1. SG6 Office of the CIO
(Previously SGRH AF MHS DEPLOYMENTS DIVISION)
RCO 0046 3618-300
Monthly Progress Report
February 2010
Finalized: Mar 2010
Submitted: Mar 2010
Prepared for: HQ AF/OCIO
Document Created by:
Planned Systems International, Inc.
5201 Leesburg Pike, Suite 1100
Falls Church, VA 22041
OCIO CLINICAL INFORMATION SERVICES Project, RCO #46 2010 Monthly Progress Report
TABLE OF CONTENTS
1. Project Status and Accomplishments 3
1.1. Project Research and Development Support 3
2. Project Scope Management 5
2.1. Change Requests 5
2.2. Contract Modifications 5
3. Status of Deliverables or Work Products 5
3.1. Project Management and Oversight 5
4. Project Problems and Corrective Action 5
4.1. Issues or Problems Experienced 5

2. 4.2. Actions 5
OCIO CLINICAL INFORMATION SERVICES Project, RCO #46 2010 Monthly Progress Report
Project Status and Accomplishments
Project Research and Development Support
Key accomplishments in February:
Ø Workflow Integration & Business Process Reengineering (Dr. Timothy
Corcoran)
o Brought COMPASS Workflow to the Little Rock AFB
§ Participated in training providers and technician staff in
COMPASS Workflow. Their clinics continue to be challenged by
‘hybrid’ AHLTA installs on their workstations- began troubleshooting
process with our office but no clear resolution by time of departure
o Did explore options with System Flight of how this situation
could be mitigated (ghost image of ‘pristine’ install, uninstall &
reinstall, etc.)
§ Presented Workflow to Family Practice, Flight Medicine, GYN NP,
and Peds
§ Discussed possible workflow scenarios with PHA clinic as well
o Brought COMPASS Workflow to the Charleston AFB
§ Demonstrated and trained Family Practice, Flight Medicine, and
Pediatrics providers & Techs on COMPASS Workflow
§ Provided accolades to Systems Flight as every workstation visited
by our Team was configured correctly despite having 3.3.3.2 AHLTA
installed
o This was a first at an AF 3.3.3.2 site
§ Explored with Sr. Systems Manager (Sean Lawrence) a trial of
virtual installation of AHLTA 3.3.3.2 utilizing VMWare (1st
priority) and
Sun VirtualBox (2nd
priority)
o To date, Citrix has been the most common platform for
virtualization of AHLTA in the AF
o Citrix has fallen short of being the ‘panacea’ that was
hoped for in simplifying the distribution & updates
involving AHLTA
o VMWare & Sun VirtualBox should be simpler to install and
much less expensive as c/w Citrix
§ Will closely monitor progress of this virtual installation which
should be concluded by end of Mar 2010

3. o Identified six major impediments to the proper deployment & use of
Dragon Medical dictation software across the AF. Working closely with Nuance
on mitigation of each of the six impediments to the proper use of Dragon
Medical. These are listed beneath each entry below. This will permit a
resumption of workflow integration of Dragon with Flight Medicine & Primary
Care within the AF
§ There are 4 categories of Dragon licenses for a given AF MTF
(the original 1080 SG purchase which has been upgraded to 10.1, 515
newly purchased SG Dragon 10.1 licenses, licenses individually
purchased by AF MTFs that were never upgraded to 10.1, and licenses
purchased by individual MTFs that are 10.1). There is no central
accounting for these different categories of licenses and therefore no
true accountability for licenses in use
o Spreadsheet is being co-developed with AF POCs and
Nuance that lists all known license #’s and types for each AF
MTF
§ License for Dragon use is not understood by receiving AF MTF
because it is not included with the software. This has resulted in a
suboptimal installation of the software at receiving MTFs
o Nuance has clarified license and drafted separate letter that
explains what constitutes proper use of license. This has been
added as an attachment to AF customized instructions for
installation & maintenance
§ Distribution of software is broken. Present method is to send a
copy of a DVD with Dragon on it to different POCs at each MTF. Upon
scrutiny of the most recent mailing list, we discovered a mixture of
POC authorities (some sent to SGH, some to Systems, some to
AHLTA trainer, etc.) and a number sent to people no longer assigned
to the MTF. This caused great problems at the receiving end and
resulted in the latest release of Dragon never getting to the end-user's
workstation
o Working with AFCEDS to post Dragon Medical software on
their secure site. All Systems Flights within the AF have access
to this secure site. This will enable an efficient distribution of all
future versions of Dragon
§ No directions for proper installation & maintenance are included
with Dragon DVD so this has resulted in an incorrect configuration &
maintenance at AF MTFs
o Have co-developed with Nuance step-by-step directions for
AF Systems to properly install & maintain Dragon Medical
§ There is no provision for providing consistent training for Dragon.
The typical scenario goes like this: After a suboptimal installation of an
old version of Dragon is installed on a provider's workstation, the
provider is told to "go through the tutorial" built into Dragon. This
amounts to voice training which is not intended by Nuance to substitute
for training. Subsequently, there are very few Dragon users in the AF
that understand the capabilities of the program

4. o Exploring the use of AHLTA Trainers to provide teaching
Dragon Medical to MTF staff. The Army had Nuance
professionally instruct a cadre of trainers hired by the Army who
then went out and trained the Army installations. Our trainers
are embedded within each AF facility and could provide the
ongoing training needed to become proficient
§ There is no central POC for AF or Nuance that could easily
process an individual AF MTF pre-negotiated upgrade or newly
acquired 10.1 licenses for Dragon. This further complicates the task of
individual MTFs obtaining software and makes central tracking of
licenses impossible. As individuals 'maintaining' the licenses in the
MTFs subsequently separate, PCS, deploy, etc. the knowledge of the
licenses goes with them
o Working with AFMOA South and Nuance to designate
respective POCs that would process orders from MTFs so
central accounting of licenses are maintained
o Continued to Critique & Provide Feedback to AIM Form Developer on the
new COMPASS Core AIM Form (“COMPASS Core 2.0”)
§ Developed an approach to removing multiple prior versions of
COMPASS AIM forms from the Enterprise
o This method of removal will permit an orderly transition
over to the new COMPASS Core 2.0 AIM form
§ Further development will be on the expected six month release of
COMPASS Core 3.0
o Gave Presentation to AHLTA Trainers on New COMPASS Core AIM
§ Provided via Teleconference
o Continue to Provide Support to the ANG/Reserves Training POC as it
Relates to AHLTA
o Assisted AFMOA’s Care Coordination Program Manager in understanding
how ‘V’ codes for BMI were calculated by AHLTA. This undocumented
behavior gave the erroneous impression that these V codes could not be
altered
o Worked with the POC for a widely used Excel macro Asthma Action Plan.
Explained to the developer the need for being able to clearly read the Asthma
Action Plan once copied into the Add Note section of AHLTA. Nurses at
various MTFs are called by patients when they have lost their Action Plan and
would like to know what the Plan was. The only record of this plain available in
AHLTA was in the Add Note section which could not be read due to the very
small size. The POC agreed for the need to have a copy that could be read in
AHLTA
o
Ø
Ø Department of Defense/Veterans Affairs (DOD/VA) Share Projects

5. (PA Robin Abbott)
o Air Force (AF) Point of Contact for matters related to DOD/VA Sharing
Initiatives. Briefed Senior Air Force Medical Service (AFMS) leadership on
progress, issues, and challenges related to projects. Provided weekly
updates on activities to AF Chief Information Officer (CIO). Provided support
to the AF Chief Medical Information Officer (CMIO) on matters related to
DOD/VA sharing and AHLTA.
o Supported service representation to meetings related to the various
DOD/VA initiatives:
§ Health Executive Council (HEC) IM/IT WG
§ DHIMS Share Updates for Leadership
§ MAJCOM Joint Venture Meetings
§ Interagency Clinical Informatics Board (ICIB)
§ Interagency Program Office (IPO)
§ Virtual Lifetime Electronic Record (VLER)
§ James A. Lovell Federal Health Care Center IM/IT Update
§ DHIMS Service Representative Meeting
o HEC Pre-Brief for AF Deputy Surgeon General
§ The HEC oversees the cooperative efforts of each agency’s
health care organizations and all councils or workgroups designated by
the co-chairs.
§ Briefed Maj Gen Hepburn on status of North Chicago Project
§ Prepared facers for AF CMIO to brief on the ICIB 2010
interoperability objectives and VLER update
o Defense Business Systems Management Committee (DBSMC)
§ Facilitated AF inputs regarding VLER to be presented by the AF
representative to the DBSMC
o VLER
§ Corresponded with individual sites to answer individual questions
related to this initiative
o Government Audit Office (GAO)
§ Attended an exit conference for the GAO review of the “Fully
Interoperable Personal Health Care Information for the VA and the
DoD”, code 310945
o Community of Interest Board (COIB)
§ Provided update to CIO so that action item related to request for
joint incentive funding for VLER could be closed
o Submitted slides related to BHIE, VLER, and NHIN to be incorporated into
presentation for Eglin MTF’s Leadership Conference: Systems of the Future
Ø Congressional Hearing Slides for Issues Binder

6. o Developed slides to be submitted into the 2010 Issues Binger for
Congress
o Slides submitted on behalf of the Surgeon General to update IM/IT
projects for VA/DOD Sharing, EHR Way Ahead, AHLTA 3.3.3.2, and
COMPASS
Ø Site Visit to Charleston Clinic, Charleston SC
o Augmented Tiger Team sent to site in response to complaints regarding
AHLTA’s speed and performance
o Worked with clinicians and the Systems Department to report issues
experienced in the clinic and results of trouble shooting
o Worked with clinicians to optimize their workflow, computer and
application settings
Ø Electronic Health Record Way Ahead (EHRWA)
o Attended 2010 MHS Conference Sharing Knowledge: Achieving
Breakthrough Performance
o Attended Single Sign On and Context Management Software
Requirements Specification Review
§ Developed a CIO approved comprehensive list of applications
that the AF requested to have included in the project
Ø System Change Request (SCR) AF Submission Process
o Continued to evolve process for tracking AF submissions
§ Attended the Outpatient System Integrated Project Team (OSIPT)
o Supported functional community to review and prioritize all
submissions from the services
Ø AHLTA 3.3.3.2 Known Issues Tracking Sheet
o Continued to update spreadsheet with new finding
Ø SG3 Policy Meeting with Deployment Operations
o Facilitated monthly meeting to support creation and updates of policies
related to medical IM/IT issues
Ø MedOps Panel
o Participated in monthly panel to answer questions about AHLTA
Ø Air Force Knowledge Exchange (Kx) Sites
o Continued maintenance of the AHLTA, COMPASS, Essentris and AHLTA
Dental Pages
Ø AHLTA Dental
o Participated in the VA Dental Record Manager System Demonstration
Expected progress next month (Feb):
Ø Support of 3.3.3.2 Deployment

7. Ø Bring COMPASS Workflow to Little Rock AFB, prototype Flight Medicine
workflow and prototype proper installation & deployment of Dragon Naturally
Speaking voice dictation software at Andrews AFB
Ø Liaison with USU for preliminary research on impact of bringing COMPASS
Workflow to medical students in training
Ø Continued support of DOD/VA Sharing Initiatives
Ø Develop project management plan for the BHIE Share Deployment at AF
inpatient facilities
Expected progress next 90 days (Feb-Apr)
Ø Continue to help stabilizing AHTLA 3.3.3.2 at AF sites that request help
Ø Aid in deployment of AHLTA once ‘pause’ is lifted
Ø Bring COMPASS Workflow Little Rock, Charleston, Offutt, and Eglin AFBs
Ø Present at USAFP AF Breakout on Workflow & Simplified Coding
Ø Produce additional COMPASS training videos
Ø Coordinating future site visits to deploy COMPASS Initiative
1.2 Monthly travel in support of task
Name Destination Arrival Date Depart Date
COMPASS
Workflow
Little Rock AFB, AK 02/01/2010 02/05/2010
COMPASS
Workflow
Charleston AFB, SC 02/22/2010 02/26/2010
Project Scope Management
Change Requests
Ø No change requests are pending.
Contract Modifications
Ø No contract modifications are pending.
Status of Deliverables or Work Products
Project Management and Oversight
Monthly Status Rpt Submitted

8. Project Problems and Corrective Action
Issues or Problems Experienced
Ø N/A
Actions
Ø N/A