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20 Navy | Summer 2017 logistics we chose the top 5 in the industry and made those the IV pumps that we buy for all the MTF's [Military Treatment Facili- ties]. By doing that, not only can we standardize our purchasing, we can also start managing the total life- cycle of these medical devices and select those devices we know are going to work with our new elec- tronic health records. We can also make sure that we're purchasing medical devices that have the cybersecurity that we need. As we started doing this we thought, what if we… used those same IV pumps downrange in our caches and our fleet hospitals and our hospital ships? Now we can standardize training, so that when people are working in the MTF and they get the call to deploy, they are familiar with those IV pumps which has a direct impact on our readiness. We've also been able to aggre- gate our buying power across all the services and work with retail and other pharmaceutical compa- nies to negotiate for the best price for our mail order and medication supplies. What we have now with the NDAA [National Defense Autho- rization Act] is the opportunity to do demonstration projects that allow us to look at value-based purchasing. ere are a variety of ways that we're looking at that: whether we use capitation [a uniform per capita payment or fee] or a primary care medical home or an accountable-care organization or bundled pricing. We can do a lot of that through contracting now. It's also exciting to have some contracting vehicles that can help us bend the cost curve by making it a requirement to use value-based care or value-based initiatives. Could you explain the impact you expect MHS GENESIS—which transi- tions all military medical records into an electronic format—to have and any lessons learned from the initial rollout? One of the first things I was looking at when I first came to the job was interoperability between DoD and VA, and one of the places of interoperability was through our electronic health record system. But I've come to appreciate that interoperability has to start within each MTF—in other words, things within the MTF have to "talk" to each other. MHS GENESIS is a real driving force for moving us toward that greater interoperability. We deliberately selected a commer- cial, off-the-shelf product with an established track record because we recognized that the technology and the science of digital records is advancing far quicker than what we can do... we looked at the features, the functionalities, and the modules within the existing electronic health records. It went through a rigorous source selec- tion… and we prevailed. Because we have a commer- cial off-the-shelf product, we get all the upgrades as they come out. We've had to change some of our infrastructure in order to support this new product, but it's all been to the betterment and stability of our existing networks… What I think will be very exciting for our patients is the patient portal where they can get their labs, they can see their provider's notes, and there's a place in there where they can communicate with their providers. ey also have the ability to request refills and make appointments. Now, we recognized that once we launched that in the Pacific Northwest we would need to make sure that everyone else didn't feel like they were completely out of luck, so we've actually bolstered our patient portal with TRICARE online, so that you can get your refills and make your appointments there, too. We have made interfaces with our existing data repositories and MHS GENESIS… so we'll have the complete records. at's the other benefit of this—we wanted to pay attention to the longitudinal aspect of patients' care, so even though a portion of their care has happened with old records, like ALTHA and CHCS, once we're on MHS GENESIS, we'll be able to retrieve those old records as well… It's not only keeping us very relevant with what's going on with health care and how to keep track of that data and patient communi- cations—but it's also encouraged us to 'up our game' across the entire system. Even though we don't have MHS GENESIS in all parts of the MHS, we can still change our procedures and our practices so that we can emulate some of that same connectedness with our patients. DHA has announced its intention to create a health information tech- nology (HIT)-based "health care ecosystem." Given that a typical treat- ment facility has approximately 20 different IT systems, that seems like a tall order. Could you tell us how you plan to integrate HIT systems across the services' health care functions? ere are a couple of ways that we've approached this… if the program or device doesn't interface or isn't interoperable with MHS GENESIS, that's the first cut. We've also recognized that… sometimes

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