# Presentation: 692335

## VHA OI and VA OI&T

**Clinical Applications Coordinators****Organization Consistency Working Group (CAC-OCWG)****Report**
**22 August 2007**

**Linda Fischetti RN, MS**
**Acting Chief**
**Health Informatics Officer **
**VHA OI**

**Ray H. Sullivan**
**Executive Director**
**OI&T Field Operations**
**VA OI&T**

##         Outline

**CAC* Working Group Background**
**OCWG Members**
**Summary Results**
**Study Timeline and Actions**
**Data Call Results**
**Recommendations**
**Phase II Issues**
**Summary/Next Steps**

*** ****CAC: Clinical Application Coordinator **

##    VA CAC - OCWG Background from Charter

**Issue:  Organizational Consistency**
**VA IT Development Realignment Working Group (DRWG) recognized VISN’s have CACs aligned with OI&T; others with VHA**
**Recommended CAC organizational consistency work group**
**Approach:  Establish new work group to provide evaluation of CAC functions**** **
**Conduct analysis of functions performed by both organizations (VHA & OI&T)**
**Determine appropriate CAC position classification and organizational assignment**
**Establish CAC “Level of Access” for VistA Systems**** **
**Scope: All CAC personnel – VHA and OI&T**
**VA-wide population included in CAC Roster is over 400**
**A data call is necessary to quantify, evaluate & classify these personnel **

##          OCWG Members

_**Co-Chairs OCWG**_
**Linda Fischetti RN, MS****	****	**
**	****Acting Chief Health Informatics Officer, VHA OI**
**	**
**Ray H. Sullivan**
**	****Executive Director, OI &T Field Operations, VA **
**	**
_**Work Group Members**_
**Gail Graham, Chief, HIIR**
**	****VHA OI**
**	**
******* Barbara C. Andrzejewski, BS**
**	****Tuscaloosa, AL**
** **
******* Nancy Clum, RN, MN****	****	**
**	****VAPAHCS,Palo Alto, CA**
**	****	****	**
******* Sally Kellum RN-BC, MSN****	****	**
**	****Durham, NC VAMC**
**	**
******* Patty Hoey, RPh.**
**	****Puget Sound, WA VAMC**
**W. Paul Nichol, MD****	****	****	**
**	****Office of Patient Care Services (11)**
******* CAC Members**

**Becky Kellen, RN, BSN, MS****	****	**
**	****Office of Nursing Services (108)**
**Patricia Mauseth, RN, BSN ****OI&T Field Operations **** **
**Clayton Curtis, MD, PhD**
**	****VHA OI**
*** ****David J. Howard, M.N.Sc.**
**	****Little Rock, AR VAMC**
**Tana Defa**
**	****Salt Lake City OIFO**
_**Advisors**_
**Bob Riera**
**	****Special Assistant, VHA OI**
**Terry Morrow**
**	****Program Analysis Officer, VHA 10A2**
**Demetrius Lowery**
**	****HR Supervisor, OI&T 005B2**
**Randy Ledsome**
**	****OI&T Field Security Operations**

##        Summary Results

**Defined the functions and position classification of VA CAC personnel**
**Developed criteria to determine individual CAC functional responsibilities and classification for both VHA and OI&T functions**
**Determined appropriate organizational alignment (VHA or OI&T) based on the developed criteria**
**22****3**** CAC positions reviewed to date for alignment through voluntary data call**
**Recommended initial CAC re-alignment (58 of 223 total)**
**Review of over 200 additional CAC employees to be completed in Phase II**
**Process confirms that VHA & OI&T CACs in 2210 series are most affected**
**Identified and validated Menu Access requirements for specific CAC functions**

##        OCWG Study Timeline

**             **_**OCWG **_
** ****Develop CAC & Non-CAC Functions**
** ****Develop SharePoint Data Call/Beta Test Plan**
**          ****1 - 30 April**

**              **_**OCWG**_
** ****Develop VistA System “Levels of Access”**
**Options for CACs**
**       ****15 May – 15 June**

**              **_**OCWG**_
** ****Compile Final CAC Functions & “Levels of Access” for Report**
**          ****20 - 26 June**

**             **_**OCWG**_
**  ****Finalize and Present  CAC-OCWG Report to VA Leadership**
**              ****July**

**                **_** **__**OCWG**_
** ****Review Study Findings**
** ****Prepare Team Report**
** ****Evaluate follow-on needs**
**             ****25 - 29 June**

_**OCWG**_
** ****Configure & Post “Levels of Access” on SharePoint for Review by CACs**
**11 – 19 June**

**       **_**OCWG/CAC**_
**       **_**Membership**_
** ****Collaboration on Functional Listing for  Validation prior to Data Call**
**         ****1 - 16 May**

_**CAC Membership**_
**SharePoint Data Call**
** ****Provided CAC & Non-CAC Functions**
** ****223 Responses  **
** ****96% Performed CAC Functions**
**   ****18 May – 12 June**

_**CAC Membership**_
** ****Validate “Levels of Access” Menus**
** ****Use SharePoint**
** ****117**** ****Responses**
**     ****19 – 26 June**

** ****Commence CAC OCWG**
** **
_**Charter Approved**_
**29 March **

_**Follow-on Work**_
** ****Final Core Menu**
** ****Position Titles**
** ****Similar ADPAC Study**
** ****HR Issues-Spec Rates**
** ****Continue Validation**

##       CAC / Non-CAC Functions Performed

_**Note:  Non-CAC Functions Include the Following (See Att. A)**_
**Create new user accounts**
**Creates VistA menus**
**Load Vista, server or workstation patches**
**Enhance order dialogs using Fileman Entry/Exit action**
**Troubleshoot using approved remote control tools (e.g., Dameware)**
**Build computed findings or TIU objects (not health summary objects)**
**Review package level settings**
**Manage users through active directory**
**Edit device file**
**Provide 24/7 support to software and / or hardware **
**Troubleshoot using advanced system access (Fileman codes @ or #, menus XUPROG, XUPROGMODE, XUMGR, EVE or security keys XUPROG, XUPROGMODE, and XUMGR)**

_**Primary Functions Performed by CACs**_
_**          **_

|  Customer Support / Trouble Shooting | 15.7% |
| --- | --- |
|  Clinical Tool Development | 14.3% |
|  Education / Training / Mentoring | 11.4% |
|  Prog Implementation / Project Mgmt | 10.6% |
|  Consulting | 9.7% |
|  Non – CAC Functions (See Note) | 8.1% |
|  Data Analysis | 6.4% |
|  Leadership | 6.0% |
|  Package, Testing & Support | 5.2% |
|  Account / Access Management | 5.2% |
|  Other | 4.0% |
|  Emergency Preparedness Planning | 2.0% |
|  Research | 1.6% |
|                                          Total | 100.2 |
|  |  |

## CAC Member Responses to VistA Menu Needs

**40%**

**Remote Procedure**

**CRP**

**41%**

**Lexicon Mgmt**

**LX**

**49%**

**Adverse Reaction**

**AD**

**62%**

**ADPAC**

**AP**

**71%**

**Vitals Measures**

**VI**

**72%**

**Toolbox**

**CT**

**81%**

**Problem List**

**PL**

**82%**

**Alert Mgmt**

**AT**

**94%**

**Health Summary**

**HS**

**95%**

**Team List**

**TL**

**95%**

**Reminder Mgrs**

**RE**

**95%**

**TIU Menus**

**TIU**

**95%**

**CPRS Mgr**

**OR**

**99%**

**Consult Mgmt**

**CO**

***Rank %***

***VistA Menu Category***

## Recommendations

**165 CAC employees in VHA (160) & OI&T (5) in other than GS-2210 series positions were determined to be performing predominantly (> 50 percent) CAC activities: No action required for the 160 in VHA; OCWG recommends alignment with VHA for the 5 in OI&T after HR review**
**46 GS-2210 CAC employees in VHA (6) & OI&T (40) were determined to be performing predominantly (> 50 percent) CAC activities: OCWG recommends reclassification & re-alignment to VHA for the 40 in OI&T; For the 6 in VHA, OCWG recommends reclassification & retention in VHA**
**Reclassification or re-alignment actions should occur after HR review **
**12 GS-2210 CACs assigned to VHA (4) and OI&T (8) were determined to be performing predominantly (> 50 percent) Non-CAC activities: OCWG recommends the 8 in OI&T remain but not as CAC; 4 VHA employees should be reviewed by HR to determine classification & alignment decisions**** **
**Implement individual - recommended VistA System “Level of Access” as determined by VistA Access Review Team**
**Determination of standing VistA Access Review Team in process**

**OCWG recommends CAC alignment within VHA Medical Centers should**
**be self-determinant depending on individual Center practices/processes**

**During Phase II, OCWG will review balance of CACs (over 200 who did not respond to the Phase I Data Call) to determine final alignment recommendations  **

##       OCWG Phase II Issues

**Address remaining CACs (over 200) who did not respond to Data Call**
**Formalize VHA Clinical Informatics Specialist position series and titles**
**Continue refinement of “Core Menu” listing **
**Identify/pursue other opportunities for collaboration/synergy between VHA and OI&T**
**Determination of “Standing” Informatics Management team to oversee overall performance, approve menu access, resolve issues, etc.**
**Development of Team charter, composition, frequency of meetings, authority, etc.**
**Conduct similar studies for ADPACs and Informatics Managers**
**Identify/address “unique” issues such as:**
**Small facilities with only person performing both IT specialist and CAC functions**
**“****Special project” clinicians requiring programming access**

**For CAC’s proposed to return to VHA and those in OI&T no longer performing CAC functions, the OCWG Work Group proposes the formation of an HR sub-group to develop recommendations addressing critical HR issues such as save pay, special rates, implications for T38, H-T38 & GS positions, etc.**

##        Summary / Next Steps

**Summary:**
**Preserved cohesive teams across VHA and OI&T that support the clinical use of VHA’s clinical IT systems**
**Achieved organizational consistency for CAC alignment and access by recommended realignments based on organizational functions**
**Determined the Vista system “levels of access” that are required for CAC performance of functions**
**Next Steps:**
**Decision memorandum submitted for OI&T concurrence & USH approval**
**Begin Phase II OCWG activities**
**Establish HR sub-group to work HR issues affecting employee transfers**

##          Final Comments

**We expect that in 6 – 12 months VA & VHA will have:**
**Supported VHA’s most important asset–its employees **
**Preserved cohesive teams across VHA and OI&T that support the clinical use of VHA’s clinical IT systems **
**Achieved organizational consistency for CAC alignment & access **
**We expect that in 1 – 2 years VA & VHA will have:**
**Identified CAC tasks that require programmer / system administrator access and worked with OI&T to develop mutually acceptable approaches that are appropriate to the CAC role **
**Established a professional career track for informaticists that addresses their HR, education, and professional needs **
**The term informaticist is inclusive of T38, Hybrid T38 and GS employees that are performing the functions of the Informatics career track**

## Questions?

## Back-up

##              Tasks from Charter

**Clearly define the functions and position classification of CAC personnel for Work Group discussions**
**Develop appropriate criteria to determine individual CAC functional responsibilities and classification for both VHA and OI&T functions**
**Based on a thorough review of current CAC personnel functional responsibilities, determine each individual’s appropriate organizational alignment, i.e., VHA or VA OI&T**
**Determine if assignment of CACs to either organization (VA or VHA) requires a new title for one or the other**
**Consult with human resource experts during the analysis of the functional responsibilities and position classification requirements for CAC personnel**
**Determine the VistA system “levels of access” that are required for CAC performance of functions.  If needed request changes to menu structure to support operations within the appropriate scope of the organizational placement.  Recommend transition pathway to achieving this goal**
**Prepare reports of findings and make recommendations to VHA and OI&T leadership not later than June 2007**

## Data Call Metrics / CAC Members who RespondedPhase I

**	****            **_**Data-Call Categories**_**	****                      **_**CAC Responses (223)**_**      **_**Projected - All CACs (400+)**_
**CACs in VHA (10 GS-2210s & 160 Other)             170  (76%)****	****                  ****	****        320**
**CACs in OI&T (48 GS-2210s & 5 GS-300)                58 (24%)****	****	****        150**
**Likely to Remain In or Transfer to VHA ****	****    ****              50 ****	****       ****	****        100**
**Likely to Stay in or Move to OI&T but****               ****	****8****	****      ****	****          30****	****	**
**	****Not as a CAC**

## CAC Data Call Summary / Metrics – Phase I Results

**CAC members responded to data call of “functions” performed**
**Participation was voluntary and 50% of CAC population responded**
**Metrics resulting from data call:**
**CAC Population (Approx)            400****	**
**Total responses                         ****	****	**** 223 (~ 50% of CACs)**
**Total VHA ****	****	****	****	**** 170 (76%)**
**Total OI&T ****	****	****               ****	****   53 (24%)**
**Percent of CAC Functions Performed**
**Responses w/predominant             ****	****	****	****	****  (> 50%) CAC functions               ****	**** ****	**** 215 (96% of respondents)**
**Responses w/predominant (**_**>**_**50%)****	****	****	****	****                Non-CAC functions (All GS-2210’s)    ****	****     8 (04% of respondents)**