VHA OI and VA OI

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VHA OI and VA OIT
Linda Fischetti RN, MS Acting Chief Health
Informatics Officer VHA OI Co-Chair
Ray H. Sullivan Executive Director OIT Field
Operations VA OIT Co-Chair
171 - Clinical Applications CoordinatorsOrganizat
ion Consistency Working Group (CAC-OCWG) Panel
Discussion 17 July 2008
Barbara C. Andrzejewski BS Health Informatics
Coordinator Tuscaloosa VAMC VHA
Sally Kellum RN-BC, MSN Lead Clinical
Coordinator Durham VAMC VHA
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Agenda

• Background Fischetti/Sullivan
• Panel Introductions All
• CAC Phase II Overview Fischetti
• HR Assessment Fischetti
• CAC Core Menu B. Andrzejewski
• Business Case Sullivan
• Collaboration Initiative Kellum
• Summary Fischetti/Sullivan
• Q A All

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OUTLINE OCWG UPDATE

• OCWG Tasking
• Key Tasks from Charter
• OCWG Members
• Summary of Phase I Results
• Phase II Actions
• Phase II Status
• Panel Reports
• Summary / Next Steps

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OCWG Tasking

• Issue Organizational Consistency
• Approach Establish work group to evaluate CAC
  functions
• Scope All CAC personnel VHA and OIT
• VA-wide population included in CAC Roster (Over
  450)
• Functions performed by both VHA OIT
• Position classification and organizational
  alignment
• CAC Level of Access for VistA System
  Application
• Evaluate, quantify classify all CACs via
  employee data call

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Key Tasks from Charter

• Define the functions and position classification
  of CAC personnel
• Criteria Functional Responsibilities
• Involve human resource experts to assist in
  defining organizational alignment (do no harm)
• Determine level of access to support CAC
  operations
• Recommend changes to menu structure / access
• Prepare reports of findings and make
  recommendations to VHA and OIT leadership

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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
• Barbara C. Andrzejewski, BS
• Tuscaloosa, AL
•  
• Sally Kellum RN-BC, MSN
• Durham, NC VAMC
• Patricia Mauseth, RN, BSN OIT Field Operations
• Nancy Clum, RN, MN
• VAPAHCS,Palo Alto, CA

• Clayton Curtis, MD, PhD
• VHA OI
• Ginger Price, PMP
• CHIO Special Projects, VHA OI
• Beth Acker
• Bay Pines OIFO (HDI)
• Tana Defa
• Salt Lake City OIFO
• Rosalind Tennison
• Personnel / Admin OIT
• Advisors
• Bob Riera
• Special Assistant, VHA OI

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Summary of Phase I Results

• Defined the functions and position classification
  of CAC personnel
• Established criteria for appropriate
  organizational alignment (VHA or OIT)
• Recommended process for re-alignment
• Confirmed that VHA OIT CACs in 2210 series are
  most affected
• Established Menu Access requirements for specific
  CAC functions
• Identified Minimum Menu Access for immediate
  implementation
• Access the Full Phase I Results Presentation at
  the following URL
• http//vaww.vehu.med.va.gov/Catalog/WBT07.c
  fm?ClassNum181

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Phase I Minimum Access Menu
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Phase II Actions

• Complete National CAC Roster with necessary
  information
• Name, location, job series, organization (VHA /
  OIT), etc.
• Continue refinement of VistA Core Menu
  necessary for CAC use
• Determine broad requirements or Core Menu
  needed for CAC performance
• Develop CAC competency definitions to ID training
  / experience requirements
• Establish follow-on activities for future menus,
  Class III s/w, quick turn items, etc.
• Identify / pursue opportunities for VHA / OIT
  collaboration
• CAC teams conduct mentoring activities
• Develop questionnaire as precursor to gain
  insight for use in mentoring activities

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Phase II Status Core Menu Working Group (CMWG)

• Panel Report on Core Menu Working Group
• Presented by Barbara Andrzejewski
• CMWG formed with VHA and OIT Members
• Addressed organizational issues involving VistA
  Access
• Conducted in-depth analysis of VistA Core Menu
  required level of access
• Reached Agreement on Core Menu Level of Access
• Necessary for the performance of CAC duties
• Min Access Menu and Menus currently held at
  selected facilities based on locally supported
  VistA packages are also recommended to remain
  approved
• CMWG recommendations and Final Report for OIT
  consideration and approval

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Core Menu Working Group

• Start with the approved Minimum Access Menu
• Foster a collaborative effort between VHA and
  OIT
• Develop a VistA CAC menu
• Required for day-to-day CAC duties in the
  clinical and training environment
• Propose and justify access to specifically
  required programmer- and administrator-protected
  menu items
• Define competency levels of CACs

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Group Members
Team Barbara Andrzejewski VHA (Co-Lead) Pat
Mauseth OIT(Co-Lead) Bernice Banks
OIT Neil Brugmann OIT Diana F.
Cranick OIT Dave W. Draper
VHA Susan M. Fawson VHA Denise
Gleave VHA Work Group
Advisors David J. Howard OIT Clayton Curtis
VHA Members for both phases of effort
Melissa A. Hughes OIT Mary Mead
VHA Emily E. Mellecker VHA Theresa A.
Miller VHA Patricia M. Pike VHA Frank
Villella OIT Lori Burton OIT
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A Collaborative Team

• VistA menu access has been a challenge
• OIT Security concerns vs. CAC access needed to
  perform their duties
• VHA and OIT members brought together
• Mutual respect free discussionreasoned approach
• Senior OIT endorsement Want CACs to be able to
  do their jobs
• Early discussions had veered from original
  focusbut
• Group re-defined approach to identifying
  challenging access issues
• Group moved forward with renewed confidence and
  meaningful work
• Solid results, laying the ground work for further
  efforts within VHA IC

Demonstrated the common goal of patient care!
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Accomplishments

• Developed a comprehensive CAC Menu (CAC Core
  Menu) based on national menu options that are
  released with all clinical software applications
• Includes all additional menus currently held or
  authorized by local facilities or by individuals,
  based on VistA packages that are locally
  supported
• Identified CAC- and ADPAC-applicable Fileman menu
  items
• Includes Read Access (Inquiry, Search, Print and
  List File Attributes)
• Includes Fileman enter/edit access for actions
  needed to correct medical record entries (e.g.
  for Patient Safety Alert)
• Identified locally developed options which may be
  candidates for Class III to Class I conversion
• Developed Business Case Justifications for CAC
  access to specifically required programmer- and
  administrator-protected menu items
• Computed Findings Personal Preferences Edit
  Ordering Provider User Release Consult Fields

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Next Steps

• Definition of CAC competency levels and
  associated access for assignment and delegation
  of primary menu
• Rapid Turn Around Process to request access to
  address new options or technologies
• Determine which locally developed menu options
  should undergo Class III to Class I conversion

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Phase II Status Business Case Justification

• Panel Report on Phase II Business Case
  Justification
• Presented by Ray Sullivan
• Issue Need for limited access to the New Person
  File
• OIT needed to protect personal information
• CACs need access to assist in troubleshooting
  user needs
• Approach
• Need for collaboration on what access is truly
  needed to assist
• OCWG workgoup members designed business case
  justification for access
• Members stated read or read/edit access to
  limited number of fields
• Request was reviewed by OIT and approved
• Result
• OIT reviewed and approved access
• OIT is designing an option for all CACs to have
  assigned

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Phase II Status Collaboration Initiative

• Panel Report on Collaboration Initiative
• Presented by Sally Kellum
• Action Identified to pursue VHA / OIT
  opportunity for collaboration
• High performing CAC and OIT staff teams to
  offer mentoring services
• Questionnaire released in May as precursor to
  mentoring activities
• Collaboration Working Group includes
• Sally Kellum
• Nancy Clum
• Barbara Andrzejewski

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Phase II Status Collaboration Initiative

• Issue Feedback from the field on breaks in
  communication
• Approach
• Questionnaire designed to obtain data
• Direct communication with some sites on their
  specific issue
• Results
• As of 6-12-08, Seventy Three sites had responded
• Will observe for additional areas for OIT and
  VHA to collaborate/negotiate

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Phase II Status Collaboration Initiative

• Clinical Coordinators Reporting Structure
• VHA 56
• OIT 19
• Other 26
• Working Relationships
• With Clinical Service Chiefs
• With Executive Staff
• With OIT

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Phase II Status Collaboration Initiative

• Twelve Sites willing to offer Mentoring
  activities
• Eleven Sites have asked for Mentoring
• Barriers
• Communication between OIT and VHA
• Large number felt a collaborative call with OIT
  and VHA staff could assist
• Lack of an Organizational Structure for Clinical
  Informatics

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Summary / Next Steps

• Summary Phase II OCWG Nearing Completion
• Core Menu access level implementation
• Recommendations of improved collaboration/communic
  ation will be reviewed for implementation
• Next Steps
• Follow-on work required for Health Informatics
  professionals
• VHA Informatics Council established

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Questions?