VHA OI and VA OI

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VHA OI and VA OIT
Clinical Applications CoordinatorsOrganization
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 OIT Field
Operations VA OIT
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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
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VA CAC - OCWG Background from Charter

• Issue Organizational Consistency
• VA IT Development Realignment Working Group
  (DRWG) recognized VISNs have CACs aligned with
  OIT 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 OIT)
• Determine appropriate CAC position classification
  and organizational assignment
• Establish CAC Level of Access for VistA Systems
  
• Scope All CAC personnel VHA and OIT
• VA-wide population included in CAC Roster is over
  400
• A data call is necessary to quantify, evaluate
  classify these personnel

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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

• Becky Kellen, RN, BSN, MS
• Office of Nursing Services (108)
• Patricia Mauseth, RN, BSN OIT 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

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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 OIT functions
• Determined appropriate organizational alignment
  (VHA or OIT) based on the developed criteria
• 223 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 OIT CACs in 2210
  series are most affected
• Identified and validated Menu Access requirements
  for specific CAC functions

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OCWG Study Timeline

• 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

Commence CAC OCWG Charter Approved 29 March

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

• CAC Membership
• Validate Levels of Access Menus
• Use SharePoint
• 117 Responses
• 19 26 June

• OCWG
• Develop VistA System Levels of Access
• Options for CACs
• 15 May 15 June

• OCWG
• Configure Post Levels of Access on
  SharePoint for Review by CACs
• 11 19 June

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

• 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
• Compile Final CAC Functions Levels of Access
  for Report
• 20 - 26 June

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CAC / Non-CAC Functions Performed

Primary Functions Performed by CACs

• 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 _at_ or , menus XUPROG, XUPROGMODE,
  XUMGR, EVE or security keys XUPROG, XUPROGMODE,
  and XUMGR)

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CAC Member Responses to VistA Menu Needs
Rank
VistA Menu Category
99
Consult Mgmt
CO
95
CPRS Mgr
OR
95
TIU Menus
TIU
95
Reminder Mgrs
RE
95
Team List
TL
94
Health Summary
HS
82
Alert Mgmt
AT
81
Problem List
PL
72
Toolbox
CT
71
Vitals Measures
VI
62
ADPAC
AP
49
Adverse Reaction
AD
41
Lexicon Mgmt
LX
40
Remote Procedure
CRP
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Recommendations

• 165 CAC employees in VHA (160) OIT (5) in
  other than GS-2210 series positions were
  determined to be performing predominantly (gt 50
  percent) CAC activities No action required for
  the 160 in VHA OCWG recommends alignment with
  VHA for the 5 in OIT after HR review
• 46 GS-2210 CAC employees in VHA (6) OIT (40)
  were determined to be performing predominantly (gt
  50 percent) CAC activities OCWG recommends
  reclassification re-alignment to VHA for the 40
  in OIT 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 OIT (8)
  were determined to be performing predominantly (gt
  50 percent) Non-CAC activities OCWG recommends
  the 8 in OIT 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

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 recommends CAC alignment within VHA Medical
Centers should be self-determinant depending on
individual Center practices/processes
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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 OIT
• 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 CACs proposed to return to VHA and those in
OIT 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.
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Summary / Next Steps

• Summary
• Preserved cohesive teams across VHA and OIT that
  support the clinical use of VHAs 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 OIT
  concurrence USH approval
• Begin Phase II OCWG activities
• Establish HR sub-group to work HR issues
  affecting employee transfers

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Final Comments

• We expect that in 6 12 months VA VHA will
  have
• Supported VHAs most important assetits
  employees
• Preserved cohesive teams across VHA and OIT that
  support the clinical use of VHAs 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 OIT
  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

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• Questions?

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• Back-up

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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 OIT functions
• Based on a thorough review of current CAC
  personnel functional responsibilities, determine
  each individuals appropriate organizational
  alignment, i.e., VHA or VA OIT
• 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 OIT leadership not
  later than June 2007

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Data Call Metrics / CAC Members who
RespondedPhase I

• Data-Call Categories
  CAC Responses (223) Projected - All
  CACs (400)
• CACs in VHA (10 GS-2210s 160 Other)
  170 (76) 320
• CACs in OIT (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 OIT but
  8 30
• Not as a CAC

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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 OIT             53 (24)
• Percent of CAC Functions Performed
• Responses w/predominant (gt 50)
  CAC functions              215 (96 of
  respondents)
• Responses w/predominant (gt50)
  Non-CAC functions (All GS-2210s)   8 (04
  of respondents)