1. Operational Information Systems: Turning Acronymic into Capability Presentation to Patient Administration Course CDR A. P. Spencer, NC, USN Revised 13 Jul 2006

2. 2 Pop Quiz Please answer the following: True/False: Information systems are all gobbledygook between acronyms, technical jargon, and technical talk that real people can’t understand. True/False: In an increasingly joint world, the service role in information systems is decreasing. True/False: Life was better with a paper record—fewer data calls. Although acronyms are used, the focus is not the HOW but the WHAT needs to be done. What is the required capability?? Look at Title X. The Services still are required to fund and support non- Defense Health Programs (P-8) activities, which is nearly all operational healthcare. Those who were there remember considerable time manually aggregating results of log books for one query and considerable manual time spent collating data that could not be verified (roll-ups only).

3. 3 Objectives Upon completion of the period of instruction, the learned shall be able to perform the following: List and discuss the components of a capability Discuss four major operational programs (capabilities, how fielded) Discuss major capability sets of operational IM/IT Discuss how the learner may obtain a needed operational IM/IT capability Discuss resources to assist the learner If I do my job correctly…

4. 4 The Instructor Current position –Navy Medicine Chief Information Officer Theater Systems Lead Navy lead for Theater Medical Information Program Joint, Maritime Navy Medicine Individual Medical Readiness IM/IT lead Yada…yada Jun 2006, left three years as: –MARFORPAC/MARCENT Deputy Surgeon and FHP Officer –Included multiple deployments ISO OIF/OEF Naval Medical Information Management Center survivor –Theater Systems Dept. Head Education –Masters in Nursing Informatics and Administration –Graduate of Marine Corps Command and Staff College And so on… Who am I to teach this subject?

5. 5 Why Is This Important to the PAD Community? Semper Administration –Meet reporting requirements –Meet tracking requirements –The electronic medical record (to be) In garrison how often does your area –Use CHCS –Use TRAC2ES –Use JPTA To your existing daily joys, please add –Daily reporting for Higher HQ (Service and Joint) –A whole lot more ad hoc needs –Poor NIPRNet access –Frequently no DSN access –Absence of existing infrastructure –A deployed service helpdesk that doesn’t understand medical –Absence of fixed support and infrastructure, rapid change over

6. 6 Why A Capability? A capability consists of the following: –Personnel [system administrator, trainer, helpdesk] –Equipment [servers, communications, networking equipment] –Training [initial, sustainment, pre-deployment] It also includes the following: –Updates New capabilities/versions Security patches for Information Assurance Vulnerability Alerts (IAVAs) Coordination for ports and protocols Reachback support Logistics support (user manuals, spares, integration into supply system) Permission to use on network (Authority to Operate) Funding for support A capability is service-blind and mission focused

7. 7 Why Can’t I Just Use Access ® and Excel ® ? For one site, access may be easy…provided: –You have someone who can support and maintain it –You don’t exchange data with anyone –You know and have all applicable standards—and people savvy enough to articulate them –It is for a small time-frame –The Line communicators Navy/Joint/Staff/General-6 owns the network, devices, communications, and means. –You will be held to the same standards as everyone else—often shifting sands… –Listen, learn, and use a “what do I need to do” attitude Isn’t Medical Different? Why is the Line Involved?

8. 8 Major Areas of Capability Clinical Documentation Individual Medical Reference Command and Control (C 2 ) Medical Logistics Medical Reference Research and Development Resource Systems Other Service Programs

9. 9 Major Operational Medical Programs Theater Medical Information Program –Program of programs –Lead by TRICARE Management Activity (TMA) –Two stage program: Joint program fields software (like Microsoft) –Software is taken from other TMA programs and “packaged”/integrated for theater use Service programs integrate, place on hardware, train, and support (like Dell) –Navy: TMIP—Maritime –USMC: separate part of TMIP—Maritime –Army: Medical Communications for Casualty Care (MC4) –AF: TMIP Air Force Clinical Documentation Individual Medical Reference Command and Control (C2) Medical Logistics Medical Reference Research and Development Resource Systems Other Service Programs

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11. 11 TMIP Coordinates programs along 5 major pillars: –Healthcare Delivery –Medical Logistics (including Blood) –Patient Movement –Command and Control –Personnel and Administration (Service programs) Started fielding 2003 to Army ISO OIF/OEF –Limited fielding to USMC in Iraq –Navy evaluating Clinical documentation –CHCS II-Theater Roughly a 2003 version of CHCS II Does not meet Joint Trauma documentation standards Does not transmit all information Supports templates Send encounter to Clinical Data Repository Clinical Documentation Individual Medical Reference Command and Control (C2) Medical Logistics Medical Reference Research and Development Resource Systems Other Service Programs

12. 12 TMIP Battlefield Medical Information System-Telemedicine (BMIST) –HP IPAQ Personal Digital Assistant –Collects SF-600 and DD-1380 (casualty tag) –Feeds CHCS II-T –Fielded by DoD, SpecOps, FEMA, 7 other countries –35,000 deployed –Also has: Vet module Pre/Post Depl Assessment Blood Mgt Wireless sensors Travax ® integration Clinical Documentation Individual Medical Reference Command and Control (C2) Medical Logistics Medical Reference Research and Development Resource Systems Other Service Programs

13. 13 Larger Architecture: TMIP Data Exchange

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15. 15 Dental Navy and Marine Corps –DENCAS (http://dencas.med.navy.mil) used for workload, scheduling, and readiness statushttp://dencas.med.navy.mil –Includes a remote (non-web) capability and soon to be PDA version –Some dental status’s kept in SAMS (if no dentist aboard) Army/AF –Use Clinical Dental Application In mid-2007, AHLTA dental module (a/k/a “the Big Tooth”) will come online, to follow into CHCS II-T Will include clinical documentation, procedures, a dentist's delight!! Clinical Documentation Individual Medical Reference Command and Control (C2) Medical Logistics Medical Reference Research and Development Resource Systems Other Service Programs

16. 16 IMR TMIP and AHLTA not ready to meet full needs of IMR Currently use Service systems –Navy (AD) SAMS (ships) –Integrates medical encounter, IMR, supply, and radiation health SAMS  AHLTA (MTFs) AHLTA and SAMS data flow to Navy Medicine Online https://nmo.med.navy.mil/imr https://nmo.med.navy.mil/imr POC Elaine Shorkey (301) 319-1310 DSN 285 –Navy Reserve and USMC Medical Readiness Reporting System –Web-based administrative system that collects all medical readiness –Now able to order and result HIVs –Ties to unit personnel feeds and TYCOM readiness system POC: USMC HM1 Sauseda (504) 678-0453 POC: Navy HMC Kloaka (504) 678-5413 –Army MEDPROS –Air Force AFCITA (Clinical Immunizations Tracking Application) Clinical Documentation Individual Medical Reference Command and Control (C2) Medical Logistics Medical Reference Research and Development Resource Systems Other Service Programs

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18. 18 Command and Control Systems Medical Analysis Tool –Medical plans and requirements generator used by POMIs –Part of TMIP –Stand-alone Joint Medical Workstation (JMeWS) –NIPRNet: https://fhp.osd.milhttps://fhp.osd.mil –SIPRNet: https://fhp.smil.milhttps://fhp.smil.mil –Integrates situational awareness, medical surveillance, and analysis –Mandated reporting & use in OIF/OEF Joint Planning and Execution System (JOPES) –Used by G-3/5 planners to access the Time Phased Force Deployment Database (TPFDD) (movement into/out of theater) Global Command and Control System (GCCS) –Larger systems of systems on SIPRNET –Plug and play component Clinical Documentation Individual Medical Reference Command and Control (C2) Medical Logistics Medical Reference Research and Development Resource Systems Other Service Programs

19. 19 Medical Logistics Defense Medical Logistics Standard System (DMLSS) –Used in MTFs and some deployed environments –USMC evaluating now for use at Medical Logistics Companies Defense Blood Standard Support (DBSS) –FDA approved program that is used at blood distribution sites and MTFs –Painful to use and maintain, considered a medical device –Often spreadsheets used at low levels –Call the JTF or CoCom Blood officer SAMS –Used for afloat medical supply and logistics –Some roll-up available at Navy Medicine Online –Has a Palm PDA application Clinical Documentation Individual Medical Reference Command and Control (C2) Medical Logistics Medical Reference Research and Development Resource Systems Other Service Programs

20. 20 Medical Reference Virtual Naval Hospital –Http://www.vnh.org Navy Medicine Online –https://nmo.med.navy.milhttps://nmo.med.navy.mil –Click on left Resources –Connects to NMIMC CD Resources –Contains 30,000+ CMEs Micromedix and Stat Ref! located in TMIP Clinical Documentation Individual Medical Reference Command and Control (C2) Medical Logistics Medical Reference Research and Development Resource Systems Other Service Programs

21. 21 R&D Systems Joint Theater Combat Trauma Registry –Program out of Army Institute of Surgical Research –Used by Army, Navy programs feeds –Focus is surgical technique and care delivery Navy/Marine Corps Combat Trauma Registry –Run by Naval Health Research Center –Web-based form in theater collects DNBI and trauma data –Provides detailed analyses TACMED CS (RF-ID) –Dog-tag and name band for wireless tracking and ID –Joint venture by NHRC and Marine Corps Warfighing Lab –Will migrate to BMIST Clinical Documentation Individual Medical Reference Command and Control (C2) Medical Logistics Medical Reference Research and Development Resource Systems Other Service Programs

22. 22 Resource Systems Centralized Credentials and Quality Assurance System (CCQAS) –Web-based program at DISA San Antonio TX –Usually done by Professional Affairs Coordinator (PACs) in MTF –Inter-facility Credentials Transfer Brief (ICTB) still needed in deployment Defense Occupational Environmental Health Reporting System (DOEHRS) –Hearing Conservation module used in audio booth is mature –Emerging syst Clinical Documentation Individual Medical Reference Command and Control (C2) Medical Logistics Medical Reference Research and Development Resource Systems Other Service Programs

23. 23 Other Defense Messaging System Outlook and E-mail Teleradiology –Computed radiography on ships and some deployed locations (EMF Djibouti) sent to NNMC Bethesda and NMC San Diego to be read by a radiologist –Often results in less than a business day –Currently using commercial product of RADWORKS, but shifting to MedWeb –USMC digital radiology product not capable of transmitting for remote reads –Highly complex program—many participants and funding streams –POC Lee Larson (301) 319-1091 DSN 285 Clinical Documentation Individual Medical Reference Command and Control (C2) Medical Logistics Medical Reference Research and Development Resource Systems Other Service Programs

24. 24 Line Networks: What’s Important Navy/Marine Corps Intranet (Navy) Integrated Shipboard Network System (ISNS or IT-21) Non-classified Internet Protocol Router Network (NIPRNET) Secure Internet Protocol Router Network (SIPRNET) Commercial Internet

25. 25 Prime IM/IT Conflicts of the Day IT as acquisition Tasking to Service with reducing service IM/IT budgets Increased IM/IT oversight (BMMP)

26. 26 Things to Think About Information Management You have tons of information –Systems –Databases –E-mail –Post-it notes –Paper..tons of lovely paper All of it needs to be managed –Archived –Sorted –Protected –Analysed? –Maintained

27. 27 Who Do I Reach Back To? Formal –If you are on a Joint Manning Document or a direct report to a Joint Task Force (JTF), your reach-back is through the Combatant Commander  Joint Staff  Service tasking –If you report to a service component, then through the component  service HQ Informal –Who do you know –Me…

28. 28 Key Take Aways The deployed N/J/S/G-6 owns the network, communications, and devices. There are not exceptions for medical. Be prepared to play by the rules. IT isn’t hard to understand—just focus on WHAT you need more than HOW to get it Training, integration, and use are not IT issues, they’re yours Ask the hard questions –What do I fund –What do I have to do now and later –Who maintains –How is my -6 involved? –How will my relief be prepared for this? –Is this a program of record?

29. 29 Learning Objectives Upon completion of the period of instruction, the learned shall be able to perform the following: List and discuss the components of a capability Discuss four major operational programs (capabilities, how fielded) Discuss major capability sets of operational IM/IT Discuss how the learner may obtain a needed operational IM/IT capability Discuss resources to assist the learner If I did my job correctly…

30. POC CDR A. P. Spencer apspencer@mar.med.navy.mil (757) 953-6878 DSN 377

31. Back-up Slides

32. 32 Program POCs ProgramOrganizationTypeE-mail Web Phone

33. 33 New requirements submission

34. 34 POCs