M2VA 16-4 (June 2012)

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June 2012 Volume 16, Issue 4

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Military Medical & Veterans Affairs Forum

June 2012 Volume 16 • Issue 4

Cover / Q&A

Features Robotic Pharmacy Automation When robotic automation first came on the military pharmacy scene in the 1990s, it offered military medical centers a once-unattainable level of accuracy, security and workflow streamlining. As its use has increased, these once relatively limited machines have evolved from secure pill counting and dispensing machines into product suites providing advanced logistics as well as patient-care centered capabilities that improve both patient outcomes and workplace efficiency.

By Christian Bourge

6

Medical Technologists Medical technologists play a crucial role the control of infectious diseases. For example, it was an astute medical technologist deployed in Afghanistan who noticed that a pattern of drug resistance might be an indication that the isolates she was dealing with could contain special mechanisms for antibiotic resistance.

By Colonel Emil Lesho

9 Integrating Data to Better Serve Veterans Virtual Lifetime Electronics Records (VLER) is one of 16 major projects at the Department of Veterans Affairs. VLER is not an information technology project but poses important IT challenges, including integrating many kinds of data from inside VA and other federal agencies as well as from organizations outside of the federal government.

By Henry Canaday

12

17 Dr. Jonathan Woodson, M.D. Assistant Secretary of Defense for Health Affairs Director TRICARE Management Activity

Departments 2 Editor’s Perspective

Medical Informatics Yellow Ribbon School Directory

22

A complete directory of schools with medical informatics programs that participate in the Department of Veterans Affairs Yellow Ribbon Program.

3 MC4 4 Program Notes, People 14 Vital Signs 27 Resource Center

Search and Rescue Search and rescue is paramount to getting a wounded warfighter or stranded hiker to treatment facilities, whether on the front line or stateside. Industry is doing what it can to provide the military with the most up-to-date solutions and technologies to minimize casualties.

By Erin Flynn Jay

Industry Interview

24 28 Kelley Harar Chief Operating Officer TRICARE Overseas Program International SOS Assistance Inc.

Military Medical & Veterans Affairs Forum Volume 16, Issue 4 • June 2012

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EDITOR’S PERSPECTIVE The Department of Veterans Affairs’ $12 billion solicitation for information technology services under its Transformation Twenty-One Total Technology (T4) acquisition vehicle is well underway. The VA Technology Acquisition Center said the goal of the solicitation is to acquire information technology (IT) and telecommunications services for program management and strategy planning, systems/software engineering, enterprise network, cybersecurity, operation and maintenance, and IT facility support.

“The T4 program has been used to execute service requirements in support of such VA IT modernization efforts as the Veterans Relationship Management program, Veterans Benefit Management System and the Integrated Brian O’Shea Electronic Health Record,” said Wendy McCutcheon, associate executive director, Editor Department of Veterans Affairs, Office of Acquisition Operations, Technology Acquisition Center.

Presently, there are six service-disabled veteran-owned small businesses (SDVOSBs) that are prime contractors on T4. When appropriate, task orders will/are being set aside for SDVOSBs, added McCutcheon.

VA is doing what it can to engage industry to be involved with the T4 contract vehicle. In an effort to be open with industry, VA will hold an Advanced Planning Briefing to Industry (APBI) . The purpose of the APBI is to brief industry on the acquisition opportunities from the Office of Information and Technology. Other topics that may be of interest to industry will likely be covered as well.

When all companies have been selected for this contract, they will compete for task orders to integrate VA systems, network and software to modernize the VA’s information technology infrastructure.

“T4 is a major tool in the transformation of VA into a 21st-century organization,” VA Secretary Eric K. Shinseki said in a previously released statement. “These contracts will enable VA to acquire services for information technology programs that will help ensure timely delivery of health care and benefits to our veterans.”

While this may be a great opportunity for companies to get a piece of the $12 billion pie, there have been protests and complaints filed to the Government Accountability Office over how applications have been reviewed that may cause some delays in awarding contracts. With such a high dollar amount on the line, I can’t really blame companies for trying everything they can to be included as a prime vendor.

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Medical Communications For Combat Casualty Care A Favorable Future for EMRs in Uncertain Times

Col. Daniel V. Chapa Jr. Col. Daniel V. Chapa Jr., the director of the Medical Capabilities Integration Center (MCIC) at the Army Medical Department (AMEDDC&S), has firsthand knowledge of just how much work goes into integrating equipment and systems into the Army’s architecture. The AMEDD is responsible for developing and integrating concepts for the Army’s medical requirements into Army formations that can provide health service support on the current and next battlefield.

Q: What are your impressions of telemedicine and teleconsultation in particular?

A: Telemedicine will provide a tremendous capability and fill gaps in the delivery of health care on the battlefield. It actually helps us connect the medical capabilities that the Army Medical Department has in the generating force to support the operational force. It’s important to be able to provide that level of expertise when and where we need it on the battlefield to ensure that initial stabilization and the follow on care make for the desired medical outcomes. The ability to screen soldiers and provide early identification for potential brain injuries or concussive events in the future will help us to provide continuity of care for those who are injured and provide better patient outcomes.

Q: How have medical logisticians been able to help providers meet certain needs?

A: We have a highly trained professional staff of medical logisticians who are dedicated to the AMEDD for one reason, and that is to support the mission of the surgeon general of the Army to reduce mortality and morbidity on the battlefield and to provide world www.M2VA-kmi.com

class health care in garrison and across the full range of military operations. Our medical logisticians in the AMEDD stay focused on ensuring that we have the right medical products, the right medical equipment and the right technology to put into the hands of the clinical staff.

Our medical logisticians are very savvy managers and they’re very adept at being able to survey the industry to see what is available for the requirement that is developed by the combat developer. It is up to the logisticians to figure out how they meet that requirement in the best way so that the clinicians we have in the AMEDD have what they need to save lives on the battlefield.

When the need arose in Afghanistan to put CT scanners in combat support hospitals [CSHs], we had to determine if a scanner with a high degree of fidelity at 32 slices with a high price tag was needed or decide if a 16-slice CT scanner that cost about half as much could work just as well. After the decision by our clinicians determined that the 16-slice CT scanner would do everything we needed, our medical logisticians developed the acquisition and sustainment plan that enabled us to field more equipment to more CSHs. Q: Budget discussions on Capitol Hill will have an impact on the future of the force.

How is this going to affect the integration of medical capabilities and ultimately programs like Medical Communications for Combat Casualty Care [MC4]?

A: We’ve already started taking some steps in that direction, as has the total Army. Our job is to try to manage risk the best we can to ensure we have the capabilities we need to support the warfighter across the 24 types of medical units that the MCIC manages, and to provide support to the other Army war fighting functional leads so that we can help them to optimize the medical capability that is organic to their formations.

We have to make sure that the soldiers in those formations are equipped and trained appropriately before going into combat.

They all need an IM/IT system to allow them

to communicate, interoperate throughout the Military Health System, and to capture the treatment that was provided to soldiers.

We’ve been given a mandate by Congress to ensure we’re managing an EMR for every soldier and capturing data beginning with point of injury through the military health system. The only way we can do that is to have a good system in place and we think that MC4 will allow us to meet the requirements that the Army has to capture that information.

We have learned a lot in the past 10 years, and we realize as the Army downsizes, we have to be really smart about how to advance and apply technology enablers where we can.

We see MC4 and the associated applications we are developing as a way to enable a medical capability to be provided to support the delivery of health service support far forward on the battlefield without having to invest in additional force structure to do it.

Q: What’s the future of the medical combat force in terms of operational force?

A: We know we are going to be a smaller force, and we have had one eye focused on the new concept development and design work to restructure our medical units, and our other eye has been focused on leveraging available technology and modernizing our equipment so that in the future we will have a flexible force but a very capable medical force.

One of the things that we will have to look at in the future is where to apply MC4 technologies as we define what it means to build medical partnership capacity and where we may need this capacity across unified operations and as the Army engages in decisive actions. In the future, we’ll be smaller, more deployable and flexible, but most importantly we will continue the hard work to ensure that we have a very capable force in the Army that will be able to save the lives of our soldiers on the next battlefield. O

www.mc4.army.mil.

M2VA 16.4 | 3

Program Notes U.S. Air Force Medical Advisory Services Contract Awarded Air Force Medical Service selected Lockheed Martin to compete for future task orders on its new Consultant Advisory and Technical Services (CATS) contract. Thirteen other companies were also selected to compete for tasks through CATS. The five-year indefinite delivery/indefinite quantity contract will support the Air Force Medical Service in its efforts to provide trusted care anywhere by delivering studies, analyses and evaluations, engineering and technical services, and management and professional support services on a competitive task order basis.

“Efficiency in health care leads to lower costs and better results for patients,” said June Shrewsbury, vice president of technical services within Lockheed Martin’s Global Training and Logistics business unit. “Our technical expertise will support the Air Force Medical Service in its strategy and delivery of essential health care to military personnel.”

Lockheed Martin’s expertise in health services includes its recent award to stand up a new research replacement laboratory for the U.S. Army Institute of Infectious Diseases at Fort Detrick, Md., and the outfitting and transition activities for the recently completed San Antonio Military Medical Center.

The company also provided the initial outfitting and transition work on the U.S. Army Medical Command’s newly established Medical Education Training Campus (METC) at Joint Base Sam Houston in San Antonio. The METC is the world’s largest enlisted military medical training campus, providing a common training ground for the U.S. Army, Air Force, Navy and Coast Guard.

The CATS initiative has a potential ceiling value of $985 million.

PEOPLE Army Brigadier General Joseph Caravalho Jr. has been nominated for appointment to the rank of major general.

Caravalho is currently serving as commanding general, Northern Regional Medical Command, Fort Belvoir, Va. Air Force Major General Thomas W. Travis has

4 | M2VA 16.4

been nominated for appointment to the rank of lieutenant general and for assignment as surgeon general of the Air Force, Headquarters U.S. Air Force, Pentagon, Washington, D.C. Travis is currently serving as deputy surgeon general, Office of the Surgeon General, Headquarters U.S. Air Force, Pentagon, Washington, D.C.

Compiled by KMI Media Group staff

VA Continues PTSD Outreach with AboutFace Campaign In observance of June as PTSD Awareness Month, the Department of Veterans Affairs National Center for Post-Traumatic Stress Disorder (PTSD) began an online initiative, AboutFace, focused on helping veterans recognize PTSD symptoms and motivating them to seek treatment.

“We must do all we can to help veterans identify possible indicators that they may be suffering from PTSD,” said Secretary of Veterans Affairs Eric K. Shinseki. “It requires a comprehensive, multi-faceted approach to be effective.

We hope that this initiative, while just one aspect of our program, will play an important role in that effort.”

The AboutFace campaign introduces viewers to veterans from all eras who have experienced PTSD and turned their lives around with treatment. Through personal videos, viewers will meet veterans and hear how PTSD has affected them and their loved ones. Visitors will also learn the steps to take to gain control of their lives.

AboutFace, which is PTSD-specific, was designed as a complementary campaign to VA’s current Make the Connection (www.maketheconnection. net) campaign. Make the Connection uses personal testimonials to illustrate true stories of veterans who faced life events, experiences, physical ailments or psychological symptoms; reached out for support; and found ways to overcome their challenges.

“VA is committed to ensuring the men and women who bravely served our nation can access the resources and services tailored for them that can lead to a more fulfilling life,” said Dr. Robert Petzel, VA’s under secretary for health. “We want veterans to recognize themselves in these stories and to feel optimistic that they can overcome their challenges with proper treatment. We set aside this month of June to urge everyone to increase awareness of

PTSD so those in need can get effective treatment that will enable them to lead productive, fulfilling and enjoyable lives.”

AboutFace launched in June to help bring attention to PTSD Awareness Month. It is located on the National Center for PTSD website, www.ptsd. va.gov. There, viewers will watch as veterans candidly describe how they knew they had PTSD; how PTSD affected the people they love; why they didn’t get help right away; what finally caused them to seek treatment; what treatment is like; and how treatment helps.

VA provides effective PTSD treatment and conducts extensive research on PTSD, including prevention. Those interested in further information can go to the website to find educational materials including courses for providers on the best practices in PTSD treatment and the award-winning VA/DoD PTSD Coach Mobile App for electronic devices, which provides symptom management strategies.

These campaigns are part of VA’s overall mental health program. Last year, VA provided quality, specialty mental health services to 1.3 million veterans. Since 2009, VA has increased the mental health care budget by 39 percent. Since 2007, VA has seen a 35 percent increase in the number of veterans receiving mental health services, and a 41 percent increase in mental health staff.

In April, as part of an ongoing review of mental health operations, Secretary Shinseki announced VA would add approximately 1,600 mental health clinicians as well as nearly 300 support staff to its existing workforce of 20,590 to help meet the increased demand for mental health services. The additional staff would include nurses, psychiatrists, psychologists and social workers.

www.M2VA-kmi.com

$543 Million Contract Awarded for Real-Time Location System The Department of Veterans Affairs recently awarded HP Enterprise Services a contract worth as much as $543 million to develop and install a real-time location system (RTLS) in all its medical facilities and mailorder pharmacies. The system will be able to track supplies and equipment within 3 feet.

When it released the RTLS procurement on January 6, department officials estimated that each of its 152 hospitals would require 80,000 RTLS tags and each of its seven mailorder pharmacies would use 3,000 tags.

VA said it wanted the winning vendor to use triangulated signals from multiple Wi-Fi access points installed in hospitals to track supplies and equipment identified by RTLS tags. The system is augmented by ultrasound or infrared technology to locate individual items within an even narrower range, such as a bin located on a shelf or in a cabinet.

Department officials also want to develop

Electronic Health Record Milestone Secretary Leon E. Panetta and Secretary Eric K. Shinseki recently announced a milestone in the Integrated Electronic Health Record (iEHR) effort.

In 2014, initial capabilities of iEHR will be rolled out at two test sites: San Antonio and Hampton Roads, Va., where DoD and VA provide medical care to thousands of servicemembers and veterans. The secretaries are also reaffirming 2017 as the target date for iEHR to replace the two departments’ separate legacy electronic health records systems.

In the three years since President Obama announced the Virtual Lifetime Electronic Record initiative, a groundbreaking vision for the future of electronic health data sharing, the DoD and VA have taken important steps to expand information sharing and eliminate gaps between health and administrative systems.

www.M2VA-kmi.com

a national data repository to track medical supplies and equipment at the local, regional and national levels.

In September 2011, HP Enterprise Services won a $10.4 million contract to install RTLS in one VA medical facility in Ann Arbor, Mich.

VA plans to use the system primarily to manage inventory, but Chief Information Officer Roger Baker also views RTLS as a way to solve a critical patient safety problem: the use of unsterilized medical equipment.

The department’s inspector general reported in June 2009 that VA hospitals in Georgia and Florida failed to properly sterilize endoscopes used for colonoscopies before reusing them. Baker told reporters in November 2011 that RTLS tags on medical equipment would prevent its reuse before sterilization.

RTLS also will enable staff to monitor temperatures in refrigerated areas that store

pharmaceuticals, tissues, organs, blood, food and other items. VA eventually plans to use RTLS to track patients and staff, although staff tracking strongly opposed by VA unions.

The contract calls for HP to provide VA with tags, handheld and fixed readers, and software that can display the location of tagged items in the mammoth national data repository.

HP will use the department’s existing Wi-Fi systems, but as of May, 111 VA hospitals lacked the type of advanced Wi-Fi systems needed to support RTLS. VA awarded Harris Corp. a $19.4 million task order in March to install advanced Wi-Fi in 26 hospitals, and the department is working on a strategy to equip the remaining 85 hospitals.

The Navy Bureau of Medicine kicked off a procurement last Thursday to track 300,000 pieces of medical equipment at 19 hospitals and hundreds of clinics worldwide.

Coalition Nations Sign International “Interfly” Proclamation of Understanding Lieutenant General (Dr.) Charles B. Green, U.S. Air Force Surgeon General, along with the surgeons general of Australia, Canada and Great Britain, signed an international “Interfly” proclamation of understanding on May 14 during the Aerospace Medical Association Conference in Atlanta.

The Interfly proclamation is intended to promote and support mutual cooperation and interoperability of the aeromedical evacuation (AE) assets between nations. It conveys the desire to promote agreements and arrangements that provide for compatible training, equipment and procedures so that AE teams from these nations

may support each other on the same aircraft where operational circumstances require this.

“They train alike, they understand the same critical care aspects, they understand aeromedical evacuation aspects,” said Green. “This will facilitate future training exercises and will serve all of our nations well.”

Although there has been an informal agreement since 2009 to clear medical equipment on each other’s similar aircraft, the formal proclamation will allow the nations’ medical teams to utilize aircraft and work alongside each other for the years to come.

“When you have a team that is trained, well equipped

and meets the standards, they should be able to board an aircraft quickly to move critical patients because we do it so well together,” said Green.

“This is a great move forward in our joint partnership.”

The other countries’ surgeons general representatives were Air Commodore Tracy Smart, royal Australian Air Force director general Air Force health services; Commodore Hans Jung, Canadian forces surgeon general; and Air Vice Marshal Aroop Mozumder, Royal Air Force director general medical services chief of staff.

Article by Jon Stock, Air Force Surgeon General Public Affairs

M2VA 16.4 | 5

Improving military medicine.

When robotic automation first came on the military pharmacy scene in the 1990s, it offered military medical centers a once unattainable level of accuracy, security and workflow streamlining. As its use has increased, these once relatively limited machines have evolved from secure pill counting and dispensing machines into product suites providing advanced logistics as well as patient-care centered capabilities that improve both patient outcomes and workplace efficiency.

Lieutenant Colonel Keith Wagner, PharmD, RPha, U.S. Army Pharmacy Informatics advisor based at Fort Gordon, Ga., and other members of DoD’s Pharmacy Information Technology Advisory Committee (PITAC) said in a joint interview that the Army was an early adopter and integrating the systems driving this pharmacy revolution come with significant challenges. Nevertheless, such automation has become an integral component of the warrior and military family patient care continuum.

“Automation plays a key factor in ensuring patient safety,” said Wagner, adding that it’s being used by the Army across the pharmacy spectrum from primary clinics located outside installations and retail pharmacies to major Army hospitals. “In the pharmacy community this is very well received and it’s going to continue to grow in terms of both inpatient and outpatient [care].”

Mike Coughlin, president and CEO of ScriptPro LLC, which was started in 1994 with the specific purpose of bringing robotics to pharmacies, said automation has brought about a revolution in pharmacist workflow, allowing for less time labeling and dispensing prescriptions and more time working with patients.

6 | M2VA 16.4

By Christian Bourge M2VA Correspondent

“They can interact with the patients [more] and help them achieve the proper outcome,” said Coughlin. “The proper outcome is so fundamental.”

He noted that while an Air Force pharmacy was one of the first purchasers of the company’s initial robotic prescription dispensing system launched in 1997, overall U.S. military interest was limited with demand not picking up until about five years ago. Its products are now in about 120 Navy sites alone. In the ensuing years, the firm has expanded its line into a varied range of pharmacist-centric products, incorporating a computer-generated labeling system in the later 1990s followed by patient script organization systems, workflow controls and other improvements.

Today, the company’s Windows-based products incorporate propriety applications and robotics ranging from its various robotic prescription dispensing systems models to electronic prescription management SP Central Pharmacy Management System. They also produce the patient service kiosk incorporating Pharmacy Services Portal and its SP Central Workflow System, which tracks processing of all prescriptions providing for insurance reporting, inventory management, and ordering with the SP Inventory Management application, as well as proper patient dispensing.

“That [first] system has evolved. It started with robotics, evolved into workflow and [then] evolved into a whole range of products, many of them suggested by the military along the way,” he said. “We have had the pleasure to know excellent pharmacists in the military that have sat down with us and told us what the www.M2VA-kmi.com

challenges are. Part of the evolution of this is that we have listened to the pharmacist in DoD.” Dave Swenson, vice president of marketing and product management for Dispensing Technologies at CareFusion Corporation, said that the company has expanded beyond their flagship Pyxis MedStation System product—a sort of “ATM” for medications that helps decentralize patient medication management by interacting with hospital information systems and thus allowing a care provider to access medication based on a patient’s individual medication orders—as just one part of a broader suite of logistics-centered products.

He noted that CareFusion, whose equipment is used at miliary medical sites throughout the United States and world, has responded to federal market need to deal with the efficiency risks by introducing technology aimed at the “entire spectrum of medicine distribution, from the loading dock to the patient bedside” and automation of non-medicinal hospital purchasing.

For instance, the company’s automated Pharmogistics Inventory Management Software can manage medication ordering not only for individual hospitals but also between hospitals, allowing for the splitting of orders. This is something Swenson positioned as quite important in terms of meeting supply needs for widely used medications that can be shared between facilities based on demonstrated need.

“Ten years ago there were only about 10 major drug shortages a year,” said Swenson. “Last year there were over 240 really severe ones. This sent hospitals scrambling.” Other products www.M2VA-kmi.com

under CareFusion’s Pyxis brand include systems that monitor the use and distribution of high-risk implantable medical devices using the Procedure Station and Supply Station, which utilize patient codes to do everything from automatically place use, lot and expiration information as well as charges on their records reordering items as needed. The line also includes the Pyxis Ecostation System, an automated waste management system, which provides a means to minimize the higher costs associated with medical versus municipal waste.

Such advances in pharmacy automation offer challenges to both the military customer and industry provider in a number of ways. Henry Gibbs, director, DoD Pharmacy Informatics, Pharmaceutical Operations Directorate, TRICARE Management Activity, explained that the tri-service panel was established with the objective of evaluating gaps and overlaps in current pharmacy information technology programs across the U.S. military while minimizing redundancies. It also provides strategic advice for integrating pharmacy automation into DoD information technology practices.

For instance, one effort underway is to track and predict workflow needs in the face of demand for five to 10 years out, or even further. Another part of their challenge is ensuring compliance with the high-level military needs.

M2VA 16.4 | 7

“We do have very stringent security requirements,” Gibbs told M2VA. “Trying to guide the commercial vendors through that process, especially if they are new to the process, does have some challenges and takes time. We understand this is one of the barriers that does make it a little bit more difficult to those commercial vendors that may not have been exposed to the DoD security regime.”

Wendy Smith, corporate sales director, corporate and international for Omnicell Inc., agreed that DoD cybersecurity requirements remain one of the major challenges for pharmacy automation manufacturers. Her firm has been working with the U.S. military for the last decade, with its systems currently installed or pending within eight Navy, two Air Force and 10 Army hospitals.

“They have a plethora of cybersecurity access requirements that differ from commercial,” said Smith, adding that, “understanding their budget practice management is [also] a challenge on a good day.”

Smith said that the firm currently supplies a medication automation cabinet and supply cabinet in these facilities they serve. They’ve also developed local medication management systems that use barcode tracking to ensure security and prescription management to that last couple of hundred feet for nurse administration.

The company’s Windows 7-based G4 systems—a relatively new platform for medication, narcotic and supply dispensing that incorporates medication error, narcotics control and workflow time reducing capabilities—is also bringing virtual servers to the fold.

According to the DoD PITAC officials interviewed, this prospect raises further security issues, both physical and IT-based, whether dealing with the inpatient and outpatient focus of the Army or the more outpatient-focused Air Force implementation.

Lieutenant Colonel Mark Lamb, USAF, BSC, Pharmacy Informatics, Air Force Medical Support Agency, acknowledged the hurdle that security poses for vendors, noting the special restrictions DoD places on how cloud computing can be implemented.

“Generally, DoD doesn’t want to send its information out to a civilian provider,” said Lamb.

The Army’s Wagner also noted there are physical facility standards that must be met, including specific heating and HVAC issues.

“One of the problems is we’re not allowed to mingle in a cloud computer environment,” continued Lamb. “DoD is coming up with a way to deal with that but it has to be done in a DoD data center or from a DoD-approved computing center.”

Moving forward, the group has the goal of bringing into use a broad template for deploying pharmacy systems across military health care facilities. This would allow for similar setups to exist between facilities and for military pharmacists to easily adapt to systems in place wherever they are deployed.

8 | M2VA 16.4

“The big challenge now is to convey the universal vision across all facilities,” he said.

Another key issue for the U.S. military is remote telepharmacy. Although telepharmacy checking is already in use to some extent—ScriptPro holds a contract for the Navy’s worldwide telepharmacy program and the Army is currently piloting such a program—wider deployment remains the ideal. It’s something Lamb said the Air Force is also very interested in.

“The concept I have is a many-to-one situation where several pharmacists anywhere in the country can log in to one service tracking prescriptions for multiple DoD pharmacies throughout the globe,” said Lamb. “I think the current technology that is commercially available is more of a one-to-one relationship. I know some companies are working on the one-to-many idea. That is one of the key things we are looking forward to.”

Wagner also posited that in maybe a decade, military facilities will be able to verify prescriptions remotely using a universal DoD record system, including a consolidated platform for inpatient and outpatients integrated with VA records, a standard that both agencies have long sought to deploy. This would reduce the complications related to tracking prescription care of the consistently redeployed or retired.

But all this current innovation and potential development is overshadowed by the impossible-to-ignore pending DoD budgetary cutbacks, which hold unknowable impacts on the bottom line.

“We don’t have specific information about how that will affect the hospitals, but I think that will definitely have an effect,” said Omnicell’s Smith.

These concerns are on top of the ongoing security, budgetary limits and deployment realities related to lengthy acquisition processes, which already serve to inhibit the further growth of pharmacy automation in the DoD sphere.

“The issue that we run into with automation really is how fast we can get the stuff into place,” said Lamb. “There is some great technology out there that we look at and we go, ‘We’d love to implement it, but it will take me too long to get through the security requirements.’ We have to concentrate on the big [items] right now, not the nice-to-have.

Some of the nice-to-have, we know we can’t buy because of the security requirements. That is the problem we run into in the pharmacy systems.” O

For more information, contact M2VA Editor Brian O’Shea at briano@kmimediagroup.com or search our online archives for related stories at www.m2va-kmi.com.

www.M2VA-kmi.com

The momentum behind the microbe.

By Colonel Emil Lesho

health care policy. Currently, 14 hospitals submit an average 400 Medical technologists play a crucial role in the control of isolates per month to the network. Isolates have been received infectious diseases. For example, it was an astute medical techfrom civilian and military facilities around the world, including nologist deployed in Afghanistan who noticed that a pattern of Alaska, Afghanistan, Europe, Haiti, Hawaii, Iraq, the Republic of drug resistance might be an indication that the isolates she was Georgia, Thailand and the continental U.S. dealing with could contain special mechanisms for The success of the MRSN depends upon antibiotic resistance. She alerted another medihighly trained, versatile and dedicated medical cal technologist who was working at a referral technologists. Our lead medical technologist, Yoon laboratory in the United States, who then had the I. Kwak, has one of the most demanding and isolates shipped to the Multidrug-resistant organcritical positions in the MRSN. To achieve optimum ism Repository and Surveillance Network (MRSN) workflow, she must coordinate and balance the to undergo special testing. This interaction was demands of the directors and clinicians, the needs the beginning of what resulted in the first report of the scientists and microbiologists, and the of the ‘super-bug’ gene New Delhi metallo-betaindividual availability and capabilities of each of lactamase-1 (NDM) in the Military Health System. the other medical technologists. She must also Furthermore, this was the first report of this gene Col. Emil Lesho ensure all quality control and quality assurance in Afghanistan, and the first report of this gene in protocols are executed. As the human interface a new species—Providencia stuartii. between those three major groups of workers at the MRSN, she The MRSN collects and characterizes multidrug-resistant must oversee and integrate specimen receiving and processing, organisms to inform infection control, clinical practice and www.M2VA-kmi.com

M2VA 16.4 | 9

organism identification and susceptibility testing, and the archiving of specimens and data, in addition to maintaining stocks of reagents and consumables.

The MRSN utilizes all three of the most widely-used commercial automated susceptibility testing systems, so Kwak and the other technologists must be proficient and able to train new team members on all of them. Kwak is also capable of performing the other major tests the MRSN uses to characterize isolates, including microbroth dilution, optical genome mapping, pulsed-field gel electrophoresis (PFGE) and next-generation sequencing. Furthermore, she must collate and integrate the results of all of those tests in the database for analysis by scientists and epidemiologists.

Specialist Romanza Green, Specialist Reyes Quintero and Specialist Deshon Smith are active duty Army medical technologists with the P9 skill identifier, which means they have additional specialized training and skills in biomedical research. They assist in the collection of isolates from outlying facilities, in the screening of 100 isolates per month from environmental surveillance using real-time PCR, and with the preparation and maintenance of material safety data sheets and chemical inventories.

Melissa Mills and Alan Mueller, both Army veterans, have translated the medical technology skill sets and clinical background they acquired during their military service to become much sought-after talent. The MRSN is fortunate to have Mills’ vast experience in characterizing a diverse array of environmental and clinical isolates, including those from health care surfaces and military working dogs. Mueller’s former experience in working with dangerous pathogens in BSL-3 environment renders him the ideal safety and regulations official for the MRSN. Together

with Major Cyruss Tsurgeon, a clinical laboratory officer of the 71E series, they lead the MRSN efforts towards obtaining CAPCLIA certification.

Eric Steele, Ligia Flores, Janice Rivera, Lan Preston, Michael Milillo and Eve Hosford round out the team of medical technologists with specialized skills and talent at the MRSN. Together with the previously mentioned technologists, they are responsible for characterizing and archiving an average of 500 isolates each month. Their jobs require tremendous vigilance and attention to detail. Small or seemingly insignificant typographical errors can lead to non-retrievable data or incorrect analyses and conclusions based on erroneous results or data. In the short time Preston has been with the MRSN, she has halved the space required to perform PFGE on each isolate. As a result, costs are reduced and throughput is effectively doubled. Medical technologists at the MRSN played key roles in reducing costs and increasing speed of optical genome mapping.

Hosford, Milillo and Quintero also travel to several hospitals collecting isolates from the clinical laboratories and processing a burgeoning array of environmental samples. A complete survey of just one hospital room generates 34 separate samples from 17 surfaces. They are our “sword to plowshare” medical technologists, using a unique combination of handheld devices and PDAs (originally developed for determining whether facilities are free of anthrax spores following an attack) to perform hospital surveillance for nosocomial pathogens.

The lifesaving and infection preventing impact the MRSN has recently accomplished would not have been possible without the talent, vigilance and dedication of the medical technologists.

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MRSN Laboratory Technologists Rivera, Green and Hosford using an automated antibiotic susceptibility analyzer. [Photo courtesy of MRSN, WRAIR] 2

Ms. Ligia Flores preparing bacterial isolates in the specimen receiving and processing laboratory for characterization and archiving. [Photo courtesy of MRSN, WRAIR] 3

Lan Preston performing pulsed filed gel electrophoresis on bacterial isolates. [Photo courtesy of MRSN, WRAIR] 4

MRSN Laboratory Technologist Milillo prepares isolates for real-time PCR and sequencing.

[Photo courtesy of MRSN, WRAIR] 5

MRSN laboratory technologists in the organism identification laboratory. [Photo courtesy of MRSN, WRAIR]

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www.M2VA-kmi.com

Medical technologists provide the momentum behind characterizing and understanding the microbe and its role in infectious diseases at the MRSN and in the Military Health System. O

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Colonel Emil Lesho is director of the MRSN, WRAIR. For more information, contact M2VA Editor Brian O’Shea at briano@kmimediagroup.com or search our online archives for related stories at www.m2va-kmi.com.

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Overcoming information technology challenges.

By Henry Canaday M2VA Correspondent

Virtual Lifetime Electronics Records (VLER) is one of 16 major projects at the Department of Veterans Affairs, according to the project’s executive director, Joseph Paiva. VLER is not an information technology project, but poses important IT challenges, including integrating many kinds of data from inside VA and other federal agencies as well as from public and private organizations outside of the federal government.

“VLER is multi-faceted,” Paiva explained.

“The technology challenge is not easy, but much tougher is the cultural and business challenge.”

Traditionally, veterans entered the VA system only after discharge. That is unrealistic in a world in which small conflicts are continual and National Guard and reserve units are activated, deployed, deactivated and go through the whole cycle again, possibly several times.

So VA is establishing a relationship with servicemen and women as soon as they sign up. “You are immediately eligible for life insurance,” Paiva said. “So we want to engage you, give you a portal and have an online account of your benefits, eBenefits.”

Thoroughness as well as promptness is part of the new approach. “We want to treat 12 | M2VA 16.4

you as a whole person,” Paiva emphasized.

That means incorporating data from agencies such as the Departments of Defense and Labor, the Small Business Administration and the Social Security Administration.

When a servicemember is discharged, VLER trains and helps transition the veteran to civilian life. “We want a seamless transition—we do not want people to fall through cracks,” Paiva said.

Business objectives come first and culture presents formidable challenges, but integration of data systems is a major effort. Paiva, once chief information officer for several private firms, said traditional methods of data integration were problematic in two ways.

“First, we had point-to-point connections between different systems,” Paiva explained. “That led to 10-by-10 crosswalk diagrams.”

The other drawback was that each agency, when it obtained data from an outside system, stored data in its own system.

“For example, when they got a phone number, they stored it,” Paiva said. “But some systems were updated and others were not.

So you did not have a single version of the truth.”

System integration for VLER is handled differently. Instead of point-to-point connections, it uses light web-based services to exchange data. And VLER stores each type of data in one place designated for this type. “Everyone will get this data from this source so we will have one version of the truth.”

Forcing better integration has not been easy. “I have to corral them,” Paiva said. “I am not the most popular person at IT cocktail parties. I have to tell some people no.”

Paiva compares reliance on a single data source for VLER to the different services learning that they could rely on each other for direct air support, rather than having their own air forces. “Information technology needs to get like that. We need to learn trust.”

Potential gains are significant, and Paiva gives several examples. Suppose a soldier is hurt in North Africa, treated on an aircraft carrier and then returned to duty. Instead of assembling paper records of this experience, the veteran logs on to his or her eBenefits portal, which has digital records that the veteran served in North Africa, sustained an injury and the injury was a result of duty. www.M2VA-kmi.com

VLER can even send an alarm to the veteran upon discharge that he may be eligible for benefits. “He will find an application form, partially filled out with information from the Defense Department,” Paiva explained. “Then he just confirms and digitally signs it.”

Other advantages are in the future.

A discharged soldier might get in a barroom brawl. Ordinarily the judge has two choices: leniency or a stiff sentence.

“We envision having connections to veterans courts,” Paiva explained. “So we would know if a veteran is in trouble and that he had been a good soldier, never in trouble before. We can contact him for counseling on drug abuse or other problems. We would like to have real-time information-sharing with veterans courts and homeless shelters.”

That is an ambitious vision, but VLER has already made substantial progress. In 13 states, 45,000 veterans are using it to share health records with private physicians. Nearly 1.5 million veterans and servicemembers use the eBenefits portal to manage their group life insurance, obtain GI Bill certificates of eligibility and access more than 40 other capabilities.

In May, VLER will enable veterans and active duty personnel to share health information with their care coordinators.

The VA will shortly award a contract for collecting electronic data from private providers.

The agency has already implemented Blue Button, providing online self-service downloads for on-demand access to personal health information for 800,000 active users.

Paiva said he has an aggressive plan for expanding VLER for the next five years. “There is huge potential for information sharing.” For example, historical data on locations of servicemembers could be used to track their exposure to special dangers, like the Japanese nuclear meltdown.

So VLER launches a new set of deliverables every six months. Paiva works closely with his partners, not only federal agencies but veteran service organizations, public health services, major health insurers and health information exchanges in states like Virginia and California.

Other important VA initiatives rely on better IT support and connecting data with both veterans and their care www.M2VA-kmi.com

providers. Private firms play an important role in these integration efforts.

Over the past few years, VA has changed IT support for its Veterans Integrated Service Networks (VISNs), medical centers and clinics from a centrally focused model to a regional model, noted Keith Finley, director of sales for Defense Healthcare at Iron Bow Technologies. Iron Bow also adjusted from solely supporting VISNs to supporting the VA from a regional and a national model. Iron Bow continues to support local medical centers and VISNs. Finley said Iron Bow has been especially distinguished for its part in VA’s telehealth initiative. “Many veterans come back home and are isolated in areas where there is not the medical attention that they require.” Using solutions like video conferencing, veterans, medical doctors, therapists and specialists can remotely communicate for specialized care. Iron Bow partners with firms such as GlobalMed, Cisco and several medical-supply companies to develop medical carts for outpatient clinics that link back to the medical centers. These carts provide primary and specialty care with cameras, stethoscopes, ultrasounds and other tools and connect back to the provider directly.

Recently, Iron Bow expanded technical solutions to include help-desk support. “If there is an issue with one of the medical carts, the VA has one point of contact to troubleshoot the issue, instead of trying to work through multiple vendors,” Finley noted.

Finley predicts this service will continue to grow in the future. “We’ve just hit the tip of the iceberg with the VA’s telehealth initiative, despite working with them for years.” Advancing technology driven by mobility and virtualization will continue to spur telehealth growth. New technologies like electronic prescriptions and electronic medical records, plus the ability to connect with patients and specialists through mobile devices and video, provide major opportunities to expand telehealth programs. “We are proud to be involved in this effort.” O

For more information, contact M2VA Editor Brian O’Shea at briano@kmimediagroup.com or search our online archives for related stories at www.m2va-kmi.com.

M2VA 16.4 | 13

VITAL SIGNS Hepatitis C Assay Completes Infectious Disease Test Panel for Blood Banks Siemens Healthcare Diagnostics recently announced the launch of its Enzygnost Anti-HCV 4.0 Assay, a hepatitis C laboratory test with high sensitivity and specificity that completes the company’s integrated infectious disease screening panel for blood banks. Now, blood banks of any size can turn to Siemens as a single-source supplier for all of their Enzygnost low-, mid- and high-volume blood screening testing needs.

Sensitive, specific and efficient infectious disease screening of blood donors ensures the safety of blood products and supports the high quality standards in transfusion medicine. In larger blood banks, where up to 3,500 donations are often analyzed in a typical day, having access to fast, accurate testing solutions is paramount. The sensitivity and specificity of the new Enzygnost Anti-HCV 4.0 assay, which can produce a test result 30 minutes to one hour faster than competing HCV assays in the microtitration plate (MTP) format, helps reduce the number of false-positive results obtained to fewer than one in 1,000 anti-HCV-negative sera. Combined, the assay’s sensitivity and specificity supports several important benefits, including fewer blood donor deferrals, more donations added to the blood supply, fewer costly

reruns and PCR/NAAT testing and earlier treatment options for donors who test positive, improving patient care.

Blood banks gain additional benefits when they run the Enzygnost Anti-HCV 4.0 Assay together with other Siemens Enzygnost screening tests (e.g., HIV, syphilis) on one of a full range of Siemens BEP and Quadriga infectious disease diagnostics systems. Because all Enzygnost assays follow the same procedures and use the same supplementary reagent components (e.g., washing solution, chromogen solution), fewer products are required onboard the analyzer, thereby simplifying system handling and reducing training efforts and the potential for human error. Plus, the Anti-HCV 4.0 Assay kit, like all tests in Siemens’ Enzygnost panel, comes complete with a bar code labeling system, making identification of all MTPs, conjugates, substrates and controls automatic, accurate and easy.

The Enzygnost Anti-HCV 4.0 assay reflects Siemens’ continuing goal of innovation leadership as part of the recently launched Siemens Agenda 2013 program, an initiative to further strengthen the health care sector’s innovative power and competitiveness.

Gian Sachdev; gian.sachdev@siemens.com

Successful Telemedicine Integration Remote Diagnostic Technologies (RDT) announced that in December, it successfully demonstrated a solution for telemedicine that enables continuity of care across all levels of care for the military clinician.

The successful integration of RDT’s Tempus IC Professional (Tempus) vital signs monitoring platform with Sierra Nevada Corporation’s (SNC) transport telemedicine (T2) technology facilitates the thorough and accurate transmission of patient vital signs data, including data contained on the tactical combat casualty card (TCCC). Patient record data and even images collected through the Tempus monitor can be transmitted to locations around the world over secure military communications. This is completed using limited bandwidth and without compromising tactical communications.

This solution combines the Tempus monitor’s airworthy monitoring and telemedicine capabilities with SNC’s powerful T2 computing platforms and networking capability. The demonstrated T2-Tempus system empowers the clinician to focus on patient care while the system automatically collects and transmits critical patient vital signs data to remote locations, e.g., receiving medical treatment facility (MTF) or command and control, over secure military radios. Most importantly, the T2-Tempus system allows for vital signs to be communicated and viewed in real time. Among the other benefits, this means that for lesser trained care providers, guidance can be provided by specialists via voice or data from MTFs or from around the globe.

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Electronic patient information and clinical condition that is captured by the T2-Tempus system can be transmitted from the point of first encounter throughout the continuum of care until arrival at a definitive medical treatment facility. Patient hand-off time is significantly reduced as the complete patient record is transmitted to the facility prior to patient admission, enabling clinical interventions to be prepared for in advance of patient arrival, therefore saving critical time.

Capturing patient data from the point of injury throughout the continuum of care has been one of the greatest difficulties encountered by the U.S. military. Utilizing the T2 technology and RDT’s Tempus IC Professional, this once impossible task can now be achieved.

Improvement of patient outcomes is the ultimate goal and can be realized by providing thorough and accurate patient data in advance of arrival.

As well as providing advanced monitoring capabilities, the small, lightweight and robust Tempus system will in future also enable users to perform advanced clinical functions such as video laryngoscopy and ultrasound FAST examinations.

Tempus IC Professional was selected in November 2011 as the primary monitor in the USSOCOM TCCC CASEVAC set provided by Tribalco. The CASEVAC set combines patient access capabilities, mobility and critical care components supporting U.S. SOF in far forward and austere environments where definitive medical support is not available.

Rachel Hill; rhill@rdtltd.com

www.M2VA-kmi.com

Compiled by KMI Media Group staff

Access to Healthcare Data Dictionary 3M Health Information Systems recently announced it will open access to the 3M Healthcare Data Dictionary (3M HDD) under an agreement with DoD and the VA. The 3M HDD will provide the core technology to enable semantic interoperability for the joint DoD/VA integrated Electronic Health Record (iEHR), making it possible to share medical knowledge and secure patient data between care providers at U.S. military treatment facilities located around the world and VA medical centers. Access to actionable clinical information whenever and wherever care is delivered will enable safer, better coordinated and higher quality care for the country’s 32 million veterans, active servicemembers and their families.

Health care industry stakeholders could also benefit, as the agreement makes the dictionary software and terminology content openly available to hospitals, health systems, physician practices, payers, vendors and public health agencies worldwide.

The 3M HDD has been built by incorporating and linking terms from multiple clinical information systems and standard terminologies, such as LOINC, RxNorm and SNOMED CT. It maps disparate medical terms to give data context and meaning, and is used to standardize data to make it interoperable and computable. Designed to be flexible and extensible, the 3M HDD’s concept-based controlled vocabulary and knowledge base have been continuously expanded and maintained for nearly two decades.

Open access to the dictionary for U.S. health care providers will help accelerate implementation of electronic health records and help health care organizations achieve meaningful use standards established by the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services. The dictionary enables clinical queries and analytics and organizes health care data to support requirements under meaningful use. It provides the foundation for enhancing health care analytics, decision support, and business intelligence.

“We look forward to helping the DoD and VA advance their groundbreaking initiative to deliver a fully integrated electronic health record that spans all health care facilities providing care to military personnel, veterans and their families,” said Jon T. Lindekugel, president, 3M Health Information Systems. “With open access to the 3M HDD, VA and DoD health care providers will have an unprecedented opportunity to innovate, collaborate and deliver value to their organizations and to their patients.”

“This agreement will accelerate EHR adoption across the industry and help achieve a common language for health care,” said Hon Pak, M.D., chief executive officer, Diversinet and former chief information officer, U.S. Army Medical Department.

“We’ll be able to access meaningful data, analyze it and deliver it back to clinicians to help them make better decisions for their patients. The HDD makes this possible in ways no other product or service can.”

All major health care standard terminologies are mapped into the 3M HDD, including SNOMED CT, LOINC, RxNorm, ICD-9, and ICD-10. Pending approval from international standards development organizations, these standards will be included with the open access software for organizations and users who have appropriate authorization. Local terminologies are also mapped into the 3M HDD, allowing health care facilities to continue to collect data with existing information systems and then crosswalk this data to industry standards for semantic interoperability.

“Health care organizations have a growing need to maintain an ever-increasing amount of structured data to comply with meaningful use requirements,” said Lee Min Lau, M.D., Ph.D., chief medical informaticist for 3M Health Information Systems. “To effectively manage, access and use this data, organizations must achieve accurate and consistent terminology use. It’s essential to meeting meaningful use measures today and supporting the data-driven processes that organizations will need tomorrow.” www.M2VA-kmi.com

Upgrades to Video Network Center The U.S. Army Medical Information Technology Center (USAMITC) is currently upgrading and expanding its Video Network Center (VNC) to meet growing requirements.

The USAMITC VNC supports and provides the infrastructure for video teleconferencing throughout the U.S. Army Medical Command (MEDCOM) enterprise network worldwide. The VNC’s bottom line is to provide video teleconferencing support to facilitate the medical needs of patients and warfighters around the globe. This includes video teleconferencing among U.S. Army Office of the Surgeon General staff members, between military treatment facilities (staff members and other health care professionals) and patients, medical consults between patients and providers, etc.

“This upgrade for the VNC is all part of a MEDCOMapproved refresh plan,” said Bruce Andrew, VNC operations manager. First, the audio bridge capacity was doubled and eliminated denial of service to audio participants. Next, a high definition video wall was installed that has increased VNC’s ability to monitor more simultaneous conferences.

Thirdly, next generation multi-conference units were successfully deployed that increased video conference capacity, increased the quality of videoconferencing services provided and supported the expansion of multisite internet protocol (IP) desktop video conferencing.

Part of the modernization was to create and implement a new, more robust video dial plan. “The old dial plan was limited and based on old technology,” said Andrew. “The new dial plan provides for existing customers and allows for future expansion.”

The VNC refresh plan included a tremendous expansion of the audio bridge. “Requests for audio bridging often exceeded capacity,” said Andrew. “Before the upgrade, nearly 900 requests for audio bridging were denied due to lack of resources. Since the upgrade, not a single request for audio bridging has been denied. Everyone in the MEDCOM, worldwide, can currently access USAMITC’s audio bridging services.”

Video teleconferencing (VTC), or telepresence as it’s also called, provides an enormous savings in cost and time, and can help improve health care.

“VTC allows leadership to cut down travel and lodging costs in general for meetings and training, and can specifically provide cost and time savings for ‘tele-health’ consults and evaluations,” said Andrew.

“Previously, a patient or provider would need to travel to conduct those sessions, which may take weeks or months to occur. Desktop IP video capability allows patient/ provider encounters to get scheduled within days of the request.”

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Tempus IC Professional - More Than Just a Monitor TM

TM

The 21st Century Approach to Vital Signs Monitoring

Tempus places the needs of the modern war-fighter at the heart of its design.

With advanced features such as NVG-compatibility and tactical mode, Tempus IC Professional is the smallest, lightest and most rugged dedicated fullyfeatured pre-hospital vital signs monitor available. It also offers a brighter display, longer battery life and glove-friendly touch screen, enabling you to manage settings and display changes easily – no more difficult keyboards or navigation.

Monitoring features include 3 to 12-Lead EKG, SpO2, NIBP (invasive pressure coming*), respiration, ETCO2 and temperature.

Tempus IC Professional has been selected as the primary monitor in the USSOCOM TCCC Casevac set provided by Tribalco.

AWR approved aboard all UH/HH-60 A/L/M, MH-60K and MH-47G Helicopters.

Changing outcomes is achievable by its simple patient record interface that builds from point of injury back to the CSH. Communications and data sharing from device to device of vitals, trends, images and the integrated TCCC card, with other record types (e.g. AF3899L*) pending, complete the picture. All this data can be quickly and easily exported into upstream patient record systems.

Call us now to arrange a demonstration: Tel: +1 757 383 8401 or e-mail: info@rdtltd.com

www.rdtltd.com

TP A 0412 *Not yet 510k cleared Tempus IC Professional and More Than Just a Monitor are trademarks of Remote Diagnostic Technologies Ltd Š Remote Diagnostic Technologies Ltd 2012.

Strategic Adviser

Q& A

Ensuring the Effective Execution of the DoD Health Mission

Jonathan Woodson, M.D. Assistant Secretary of Defense for Health Affairs Director TRICARE Management Activity

Dr. Jonathan Woodson is the Assistant Secretary of Defense for Health Affairs and director, TRICARE Management Activity. In this role, he administers the more than $50 billion Military Health System (MHS) budget and serves as principal adviser to the Secretary of Defense for health issues. The MHS comprises over 133,000 military and civilian doctors, nurses, medical educators, researchers, health care providers, allied health professionals and health administration personnel worldwide, providing our nation with an unequalled integrated health care delivery, and expeditionary medical, educational and research capabilities.

Woodson ensures the effective execution of the Department of Defense medical mission. He oversees the development of medical policies, analyses and recommendations to the Secretary of Defense and the Undersecretary for Personnel and Readiness, and issues guidance to DoD components on medical matters. He also serves as the principal adviser to the Undersecretary for Personnel and Readiness on matters of chemical, biological, radiological and nuclear (CBRN) medical defense programs and deployment matters pertaining to force health.

Woodson co-chairs the Armed Services Biomedical Research Evaluation and Management Committee, which facilitates oversight of DoD biomedical research. In addition, Woodson exercises authority, direction and control over the Uniformed Services University of the Health Sciences; the Armed Forces Radiobiology Research Institute; the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury; the Armed Forces Institute of Pathology; and the Armed Services Blood Program Office.

As director, TRICARE Management Activity, Woodson is responsible for managing all TRICARE health and medical resources, and supervising and administering TRICARE medical and dental programs, which serve more than 9.6 million beneficiaries. He also oversees the TRICARE budget; information technology systems; contracting process; and directs TRICARE regional offices. In addition, he manages the Defense Health Program and the DoD Unified Medical Program as TRICARE director.

Prior to his appointment by President Obama, Woodson served as associate dean for diversity and multicultural affairs and professor of surgery at the Boston University School of Medicine, and senior attending vascular surgeon at Boston Medical Center. Woodson holds the rank of brigadier general in the U.S. Army Reserve, and served www.M2VA-kmi.com

as Assistant Surgeon General for Reserve Affairs, Force Structure and Mobilization in the Office of the Surgeon General, and as deputy commander of the Army Reserve Medical Command.

Woodson is a graduate of the City College of New York and the New York University School of Medicine. He received his postgraduate medical education at the Massachusetts General Hospital, Harvard Medical School, and completed residency training in internal medicine, and general and vascular surgery. He is board certified in internal medicine, general surgery, vascular surgery and critical care surgery. He also holds a master’s degree in strategic studies (concentration in strategic leadership) from the U.S. Army War College.

In 1992, he was awarded a research fellowship at the Association of American Medical Colleges Health Services Research Institute.

He has authored/coauthored a number of publications and book chapters on vascular trauma and outcomes in vascular limb salvage surgery.

His prior military assignments include deployments to Saudi Arabia (Operation Desert Storm), Kosovo, Operation Enduring Freedom and Operation Iraqi Freedom. He has also served as a senior medical officer with the National Disaster Management System, where he responded to the September 11 attack in New York City.

Woodson’s military awards and decorations include the Legion of Merit, the Bronze Star Medal, and the Meritorious Service Medal (with oak leaf cluster).

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In 2007, he was named one of the top vascular surgeons in Boston and in 2008 was listed as one of the top surgeons in the U.S. He is the recipient of the 2009 Gold Humanism in Medicine Award from the Association of American Medical Colleges.

Q: How will global health care change as the conflicts in Iraq and Afghanistan are coming to an end?

A: Clearly, the end to the war in Iraq and the drawdown in Afghanistan is going to reduce the ops tempo—for all of our forces and for the medical community. After 11 years of war, that is a good thing—for our servicemembers and their families.

Our focus on global health challenges, however, is entirely undiminished by the ends to these conflicts. When we say “we’re ready to go, anytime, anywhere,” there is a tremendous amount of behind the scenes work that ensures we can back up that statement. Our readiness training programs continue; we’re monitoring infectious disease threats around the world; we’re engaging with foreign nations through our medical military-to-military and military-to-civilian exercises; and we continue to be ready to respond to natural or man-made disasters.

So, for us, the deployment cycle and the related stressors ratchet down. But our global medical readiness mission doesn’t change one bit.

Q: What are some of the ways the Military Health System [MHS] will improve clinical outcomes and efficiency in health care?

A: Well, to start with, this country should be rightly impressed with our clinical performance and clinical outcomes in the deployed environment. We have the data to show it, too. I’m proud of the discipline we used to collect and analyze our performance. Here’s just a few of those outcomes: the lowest rate of what is called “disease, non-battle injuries” or DNBI ever seen in warfare—a testament to the preventive health and environmental medicine expertise we put into theater; the lowest “died of wounds” rate ever seen—a testament to a combination of exceptional medical expertise, long-term medical R&D investments, improved training, and better, lighter equipment far forward in the battlefield. And we saw a revolution—not just an evolution—in our aeromedical evacuation practices that allowed us to move very ill and injured servicemembers more rapidly than ever before back to Landstuhl or here to the United States.

Still, we always look to improve, and the MHS is one of the great learning organizations in the world. We are always asking ourselves “How do we get better? What did we learn from these past 11 years in how we train, what was missing, where should we invest for the next conflict?”

Back here at home, in our military hospitals and clinics, we know the absolute best approach to improving clinical outcomes is simple to identify, but hard to implement—and that is to prevent the disease from occurring in the first place. And when disease or injury does occur, catch it and treat it quickly. It’s better medicine, and it’s more efficient by a long shot.

That’s why the theme of our annual national gathering of medical leaders this year was “Moving from Health Care to Health.” The MHS is a unique organization in this country—we are better incentivized to keep our people healthy than any employer in the country. It matters for your ability to do your job; the integrity and health of the family is vital to us, and we have responsibility for the lifetime health care costs of 4 million retirees and their families.

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Q: How does the MHS plan to achieve higher levels of quality in care delivery, patient satisfaction and desired functional outcomes over the course of 2012?

A: For the last two years, we’ve invested a lot of our resources in the patient-centered medical home. It’s central to our strategy to improve the health of the population and patient satisfaction.

At our more mature sites—those who instituted the medical home earlier—we are seeing the outcomes we hoped for: greater continuity of care, better access to care, reduced use of emergency rooms and higher patient satisfaction.

Q: What new initiatives is the MHS implementing to create a more resilient military population?

A: We’re looking at and learning a great deal about resiliency at a number of levels—individual, family, organizational and operational resilience.

One of the fundamental facts is that there is no “silver bullet” solution that will create greater resiliency—there’s not a course, or a screening tool, or any other measure that tells us “this servicemember is going to be more resilient.”

But there is a suite of tools that the services have focused on developing to help build resilience in a population. Awareness, training, sustained access to community resources—all of these help build resilience. It’s important to note that the efforts at building resiliency is a militarywide effort, sanctioned and led by the senior line commanders in the military. We must pay particular attention to developing people in all dimensions important to resilience: physical, spiritual, social, emotional, cognitive and behavioral. Building strong personal relationships and enhancing personal values is also important.

Q: What strategic innovations does the MHS have planned to transform health care delivery in local community medical markets?

A: The MHS has a history of introducing innovation that is later adopted by the civilian health care community. I think we are already seeing evidence of that “innovation transfer” in the area of trauma medicine, and in our approach to preventing, diagnosing and treating traumatic brain injuries. For instance, in January, the White House hosted an event with the leadership of almost every medical school in the country where we—the MHS—provided civilian medical schools with our clinical practice guidelines for diagnosing and treating TBI. So, in this sense, the work is already underway.

This year, I have also brought more focus to deepening our culture for innovation across the system. In almost every trip I’ve made in this job, I come across local innovations that really have the potential for being scaled across the enterprise. We’ve got some of the most creative, can-do workforces in the country. I want to tap into that in a more systematic way. Over the next few months, we are going to host a number of small gatherings of subject matter experts in select priorities—how do we recapture care; how do we reduce the rates of obesity and tobacco use; how can we share information more effectively—and then pilot the best ideas that come out of these sessions. We want to make information more usable and distribute it across the enterprise more rapidly. And we’re going to have more input from people in the field than we have from headquarters. www.M2VA-kmi.com

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Q: What steps is the MHS taking to improve the behavioral health support in an operational environment?

A: We’ve done quite a bit already—we’ve embedded our behavioral health specialists with the forward-deployed forces; we are monitoring them in theater. But, the most important steps we can take are before deployment—building resilience; ensuring there is sufficient down-time between deployments; helping ensure the entire family is well. It’s a complex set of activities, and we are also continuing to invest in medical research to ensure what we do is informed by medical evidence. Providing easy access to quality health care is a must. We now assess servicemembers for behavioral issues before and at least four times after deployment. This provides opportunities to assess and treat servicemembers for delayed problems such as post-traumatic stress disorder [PTSD].

Q: What are the primary challenges of coordinating health care of patients wounded in theater to military treatment facilities in the United States?

A: As I mentioned earlier, the movement of patients from the battlefield to home has undergone a revolution. We have put both trained medical personnel and customized technology on our aircraft to safely move the most seriously wounded servicemembers—in some cases, in less than 48 hours from their injury.

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One challenge had been ensuring that the patient’s medical record moved to Landstuhl or our stateside medical systems even faster than the patient. I give a lot of credit to our medical IT experts who figured out how to move data securely and quickly. We even have the ability to ensure the VA can access critical information for those wounded warriors who are likeliest to move to the VA polytrauma centers.

Q: What are the major technological challenges affecting the MHS in 2012?

A: We are coordinating with the VA on a broader scale than ever before, to the great benefit for our patients. We’re also purchasing care from the civilian sector at a greater level than ever before. Our number one challenge, and opportunity to be a true national leader in health information technology, is our collaborative effort to build an integrated electronic health record with the VA. But our solution has to be more than just sharing information between the DoD and VA. We need to build a system that can communicate with private sector systems, so we can share information with our network providers too.

And, we need to do a better job in ensuring that our patients have easy access to their records, that they become more engaged in—and knowledgeable about—their own health.

These are linked initiatives. What makes this exciting is that there is no doubt about the intent and expectations of our leaders. Secretary Panetta, like Secretary Gates before him, has worked closely with Secretary Shinseki to ensure our collaboration with the VA stays on track.

In some respects, our challenges are less technological than they are institutional. We need a new way of doing business—with the patients at the center, not the organizations that serve them.

Q: How is the DoD working with the VA to reduce cost per capita and create a seamless transition of servicemembers’ medical information between the MHS and the VA health system?

A: Job one is the issue I just described. We’re building a health information system together with the VA—it’s going to have positive downstream effects on quality, cost and patient satisfaction. This is a game changer in how these two big bureaucracies work together. We are also working on integrated clinical practice guidelines and longitudinal health outcomes with follow-up studies. We are committed to working with the VA on innovative and collaborative work products.

Q: How will the optimized pharmacy distribution model impact the future of DoD pharmacy?

A: From the enterprise perspective, the optimized distribution model focuses on the MTF and mail order points of service because they represent the lowest cost both to the government and to beneficiaries.

DoD pharmacy strategy has been to focus on maximizing utilization of these two points of service. For example, the comprehensive effort to increase home delivery utilization resulted in a 28 percent increase in prescription volume in March 2012 compared to March 2011. At the same time, retail prescription volume has fallen 13.4 percent since March 2011; historically, retail volume had been growing at a 4.6 percent rate.

The TRICARE Mail Order accepts electronic prescriptions as well as the majority of retail pharmacies—at the end of 2010, 91 percent www.M2VA-kmi.com

of the nation’s community/retail pharmacies were connected to the electronic prescribing network. TMA’s efforts to optimize use of MTF pharmacies include a program to ensure that MTF pharmacies can accept electronic prescriptions from civilian providers. The “ePharmacy Initiative” is a project that focuses on the routing of electronic prescriptions between the civilian commercial infrastructure and the MHS [e.g., Composite Health Care System]. TMA views the application of this concept to the MHS as an effort to allow electronic prescribing from all points of prescription order entry [i.e., both civilian and military treatment facility providers] to all points of dispensing, including MTF, TRICARE Mail Order and retail pharmacies. National trends and provider and beneficiary inquiries demonstrate that the MHS is at risk for a shift in pharmacy utilization from MTF to retail pharmacies if civilian providers are unable to electronically prescribe to MTF pharmacies. TMA is implementing a process to remove the barrier and enable civilian providers to electronically prescribe to MTFs. A recent analysis shows that if 1 percent of the current retail prescription volume—420,000 prescriptions—could be e-prescribed to MTFs, it would be $5.8 million less costly to the MHS. Q: Can you explain some of the benefits of creating accountable care organizations with in the MHS? A: We’ve been an accountable care organization since before someone coined that term! Accountable for the health and readiness of the force; accountable for the health care delivered to almost 10 million Americans, whether they receive that care in a military hospital or from a civilian hospital.

Now, the term is being bandied about to describe certain integrated delivery systems serving geographically-defined areas—the likes of Kaiser, Mayo, Cleveland Clinic, Geisinger, Intermountain Health and others. The Center for Medicare and Medicaid Services is running some very interesting pilot programs to see whether alternative forms of financing health care can produce better outcomes for our patients. I’m completely on board with this effort. It returns the focus to outcomes—how did the patient do? Not a count of how many visits, or admissions or procedures the system did, but whether the system is organized to produce the best result for the patients it serves.

Q: Is there anything else you would like to say that I have not asked?

A: I would just want to say that we, the MHS, have never been an organization at rest. We do extraordinary things, and then we ask ourselves—how can we do better?

I know there hasn’t been a medical organization that experienced a sustained tempo like we have for the past 11 years. And beyond the battlefield miracles, the personal sacrifices of service members and their families, we still kept a peacetime system running well.

We delivered thousands of babies; performed millions of pediatric immunizations; stood up new benefits and programs; built new stateside hospitals; and did a very good job of managing the costs of this incredibly complex system.

Starting in 2013, we have a new set of financial and organizational challenges. We are going to increase our emphasis on joint operations and joint solutions. We’re going to continue to be responsible stewards of the taxpayer dollars, and we are going to be smaller. And we will unceasingly work to be better than we were yesterday. O www.M2VA-kmi.com

M2VA 16.4 | 21

Medical Informatics Yellow Ribbon School Directory

Biomedical informatics encompasses the application of the principles of computer science and information technology to all aspects of biomedical science, clinical research and care.

Specifically, biomedical informatics can be broken down into four categories: research informatics, which covers the spectrum of basic, translational and clinical research; health care informatics, which covers the point of care; public health informatics, focused on epidemiology and surveillance registries; and personal informatics, an emerging field based on mobile tools and apps that allow an individual to capture, query and analyze their own personal health data. Biomedical informatics solutions rely heavily on the integration and use of data from a range of heterogeneous data sources. Successful implementation of biomedical informatics solutions involves the integration of the needs of the community using the tools, the technology or platform to support the tools, and the data that is stored and made available for querying and analytics within the tools.

By Michael Keller, senior associate, Booz Allen Hamilton

Arizona State University

Carnegie Mellon University

M.S. - Biomedical informatics 1151 S Forest Ave. Tempe, AZ 85281

M.S. - Computational Biology 5000 Forbes Avenue Pittsburgh, PA 15213

M.S.P.H - Public Health Informatics 1518 Clifton Road NE Atlanta, GA 30329

Boston University

The Catholic University of America

Fairleigh Dickinson University

M.S. - Information Technology with a concentration in Health Information Technology 3600 John McCormack Road NE Washington, DC 20064

M.S. - Medical Technology 1000 River Road Teaneck, NJ 07666

M.S. - Bioinformatics 1 Silber Way Boston, MA 02215

Brandeis University M.S. - Health and Medical Informatics 415 South Street Waltham, MA 02453

University of California - Davis M.S. - Health Informatics Mrak Hall Drive Davis, CA 95616

Capella University M.S. - Health Information Management 225 South 6th Street Minneapolis, MN 55402

University of Cincinnati M.S. - Bioinformatics 2600 Clifton Avenue Cincinnati, OH 45221

Columbia University M.A. - Biomedical Informatics 2920 Broadway New York, NY 10027

Drexel University M.S. - Health Informatics 3141 Chestnut Street Philadelphia, PA 19104

Duke University

Emory University

The University of Findlay M.S. - Health Informatics 1000 N. Main Street Findlay, OH 45840

George Mason University M.S. - Bioinformatics and Computational Biology 4400 University Drive Fairfax, VA 22030

Grand Valley State University M.S. - Medical and Bioinformatics 1 Campus Drive Allendale, MI 49401

University of Idaho M.S. - Bioinformatics and Computational Biology 875 Perimeter Drive Moscow, ID 83844

University of Illinois at Chicago M.S. - Health Informatics 900 W Taylor Street Chicago, IL 60607

Indiana University M.S - Bioinformatics 107 S Indiana Avenue Bloomington, IN 47405

Georgia Institute of Technology

Indiana UniversityPurdue University Indianapolis

M.S. - Bioinformatics 900 Atlantic Drive NW Atlanta, GA 30318

M.S. - Bioinformatics 420 University Boulevard Indianapolis, IN 46202

M.M. - Clinical Informatics 2138 Campus Drive Durham, NC 27705

22 | M2VA 16.4

www.M2VA-kmi.com

Medical Informatics Yellow Ribbon School Directory The University of Iowa

University of Missouri

M.S. - Health Informatics 138 Iowa Memorial Union Iowa City, IA 52242

M.S. - Health Informatics 800 Conley Avenue Columbia, MO 65201

Iowa State University

University of Missouri Kansas City

M.S. - Bioinformatics and Computational Biology 2229 Lincoln Way Ames, IA 50011

Johns Hopkins University M.S. - Bioinformatics 3400 North Charles Street Baltimore, MD 21211

The University of Kansas Medical Center M.S. - Health Informatics 3901 Rainbow Boulevard Kansas City, KS 66160

University of Maryland University College M.S. - Health Administration Informatics 1132 Regents Drive College Park, MD 20740

University of Memphis M.S. - Bioinformatics 101 John Wilder Tower Memphis, TN 38152

University of Michigan M.S. - Bioinformatics 1009 Greene Street Ann Arbor, MI 48109

Milwaukee School of Engineering M.S. - Medical Informatics 1025 N Broadway Milwaukee, WI 53202

University of Minnesota M.S. - Health Informatics 1049 University Drive Duluth, MN 55812

www.M2VA-kmi.com

M.S. - Bioinformatics 5100 Cherry Street Kansas City, MO 64110

University of Nebraska M.S. - Bioinformatics 600 N 15th Street Lincoln, NE 68508

University of Nebraska – Omaha M.S. - Bioinformatics 6001 Dodge Street Omaha, NE 68182

New England College M.S. - Health Informatics 98 Bridge Street Henniker, NH 03242

Nova Southeastern University

M.B.A. - Health Care Informatics 2500 North River Road Manchester, NH 03104

M.S. - Biomedical Informatics 3200 South University Drive, Suite 1518 Fort Lauderdale, FL 33328 Christine Nelson Program Manager http://medicine.nova.edu/msbi 800-356-0026 ext. 21038 msmi@nova.edu Offered both online and on site, this skill-based program enables working professionals to obtain a master’s degree without career disruption. Courses leading to Lean Six Sigma Green Belt, CPHIMSS, NextGen certifications and a paid internship at NSU’s clinic are available. Graduate certificates in Medical Informatics and Public Health Informatics and an M.S.N. in Nursing Informatics are also offered.

The University of North Carolina at Charlotte

University of Phoenix

M.S. - Health Informatics (PSM) 9201 University City Boulevard Charlotte, NC 28223

M.H.A. - Informatics 4635 East Elwood Street Phoenix, AZ 85040

North Carolina State University

University of Pittsburgh

M.S. - Bioinformatics 2701 Sullivan Drive Raleigh, NC 27607

Southern New Hampshire University Online

M.S. - Biomedical Informatics 3925 Forbes Avenue Pittsburgh, PA 15260

Northeastern University

Polytechnic Institute of NYU

M.S. - Bioinformatics 400 Huntington Avenue Boston, MA 02115

M.S. - Bioinformatics 6 MetroTech Center Brooklyn, NY 11201

Northern Kentucky University

Rochester Institute of Technology

M.S. - Health Informatics 1 Nunn Drive Highland Heights, KY 41099

M.S. - Medical Informatics 1 Lomb Memorial Drive Rochester, NY 14623

Northwestern University

University of the Sciences in Philadelphia

M.S. - Medical Informatics 339 East Chicago Avenue Chicago, IL 60611

M.S. - Bioinformatics 600 S 43rd Street Philadelphia, PA 19104

University of South Florida M.S. - Bioinformatics and Computational Biology 4202 East Fowler Avenue Tampa, FL 33620

College of St. Scholastica M.S. - Health Information Management 1200 Kenwood Avenue Duluth, MN 55811

Stanford University M.S. - Biomedical Informatics 450 Serra Mall Stanford, CA 94305

Tulane University M.S. - Bioinformatics 6823 Saint Charles Avenue New Orleans, LA 70118

University of Utah M.S. - Biomedical Informatics 1645 Campus Center Drive Salt Lake City, UT 84112

Walden University M.S. - Health Informatics 155 5th Avenue South Minneapolis, MN 55401

University of Wisconsin – Milwaukee M.S. - Health Care Informatics 3202 North Maryland Avenue Milwaukee, WI 53202

Vanderbilt University M.S. - Biomedical Informatics 2201 West End Avenue Nashville, TN 37240

Virginia Commonwealth University M.S. - Bioinformatics 711 West Main Street Richmond, VA 23220 M2VA 16.4 | 23

Finding and treating those injured in the field.

By Erin Flynn Jay M2VA Correspondent

Search and rescue is paramount to getting a wounded warfighter or stranded hiker to treatment facilities, whether on the front line or stateside. Industry is doing what it can to provide the military with the most up-to-date solutions and technologies to minimize casualties.

Medevac The U.S. Army outfits Sikorsky-built UH-60L Black Hawk helicopters with medevac litters, but relies increasingly on a dedicated air ambulance—initially with 30 HH-60Ls but since 2007, the HH-60M Black Hawk helicopter—that has cabin provisions for eight ambulatory or six litter-bound patients.

Designed to provide the highest order of care, HH-60M aircraft come with an 800-plus pound clinical interior that includes 24 | M2VA 16.4

air conditioning, powered litter lifts, aero-medical oxygen and suction systems to stabilize trauma cases.

HH-60M aircraft share the propulsion, dynamics and integrated cockpit of the utility UH-60M, but are assembled and completed on a separate production line at Sikorsky’s Stratford, Conn., facility. Sikorsky has delivered almost 100 HH-60Ms to the U.S. Army of a planned 419 aircraft production run.

Chief Warrant Officer 5 Kevin Slinker, with U.S. Army Reserve 11th Aviation Command, said the search and rescue mission they currently have is a mission out of Fort Lewis, Wash., based out of Mt. Rainier. Because of the altitude of the mountain, normal aircraft can’t get there. Often the missions have to be done from CH47s.

“On a fairly regular basis during climbing season, they will go up and pull stranded climbers off the mountain, who either www.M2VA-kmi.com

Members of the litter team carry in equipment from an HH-60G Pave Hawk during a personnel recovery mission. The 26th Expeditionary Rescue Squadon flies the helicopters to various locations in Afghanistan to recover wounded service members and fly them to the nearest medical facility. [Photo courtesy of DoD]

zero and in about a three-year get injured or run into some timeframe, we went from not unexpected bad weather,” said having an airplane sitting on Slinker. “We don’t anticipate the ramp to airplanes sitting picking up any additional search on the ramp with the pilot and rescue missions right now. and flight medics being ready What we are fielding is medevac to deploy in a short timeunits. The primary mission of frame.” the 11th Aviation Command is For the U.S. Army Reserve, medevac.” unlike the active component, “We have one medevac comthe 11th Aviation Command pany that is in theater doing doesn’t have a huge number operations in Afghanistan. of men to draw from for airThose are HH-60L model airplane crews, for the medics craft that have been upgraded and for the non-medic crewwith FLIR [forward-looking members in the back. “We infrared] and hoist capabilities had to recruit a high percentso they can do the medevac operations in the high moun- Following the 10,000 hours milestone of two HH-60G aircraft on Aug. 30, 2011 at Kirtland AFB, air age of those pilots, medics and maintenance crew gathered for a photo. [Photo courtesy of Sikorsky] and non-medic crewmembers. tainous regions in Afghanistan,” Once you recruit them, you’re added Slinker. looking at a year and a half to get them through flight school The 11th Aviation Command is currently fielding the HH-60 and their initial training to be crew chiefs and flight medics,” M model. “The M model has a glass cockpit, an autopilot capabilsaid Slinker. ity. It has an upgraded medical interior suite; also, it has FLIR Once the command gets them to the units, they have to do and hoist capability. As we continue to field those, we anticipate additional training called readiness level (RL) training. “RL trainsending them into the combat theater in 2014. Those aircraft ing at the unit can take up to a year and actually prepares the are sitting in four different locations right now—in Fort Carcrews for combat. We have been asked by the Army to get flight son, Colo., Kingsville, Texas, Fort Knox, Ky., and Johnstown, medics up to paramedic level of training; that is an additional Pa.,” said Slinker. “It is a huge task to field them in the manner year or more after they complete Army Medic training,” said we have been asked to field them. We had to start from ground www.M2VA-kmi.com

M2VA 16.4 | 25

Slinker. “Taking a brand-new aircraft like HH-60 and learning to fly and maintain it is a huge challenge for active duty units; in the Reserves, we work a 9-to-5 job and then do our military training. The time and sacrifice are tremendous.”

The command initially had technology shortfalls in the aircraft themselves. “We have six or eight brand new hoists that we had to mount; we were the experimental test dummies for the new hoist. We had several issues with them that I believe we have worked out,” said Slinker.

“The company that was providing litters for us went out of business, so now we’re looking for another litter that meets the Army’s specifications. There is an Armywide shortage of FLIRequipped aircraft. Maintaining and updating those FLIR systems, and keeping them operating correctly, is a challenge,” concluded Slinker. “In the Army, we are a bit behind on the personal protective equipment for the pilots and flight crews. The fireproof equipment that will keep them warm and dry in the high altitudes of Afghanistan is in short supply. The Army is always trying to come up with better solutions for aviator flight gear.”

the whole continuum of TCCC anywhere necessary,” Calkin said.

“That also includes, but is not limited to, state-of-the-art burn treatment, difficult airway and hemorrhage control training. We will do multiple deployments if necessary. All training is done free of charge. The military covers all expenses and freight on the equipment, which is donated to the project at the end of the training.”

Combat Search and Rescue

The U.S. Air Force also operates a dedicated fleet of rescue helicopters—the HH-60G Pave Hawk (based on the L-model Black Hawk). “Though also responsible for saving lives, the HH60M helicopter is designed for a significantly different purpose than medevac,” said Tim Healy, Sikorsky’s director of Air Force programs. “Specifically, its purpose is to fight its way into and out of contested areas to recover isolated or stranded personnel,” Healy said.

Traditionally, this has meant downed aircrew, but recently has come to include a myriad of U.S. and allied personnel engaged in irregular warfare, as well as those engaged in diplomatic and humanRescue Challenges itarian activities.

Beginning in the early to mid-1980s, Sikorsky When a soldier is injured, the medic or other delivered 112 HH-60 Pave Hawk helicopters to the military person will initiate a nine line request for U.S. Air Force for combat search and rescue misan aircraft, said Bud Calkin, vice president/general sions. An air refueling probe, internal fuel tanks manager, Skedco Inc. and upgraded navigation systems gave the aircraft “When the aviation people are satisfied that Tim Healy extended operational reach. it is a legitimate request, they will launch the Since that time, Healy said, the Air Force has helicopter,” said Calkin. “It is important that all conducted a series of upgrades to the HH-60G configuration nine lines are completed before the helicopter approaches the with secure and satellite communications, integrated flight landing zone, but they will launch an aircraft before they are all management and navigation systems, and improved weapons and completed. Weather, scene safety and other safety requirements defensive systems. must be considered. They will not risk an aircraft unnecessarily, “High operational tempos during wars in Iraq and Afghaniso communication is extremely important.” stan have given rise to high maintenance man hours, and some A lot of the challenges are as follows, Calkin added: What is structural fatigue. Sikorsky remains engaged with the Air Force, the condition of the patient? What are the weather conditions? providing engineering and support,” he said.

What sort of terrain are they dealing with? What is the level of The critical importance of the rescue mission and the age of expertise of the rescue personnel? What sort of rescue equipment their HH-60G fleet has enabled the Air Force to order new UH-60 assets does the rescue team have? What is the type of atmosphere Black Hawks to bring the fleet back up to its full size of 112. in the rescue site? What kinds of transportation assets are availTo date, Healy said, Sikorsky has delivered four of six aircraft able after the victim is stabilized and extricated? contracted through the service’s Operational Loss Replacement Skedco products are efficient in all types of terrain and program, and Congress has appropriated an additional 19 airpatients can be immobilized in an Oregon Spine Splint, intucraft. Sikorsky is working with the U.S. Army and U.S. Air Force bated using the Skedco Laryngoscope kit, and packaged in a to get these aircraft on contract.

Sked. Skedco tripods and rope rescue items are used for hoisting In early 2012, the Air Force launched a competition to or lowering patients from the site of the injury. acquire an all-new combat rescue helicopter (CRH) to replace the Skedco casualty evacuation (casevac) kits are packed with HH-60G fleet. The Air Force expects to order 112 CRH aircraft, necessary supplies for stabilizing patients and keeping them though that could be increased to as many as 148 aircraft. Sikorwarm, as well as a small Sked litter or quad folding litter for sky and principal teammate Lockheed Martin will respond jointly transport and items to secure them to the floor of an aircraft to a final RFP expected this summer. or casevac vehicle, noted Calkin. Skedco rope rescue kits proA contract award is expected in 2013 for an initial operational vide necessary items for virtually any rope rescue. Skedco has a capability in 2018. O complete line of rescue and EMS items available to address these rescues.

“Skedco is available to provide training on all of its products For more information, contact M2VA Editor Brian O’Shea and will go anywhere our military goes to do it. We went to Iraq at briano@kmimediagroup.com or search our online archives a little over a year and a half ago and we are working on arrangfor related stories at www.m2va-kmi.com. ing a training session in Afghanistan. The Skedco team can teach 26 | M2VA 16.4

www.M2VA-kmi.com

The advertisers index is provided as a service to our readers. KMI cannot be held responsible for discrepancies due to last-minute changes or alterations.

M2VA RESOURCE CENTER Advertisers Index

Calendar

CSSS.Net. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 www.csss.net Idaho Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 www.bio-surveillance.com RDT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 www.rdtltd.com Revision Military Ltd . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 www.revisionmilitary.com/batlskin ScriptPro. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C4 www.scriptpro.com Skedco. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 www.skedco.com Zoll Medical Corporation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C2 www.zoll.com/nextgen

July 12-13, 2012 Warrior Expo East Virginia Beach, Va. www.adsinc.com/warriorexpo

September 25-27 Modern Day Marine Quantico, Va. www.marinemilitaryexpos.com

August 13-16, 2012 ATACCC Fort Lauderdale, Fla. www.ataccc.org

October 22-24, 2012 AUSA Washington, D.C. www.ausa.org

September 9-12, 2012 NGAUS Reno, Nev. www.ngausconference.com/12NS/

December 15-18, 2012 Special Operations Medical Association Conference (SOMA) Tampa, Fla. www.specopsmedassociation.org

Growing Taking its place in KMI Media Group’s family of publications

Border & CBRNE Defense makes eleven Border Threat Prevention and CBRNE Response

11 Border & CBRNE Defense

SPECIAL SECTION:

Integrated Fixed Towers

Geospatial Intelligence Forum Ground Combat Technology Military Advanced Education Military Logistics Forum

Border Protector

www.BCD-kmi.com

Michael J. Fisher Chief U.S. Border Patrol U.S. Customs and Border Protection

June 2012 Volume 1, Issue 1

Military Information Technology Military Medical & Veterans Affairs Forum Military Training Technology

Leadership Insight: Robert S. Bray Assistant Administrator for Law Enforcement/Director of the Federal Air Marshal Service

Wide Area Aerial Surveillance O Hazmat Disaster Response Tactical Communications O P-3 Program

Special Operations Technology Tactical ISR Technology U.S. Coast Guard Forum

For more information on BCD, please contact Editor Brian O’Shea at briano@kmimediagroup.com

www.M2VA-kmi.com

M2VA 16.4 | 27

INDUSTRY INTERVIEW

Military Medical & Veterans Affairs Forum

Kelley Harar Chief Operating Officer, TRICARE Overseas Program International SOS Assistance Inc. Kelley Harar serves as chief operating officer, for International SOS Assistance, the administrator of TOP. She is responsible for strategic oversight and operational leadership of the company’s TRICARE Region. Previously, Harar held numerous executive level and board positions in the satellite industry, specifically within the government market. As the spouse of a military retiree and with overseas deployed family members, Harar fully understands the unique challenges of TOP. Q: Who is International SOS? A: International SOS is the world’s leading medical and security services company operating from over 700 sites in 76 countries with 10,000 employees. Our global services include medical and risk planning, preventative programs, in-country expertise and emergency response for travelers, expatriates and their dependents. Since 1998, International SOS has supported TRICARE in ensuring that active duty servicemembers and their families receive the highest quality care in remote locations. In 2009, DoD selected International SOS to become the first contractor to provide integrated, comprehensive health care services to all TOP beneficiaries serving nearly 500,000 TRICARE beneficiaries outside the continental U.S., across 207 countries.

Q: How is International SOS’s service delivery model unique?

A: International SOS’s boots-on-the-ground approach ensures our resources are where the beneficiaries are, delivering consistent, standardized health care in areas with unique sets of laws and cultures. The company manages an extensive network of credentialed providers, leveraging an expanded network of remote medical clinics/facilities and dedicated air ambulances across five continents.

TOP network providers are continuously monitored and credentialed to meet beneficiary access-to-care standards as well as claims submission guidelines, utilization efficiency and appropriateness of care. Providers are educated in native languages and our team provides ongoing, specialized support.

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clinics and over 700 remote sites around the world. This medical oversight and routine health care delivery infrastructure helps ensure the readiness of troops while they are deployed overseas, while facilitating our ability to expand services when and where military requirements dictate.

This approach helps bridge U.S. health care requirements and standards with local cultures. We make sure our beneficiaries know what to expect when seeking health care.

Q: Describe your role as the TRICARE Overseas Program contractor.

A: We support the following beneficiary groups: TOP Prime, TOP Prime Remote, TRICARE Retired Reserve, TRICARE Reserve Select, TRICARE Young Adult, TRICARE Standard, and stateside enrolled beneficiaries who are traveling overseas.

Comprehensive services delivered through our four TOP Regional Service Centers in Philadelphia, London, Sydney and Singapore: • Beneficiary education and enrollment • TOP claims assistance • Multi-lingual 24/7 customer service • Health care finder • Provider network management • TRICARE covered benefits check and referrals and authorizations • Emergency medical assistance and aeromedical evacuations • Top prime remote wellness • Network and clinical quality, program integrity, monitoring and improvement Q: How does International SOS’s infrastructure support military readiness and changes in deployment cycles?

A: Our worldwide presence makes it easy for us to meet the ever-changing needs of the U.S. military overseas. Our infrastructure comprises an extensive provider network, dedicated air ambulances, preferred provider air carriers, 27 alarm centers, 32 international

Q: How does International SOS assist DoD in patient movement and urgent care?

A: We provide emergency coordination and medical case oversight, arranging for the right care at the right time: from evacuating a beneficiary to the nearest center of medical excellence to obtaining a second opinion from a network provider. We coordinate with overseas patient movement requirements centers to provide aeromedical evacuations and relocations through rapid patient transfer by air ambulance, commercial airline, helicopter, jet, or even military aircraft. Physicians and nurses accompany patients and provide care in transit.

For a critically ill servicemember who was dependent on an external bi-ventricular assist device, we coordinated the first ever trans-Atlantic air ambulance transport. An incident management team was assembled, comprising International SOS and military physicians, device specialists, treating medical officers, and others who carried out in-depth contingency planning and virtual practice runs. The entire bed-to-bed transfer lasted 12 hours, ensuring altitudes, power conversions, re-fueling and other critical factors did not adversely impact patient stabilization. International SOS responded swiftly to the Japanese earthquake and tsunami disaster, developing and implementing business continuity plans, and calling all Prime Remote beneficiaries to make sure they were safe directly after the event.

We are proud to serve our nation’s heroes and their families.

Working together, we can help achieve the quadruple aim of military medical excellence throughout the world.

For more information, visit www.tricareoverseas.com or www.internationalsos.com. O www.M2VA-kmi.com

NEXTISSUE

August 2012 Vol. 16, Issue 5

Dedicated to the Military Medical & VA Community

Cover and In-Depth Interview with:

Maj. Gen. James K. Gilman

Commander U.S. Army Medical Research and Material Command

Special Feature Tactical Combat Casualty Care

The immediate traumatic effects of battlefield injury may have changed in character or intensity over the centuries, but the need to speedily intervene to maximize the survival and recovery of casualties has not.

Features Remote and Expeditionary Medicine

Treatment of a wounded warfighter often takes place at the location of the incident. Medics from all branches face challenges in providing such treatment in nontraditional environments.

EHR Way Ahead

The joint electronic health records program between the Department of Veterans Affairs and the Department of Defense is crucial to providing warfighters with the very best care, and communication between facilities is key.

Tissue Injury/Wound Healing

Dealing with battlefield wounds requires skilled people and the best equipment. U.S. military forces are pushing for better training and improving dressings that stop bleeding, which is often the first requirement of lifesaving care.

Combat Search and Rescue Roundtable

Experts from several branches discuss the future of search and rescue efforts including combat search and rescue, medevac and tactical recovery of aircraft and personnel.

Insertion Order Deadline: July 12, 2012 • Ad Materials Deadline: July 19, 2012