To wrap up 2017, FedHealthIT recognized 100 individuals who were nominated by their peers for driving change and advancement in the federal health information technology market. Some of the common themes among those who were selected included the desire and willingness to challenge conventional wisdom, to go above and beyond, to drive innovation, and to give back to the larger Federal Health IT and consulting community.
We also recognized two individuals with Lifetime Achievement Awards. The Lifetime Achievement Award, FedHealthIT’s most prestigious award, honors leaders who have made and continue to make extraordinary contributions to the Federal Health community, making a significant and lasting national impact. These leaders have earned the respect and admiration of professional colleagues and freely engage not only with contemporaries, but are also committed to maintaining a dynamic connection to all generations within Federal Health.
Over the course of 2018, we’ll speak with many of these industry leaders and will share with you their insights on how the industry may continue to move forward and advice about getting involved.
Dr. Paul Tibbits was recognized in both categories.
Dr. Tibbits is the Program Executive Officer for the Financial Management Business Transformation (FMBT) Special Program Office at the Department of Veterans Affairs (VA). His career spans several decades of involvement, both as a medical professional, as well as a technology expert. Tibbits says that he was driven to work where medicine and IT crossed: to look for opportunities where the patient, the doctor, and the information would be in the room at the same time. He has worked on the IT side since 1988, and led the DoD’s first and second Electronic Healthcare Record (EHR) efforts.
FedHealthIT recently spoke with Dr. Tibbits about FMBT’s development at VA.
Tell Us a Bit About Your Current Role and Focus
VA is committed to modernizing its systems, which means replacing the legacy, 30-year-old Financial Management System currently in use. We’re implementing a new commercial, off-the-shelf solution that uses an un-modified Software-as-a-System offering in the cloud. From an architecture standpoint, we’re on the edge of where we should be in taking advantage of capabilities without changing the commercial product.
The FMBT program aligns with the Office of Management and Budget (OMB) initiative for shared services across the Federal Government, and supports VA’s strategic objective to “Enhance Productivity and Improve the Efficiency of the Provision of Veteran Benefits and Services.” The FMBT program is overhauling VA’s current financial management system to move to a comprehensive financial and acquisition management system. This system ensures compliance with federal regulations, and enables VA to meet financial management goals and objectives.
Along the way, VA is adopting Federal best practices that are the underpinning of the system. Ultimately, we aim to implement Federal best practices in finance and acquisition across VA.
What Does the Rollout Look Like?
We will do this through an incremental approach because we expect to learn as we go. So we’ll start by turning on limited functions, assess how they actually interact, and their impacts. This means turning these limited functions on everywhere in the Department to really look at their big picture operability. We’ll start with a low-risk function that doesn’t involve a large number of people, but requires a lot of technical underpinnings.
As far as full operating capabilities, we’re still doing our analysis, and haven’t made any recommendations for the timeline. We’re looking at going live with the first phase of functionality this March.
What Changes Have You Seen Over the Years in the Health Information Technology Space?
Over the years, I’ve seen a 180-degree change: we went from convincing people that computers were a good thing, to struggling to be able to live up to the expectations of what technology can do.
At the technical level, some of the biggest changes have been introduced by local area networks. When I started, there was no such thing. When the concept was introduced, the boundaries of computer systems became fuzzy and since then, it’s been driving architectural change much faster than anything else.
I suspect the next big leap will be the cloud and the willingness of Government to outsource a lot of the IT complexity that isn’t part of its core missions. That, I think, will be as impactful as the local area networks are to us now. Mobile will also be a big change, both in the fact that we are mobile and that miniaturization is driving how we approach things.
At the same time, there is a self-reinforcing barrier, where the demand from clients isn’t high enough, so the response from industry isn’t being pushed. There are a lot of advances in IT and artificial intelligence (AI) where we aren’t making the progress we should in Healthcare because the demand just isn’t there.
What Needs to Happen for That Next Change to Come?
Human-centered design could do great things in terms of optimizing patient flow, the office setting, care in the home living room, the waiting room experience, down to using the right tools and technologies and keeping the patient at the center of it all.
The IT community has been slow to bring human-centered design to the table and, perhaps because, customers are not asking for it or the development and business communities invested in it. The big problem has been, and remains, use cases. Technology vendors want to sell us something, without understanding the top use cases of the technology in our hands. There are solid examples of combining IT investment with efficiencies in the logistics community and just-in-time delivery communities, but that information is lacking within Health IT. That kind of disruptive change can also help doctor-patient interaction and other areas of Health IT, but we need to see measures that show the outcome of investing in IT and the resulting business efficiency.
There are perverse economic incentives in Healthcare that are creating barriers to interoperability, and to the right focus on patient well-being. The health information model is still struggling, and until these barriers are overcome, we may not see the change we hope for.
What Keeps You Up at Night?
I’m very concerned that in IT, we continue to have a challenge related to knowledge, tools, and ability. There are a lot of VA IT positions that go unfilled, because we can’t find candidates that combine skills in all three. Training current employees is always a concern. As VA is shifting toward a culture of buy-first and moving toward COTS products and managed services, we need employees that have skills that span all three areas and can grow into project management roles.
I’m also concerned that we aren’t paying enough attention to the socioeconomic determinants of health. Genomics is a growing field, but it needs to be approached from the perspective of a “lock and key” situation. Scientists today are only interested in the key (the genome itself), but not the lock (the environment with which the genome interacts). When it comes to clinical trials, our knowledge base is not large enough, our sample size is frequently not large enough for detection of important things like drug-drug interactions, resulting in a weak basis for making clinical decisions.
How Does Collaboration Work Across Federal Agencies?
Agencies are happy to share lessons learned. At VA, we have digested reports from other agencies concerning financial systems modernizations and have lessons learned from prior experiences that we try to capitalize on and are happy to share with others. We’ll seek and depend on the robustness of recommendations from industry partners regarding how we implement technologies and are ready for what is to come.
How do the Pieces of Emerging Technologies Play a Role?
VA is going to be strategic about which new technologies it pursues. For VA, blockchain is compelling in the amount of disruption it is likely to create in the financial industry, although it will be a long time before that is directly relevant to us. Analytics however, could become relevant to us tomorrow, based on how we put our warehouse together, and the analytic questions we ask.
Data management and memory computing will be a great benefit to VA in the short term. Robotic process automation could also become relevant in many areas, not just in finance and acquisition, but in many simple, repetitive processes that could become faster and more repeatable with less variation than a human could achieve.
In terms of AI, the possibilities are almost limitless. I see it being attached to robots for pattern detection in more complicated processes such as diagnostic and therapeutic decision making. That could actually become relevant fairly quickly.
Dr. Paul Tibbits was inducted into Senior Executive Service (SES) in February 2004 in DoD, and served as Deputy Chief Information Officer for Enterprise Development for VA. He then served as Deputy Chief Information Officer for Architecture, Strategy, and Design, and is now serving as the Program Executive Officer for the Financial Management Business Transformation, Special Program Office. In DoD, he served as Director of the Business Management and Modernization Program and Transformation Support Office, and as Deputy Director of Military Health System (MHS) Office of Transformation.
Dr. Tibbits also served as Program Executive Officer of the $400M Defense medical IT enterprise, supporting MHS health care. He developed and implemented two worldwide medical record systems; restructured IT management, regularly represented IT projects to highest DoD executives and Congress, and implemented the first and largest change management program in support of the largest medical IT program in DoD.
After retiring from a distinguished career in the U.S. Navy as a cardiology and before joining DoD in 2004 as an SES, he was a Principal and Founding Member of MAPA Ventures LLC, providing business development advice to clients, growing the business to 11 partners. He also served as lead consultant for information technology and Veteran transition and on the Presidential Task Force to Improve Health Care for Veterans.