The Defense Health Agency Stands Up

We have stood up the P4I initiative, which is a partnership for improvement of which the core of that will be the Defense Health Agency analytic cell, but the Defense Health Agency Healthcare Operations has become a gathering spot or the platform where the services come together. And for the first time, we have an enterprise dashboard. There [are] about 30 metrics out there where we’re looking at quality, safety, and access…. That’s just one example. And I could go through each of the shared services one by one by one and talk about where we have made a difference.

Consolidating Services

Lt Gen Robb. One of the ones that has been as exciting as anything and challenging at the same time is our health information and technology consolidation, which is being led by Mr. Dave Bowen, our chief information officer [CIO]. We had a single health care record, AHLTA, but we were basically running 3 separate health information and technology systems—Army, Navy, and Air Force. When you talk about being interoperable on the battlefield, sometimes we had some centralization on the battlefield, but as it worked its way back, you started working your way into 3 separate systems.

When you look at any major health care organization that has consolidated,… we absolutely spent time with leaders in the health care industry about how you set up an enterprise-wide health care system that’s effective and efficient. But most important, how do you drive quality and how do you drive safety? Standardization is key not only in what we would call cost and resource things, but standardization also drives—and study after study also drives—increased quality.…

What we’re doing is we’re going basically from the major data warehouse servers all the way down to the desktop, [it] is going to be managed centrally. But when I say “managed,” I’m talking about manned and managed. So the men and women that were running the health care information technology for the Army or the Navy or the Air Force are now part of a large organization called the Health Information and Technology [HIT] Directorate.

And we are standardizing. We’re standardizing the desktop, we are standardizing the infrastructure at the base level, at the service level; and with the help of the DoD CIO across the board. This is exciting. And as you can imagine, there are savings to be had there in the reduction of duplications. In fact, in 2014 just in the infrastructure consolidation, HIT came up with about $5 million [savings] and then another $12 million in savings so far in 2015. We have created a single, joint integrated infrastructure that supports our joint integrated delivered health care so it makes sense.

About 45%, almost 50% of our health care direct care systems, in other words our military treatment facilities, is delivered in 6 markets where 2 or more of the services—Army, Navy, or Air Force—exist side by side. You think of San Antonio with the Army and the Air Force; you think of the National Capital Region Army, Navy, and Air Force medicine; you think about the tidewater area where you have Army, Navy, and Air Force medicine. It makes sense that we have a single, integrated, consolidated health information and technology.

Interoperability and Interdependence

Lt Gen Robb. By nature of what we do, we’ve created an interoperability and interdependence within the Defense Health Agency.

Let’s look at education and training. The 3 services had up to 23 different online knowledge systems. It was either a library of knowledge or there was training going on. The Education and Training Directorate leadership said, “Hey, it makes sense to put all of our different learning portals on 1 portal.” So we’re consolidating from about 23 down to a single learning portal.

And you can just begin to imagine the efficiencies gained there, not to mention the savings. We’re looking at about $500,000 in savings in 2015 and probably another million [dollars] for 2016 just on consolidation of that. So these are all early deliveries by a very young but enthusiastic and aggressive organization called the Defense Health Agency.

We’re looking at a single entity for, what we call, third-party collections across all 3 services. We could never do that before, but now we can. We’re also looking at the way we account for dollars. In other words, when you want to manage your budget, and, as you know, we have different bags of money and each of them is used for certain things, but we weren’t doing that in a standardized manner. So if you want to make a system efficient, you’ve got to call things the same, you’ve got to measure things the same, you’ve got to measure them in the same bucket of money.…