Informational_MHS Conference Slide_EIDS_MIP.pptx

MHS Information Platform (MIP) Overview of Data Products and Services Chris Nichols MHA, BSN, LSSBB Program Manager, Enterprise Intelligence and Data Solutions (EIDS)

UNCLASSIFIED

Conflict of Interest/Disclosure Speakers have no relevant financial or non-financial relationships to disclose relating to the content of this activity.

The views expressed in this presentation are those of the author and do not necessarily reflect the official policy or position of the Department of Defense, nor the U.S. Government.

This continuing education activity is managed and accredited by the Defense Health Agency, J-7, Continuing Education Program Office (DHA, J-7, CEPO). DHA, J-7, CEPO and all accrediting organizations do not support or endorse any product or service mentioned in this activity.

DHA, J-7, CEPO staff, as well as activity planners and reviewers have no relevant financial or non-financial interest to disclose.

Commercial support was not received for this activity.

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Speaker Introduction

Mr. Chris Nichols Program Manager Enterprise Intelligence & Data Solutions (EIDS), PEO DHMS

Mr. Chris Nichols serves as program manager for the EIDS program management office. In his role, Mr. Nichols is responsible for delivering secondary data solutions around a digital health hub model; rationalizing legacy data capabilities; orchestrating integration for systems such as MHS GENESIS; and providing enterprise clinical intelligence to include clinical support applications, readiness reporting, research, ‘big data’ techniques, and dashboards for the entire Military Health System (MHS) and other federal partners.

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Learning Objectives Discuss the current and future state of the MHS Information Platform (MIP).

Elaborate on the MIP Core Capabilities including workflow applications, analytics / business intelligence workbench, precision medicine, core platform services, information platform, and complex registries use cases.

Explain how clinical data from legacy system is seamlessly exchanged through Health Information Archive (HIA) viewer.

Discuss how organizations can leverage the capabilities of the MIP.

Elaborate how the MIP supports MHS leadership strategic priorities.

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Scale of MHS Data Total MHS GENESIS + TRICARE Data Since 2017

140K # Clinical Notes Daily

20+M # of Messages 165K # of Encounters

# Patients 12.7M # Encounters 839M # Observations 961M # Diagnoses 1.6B # Procedures 782M # Medications 88M

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Complexity of Current Data Ecosystem

*MIP - 130+ Interfaces 23 Warehouses / 19 systems rationalized in the last 4 years

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What is Driving Prioritization for Military Health?

Research Reserves

CDS

OMDS

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How Do We Organizationally Manage the Data Demand?

Requirement

Costing

Internal Prioritization

AF

Med

Reserves

VA

Navy

Army

PEO

DHMS

Project Requests Health Affairs Customers MHS Data & AI Policy Council

(MDAPC)

CDAO

Advana/Maven

DOD-Wide P&R

COCOMs/ OJSS

USUHS

J-3/5/7

AD-S/CAE

J-4, J-6, R&E (Service Labs/GME)

AD-HCA

MA, HCO, Tricare, USPHS

Project Requests MHS GENESIS Leadership Group

(MGLG)

DHA

Customers

AD-R&PI

J-1, J-8

P&R EIDS Delivery and Integration

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NIH

CMS

CDC

HHS

Evolution of EIDS and the MIP Since 2018, EIDS has provided access to increasing amounts of data across domains, enabling downstream data flow and advanced analytic capability to produce new insights.

Medical Readiness

MHS Information Platform Modernization & Services Rationalization, Optimization and Cost Reduction 2022-2026 2021-2025 Evolution of data availability Interface with electronic health record data / direct care

Add data from Reserves

Service Readiness Systems

New analytic capabilities

Purchased care

Data Pipeline

OMOP

Data Catalog

Data Analytics Applications

MILPERS

Dental readiness data from MHSG

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MIP Outcomes MIP Services at the Intersection of Data...

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Health Data

OPMED

Healthcare Ops Data

External Partner Data

Operational Medicine Systems

Legacy Clinical Systems Data

ASIMS,

Service Medical Readiness Systems

NMO,

MEDPROS

+ others

Accessible Data for Functional Decision Making Health Surveillance Readiness

Data as a Service

Applications as a Service

High trust, governed data ecosystem Analytics as a Service

Population Health Corporate Metrics / Measures Clinical Decision Support Tools Big Data Analytics Clinical Research Operational Analytics Medical Readiness Dental Machine Learning & AI Data as a Service: Health surveillance data Analytics as a Service: Data workbench for Population Health Analytics Applications as a Service: DMSS (PROMIS, DMED, DODSR, DMS-MT), ESSENCE, Digital BioBank

DMSS

ESSENCE

Digital BioBank

Today the MIP compiles over 5 PB of data from 130+ sources on a scalable platform

PEO DHMS - 11

FY24 Top 5 Key Accomplishments

Key Accomplishment 1: MIP-ITR MHS Information Platform Immunization Tracking & Reporting (MIP-ITR) successfully went live on 26 May 2022, taking over immunization data broker functions from DEERSi and becoming the single source of truth for immunization records across DoD. MIP-ITR creates a near real-time flow of immunizations between EHRs and IMRs and integrates PDTS commercial market records, providing a comprehensive view of vaccination status for force health and readiness.

Key Accomplishment 2: FY22 RDT&E Investment Virtual Data Environment (VDE) initiative was invested to develop a proof-of-concept for a self-service, low/no code data research environment, housing a research-ready DHA dataset, available to end-user researchers for insight and analytics.

MDClone's platform was evaluated from a cyber security standpoint as an approach for clinicians to rapidly discover information to improve patients' health leveraging synthetic data.

De-identification project purpose was to demonstrate proof of concept of a cost efficient, time efficient, automated de-identification process for unique data types data types utilizing a prototype of an "off-the-shelf" pipeline process to readily access de-identified data within the Healthcare API.

MITRE continues to make strides with Bulk Data Extract 3.0

Key Accomplishment 3: Health Information Archive (HIA) Launched Health Information Archive for CHCS at IOC sites (29 July 2022) LDCS successfully completed Joint Longitudinal Viewer (JLV) cutover for Mountain Home Air Force Base, which pointed the Data Exchange Service (DES) interface to the MHS Information Platform (MIP) HIA for retrieving MT Home CHCS legacy data Decommissioned CHCS at Mountain Home AFB, DES/JLV cutover at LeMoore (September 2022) Conducted HIA training to over 300 clinical end users; user traffic will increase as CHCS sites continue to decommission (September 2022) MIP Health Information Archive status: CHCS 2/99; Essentris (GDR and nonGDR) 0/59; S3 3/55; ARMD 4/64; EBMS-T 1/1

Key Accomplishment 4: Operation Helios On 15 September 2022, EIDS completed the transition of the MHS Mart's (M2) 4.5 Terabyte database from IBM DB2 in DISA Capacity Services to the MHS Information Platform (MIP) Amazon GovCloud Redshift database. M2 is an MHS Data Repository (MDR)-derived data mart designed for self-service access to over 600 fiscal year tables for a variety enterprise data types using Business Common Services (BCS) as the front end user interface. It serves as a powerful ad-hoc query tool leveraged by over 2,500 users to manage and oversee operations worldwide. As of 2 November 2022 there have been over 50,300 M2 queries run against the MIP AWS Redshift database. DISA Capacity Services completed the decommission of the IBM DB2 database on 24 October 2022. This transition will save the DHA $2.5M over the next five years.

In October 2020, EIDS kicked off the Operation Helios project to migrate the MHS Data Repository (MDR) from DISA Capacity Services to the MIP. The MDR is an approximately 1 Petabyte data warehouse containing over 46 million data files about healthcare provided to beneficiaries of the MHS, and grows at an average of 5 Terabytes per month. The Operation Helios project team is leveraging Talend Extract, Transform, Load (ETL) features to automate 35 data type processors, implementing technical data governance and establishing over 85 inbound and outbound data connections to interface partners throughout the enterprise. As of 2 November 2022, EIDS has migrated over 800TB of MDR data using AWS Snowball Edge devices and is currently on track to cutover MDR to the MIP on 17 January 2023.

Key Accomplishment 5: DES/CHDR Deployed CHDR in the GovCloud (21 SEPT) allowing CHDR to decommission at DISA (30 SEPT)

FY25 Top 5 Goals MIP Modernization Transform 80% of MIP product delivery to DevSecOps model Deploy enterprise tools required for DSO oversight and planning Continue to migrate sites to the Health Information Archive in conjunction with providing PMOs historical data storage service Improve data literacy Deliver normalized data sets based on OMOP standards Elaborate Data Catalog Improve operations Integrate DES/CHDR Complete AWS account consolidation Provide PMO standards for test, release, and configuration mgt

Big Rocks Finalize FY23 Bio Surveillance Scope & Funding Transfer COR duties to EIDS on EIDS efforts Contract actions: Essence and OMOP Multiple Hiring actions Complete M2/MDR migration

MHS Information Platform

Provides a comprehensive analytics solution with flexible tools Compiles aggregated data from 130+ DOD data sources on a scalable platform

MHS’ Analytics & Data Visualization Platform Pulls information from disparate health-care systems in real time Allows authorized users throughout DOD and the VA to view clinical information Enables the archival and decommission of DHA legacy systems Provides clinicians with direct access to a patient’s historical medical record Collects near real-time data from MHS medical facilities to support the early detection and monitoring of health events Provides prompt notifications of actionable and emerging health concerns EIDS delivers, connects, integrates, and curates health data to enable informed decisions, research, and innovation MHS Information Platform

(MIP)

data warehouses 30+ Maintains LARGEST repository of secondary data in the DOD through rationalization of 130+ data sources Remote component servicemembers and DoD Civilians 800,000+ Modernized the Reserve Health Readiness Program (RHRP) for Health Surveillance (HS)

Digital Exchange Service (DES) Joint Longitudinal Viewer (JLV)

Health Information Archive

(HIA)

USCG

USDOE

CDC

NOAA

DOD MTFs

(MHS GENESIS)

Other Partners

DES/JLV

Real time data interoperability across disparate systems

HIA

Access to legacy healthcare data after system archival and decommissioning

HS

Disease surveillance, early detection, and rapid response

MIP

FEHRM

JOMIS

DHMSM

HIE

EIDS

Tricare/Purchased care

ADVANA/MAVEN

Service/DHA MILPER, CIVPER

Admin Data

HA/DHA Business & Financial Systems

Outcomes/ Achievements since EIDS standup in 2018 Over 5.0 PB of active data Rationalized & Developed 32 Applications 60,000,000 Conducted the

LARGEST DATA MIGRATION

in DHA’s history. transferring over health records annually 60,000,000 Conducted the

LARGEST DATA MIGRATION

in DHA’s history. transferring over health records annually

-EIDS stood MIP up in 2018 – Intent & purpose 1) to consolidate disparate data capabilities under 1 PMO and into 1 platform 2) J6 data/system consolidation and financial recoupment 3) Data integration point for clinical, business and administrative data to include medical personnel (MILPER/CIVPER) data -Without MIP – no integration of direct, purchased care data (60% of care provided via Tricare Managed Care Support contractors) and legacy health data nor integration with Readiness systems or other federal agencies (VA, etc) -MIP also hosts Data Exchange Service (DES) and is the query backbone of JLV and VA partnerships for data

MIP Offerings: Data Products and Services

MIP Data Products Data Apps as a Service

Data & Analytics Advisory MIP Customer Care Data Services

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Data Products: Data Apps as a Service

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MIP Data Products Data Apps as a Service

Hercules

Hercules

RHRP

Readiness

Clinical

Complex Registries

Opioid Registry

Data Products: Data as a Service

MHS GENESIS Data Bulk Data Extract (BDE)

MIP FHIR API

HealtheIntent API

HL7 API

Legacy Data

Transactional Data Data Exchange Service Joint Longitudinal Viewer (JLV)

Normalized Data MHS Common Data Model (CDM)

DAVINCI

MIP Data Products

Data Apps as a Service

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Data Products: Analytics as a Service

MIP Data Products

UNCLASSIFIED

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Machine Learning

MIP

Omics / Genomics

Analytics Workbench

NLP / OCR

Comprehend

Data Products Enabler: Platform Service & Portfolio Management

UNCLASSIFIED

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MIP Data Products

Data Exchange Service Cloud Services Data Solutions Service UI/UX Service Cyber Services

Platform Services OPMED and CCMD Products DHA Data Domain Emergent Capabilities Data Transfer and Archival Information Portal

Portfolio Management

Data Products

Data Services: Data & Analytics Advisory

Weekly Data Literacy and Data Science Meetings

Consultation Services Support Initiatives to Foster a data-driven culture Assist with organizational data literacy Consult on data-related strategies Support policy and procedure development Bridge the gap between business and technology

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Data Services: MIP Customer Support

Weekly Meetings

MIP User Group

MIP User Group Monthly Call

MIP Status Calendar

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MIP Data Flow and Usage

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Data Use Data Partners

Unstructured Data Genomics

Art of the Possible

Contact Tracing Data Bio-Medical Data Wearables Data Social Determinant Data

MHS GENESIS

Future state - mix of real time data & extracts based upon customer need Expect 80+% of day-to-day data needs to be accomplished via MHS GENESIS tools ~Near-real time HL7 feed (Admission/Dispositions/Transfer, Lab, Vaccinations, Problem list, Clinical notes) MIP Potential Warehouses Ex: Financial, Personnel, Other… Service Medical Readiness

DOD CDAO

Public Health Partners Research Institutions Services Other Federal Health Partners Population Health Corporate Metrics/Measures Clinical Decision Support tools Big Data Analytics (Predictive/ Prescriptive) Clinical Research Operational Analytics Medical Readiness Innovation Artificial Intelligence (AI) Machine Learning (ML) Data Solutions

Bio Surveillance DOD Trauma Registry Health Information Archive Complex Registries Clinical Decision Support Tools Digital Biobank Others…

Financial, Personnel, Other….

ASIMS

MEDPROS

NMO

Others Operational Medicine Systems

Future bidirectional FHIR APIs Bulk data extract (BDE) 350 tables nightly

Purchased Care

Application Data ~Legacy Clinical Systems’ Data

CHCS – NRT from all sites AHLTA – Nightly CDR extract Essentris – Streaming data Q3 S3/ARMD – aligns with Decom EBMS-T – aligns with Decom NRT MIP to Readiness Systems

MIP-Immunization Tracking Record

MHS Information Platform (MIP) (118+ data sources & growing) Joint Longitudinal Viewer

Current EIDS PMO Priorities

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Contributing Factors: Data Quality Clinical Factors Technical Factors Business Factors

Completeness All required fields are populated No critical data is missing

Timeliness Data is available when needed Up-to-date information

Consistency Data matches across system Uniform formats and definitions.

MHS Common Data model deployed Q4 Fy24

Validity Adheres to predefined rules or ranges Uses correct formats and standards

Traceability Source and history are documented Enables auditing and lineage tracking

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Code Mapping

Diagnosis to billing or surveillance codes

Codes alignment to patient care

Revenue Cycle

Workflows

Governance

Billing and claims processes

Claims audit

Standardized clinical workflows

Consistent scheduling, admission, discharge

Define standards

Set policies

Standardization

Consistent clinical workflows

Patient Identity

Unique and accurate patient identifiers

EDIPN vs SSN vs CernerID vs DEERS

Temporal Consistency

Consistency after policy changes

Consistency in documentation

Clinical Documentation

Completeness of clinical notes

Accuracy of provider’s coding

Data aligned to standards (ICD-10-CM, LOINC, etc.)

MIP: From Data Sources to Domains to Products

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MHS Common Data Model Information and Resources https://health.mil/Military-Health-Topics/Technology/PEO-DHMS https://carepoint.health.mil/sites/MIP/pages/commondatamodel.aspx

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MHS Common Data Model Data Sources

Person

Person (e.g., demographics)

Location (e.g., zip code over time)

Care Site (e.g., facilities)

Provider (e.g., provider type)

Clinical Events

Visit Occurrence

Condition Occurrence

Observation

Measurement

Procedure Occurrence

Drug Exposure

Device Exposure

Health Economics

Cost MHS CDM Maps to Standardized Definitions and Vocabulary in the following areas:

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MHS CDM 3.0

MHS

GENESIS

TED-I

TED-NI

PDW

TMDS

OMDS

Clinical Notes

Death Files

PROs

Accession / Waivers

ITR

Oct 2025 Sept 2026 ITR + Clinical Notes Death Files/Acc/Waiv Discovery Jan 2026 April 2026 July 2026

MHS CDM 2.0

MHS CDM 3.0

Personnel / Financial

FY26

Oct 2024 Sept 2025

PDW + DEERS

OMDS/TMDS Discovery

TMDS +

OMDS (HL7 / FHIR) +

DAVINCI Merge April 2025 July 2025

MHS CDM 1.0

MHS CDM 2.0

Jan 2025 Q2 Refresh & QA of MHS CDM (MHS GENESIS & Tricare) Q3 Refresh & QA Q4 Refresh & QA (MHS GENESIS + Tricare +

DEERS + PDW)

Q1 Refresh & QA

Monthly Refreshes of MHS CDM Quarterly Refreshes of MHS CDM

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MIP Target State Architecture

2025 MHS Conference 26 The Target State Data Architecture for PMO EIDS future D&A platform capabilities and how they fit together to satisfy all stakeholder use cases

Target State Data Architecture

Key Benefits for the Federal Digital Health Hub:

Allows EIDS to seamlessly integrate, access and share a diverse set of data (structured, unstructured, internal and external) within a single cohesive environment Supports a broad range of users – from business users to data scientists and external consumers Provides self-service access to high trust, governed data Enables traditional reporting and dashboarding capabilities (which are the primary need of PMO EIDS data consumers) Enables analysts to explore a broad set of data and provides analytics tools for preparing and analyzing it Enables AI/ML use cases and requirements (including NLP) – including operationalization and governance of AI/ML models Enables users to quickly understand what data is available, what it means and how to find it (Data Catalog) Ensures seamless (and where possible, automated) compliance with data governance policy and provisions data access to those who have appropriate permissions Provides PMO EIDS business applications the benefits of leveraging analytics and PMO EIDS master data

2024 by the Numbers:

NLP on MHS GENESIS Clinical Notes

UNCLASSIFIED

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Clinical Notes processed with National Language Processing 36M+

Key Takeaways The MIP enables data knowledge action for military medicine by providing:

Connection to external systems, data feeds, and data exchanges; capabilities for customers through the data, logic, and presentation layers; underpinned by data security, compliance, and role-based access control (RBAC) Core Data Products:

Data as a Service - Provide standardized data products (i.e., creating usable data sets) made accessible and available via a user-friendly data marketplace/catalogue Analytics and as Service - Provide scalable analytics tools and capabilities to support BI/AI/ML Data Applications as a Service - Design and deploy data applications that have a custom UI/UX interface to support MHS clinical and operational decision Governance and Priorities – Documented and Assumptive Demand vs Capacity Internal Platform demand (development, data management, data science, AI/ML etc.) to keep up with the continuous technological pace External Customer demand – Lack of Governance and Prioritization (HA, DHA + suborganizations, COCOMS / OJSS, DOD, Services, VA, etc.)

Internal PEO demand and tradeoffs EIDS priorities include data accuracy & validity, stabilizing the platform, maintaining cost efficiencies, and creating an innovation space in line with overarching DOD VAULTIS data strategy (Visible, Accessible, Understandable, Linked, Trustworthy, Interoperable, Secure) EIDS is constantly looking to help our customers solve challenges by leveraging data as a strategic asset through external use cases such as clinical, readiness, surveillance, research, federal and connections to external systems

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Conclusion

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130+ data sources Data as a Service (DaaS) - Ex: MHS Common Data Model, JOMIS Patient Data Seeding, Real time Readiness integration

Data Science & Analytics enabler – Ex: Analytics Workbench, pre-built AI/ML models, 400+ data visualization and metrics, MILPER/CIVPER analytics

Data Applications as a Service – Ex: Joint Longitudinal Viewer/DES, Digital Biobank, Patient facing questionnaires, Complex Registries, Essence, J4 contracting repository Core Data Products The MIP as the Digital Health Hub integrating disparate data and unlocking new knowledge and insights to accelerate innovation by providing Data Products and Services.

REQUIRED - Continuing Education Placeholder This slide will be added later if the session is accredited for CEU

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Contact Mr. Chris Nichols Program Manager, EIDS chris.e.nichols.civ@health.mil

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Thank You!

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