustainment costs, when you take a look at those across time, have been running in sort of the low 90 percent, so that doesn't leave us every much money in terms of being able to modernize those systems, things like that. And that's why we want to effect a transition to a new system. Certainly in a budgetary environment where we're sort of either under CR capped with sustainment costs increasing, the dollars available to do modernization and enhancement certainly gets smaller and smaller. So, cost is certainly one.

 

Another factor that is a challenge for us is as our service members seek care outside of our direct care system, they go to commercial providers through the health plan, we have more and more of a need to get the data that are generated by those kinds of activities back into their military record. Obviously, they can go to lots of different providers. There are lots of different systems out there and trying to get data back from them continues to be a challenge just because of all of the privacy regulations, the technology dimensions of dealing with all those different systems and all of that.

 

And then, finally, a challenge for us going forward is, as I mentioned, is going to be how do we sort of replace our current systems which the Department of Defense has decided to undertake, and how do we fund that replacement? How do we make a selection? How do we deploy a new system across, as I said, 400 care sites in our direct care system alone? And then, we're talking about, you know, ships and submarines and things like that in addition to that. So, that's going to be a very major activity for us in the upcoming years. So, those are some of our major, major challenges.

 

Gio Patterson: So, along with these challenges, given your role, there's probably unanticipated or unexpected surprises. To that end, what surprised you most since taking on this role?

 

Dave Bowen: What surprised me most? Well, it's interesting. I -- you know, I came over to the Defense Department, and I guess I grew up in an era where I was kind of between wars and never served in the military and always sort of looked at the DOD as being sort of the ultimate, you know, the department that does things really well, and the rest of us in the civil part of the government, we're always trying to catch up to the DOD. And certainly coming into the DOD, I get a little bit different perspective.

 

But one of the things that struck me the most was that the services are all different. I thought that they would be very much the same and operate the same, but they're all very much different. They have their different cultures. They have their different practices. And so when we're trying to put components of the service organizations together into a single organization, these differences really impact the way that we can do things and the way we operate. The services have different HR processes. They have different sort of performance years, if you will. Not only within -- not only across the services, but even within the service, you'll find that different ranks, you know, have a different performance year and things like that. And so that's been really kind of an eye-opener for me. I thought the services would be kind of much more standardized in the way they do things, and I was surprised to learn that they're not.

 

Michael Keegan: So, Dave, I've had the pleasure of having you as my guest on the show twice during your tenure at FAA as the CIO over there. And I also know that you came over from the private sector, and you were the CIO of a health care organization. I was wondering if you could tell us how have those experiences shaped your approach here at the DOD?

 

Dave Bowen: Mmm. Okay. Well, certainly, you know, I went to the FAA and came into government to join the FAA because I, as we talked about, I had a passion for aviation, a passion for flying, but my career responsibilities really were in the health care IT area, and I have been the CIO of a number of multihospital systems, seven hospitals, 14 hospitals, last one being 50 hospitals, and then also a Blue Cross Blue Shield plan. So, I have a lot of health care background up in health care IT. So, it was kind of coming, in that sense, coming over to the MHS was kind of coming home in terms of dealing with the physicians and the hospitals and things like that. So, I did a lot of systems integration, systems acquisition, in the hospital world and in the health plan world before I came back into government. So, that's kind of the background. And so that's a pretty good fit there.

 

Coming from the FAA, it's been really interesting. The experience -- one of the experiences, the major experience, that I helped lead at the FAA was their transition to IT shared services. They embarked on their journey a couple of years ago, and it's a very similar process. At the FAA, we had 13 lines of business within the DOD. We basically have three or maybe four lines of business, those being the services and the TMA. So there were a lot of similarities, and when I began talking -- they -- when the DOD people began talking to me about the concept of a IT shared services and what they were trying to do, I said, well, you know, we did all of that at the FAA. And they said, oh, really. How did you do that? And I said, well, let me put together some material and, you know, present it. And so I sat down with our leadership and kind of ran them through what we had done at the FAA. And they said, well, gee, that's exactly what we want to do. That's a perfect road map. So, we kind of got off to a fast start because I had been through some of this stuff before, and I sort of knew where the pitfalls were and what was going to be important and what wasn't so a lot of similarities.

 

As I said, the FAA had 13 lines of business. We have three or four lines of business here. And so certainly affecting organizational change and implementing that change in these agencies is, to a degree, similar. As I talked about the service differences, there are some differences with the cultures and things like that.

 

One of the things I told folks at the FAA and I shared with the folks when I joined the DOD is that I do enjoy a challenge. And these are very challenging efforts. These are very challenging times, obviously. And so operating within this environment and trying to implement major change should provide anybody who enjoys a challenge a sufficient amount of challenge for them to take advantage of. That's for sure.

 

Michael Keegan: So as a follow-up, Dave, what makes an effective leader, and does your unique leadership role require a different kind of leadership approach?

 

Dave Bowen: You know, what makes an effective leader, I think, was kind of what you asked. I'm not sure that leadership in this particular setting or any specific setting is really much different than sort of general leadership principles. You know, we've got to establish a strategic direction, priorities, communicate them meaningfully to the staff, manage change, you know, motivate and manage our work force, and all those kinds of things. And certainly, you know, in these kinds of times, we're probably more challenged in the human dimension of management than we ever have been before, certainly within the government and certainly in private sector. So very strong communication, very strong on making sure people know exactly what's going on, how it affects them, sometimes we don't have all the answers. And when we don't, we tell them that we don't. We'll get back to them.

 

And then in a sense of what we're trying to do with the DHA and the IT shared services, we're, at this point, pretty much at a tactical level in terms of execution. I mean, the strategy's pretty much been determined. And as I told my folks in an off site a couple of weeks ago, basically strategy number one is not to break anything while we go through this transition. And strategy number two is basically hold ourselves accountable and deliver the results that we promised in the business case. So, we have a very, very hard focus on results and a very hard focus on accountability and holding people accountable. And I think that is somewhat new for some of our folks. It's very -- certainly very common in the commercial world where you live or die by your results, and we're trying to bring some of those disciplines into the management style and the way we manage the organization now.

 

Michael Keegan: What is the information technology strategy for DOD's Military Health System? We will ask its CIO, Dave Bowen, when our conversation continues on The Business of Government Hour.

 

Welcome back to The Business of Government Hour. I'm Michael Keegan, your host. And our guest today is Dave Bowen, Chief Information Officer with the U.S. Department of Defense's Military Health System. Also joining us from IBM is Gio Patterson.

 

So, Dave, you've mentioned that the Military Health System is a global system delivering health care and health services anytime anywhere. And in the last segment, you also underscored the fact that information technology are critical to doing this and making this so. I'd like to step back a bit and get your strategic vision for IT in the Military Health System. Could you tell us a little bit more about your goals and objectives and how are you modernizing the system?

 

Dave Bowen: Well, sure, I'd be glad to. Certainly, our goals and objectives, I think as I mentioned, are, at this point, we're sort of in tactical mode. We know what the strategy is. Basically, you know, I've told our folks don't break anything. Deliver the results that we are holding ourselves accountable for. So that's kind of it going forward at this point.

 

The selection of the new clinical system, which we're going to talk about, right now, is sort of being handled by another part of the organization. And I can talk about that later. So, you know, our goal is really around efficiencies and cost savings and how do we put all of these components together. Each one of the services has their own sort of IT operational arm. We have multiple help desks. We have multiple data centers. I'm sure if you've had people from OMB and other areas of the government involved in IT, you know there's a data center consolidation program going on. So, we're trying to conform to all of that. And I regularly touch base with Teri Takai and the service CIOs at the DOD. So, we're trying to be consistent with DOD policy, OMB policy, and move all of that stuff forward. So, that's kind of where we are.

 

Michael Keegan: Well, you mentioned earlier about the standing up of the Defense Health Agency. I know it's sort of the center of the MHA -- MHS's governance reform, but could you tell us a little bit about the benefits associated with transitioning the core of tricare management activity to DHA?

 

Dave Bowen: Well, primarily from a business standpoint, what it allows us to do, Michael, it allows us to better integrate our health plan operations with our provider organizations. Probably the best model for this kind of coordination you can find in Kaiser because of the way they operate. They both have a health plan and a provider organization. We've talked to Kaiser a number of times, a lot of interaction between our two organizations, and that's where we're trying to go. We're trying to basically better integrate the pair organization with a direct care, certainly the direct care organization so that we are more cost effective, and we sort of get back to the kind of the quadruple aim components of the strategy: better care, you know, better medical readiness, etc. So, you know, that's one of the transitions.

 

I think from an IT standpoint, and Gio and I were talking about this during the break, we've got a lot of redundancy. Now we've got, you know, we've got Army, Navy, Air Force and TMA all having their own IT shops, all having their own data centers, all having their own help desks, multiple applications doing the same thing. So now, we have the ability to really, because all of this is now under our umbrella, to really look at how we can more efficiently consolidate, eliminate duplication, and provide our IT infrastructure and application services at a more efficient level. Certainly, commercial businesses that are profit-motivated and, you know, trying to save money and put money on the bottom line have done this a number of years ago, and we're kind of just getting around to it. So, that's another benefit.

 

We're going to transition 3,000 people from DOD Health Affairs and what was formerly the tricare management activity. We transitioned them, I guess, about a year and a half ago into a single building so we've got an element of physical consolidation where we now have the tricare folks along with the senior medical leadership of the services together all in one building. So, I can walk downstairs and see the Navy, you know, surgeon general or the Air Force surgeon general, whatever, and sort of have a lot of good interaction that way. So, there's sort of a geographical or a location advantage here.

 

And then finally, sort of getting back to IT, when we proposed to the shared service for IT, we developed a business case which I touched on briefly, ran it through our approval process, our governance process, had a thumbs-up from all the surgeons general so we've got to deliver results, and we're holding ourselves accountable to be able to do that. So, that's kind of the various sort of dimensions of what the consolidation has brought so far.

 

Michael Keegan: Great perspective.

 

Gio Patterson: Dave, given the Military Health System carries out multiple and often complex missions, its IT requirements and portfolios reflect the complexity. Would you elaborate on your efforts to foster an enterprise view that supports a one-connected enterprise and influences movements towards an actionable, strategically focused enterprise?

 

Dave Bowen: Sure. That's a great question, and when you sort of think about all of the far reaches of the Department of Defense, both on the, you know, the military, the active military side, our theater operations, as well as all of the different care venues that could exist in the military, whether it be on an aircraft, on board ship, in a hospital, in a clinic, field hospital, whatever, and you start thinking about the IT implications of that, it really gets to be very, very broad.

 

So I guess, a couple of things that have changed in terms of the DHA and how that's -- that has impacted that, certainly, in the past, we have been very service-focused on developing IT solutions to meet the various garrison and theater needs of the various services. So in doing that, oftentimes, some of the services weren't served by our applications so we had situations where we're taking a long time to develop the app. It may be by the time it was delivered, it didn't meet the needs or the users' needs had changed so we think that, you know, one of the things we've got to do is, certainly, is be faster in terms of meeting our customers needs. So to account for that, one of the things I need to make a point about is that the DHA has big designated as a combat support agency. And so as such, it's always going to be led by a flag officer. Our current DHA director is General Douglas Robb, who's a three star. And so, it places a high degree of importance upon the agency and our ability to deliver.

 

Under the DHA governance structure within the new information technology directorate, we're going to ensure that the right service leadership is involved in the health IT requirements generation process and that we deliver the right application in the right way at the right time. Certainly, as I talked about, there are a lot of characteristics that are unique to us. I talked about the different care locations. One of the things I didn't talk about yet from IT standpoint, but it's important to us, is the fact that oftentimes, our systems are operating in remote environments where they can't basically call home. They could be on board ship, you know, down in a submarine, etc., etc. So, that is sort of a unique requirement of our situation that a lot of -- a lot of system providers don't have to worry about because, you know, when you're operating in a hospital, normally, you can always connect and always get back. And that's not the case.

 

The other thing that I'll mention is that we do a considerable amount of veterinary business because we do have animals in support of our troops, and we have systems that basically provide electronic health care record for the animals that are assisting those troops. So, that's kind of another fun dimension of our job.

 

Gio Patterson: Okay. So enterprise governance did is critical to the success of your efforts. I'd like to explore your efforts to enhance the MHS IT governance process. How does governance enable your organization to optimize resources across the enterprise?

 

Dave Bowen: Well, Gio, this is a great question, and it would be even better if you asked it of me, like, this time next year. My organization is 18 years old -- 18 years -- 18 days old, and so we're still working on some of those processes. We do have some overall governance processes in place at the DHA, though, that we're trying to plug in to and figuring out how we do plug in to those. We have sort of both clinical and operational subgroups under a group of our deputy surgeons general. They make decisions -- make recommendations, up to our surgeon general group who reports up to Dr. Woodson who is assistant secretary of defense for health affairs. So, we sort of have a chain of command that we can plug things in to, and if we need certain decisions, run them up that chain to get the decisions we need.

 

Certainly, our service CIOs are part of our organization, but they also remain sort of -- and keep a dotted line connection to their own service surgeon general so when we're deliberating something as a group and we need to, you know, run that up the chain, the CIOs will go back to their SGs, brief them up, and so we sort of make sure that we stay in touch with them. And then we have groups of clinicians that are always working with us and will continue to do so to develop requirements, provide a clinical perspective, bring the garrison and theater requirements to whatever kinds of decisions we're making and make sure that that input is also considered. So, those are some of the things that are currently in operation. But, again, as I said, if you invite me back next year, I'll probably be able to answer that a little bit more specifically. Great. Thanks.

 

Gio Patterson: I was going to say for 18 days, you're doing great. So, the next question is actually my favorite question. So, the procuring of health IT-related products and services is quite different from purchasing heavy military hardware. To that end, what are some of the significant acquisition challenges being faced by you and your organization given the military acquisition processes? What are you doing to create a more efficient acquisition process, and to what extent are you looking to implement systems from private sectors that are plug and play to replace the aging and costly legacy systems?

 

Dave Bowen: Okay. Well, we certainly talked about the aging and costly legacy systems and the need to have to replace those and sort of the financial conundrum around that. You know, when I came to government, I didn't understand the acquisition process certainly in the civilian world. Yeah, I mean, it sort of just boggled my mind. And then transitioning from the civilian sector of the government over to the DOD, I find that the acquisition process is a whole new ball game. I have spent a couple of very enjoyable nights reading through the DOD acquisition regulations so I think they're exactly 5,000.01, 5,000.02 trying to understand what is actually trying to be accomplished there. And as you said, I think what we have been trying to do in the past has been exactly that, and that is to plug the acquisition of a commercial system into an acquisition process that is really geared to the development and deployment of military technology.

And you can see this very clearly in the acquisition regs when they're talking about the various milestones and, you know, you -- if you're buying a jet fighter, you have the specs and somebody builds a prototype, and then you, you know, have a preliminary manufacturing, and get into manufacturing and all that stuff.

 

So, it really is a challenge. And I'm not sure -- I'm not sure I have a real solution. There are -- there have been -- there have been attempts by the DOD to recognize and develop a more streamlined process are around what they call MAIS, major acquisition of information systems, or something like that and sort of tailor that process. But basically, as we go forward, we're kind of plugging in to the DOD acquisition process and doing the best we can to manage inside that. It's certainly a challenge, and it will be a challenge going forward.

 

Michael Keegan: So, Dave, just from an operational perspective, and I understand the infancy in which you're operating in in terms of your organization's age with the transition, but what are you doing to identify and implement best practices and standards across the enterprise?

 

Dave Bowen: Well, as you said, Michael, we're very  -- a very young organization, not even a month old yet. So, in terms of the capital investment processes and things like that, we're still working on standing them up. However, one of the going-in assumptions in our business case that was approved by our leadership is that as we transition from initial operating capability to full operating capability and we begin to control more and more of the IT landscape, our goal is to control more and more of the IT dollars and have that funnel through a single point basically being my office.

 

Now, we have procurement dollars. We have R&D dollars. We have operational dollars. We have dollars going to specifically the IT through sort of the DHA, but we also have IT dollars being spent at the regional level, at the military treatment facility, the hospital level, and we've got to get our hands around all of that and try to bring it together. So, we are working to identify that.

 

You sort of asked me what we're doing. The plan is to sort of try to identify, you know, as much as we possibly can, and then begin over the course of a couple of budget cycles over the next couple of years, to get more and more incorporated, more and more of that incorporated into our budget so that we can really use that as a tool to help control spending that's maybe not in accordance with our strategic priorities or duplicative, or whatever, and make more efficient use of those dollars. So initial steps, again, that might be another question for a later discussion.

 

Michael Keegan: You just triggered my memory. Is it sort of a model that VA is doing or VA has done at all in terms of the CIO (Indiscernible) to take control of the dollars?

 

Dave Bowen: Yeah. The VA's been very progressive in this area, and I've got to compliment them on the way they've done this. The CIO who put a lot of this together is a guy by the name of Roger Baker. A very good -- not a good friend of mine, but Roger and I have had a number of conversation about what he's done at that agency. And, yeah, I mean, we're certainly adopting certainly the funding components of what he did at the VHA.

 

Michael Keegan: How is MHS modernizing its technology infrastructure and realizing a robust, integrated electronic health record? We will ask Dave Bowen, Chief Information Officer with the U.S. Department of Defense's Military Health System when our conversation continues on The Business of Government Hour.

 

Welcome back to The Business of Government Hour. I'm Michael Keegan, your host. And our guest today is Dave Bowen, Chief Information Officer with the U.S. Department of Defense's Military Health System. Also joining us from IBM is Gio Patterson.

 

Dave, there's been much discussion about the efforts to realize a robust, integrated electronic health record. Would you tell us about your efforts in supporting the development of the integrated electronic health record, and could you highlight more particularly the path forward?

 

Dave Bowen: Sure. I'd be happy to, Michael. The IEHR, the integrated electronic health record, had -- DOD's been involved in this for quite a while. There's certainly a good bit of history that predates me. I just came up on my first anniversary with the DOD, and these efforts certainly were in place and going on long before I joined the DOD. But sort of my history goes back to an agreement that the DOD and the Veterans Affairs department, the VA, had to basically go out and jointly acquire an electronic health record or jointly develop an electronic health record. And the way that they were going to do this was to acquire sort what we call the best in breed. So, they were going to look at what's the best pharmacy system, what's the best lab system, what's the best or radiology system, and tie all of that stuff together. And so, that was the strategy. And there was an office formed called the Interagency Program Office to manage this activity, and those activities were in place and operational, and they were doing great things and moving forward.

 

I joined the agency in September, and towards the end of the year last year, we realized that that was going to be a pretty long process and probably going to be pretty expensive. So, we sort of did some soul searching and decided that maybe there were some things that we could do to shortcut that, one of those being adopt a strategy that looked at sort of best of suite where we buy capabilities that are all bundled together at least to some degree so that you're not looking at sort of the best of everything. You're looking at sort of a core of applications that we would both agree to buy and then tack on stuff as we needed.

 

And so, there was some discussion around that. And then in the early part of the year, the VA came back to us and said, you know, we like this core strategy, but we think that the best way for us going forward is to modify our current core, rather than going out and buying a new core. And so, that left DOD with sort of, you know, without a partner, if you will. And so, we kind of looked at our options. And I think it was back in March, the secretary had talked to Congress and told them that he'd get back with a decision on this. And back in March, I think it was, he made the decision that the DOD would probably be best served by going out and buying a commercial product.

 

And so, to that end now, we've been moving down that road to basically look at the acquisition of a commercial product. And we have a group of folks in our acquisition testing and logistics area that have been assigned the responsibility for overseeing that acquisition. This is certainly a major acquisition for the DOD. And when you read the acquisition regs, basically the major acquisitions for the department are all managed out of ATNL, be it, you know, fighter planes or whatever. And so, this is very consistent with the Department's policy. So, there is a program executive office that has been stood up and is charged with the responsibility of making that acquisition. So, where I plug in and my guys plug in is to assist that program office by determining what our clinical requirements are. So, our clinicians are very, very heavily involved. Our chief medical officers are involved. We just sent one of our guys over to be part of the program office staff. He's a physician, and he's going to be sort of the program office chief medical officer that will sort of lead the medical community in their interaction with the program office to develop the requirements for this acquisition.

 

My office, on the other hand, is probably going to be involved with implementing whatever is acquired so we're starting to play in some of the nonclinical areas. What are my interface requirements? How do I interface to my current legacy systems that will remain and not be replaced? You know, what kind of infrastructure footprint do we have to lay down for running this on basically a worldwide basis? Sort of what are the databases, the technologies involved, and all of that so we're going to play by providing, I think, probably a set of requirements in sort of a nonclinical area. Certainly, my experience in the commercial world will help in terms of, you know, what's going to be our training methodology, what's going to be our deployment methodology, how do we run the new systems at the same time we run the old systems. It's going to be a very interesting couple of years to put a new system in across our infrastructure as I've talked about.

 

Gio Patterson: So, Dave, I want to switch gears a bit and talk about IT security. The security and privacy of MHS beneficiaries is utmost importance to MHS. Could you elaborate on your efforts to secure the IT infrastructure and combat cyber security threats? And what are you doing to implement safeguards to reduce attacks and sustained, heightened user security awareness?

 

Dave Bowen: Security, well, Gio, I guess I'm very fortunate. I was responsible for all the IT security at the FAA, and we sort of did our own thing so I could talk very knowledgeably about that. Fortunately, within the DOD, we have some people who are very, very good at doing this. And so our approach has basically been to contract that out to them. And so, it's not as big a dot on my radar screen, if you will, because I have got the assurance that I have probably some of the best resources within the DOD that we've contracted to ride herd on the security of our networks and the privacy information and things like that. So, that's a good thing for us.

 

Michael Keegan: So, Dave, we've touched on a little bit fiscal austerity, sequestration, the shutdown, the creation of a new organization in which we're leading the IT part of it. That's a lot of stuff to deal with, and you've recognized, I know, doing the research for this interview, you've acknowledged that you can't continue to do the same things the same old ways in that kind of environment. Would you elaborate on your strategy to operate at full potential despite these difficult situations, circumstances?

 

Dave Bowen: That's kind of a loaded question today, Michael. You know, we're sitting here, you know, just winding up the government shut down and things like that. I was just reading an article this morning that the secretary of defense has come out and said, you know, even though the government is operating, you know, we still have sequestration. We may have a continuing resolution, whatever, so still a number of challenges out there.

 

You know, my kind of response to this question, and it may be somewhat tongue in cheek, is we're kind of taking it one day at a time. You know, we don't have a budget yet. We're still unsure of the funding. We may have another, you know, issue when our current -- the current deal, you know, comes to an end in January. So, you know, we know how we need to march down the road. We're doing that to the best degree that we can. We certainly are cognizant of the need to keep communicating with our employees, make sure that our best performers know that they're valuable to the organization, that, you know, they're going to be well taken care of during this transition. So, it's really a matter of communications. And I can tell you that, you know, as an information technology professional, most of my efforts these days are not around technology. They're around people management, governance management, which we've talked about, and some of these nontechnology dimensions that certainly in these times become very, very important.

 

Gio Patterson: Dave, you mentioned earlier about the priority in sustaining a healthy and fit force is key to MHS. I'd like to explore the role and importance of mobile platforms and mobile applications in the DOD's effort. Would you tell us more about mobile solutions you are pursuing to help people manage their own health?

 

Dave Bowen: Yeah. I can talk a little bit about that, Gio. There are a number of things going on in that area. You've heard a lot about what we call TBI, traumatic brain injury. We've got -- some of our researchers are developing mobile apps that can actually go on to a soldier's cell phone and basically help him deal with TBI or measure the effects or determine whether or not he may have some brain injury that he needs to be focused on.

 

Certainly, I talked about all of the, you know, the healthy fighting force initiatives that we've got. We've got mobile apps that sort of support that and encourage people to, you know, stop smoking and eat healthier, things like that.

 

Some of the things we're working on from sort of-- on a larger scale-- are to drive to a position where we will have the soldier's or family member's electronic health record available wherever they are. And so, if we take a look at an active-duty soldier maybe that gets injured, you know, out in the theater, what we want to do is basically have that health record available for a clinician all the way from the battlefield back to the hospital, including air transport and things like that. So, we're looking at mobility from a standpoint of not only sort of the tablets and stuff, but also the connectivity that would enable mobile access to that record all the way across the transition. We've got some R&D work going. We're looking -- for instance, we looked at a -- we're looking at a device that we can actually drop into a battle zone. The thing wakes up and sort of looks around and looks for cell phone towers and looks for other means of communication. And if it can't find anything, it starts looking for satellites but it will basically find you a network wherever you are.

 

And so we've actually -- and that's something that we actually just this past summer deployed in a field exercise that was conducted up in New Jersey where we dropped this thing in and, you know, the clinicians were using it to get at the health records of the, you know, of the guys on the battlefield. So, those are some of the areas that we're working on. You know, we certainly want to make that information available as widely as we possibly can and so battlefield to hospital is sort of the one dimension that we're pretty proud of, actually.

 

Michael Keegan: So, Dave, looking at your IT professional hat and wearing that hat, what other exciting developments are happening in the field of health IT, and what are some promising technologies?

 

Dave Bowen: Well, promising technologies, I think I talked to -- just talked to you about one in the communications area. There's so much stuff going on, and a lot of it's around connectivity. You know, I'm sure you guys have, you know, your own physicians and hospitals you go to. You see more and more of them putting out health record. You know, you go -- your family physician prescribes a, you know, a set of lab tests and you go to the lab and you have your blood drawn and then they e-mail the results back to you and things like that. So, we're doing all of that stuff. That's really been important in terms of getting people more and more involved in their own care. And so, we're certainly doing all that kind of stuff.

 

There's some terrific technology around electronic medical textbooks that some of our physicians are using, anatomy kind of capabilities where you can electronically peel back pieces of the body and see all the anatomy and things like that. A lot of, again, connectivity sort of devices calling home, you know, your pacemaker needs to change a battery so it calls the, you know, the company and you get contacted, things like that. Whether you're, you know, blood sugar levels, if you're a diabetic, you know, older monitors that used to be running a tape now can be, you know, broadcast and networked back. So, the whole networking stuff is a dimension of things that are driving new technologies in health care.

 

Michael Keegan: What does the future hold for information technology within the DOD's Military Health System? We will ask the CIO, Dave Bowen, when our conversation continues on The Business of Government Hour.

 

Welcome back to The Business of Government Hour. I'm Michael Keegan, your host, and our guest today is Dave Bowen, Chief Information Officer with the U.S. Department of Defense's Military Health System. Also joining us from IBM is Gio Patterson.

 

So, Dave, I talk to many of my guests about the use of collaboration and partnerships among agencies and with the private sector to achieve mission results. Would you tell us more about your efforts to leverage partnerships and improve IT operations or outcomes?

 

Dave Bowen: Sure, Michael. When I kind of look at this question, it kind of falls in a couple of different areas which I'll talk about. I think I talked a little bit about R&D in the last question, and this is an area where we really want to partner with industry to look at new technologies, new ways to research things, the application of high technologies to new situations, and those kinds of things. So, we have a number of R&D programs that actively seek out companies and look to provide new technologies in a sort of a private/public partnership model there.

 

Certainly the other thing, in terms of partnerships which I talked about a little bit before way back at the beginning, is that, you know, a lot of our health care that's received by our DOD beneficiaries is delivered outside of our direct care system. And so, you know, the technology around how do we connect to those many, many different systems of all of those providers in order to get that data back is a challenge for us. And certainly, we've got to establish, you know, healthcare data interoperability based on national standards. We've got to focus on ensuring that our systems, the systems that exchanging data uses national standards.

 

One thing I didn't talk much about, which is an important point to make to us, and that is that we share an enormous amount of data with the VA. There's been a lot of public discussion around veteran disability claims and veteran health care at the VA. There's been some reference to the data that they get from DOD, and we probably share more data with the VA than any two health care organizations in the world. I mean, we actually track this on a daily basis. I can tell you that on a daily basis, we're shipping millions and millions of fields of data to the VA every single day.

 

So, we have a challenge in terms of making sure that our data going to them is based on standardized -- standards that we both understand so that, you know, if we call a lab test one thing and they call it another, we have the ability to translate that back and forth. So, as a result in the very near term, we'll be able to bring data together from the DOD and VA legacy systems to create an aggregated patient record for our service members that transition from DOD and VA. We can make this data accessible to our users and to our clinicians through a common viewer. And through this viewer, the DOD and VA physicians will have the data that they need to quickly and confidently make critical medical decisions.

 

So, laying that foundation of infrastructure, business rules, and things like that, certainly, we work not only with our industry partners, but we work with standard-setting bodies. We work with the office of the national coordinator, health care national coordinator at the White House and many other people. So, those are some of the sort of public/private activities that we're involved in.

 

Gio Patterson: Dave, in an era of fiscal constraint, it's critical that agency leaders such as yourself act with strategic intent and keep the work force motivated to meet mission. You spoke earlier about this topic. Reflecting on your leadership at DHA MHS, would you tell us how to continue to keep your employees focus and motivated in the face of dramatic and sometimes painful changes?

 

Dave Bowen: Well, I guess, I would respond to that with three words and that is: communicate, communicate, communicate. You certainly can't communicate enough these days. As we said, we've got a far-flung operation and getting information out and feedback back from the very far reaches of our organization continues to be a challenge. As a matter of fact, I just had this discussion with my leadership team yesterday to make sure that we're trying to purposely reach out and touch all those people that are all across the world and make sure that they know sort of what the DHA is doing, what does it mean for them, sort of where we're going, what we hope to accomplish, and how they fit into that picture. So, that's a challenge, and I would tell you that if we can do that well, we will continue to have a motivated work force, despite the fact that we've got very challenging economic times as you said.

 

We certainly want to do whatever we can for our folks, but, again, I think, as we talked earlier, you know, it's no different, I think, than you would be doing in sort of a normal era if you're a good manager. We just have to do more of it and focus more on those kinds of activities in this environment.

 

Gio Patterson: Great. Given the critical role IT plays in mission and program delivery, how was the role of the CIO evolved into more trusted advisor? What are the characteristics of a successful CIO of the future?

 

Dave Bowen: Well, that's a great question, and I've been a CIO in a lot of different organizations, and I've worked for, you know, everybody from the chief executive officer, the chief financial officer, the chief medical officer, etc. I think there's a model somebody's got. It might be Gaertner. I'm not sure. But it sort of talks about the stages of evolution of a CIO from basically being an order taker to a service provider to whatever and up to a trusted partner. You know, as I kind of look back on it, there are a couple of dimensions of the job that I think are important. Number one, the CIO, whoever he reports to needs to be sort at the strategy table. To me, reporting relationships aren't as important as what venue the CIO has to participate in, helping set strategic direction and understanding the company's strategy and executing.

 

You know, in terms of the business IT interaction, that sort of has evolved over time, but I think that, you know, the end state for me would be to be a CIO that is respected by my business partners, as being potentially somebody who can bring technology to the table to implement a business solution that they hadn't thought of before. So, this kind of goes beyond business giving IT its requirements. What this is, is IT coming back to the business and saying, you know, we have a technology that would enable you to run your business differently or enable you to bring a new product to market or enable you to be much more cost effective in a way that maybe you hadn't realized was possible before.

 

You know, when I looked about this and thought about examples, I think there's an example out there. The Progressive Insurance people have come out with a gizmo you plug in to your car and it tells them how you drive and everything. That, to me, is a new technology, a new way of doing business. You know, if we can be the CIO who's helped drive those kinds of innovation, I would say that's a trademark of a successful CIO.

 

Michael Keegan: So, Dave, looking towards the future, what are some of the major opportunities and perhaps challenges your organization will encounter in, say, the next couple of years, and how do you envision your office to evolve to meet these challenges and seize the opportunities?

 

Dave Bowen: Well, I think we sort of covered this in bits and pieces as we went through the discussion, Michael. Certainly, you know, in terms of challenges, we've got to reduce the cost of our direct care system. That's one of our strategies. We've got to be proactive in promoting health. We've got to be proactive in connecting to our commercial providers to get their information back there. But to those, I would add a couple of other things, and I think the DHA will help us do this. One is to sort of step back and take an enterprisewide view and say, you know, if we're going to go out and buy an application to meet a certain need that we have, let's be sure that it's an enterprise need. Let's be sure that we're buying a solution that we can leverage across all of our services, all of our military treatment facilities, rather than somebody gets a, you know, great idea, you know. A vendor comes in to one of the hospitals and they like it and so they buy it. You know, we've got to be more cost effective with our dollars and be able to do that.

 

I think another challenge is basically saying, “No”.  And telling people, “We know that you had IT budgets in the past and you like to do certain things, but, you know, in the future, maybe they may not be in the best interest of the overall organization so we're going to say no”. That's a discipline that we have to develop. We've largely not had that in the past.

 

And so, I guess the other one would be as an organization, not just within a IT, but across the organization, and that is much more focus on accountability for results be they results in the IT arena, results in terms of clinical performance in our military treatment facilities, in our hospitals, better results coming from our private care providers. These are all going to be a challenge for us.

 

We are very actively encouraging our business leadership to standardize the clinical processes that we have in place at our hospitals. This was one of the lessons that we learned from talking to Kaiser and that is, you know, you've got to standardize your process. You've got to look at best practices. You've got to reduce the variability of outcomes. And that, in turn, will drive down the costs of your care. Well, when you translate that back into an IT environment, that variability translates into more variability in your IT systems to have to support that, and that, in turn, translates to a higher operating cost. So the more we can standardize our care process, the more we can standardize our systems and be more efficient and effective. So, I think those are some of the major things that we're going to be facing over the next couple of years.

 

Michael Keegan: So, Dave, what advice would you give someone who's thinking about a career in public service?

 

Dave Bowen: Ah, what advice would I give somebody that was thinking about a career in public service? Well, you know, a couple things. One of the things that really strikes me as I've looked at my service in Government is that people who are successful in public service are passionate about the mission of their agency and whenever it is. So, you know, I would tell people if you can get passionate about something or you're really passionate about something and there's an agency that sort of does that something, then, yeah, I would say, you know, gravitate toward that agency and see if you can make a difference. And there are just an amazing number of different careers and different things that you can do in government. As I've talked to different IT colleagues in other agencies and stuff, I mean, the Government has an absolutely fascinating array of, you know, of interesting jobs and interesting challenges.

 

The Government -- I would also tell you, and, again, I was quite surprised at this, but there are amazing opportunities for education and career development. You know, you can get advanced degrees. You can go to different government schools, get certified, do all that stuff so a terrific way of learning and growing and getting exposure to a lot of things.

 

The other thing that I would tell you is, again, sort of back to my conversation around challenges. Somebody once told me if you want to get a shot at trying to solve big problems, come to the government. And so, you know, when I look at, you know, what my IT budget is, where my services are provided, you know, we're a global health care organization. We provide health care to huge numbers of people in very adverse environment, all different kinds of environment. On the global scale, we've got a -- I've got a huge budget. We've got a huge operation. This is a big challenge and a big job so if you want to get involved in large-scale kinds of operations, it's certainly a great opportunity for people who like a challenge.

 

Michael Keegan: Well, Dave, I want to thank you for joining us again. It's great to always have you in here. In fact, I'd like to offer and extend an invitation to come back in the future when you have some time. But more importantly, Gio and I would like to thank you for your dedicated service to the country.

 

Dave Bowen: Well, thank you. I appreciate that. You know, I was telling Gio at the break, we have a video that sort of talks about all the different dimensions of the Military Health System, some of which we didn't even talk about here like our Uniformed Services University and things like that. And as I shared with the group when I was speaking, I played the video. And after the video, I sort of said, you know, it gives you -- this is something that gives you a reason to come up and get up every morning and come to work. So, really proud to be here. Proud to be serving the men and women of our armed services, and will look forward to coming back.

 

Michael Keegan: This has been The Business of Government Hour featuring a conversation with Dave Bowen, chief information officer the U.S. Department of Defense's Military Health System. My cohost from IBM has been Gio Patterson.

 

Be sure to join us next week for another informative, insightful, and in-depth conversation on improving government effectiveness. For The Business of Government Hour, I'm Michael Keegan, and thanks for joining us.

PDF transcript: 

Using Crowdsourcing In Government

Tuesday, August 13th, 2013 - 10:37
Author(s): 
The growing interest in “engaging the crowd” to identify or develop innovative solutions to public problems has been inspired by similar efforts in the commercial world.  There, crowdsourcing has been successfully used to design innovative consumer products or solve complex scientific problems, ranging from custom-designed T-shirts to mapping genetic DNA strands. 

Tommy Morris interview

Friday, June 5th, 2009 - 20:00
Radio show date: 
Sat, 06/06/2009
Guest: 
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