Case Study: A Roadmap to Success, IBA's Approach to the Successful Management of the Military's Clinical Reporting Tool

Client's Challenge
Clinical users, particularly doctors and nurses, were eager to access data coming out of AHLTA. AHLTA captures EHR data elements such as vital signs, laboratory and radiology orders and results, and patient demographic information. These users needed a software tool that would obtain these data elements, package them into pre-defined reports, and also provide the ability for users to create ad hoc queries. Doctors, nurses, and other clinicians could then use this application to improve health care delivery, disease prevention, and disease management. Additionally, MHS leadership recognized that having a clinical reporting tool would greatly facilitate the adoption of AHLTA, since it would give the people entering EHR data into AHLTA the ability to use the data for actionable clinical decision-making.

Given the complexities of building a tool to receive large volumes of data, the work required to establish consensus on pre-defined reports, and the engineering necessary to generate fast ad hoc queries, this project presented a stiff challenge to the MHS. The principle question became how could the MHS develop such an application?

IBA's Solution
Defense Health Services Systems (DHSS) turned to IBA to help oversee the end-to-end delivery of the CDM project. IBA utilized its project management methodology, known as the IBA Quality Management System (IBA QMS) to manage the planning, design, development, and deployment of this application. The IBA QMS is a project management roadmap that outlines the process flows, provides process guidelines, and includes a methodology toolkit (tools, templates, checklists, and sample artifacts). Our approach identified and addressed project risks, included formal project gateways, and contained a plan for communicating with the CDM’s diverse stakeholder community. This plan enabled DHSS to deploy CDM in 2008, and release significant enhancements since the product’s inception.

IBA coordinated closely with the clinical user community to identify and to develop actionable pre-defined reports. For instance, using 18 months of AHLTA laboratory result, disease classification, and patient demographic data, CDM identified more than 56,000 patients worldwide at risk for chronic kidney disease. The real power of this report revealed that nearly 80% of those patients had not yet been diagnosed officially with chronic kidney disease. This finding enabled AHLTA providers to identify those patients and avoid placing these individuals on medication that could expose them to the high-risk of renal failure and other serious complications.

The ability to handle large ad hoc queries and thousands of users posed another, more technical challenge. IBA helped DHSS select a robust, scalable, architecture platform to solve these issues. Our team conducted an Analysis of Alternatives and recommended acquiring Commercial-Of-The-Shelf (COTS) tools from industry capable of performing the job. The combination of a web-based business intelligence front-end and a dependable back-end cut ad hoc query times from over 4 hours on a prototype system to less than 60 seconds.

Conclusion
CDM is now used throughout the MHS to equip clinicians with patient-centric EHR reports from AHLTA. These reports literally help the MHS save and improve the lives and health of the MHS’s 9.2 million beneficiaries. CDM was released to a limited number of users in 2007 who used the application to identify 8,000 patients who were potentially affected and 348 patients who were directly affected, by a national voluntary vaccine recall at the Navy Medical Center in Portsmouth, Virginia. The entire process, from identification, to drafting a letter to notify these patients, took less than three hours. A previous national vaccine recall at Portsmouth took more than six weeks and 3,840 man hours to implement, because staff workers had to manually comb through individual medical records to find needles in the haystack.

In October 2008, CDM was recognized by Government Computer News for Outstanding Information Technology Achievement in Government. DHSS was lauded for building an application that mines the AHLTA EHR to safeguard patients from adverse medical reactions and for identifying clinical quality indicators to improve direct patient care.

IBA takes great pride in helping the military deliver a system that is vital to the protection of our armed forces and their family members. The ability to report essential clinical information on immunizations, cancer screenings, diabetes, asthma, hypertension, obesity, high cholesterol, smoking cessation, and weight management is crucial to effective patient care and illness prevention.