Air Force Medical Service

CAPITALIZING ON INFORMATION MANAGEMENT FOR DECISION SUPPORT.

The Air Force Medical Service (AFMS) is responsible for all wartime and peacetime health care operations for over 2.6 million Air Force beneficiaries (active duty, retirees and families). Operating with a budget of $6.9 billion, the AFMS is comprised of more than 40,000 health care professionals serving at 76 military clinics, hospitals, medical centers and battlefront facilities worldwide. Despite their use of multiple information systems, the AFMS was unable to convert the terabytes of data into meaningful, actionable information. Like many large organizations, the AFMS was data rich, but information poor.

FOCUS ON PROCESS IMPROVEMENT

In response, the Office of the Air Force Surgeon General, Modernization Directorate (AF/SGR) established the Data Modeling and Analysis Office (DMA) to build and maintain centralized, Web-based informatics tools to improve efficiencies and cultivate best practices. Early efforts focused on key indicators identified as priorities by the Air Force surgeon general, such as access to care, customer satisfaction and population health metrics. Experts in these areas then used centrally available datasets to define and monitor the measures.

Establishing common definitions was an essential step to focus all eyes on the same processes and measures. Initially, metrics were quite basic, plotting month-to-month trends as commanders worked to meet the goals set by headquarters. However, as the process matured, improved statistical analyses resulted in more sophisticated metrics that distinguish between random and special-cause variation, allowing managers to cut through “data noise,” identify variance and understand the true performance results.

CENTRALIZED REPORTING

DMA partnered with IMS Government Solutions Inc. to build a balanced scorecard website to provide monthly progress reports on each metric with breakout views for each major command and individual medical treatment facility (MTF). In addition, over 50 different “push reports” were developed to provide more in-depth analysis of a variety of measures for specific audiences. Users could subscribe online to have updated reports automatically e-mailed to them each month. Together, the push reports and balanced scorecard provided unprecedented visibility to processes across the entire enterprise, as well as several unanticipated benefits to the organization:

• Improved data quality: The tools give full, high-level visibility to data that was previously scattered and buried within different systems. Bringing this information to the forefront of the organization highlighted chronic data quality problems that had previously gone undetected or ignored. This new emphasis on informatics motivated managers to improve data quality, and as users developed a better understanding and appreciation for how data is used, inputs continued to improve.

• Internal competition: Full information transparency fostered friendly competition to improve performance, both within the organization and among different facilities. For instance, physicians now have visibility to the productivity metrics of all other physicians, allowing them to see how they stack up against their peers.

• More nimble organization: Providing “gold standard” tools allows leadership to focus many disparate, widespread facilities on key tactical and strategic goals. Therefore, new headquarters’ priorities are more easily understood and are quickly implemented by the field.

CENTRALIZED INFORMATICS TOOLS

As analysis improved and more and more processes were being centrally evaluated, MTF leadership was under increasing pressure to show improvement in the various metrics. Process improvement at the local level required not only understanding of the metric, but also insight into the data and the processes from which the data are derived. In turn, demand for local data analysis skyrocketed—it’s one thing to understand a metric, it is another to understand the “why” behind the score, good or bad. Resources were sometimes wasted in an attempt to “debunk” metrics that indicated poor performances rather than to identify and fix the underlying problems. The AFMS lacked standardized methods to investigate and diagnose poor performance,  and as a result, many hours were spent at different MTFs searching for what often turned out to be common solutions.

In response, DMA gathered best practices from the field to build several Web-based tools to analyze and diagnose performance issues. These decision-support tools provide full transparency to health care and business data, allowing users to look both horizontally, across facilities and product lines, and vertically, drilling down from headquarters’ composite views to physician and patientlevel data. These tools include:

SG-Executive Global Look-Virtual Analyst—Provides easy access to the underlying data for each balanced scorecard metric, as well as tips on how to improve, algorithm definitions, and querying capability for more focused analysis and process improvement.

Access Improvement Module (AIM)— Provides reports on provider schedules and patient demand, updated daily, for managers to maximize access to health care. It compares forecasted patient demand to schedules for over 10,000 clinicians to identify appointment shortages and surpluses at the clinic and physician level. The newest feature allows users to test “what if” scenarios 26- weeks into the future to bring supply and demand into equilibrium while predicting the impacts of staffing shortages, throughput rates, training, administrative time and wartime deployments.

Business Plan Reporting Analysis Decision And Reconciliation (BP RADAR)— Monitors productivity across the health care system and provides diagnostic tools to help front-line managers determine where, how, and why facilities compare to their annual productivity targets, industry benchmarks, and AFMS peers. The forecasting module sets production targets according to historical seasonal demand and looks forward 35 days in physician schedules to predict whether enough appointments exist to meet production goals. Managers can then act proactively to mitigate production issues.

Complex Patient Management Tool (CPMT—Applies user-defined criteria, such as number of patient visits, number of prescriptions, and diagnosis codes to a group of health care beneficiaries, to identify specific patients who may benefit from focused case and disease management services.

Service Delivery Assessment (SDA)— Provides each MTF with patient feedback from a centralized telephone survey program. Survey questions can be customized by each facility, and the results are provided in a weekly push report to MTF leadership.

ORGANIZATIONAL IMPACT

The AFMS information management tools effect positive change by providing timely, detailed and actionable information on a broad variety of tactical and strategic goals. The tools provide full transparency, both vertically (from the clinician level up to a headquarters view) and horizontally (across specialties, product lines and clinics), which allows managers to identify, investigate and eliminate unwanted variation in organizational processes and identify best practices throughout the AFMS. The informatics tools all but eliminated outmoded information stovepipes that provided limited access to pockets of information without “connecting the dots” of how the data interrelates. Information management efforts have had an especially profound impact in the following areas:

• Clinical Operations: Robust information management has helped health care managers and clinicians improve workflow, staffing, patient tracking, management, and overall population health.

• Customer Service: A patient-centric approach to information management has led to improved access, timeliness, increased provider time, appropriate level of care, as well as rapid implementation of customers’ suggestions.

• Quality Improvement: Information management greatly improved visibility to data that was previously scattered and buried within different systems. Bringing this information to the forefront of the organization highlighted chronic data quality problems that had previously gone undetected or ignored. A new emphasis on quality has improved data accuracy, completeness, and timeliness across the board, facilitating better decisions in both the business and clinical arenas.

Information management has been instrumental in driving substantial improvements in communication, efficiency, and effectiveness among health care professionals throughout the AFMS. DMA was recognized as winner of the 2007 Microsoft Healthcare Users Group Innovation Award for Outcomes Reporting for its Web-based informatics tools that enable AFMS medics to provide the highest quality care to our patients at home and abroad. ♦

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