New IT Service Requests and New Commercial Technology Requests:  A How-To Guide for VHA researchersMay 16, 2006

David M. Douglas MD

Geriatric Psychiatrist

Associate Director for Information

Member IDMC Screening Committee

Portland VAMC

Mike Davey MD PhD

ACOS Research & Innovation

AGENDA

What is the role of the Informatics and Data Management Committee (IDMC)?

What are New IT Service Requests (NSR) and New Commercial Technology (NCT) requests?

What does a researcher need to do to place a request?

How can Research help OI?

Defining the Request:NSR vs. NCT

New IT Service Request New IT Service Requests are requests for products, product enhancements and changes to information systems maintained by OI. 

New Commercial Technologies Commercial Technologies can be described as developmental software and/or information devices and systems written by VA employees, by vendors, contractors, or development partners. The evaluation process applies to 1) Devices displaying VistA data in a different format, and/or 2) Any device, external system, or vendor or locally developed software writing to VistA other than Diagnostic, Imaging, or Clinical Procedures equipment using nationally supported HL7 or DICOM protocols.

IDMC Screening Committee evaluates both requests. 

IDMC SC Charter

SC established to work cooperatively with OI

Perform analyses on all IT requests to ensure alignment with VHA priorities

Provide guidance on prioritization of IT initiatives

IDMC Screening Committee

Informatics & Data Management Committee (IDMC) is the advisory group to the USH through the NLB on IT resources, policies, and issues. 

The following committees report to IDMC

IDMC Screening Committee (IDMC SC or SC)

OI Health Information Systems Executive Boards 

VHA Data Consortium 

VHA Key Organizations & Relationships - Current

I & T (CIO)

Cyber & 

Info Sec

Info Tech

Operations

Policy, Portfolio 

Oversight & Exec

Auto-mation Center

IT Enterprise

Architecture

Dep CIO VHA

VA

VHA

Dir ServNet (E, C, W)

21 VISN

OI

CHIO

HISEB

NLB

ESMs

IDMC

EIB

DUSH O&M

Strat Plan C

Health System C

Finance C

Comm C

HRC

Screening Subcommittee

DUS Ops & Mgmt

Major Organizations

IT 

Business

Permanent Organizations

Boards, Committees, Working Groups

Coordination

Direction

Facilities

P/D

HPMO

HSD&D

Health Data & Informatics

VHA Chief Architect

Data Consortium

Data Standard-ization Oversight Board

VHIM Stake-holder Council

Patient Care Services Data Workgroup

Collaborative Health Information Partners (CHIP)

Domain Prioritization Workgroup

Domain Action Teams

Data Management Board

Data Archi-tecture Working Group

VISN CIO Council

Architecture Planning Workgroup

VSSC Oversight Board

IDMC SC Membership

Renee Oshinski (Chair)	Deputy Network Director, VISN 12

William H. Beer, MD	CIO, San Antonio VAMC

Cynthia Breyfogle	Chief Business Officer, VISN 23 

Kathryn Corrigan, MD	Interim ACOS Amb Care Tampa VAMC

David Douglas, MD	Assoc Dir Information Portland VAMC 

Brian Heckert		Director, VAMC Columbia

Peter Henry		Director, Black Hills VAMC 

James Laub		Chief Information Officer (CIO), VISN 18

Michael Simberkoff, MD	COS, NY Harbor Health VAMC 

Initial Assessment & Briefings (IABs) prepared by

Office of Information’s 

Health Systems Design & Development - Planning & Analysis

With input from Office of Information’s

Enterprise Systems Management HISEBs (Executive Boards)

NLB’s Informatics & Data Management Committee

HISEB

Health Data Systems

HISEB

Health Provider Systems

HISEB

Management & Financial Systems

HISEB

Infrastructure

HISEB

Common Services

IDMC 

Screening Committee

HISEB

Veterans Programs

Executive Board input to IDMC SC

Health Provider Systems (HPS)

Supports health care providers in the care of veterans.  Key HPS systems include BCMA, CPRS, Lab, Nursing, Pharmacy, and VistA Imaging.

Primary Stakeholders:  Clinical Providers

Health Data Systems (HDS)

The storage and use of data and related efforts for interoperability and standardization of information.   Key HDS systems include data standardization, information sharing, clinical data repositories, warehouses, and data marts.

Primary Stakeholders:  Groups who use clinical data, external users.  (Patient care, research, epidemiology, biostatistics, patient safety, decision support, quality/ performance improvement, clinical and administrative management)

Management, Enrollment & Financial Systems (MEFS)

Management, financial, and business aspects of VHA.   Includes financial systems, logistics systems, pay, enrollment and eligibility, scheduling and billing.

Primary Stakeholders:  Chief Business Officer, Chief Logistics Officer, Chief Financial Officer

Executive Board input to IDMC SC

Veteran Programs (Under discussion, may leave with HPS)

Systems used directly by veterans, their families, veteran advocates, and designated VA and non-VA health providers.  Included are MyHealtheVet (MHV) and Home Telehealth.

Primary Stakeholders:  Veteran Representatives

Systems for External Information Exchange (Under discussion)

An outward looking portfolio for information exchange with users outside VA/VHA, to include CDC, IHS, DOD, RHIO’s.

Primary Stakeholders:  External Users

Infrastructure, Common Services, Foundations (may be renamed)

Common requirements of the primary programs, such as hardware, platforms, and software infrastructure.

Primary Stakeholders:  Internal to OI

New Service Requests (NSR)

NSR process initiated via Planning and Analysis Service (PAS) Webpage

NSRs must be authorized by an approving authority

Submit Request

View Request

Guidance Policy

Authorized Approving Authorities
        - Approved List of Endorsers 
        - Secretary of Veterans Affairs
        - Deputy Secretary for Veterans Affairs
        - Under Secretary for Veterans Benefits

Veterans Benefits Administration CIO

Director, C&P Service

Associate Deputy Under Secretary for Programs & Policy (VBA)
        - Under Secretary for National Cemetery

National Cemetery Administration CIO
        - Director, Office of Financial Management
        - Deputy Assistant Secretary, Acquisition and Materiel Management
        - Assistant Secretary, Human Resources and Administration
        - Assistant Secretary, Information and Technology
        - Assistant Secretary, Public and Intergovernmental Affairs
        - Assistant Secretary, Congressional and Legislative Affairs
        - Assistant Secretary, Policy and Planning
        - Assistant Secretary, Management
        - a. VHA Board of Directors
        - Under Secretary for Health
        - Principal Deputy Under Secretary for Health
        - Chief of Staff (USH)
        - Chief Compliance & Business Integrity Officer
        - Chief Management Support Officer 
        - Deputy USH for Operations & Management
        - Deputy USH for Health Policy Coordination
        - Medical Inspector
        - Chief Quality and Performance Officer
        - Director, Office of Research Oversight
        - Chief Patient Safety Officer
        - Assistant Deputy USH for Policy & Planning
        - Director, Strategic Initiatives Office
        - Chief Communications Officer
        - Director, National Center for Ethics in Health Care
        - Chief Prosthetics and Clinical Logistics Officer
        - Chief Patient Care Services Officer
        - Chief Research and Development Officer
        - Chief Public Health and Environmental Hazards Officer
        - Chief Academic Affiliations Officer
        - Chief Readjustment Counseling Officer
        - Chief Business Officer
        - Chief Financial Officer
        - Chief Facilities Management Officer
        - Chief Information Officer 
        - Chief Health Informatics Officer
        - Chief Employee Education System Officer
        - Director, Veterans Canteen Service
        - Chief Nursing Officer
        - b. All VISN Directors
        - c. All VISN Chief Information Officers
        - d. Office of the Chief Information Officer

Director, Health Enterprise Strategy

Director, Enterprise Systems Management

Enterprise System Managers

Director, Health System Implementation, Training and Enterprise Support

Director, Health Systems Design & Development

Director, Health Data and Informatics

NCT Requests

NCT requests require two key endorsers: VISN Chief Information Officer (CIO) and Medical Facility Chief of Staff (COS)/Director. 

NCT requests require that the product must be entered in the Commercial Products Registry

NCT requests require a Vendor Product Evaluation Packet

What are the steps in the Process?

Once the request is submitted, Planning and Analysis (P&A) team members will begin the analysis process.  

The initial steps include: assigning of a functional and business analyst, contacting the appropriate development team(s), verifying endorsement and contacting the requestor.  

P&A determine whether the request will need to be submitted to the Screening Committee for approval. If so, the functional analyst and business analyst will contact the requestor and subject matter experts to gather information to support the request. The development teams are also asked for impact information.  

Once the necessary information is gathered, the completed packet is submitted up for approval.  

How do New Service or New Technology Requests get screened?

After requests have been submitted to the website, P&A staff create a document which serves as the basis for screening by the committee.  The document comes to the IDMC SC in 2 forms

Intent to Proceed

Initial Assessment and Briefing

ITP: Intent to Proceed

Projects with legal, political, or financial implications so compelling that they come to the SC basically as a fait accompli

SC asked to provide input but not asked to approve or prioritize

IAB:  Initial Assessment and Briefing

Decision Support Memo to SC  

Overview

Description of Request

Background

Description of Project

Legacy Vista Changes

HeV Vista Enhancements

High Level Impacts

Resources Needed

Project Schedule

Considerations/  Recommendations

AS-IS vs. TO-BE flowcharts

SC reviews IAB and then recommends disposition to IDMC

SC Meeting Agenda 

VANTS call 4th Thurs 2-4PM Eastern

ITP review

IAB review/discussion/disposition

Weekly summary of new IT service requests (is Fast Track warranted?)

Quarterly Review of Parking Lot Items

Disposition

IDMC reviews/approves SC recommendations

“Approved” projects may be parked or put on hold and might be subject to lengthy delays due to competing projects/ scarce resources

SC/IDMC Approved Projects

Decision memos sent to requestors via Outlook

Decisions can be appealed

Parking Lot items AKA Parked Projects 

These projects have been approved but are parked awaiting funding or are dependent on another application under development before work can start.

Parked projects are reviewed quarterly to determine the need for re-prioritization, deletion, or acceleration based on current VHA strategic initiatives, performance goals, and/or business drivers 

Common Reasons for Disapproval

Insufficient business case

Enhancements to legacy Vista would not be complete until after anticipated release of HeV

Project would cause unacceptable delays in other high priority projects

Limited national applicability (one facility or only one VISN affected)

Recent Enhancements to NSR/NCT Process

SC to ask for IDMC review/approval of items in the Parking Lot

SC to develop a Fast Track Process

SC to revisit/propose process for evaluation of New Commercial Technologies

Promote/Improve input from HISEBs

Publicize the NSR and Fast Track Processes

Fast Track

Process clarified and enhanced after August NLB meeting

SC and IDMC review items in the Parking Lot quarterly

Business Owners/Requestor and OI ESMs invited to directly participate in SC meetings

SC will review weekly summaries of NSRs to identify projects which should be Fast Tracked

Fast Track, cont’d

HISEB input sought earlier in the process so as to be included in the IABs referred to the SC

HISEB review and response time shortened from 2 weeks to 1

Fast Track projects will have an expedited review

5 - 7 DAYS

Notification sent to Requestor 

Indicating IDMC Decision

Preparation of Intent to Proceed (ITP)

“Must Do Work”

HISEB Review Period 

1-2 Weeks

Preparation of Initial Assessment and Briefing (IAB)

OI Leadership Review Period

Development Teams and SME’s/User Groups

HSD&D Conducts Initial Planning & Analysis Functions

VHA Fast Track IT Service Request

Patient Safety Initiative or a

Legislative/Strategic Initiative endorsed by USH/PDUSH

New IT Service Request

Must be endorsed by NLB Member (VISN Director or Program Officer)

http://vista.med.va.gov/pas/NewITRequestForm.asp

Endorsed by Facility/VISN Leadership

Screening Committee Review   ALL Feedback is forwarded for review process.

Multidisciplinary SC Membership 

IDMC 

Review of Screening Committee’s Recommendations

Multidisciplinary IDMC Membership 

APPROVED

Entered OI Technical Service Project Repository

DISAPPROVED

Requestor may re-submit request or ask for appeal through IDMC Manager

3 - 4 MONTHS

Notification Sent to Appropriate HISEB

Scenario 1:  NSR for a change to a VistA package to roll data up nationally

Researcher submits NSR after obtaining endorsement

NSR indicates national rollup of data is needed

Planning and Analysis staff assist in solidifying requirements which includes setting up Kick-Off Call

Packet workup then begins to assemble the documentation to support further discussion and decision making

IAB (or ITP) sent to HISEBs for comment

IAB AND HISEB feedback sent to IDMC SC members prior to monthly call where requestor will participate

IDMC SC makes recommendation to IDMC

IDMC approves, disapproves, requests further analysis

Requestor notified

Scenario 2:  NCT for a clinical decision support system

Researcher enters product into registry, completes paperwork, obtains endorsement and submits NCT

Planning and Analysis staff request security and architecture review

Packet workup then begins to assemble the documentation to serve as the basis for discussion and decision making

IAB sent to HISEBs for comment

IAB and HISEB feedback sent to IDMC SC members prior to monthly call where requestor will participate in the discussion

IDMC SC makes recommendation to IDMC

IDMC approves, disapproves, requests further analysis

Requestor notified

New Commercial Technology  Process will be re-engineered 

5 aspects of NCT process reviewed at special February meeting of SC

1)  Governance 

2)  Funding to Maintain Innovation 

3)  NCT Review Process Timelines 

4) Procurement for Testing Products 

5) Market Analysis 

Summary and Forecast
        - NSR Process Clarified
        - Insufficient resources and competing projects mean that many worthwhile projects will be delayed
        - Centralization, IT Reorg and Budget cuts cast further uncertainty on the process
        - HISEB and field input essential but not well operationalized
        - NCT process will be re-engineered later this year

Questions?