1. MHS Capstone (27 Oct 2011) Lt Gen Green (1-Hour)Meeting: MHS Capstone, 27 October 2011, 1045Theme: Partnerships Among the ServicesAudience: ~ Senior Leaders in MHS, OSD, VAPurpose: Updates on AFMS hot topic health issuesDesign: AFMS hot-topic issues: JUMC, mission and strategy, advances, andcurrent situations and how the AFMS mission/strategy tie into Joint healthcareFormat: UnclassifiedSources: NIH/CTSA brief, Emergency Medicine Conference brief, ArmyStrategic message Integrity - Service - Excellence 1

2. Headquarters U.S. Air Force Integrity - Service - ExcellenceCapturing Care at Specialty Hospitals Lt Gen C. Bruce Green Surgeon General 27 Oct 2011 2

3. Were All In! AF Mission The mission of the United States Air Force is to fly, fight and win(in air, space and cyberspace AFMS Mission AFMS VisionSeamless Health Service World-Class Healthcare Support to USAF and for Our BeneficiariesCombatant Commanders Anywhere, Anytime Through Global Vigilance, Reach, and Power! Integrity - Service - Excellence

4. Our Focus and Alignment2 Strategies OverlappingMission Areas Transform Deployable Capability Rapid Response to Any Worldwide Contingency Fit Force Build Patient-Centered Care Continuity & Prevention to Optimize Health Invest in Education, Training & Research Sustain Our Future Capabilities Strategy Common Practice Culture Integrity - Service - Excellence

5. Continuous Learning2 Guarantees Success Continuous Increase In Level of Care ProvidedLevel of Care Lvl-III/CSH, Definitive Lvl-II/Forward EMEDS, EMF Care BAS Surgical Teams En Route Wounded Time Critical Care Rotary Transport Learning From Coalition Partners, Single Intensivist We Leveraged Trauma Registry Augmentation Data To Build Innovative Solutions -Two TCCET Teams - 1st Deployed June 2011 Tactical Critical Care Evacuation Team - 77 Critical Patients Moved as of Oct 11 Capability Must Constantly Evolve to Meet Mission Requirements Integrity - Service - Excellence

6. Constant Improvement of Capability Immediate < 20 min ER < 2 hrsT+0 hrs T+3 hrs OR & ICU < 3 hrs EMEDS Health Response Team a Reality! Self-Aid Combat Medics Forward In Theater Care Definitive Care Buddy Care Navy Corpsmen Resuscitative Rehab/Recovery Home w/Family Care AF Theater Hosp SAMMC Expeditionary g r i t y - S e r v i c e - E x c e l l to Save Lives! I n t e Operations2 Evolving e n c e

7. Recapturing Care Together Where It Makes Sense Delivering Patient Centered Care To Our Beneficiaries Creating Currency Opportunities To Support Readiness Allowing Medics To Practice Full Scope Of Care Tackling Per Capita Cost Through Targeted Investments Travis AFB, CA Wright Patterson AFB, OH Langley AFB, VA Nellis AFB, NV Keesler AFB, MS Systems-Based Approach Required To Optimize Our Integrated Delivery System Eglin AFB, FLElmendorf AFB, AK Building Joint Capability...Expanding Services2Improving Currency Integrity - Service - Excellence 7

8. AFMS Strategies Medical Home Family Health Clinics Implemented 61 DATE MAJCOM MTF Purpose Enrolled FH Population 622,224 Seymour 01 Oct ACC PCMH Sr Consultant visit Johnson Pediatric Clinics Implemented 11 3-5 Oct PACAF Eielson PCMH visit #2 Enrolled Population 26,531 4-6 Oct AMC Dover PCMH Sr Consultant visit 10-12 Oct AETC Vance PCMH visit #1 Total Population Enrolled 648,755 Altus 12-13 Oct AETC PCMH Sr Consultant visit 57% of AFMS Enrollment 13-15 Oct AFMC Tinker PCMH Sr Consultant visit 83% FH Enrollment 18-20 Oct AFGSC Whiteman PCMH Sr Consultant visit 11% Pediatric Enrollment 24-26 Oct USAFA USAFA PCMH visit #2 26-Oct ACC -ellis PCMH Sr Consultant Visit 1- 5 -ov PACAF Anderson PCMH visit #2 1 -5 -ov PACAF Kadena PCMH visit #2 1-5 -ov PACAF Osan PCMH visit #2 2 -ov AFSPC Peterson PCMH Sr Consultant visit 2 -ov ACC Dyess PCMH visit #111/10/2011 Integrity - Service - Excellence Data effective 1 Oct 11 from DSS enrollment numbers Sep 2011 8

9. Create The Setting For Right Behaviors Percent of Patients Satisfied* Continuity of Care Other Provider $ Family Health Providers at PCMH Sites MTF Primary Care Visit Distribution* 100% Family Health / PCMH Patients 100% 21471 95% 90% PCMH Team 64954 % Satisfied 80% 42400 90% UP is 70% Good 60% 85% PCMH PCM 50% PCMH TEAM 40% 80% 30% 123681 121580 Continuity 20% Other Provider 75% 10% (Family Health Jan-11 Mar-11 May-11 Jan-11 Mar-11 May-11 0% Clinic) Non-PCMH Sites (41/322163) PCMH Sites (34/351952) PCM PCMH Aggregate Non-PCMH Aggregate (Non-PCMH Dec 2010 - May 2011 Sites) Satisfaction: Goal > 95% Continuity: Goal > 90% $ $ Monthly Emergency Department and Urgent Care Utilization* HEDIS Measures - Patients Enrolled to PCMH Clinics Per 100 PCMH Patients 10 40Average Monthly Visit Rate (per 100) 8 30 6 Score 20 4 DOWN 10 UP is 2 is Good $ Good 0 0 Dec-10 Feb-11 Apr-11 Dec-10 Feb-11 Apr-11 Dec-10 Feb-11 Apr-11 Dec-10 Feb-11 Apr-11 PCMH Aggregate Non PCMH Aggregate PCMH Aggregate Non-PCMH Aggregate ED/Urgent Care Rate: Goal < 3/100 HEDIS Aggregate: Goal > 40 Inspiring Trust & Confidence by Measuring and Rewarding Outcomes Integrity - Service - Excellence 9

10. Leveraging Medical InformaticsDATA INFORMATION KNOWLEDGE WISDOM CHANGE Better CareTMDS Clinical Through Practice Evidence Based GuidelinesDEERS Practice CarePoint Medication Better HealthPDTS Alerts Enhanced Patient Registries Safety$ / M2 User Home Best Value Interfaces Sensors Healthy BehaviorDMHRSi Expedited Better CareEHR Test Results Improved Patient Experience Decision Support Is No Longer Just For Our Providers Integrity - Service - Excellence

11. Transforming Data Into Knowledge Ready Better Health Better Care Patients receiving Diabetic patient massive infusions of > educated on 10 pints experienced remote mortality of 33% monitoring glucometer Clinical Study Readings Practice registry MTF calls automaticallyGuideline to identify patient to sent todeveloped trends discuss healthcare management team Conclude infusing whole blood Uncontrolled sugar reduced mortality levels Identified to less than 20%Using Informatics to Accelerate Change in Practice Patterns & Behavior Integrity - Service - Excellence 11

12. Activating Patients & Care Teams Health Team PatientDecision Patient DecisionSupport Support CenteredPCMH Is The LynchpineTorBetter Decision Support ForlPatients & Health Teams Int g ity - Service - Excel ence

13. Electronic Health Initiatives Project (eHIP)Integrity - Service - Excellence 13

14. Consumer Driven Health Begins With Information & Transparency Cost Access to Info Safety Alternatives For A Quality Sustainable Future?On-line Resources Hospital Find It Fast! Compare Risk Pay For Health HHS.gov Diseases & Conditions & Readiness AZ - Health Savings AccountBenefits - Selective Co-pays Concierge Care Self-Care Apps (PMPM) - Wounded Warriors - Chronic Conditions Motivating patients to be proactive2 We Must Drive Informed Decisions Integrity - Service - Excellence 14

15. Investing In Education, Training, & Research Opened June 1stJoint Capability is Greater Than Any Single Service Capability Integrity - Service - Excellence 15

16. Enduring Academic Partnerships Physician/Dentist Education (GME/DME) Stand alone programs Masters with civilian universities Integrated/affiliated with Federal partners 84 Advanced Education General Dentistry-1 slots/yr Dental Specialty certificate/Masters program opportunities Nurse Education (Transition Program) Increasing to 241 enrolled students in FY10 New sites include: Cincinnati, OH & Scottsdale Healthcare, AZ Nurse Enlisted Commissioning Program (NECP) 50 per year with school of their choice Research USAF Dental Hygiene Program Diabetes 10 scholarships per year Telepathology Trident Technical College (SC) Teleradiology St. Petersburg College (FL)Education & Research Absolutely Critical to Building & Sustaining Medical Services Integrity - Service - Excellence

17. AHLTA on the2 Information Highway Peak of Inflated Opportunity! Expectations Plateau of Swamp of Productivity Diminishing Vehicle of Returns Opportunity! Innovation Trigger Slope of Enlightenment Cliff of Obsolescence Trough of Disillusionment Time* Gartner Inc., chart from Mastering the HYPE CYCLE by Jackie Fenn and Mark Raskino Integrity - Service - Excellence

18. Sec Def/Sec VA DecisionCombined Efforts Provide the Best Future EHR Integrity - Service - Excellence

19. DoD-VA To-Be iEHR Architecture Common DoD-VA Requirements: HL7 EHR-S Functional Model with DoD and VA vetted Extensions (SV-4) Common DoD-VA Integrated Health Business Reference Model (OV-5) Common DoD-VA To Be Process Flow Model (OV-6C) Presentation Presentation (Common GUI) Layer Team Applications and Services DoD Unique (16) Common (Joint) Applications & Services (30) VA Unique (6) Systems Battlefield Pediatrics Pharmacy Personal Laboratory Blood Mgmt Nursing Long TermMission Capabilities Care Health Record Home CareRequirements Disability Inpatient Emergency Document Team Military Obstetrics Evaluation Orders Mgmt Dept Care Mgmt Rehabilitative Transient& Performance Readiness Care Outreach Consult & OperatingOutcomes Enroute Veterinary Dental Care Referral Mgmt Immunization Room Mgmt Pharmacy Occupational Care Mail Order Health (VA)Team Common Interface StandardsBusiness Enterprise Common Services BrokerProcess Architecture (includes Enterprise Service Bus (ESB) and Infrastructure Services)Team Team Common Interface Standards Common Data Centers Data Inter- Common Information Interoperability Framework (CIIF) operability Common Information Model, Common Terminology Model, Team Information Exchange Specifications, Translation Service Common Data Standards: SNOMED CT and Extensions, LOINC and RxNorm Common DoD-VA Measures of Effectiveness, Measures of Performance and key Performance Parameters Joint DoD/VA DoD Only VA Only Integrity - Service - Excellence 19

20. Leading the Way with Open Source HOSPITAL PHARMACY VISIT Electronic Electronic PROVIDERRADIOLOGY Health Record Health Record OFFICE VISIT PUBLIC LAB SYSTEM HEALTH SERVICE Open-Source Provides Integration Without Barriers Integrity - Service - Excellence 20

21. Federal Agencies Leading the Way with Open Source Auto-Generated Documentation Doxygen Code Repository Git Cross-Platform Build Tools CMake Bug/Feature Tracker Mantis Documents/Resources Wiki Mailing Lists Code Reviewer Gerrit Software Quality Dashboard CDash Technical Journal Insight Journal Source: Rick AviloIntegrity - Service - Excellence 21

22. PPC Roadmap Complete Strategy IMS Document Base-lined Complete Idea Factory Headquarters U.S. Air Force Change Readiness Concept INTEGRATED Training Planning Office Stakeholder Charter Complete Analysis Strategic Leadership ROADMAP Comms Engagement Integrated Plan Resource Integrity - Service - Excellence Roadmap Complete EHR Tri-Fold Library Complete Risk/Issues Press Clips & Base-lined Newsletters Website Program Mgmt Content Mission/Vision Plan Statements Tech. Gov. Lifecycle Policies & Acronym Biographies Procedures List Complete CMM Interactive EHRWA Deliverables Presentations Style Guide Document Templates Acquisition Strategy Acquisition IA Strategy Systems Engineering Plan Industry Days Held Final PESHE TEMP IA Strategy Capability Develop. Document The image part with relationship ID rId2 was not found in the file. Information AoA Phase II Support Plan CARD Data Mgmt Strategy RFI-I / RFI-II Released Engineering Action Plan From, EHR Way Ahead, Aug 2011 Paula Friedman, Director, EHRWA, DoD MHS ADM Complete LEGEND: SCHEDULED IN PROGRESS COMPLETE

23. Integrating New Technology Current CCATT mission Future CCATT mission - Wireless From Force Health Protection To Logistics To Portable Surgical Tools AutomatedDirected Information Hand-held,Energy & Data Battery-powered,Sensors Collection Laser Cautery & Video (AIDC) Ablation Tool Assisted IntubationImproving Our Environment Of Care To Deliver Better Outcomes Integrity - Service - Excellence 23

24. Shaping the Future of Military Healthcare AMEDD Futures 2039 AFMS Futures 2045 Planning Factors Planning Factors Joint Organization Patient-Centered Care MILHEALTH Military-Civilian Synergy Synergy-Joint & Coalition (Education & Currency) Cultural Adaptability Organizational Agility Personnel Interoperability Global Engagement Precision Healthcare Surveillance/Public Health Technology Integration Technology IntegrationWorking Together, Achieving Success Through Common Vision Integrity - Service - Excellence

25. The Focus is on Us Walter Reed National San Antonio Military Medical Center Military Medical Center (WRNMMC) Walter Reed National San AntonioMilitary Medical Center Military Medical Center (WRNMMC) Joint Healthcare San Antonio Military Health System SAMHS San Antonio Military Health System Ft Belvoir Community SAMHS Hospital (FBCH)Ft Belvoir Community Hospital (FBCH) AF Theater Hospital, Craig Joint Theater Wilford Hall TheaterAndrews Ambulatory JointJoint BaseHospital, AF Theater Base- Balad- Balad Andrews Ambulatory Craig Joint Hospital Center Hospital - - Bagram Ambulatory SurgeryBagram Wilford Hall Ambulatory Surgery Center Care Ctr Care Center Improving eSynergy Through E xCommon Vision Int grity - Service - a cellence

26. TRUSTED CARE ANYWHERE26