M2VA 17-2 (April 2013)

Dedicated to the Military Medical & VA Community

Health Provider Col. Jeff Clark Commander Europe Regional Medical Command Command Surgeon U.S. Army Europe

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April 2013 Volume 17, Issue 2

Biosurveillance O RTLS O EHR O VA Contract O SOF Combat Medics

2013

Military medical & Veterans Affairs Forum

Editorial Calendar MAY 17.3

JUNE 17.4

AUGUST 17.5

SEPTEMBER 17.6

NOVEMBER 17.7

DECEMBER 17.8

q&a

q&a

q&a

q&a

q&a

q&a

David Bowen

Dr. Jonathan Woodson Assistant Secretary of Defense for Health Affairs

Vice Adm. Mathew L. Nathan

Lt. Gen. (Dr.) Thomas W. Travis

Col. Peter J. Benson

Chief Information Officer

Lt. Gen. Patricia D. Horoho U.S. Army Surgeon General

U.S. Navy Surgeon General

U.S. Air Force Surgeon General

Command Surgeon, U.S. Army Special Operations Command

special section

special section

special section

special section

Combat Search & Rescue

Field Hospitals

TRICARE Pharmacy

Medical Simulation/Training

PUBLIC HEALTH focus

PUBLIC HEALTH focus

Hepatitis C

Hypertension

HEALTH IT focus

HEALTH IT focus

Health Analytics

Privacy & Security

features

features

Dental X-ray

Tactical Combat Casualty Care

Military Health System Office of the Assistant Secretary of Defense for Health Affairs

special section Mobile Health IT

PUBLIC HEALTH focus Sleep Disorders

HEALTH IT focus EHR

features Army Dental Service Polytrauma Rehabilitation Medical Staffing

tradeshows DoD/VA Healthcare 2013* Maritime Homeland Security Summit

special section Health Care Education Directory

PUBLIC HEALTH focus

PUBLIC HEALTH focus

Cancer

Asthma

HEALTH IT focus

HEALTH IT focus

Nursing Informatics

Meaningful Use

features

features

Patient-centered Medical Home

Pre-hospital Trauma/ Life Support

Military Medical Deployments Hemorrhage Control

closing date June 11

Medical Service Outsourcing Airway Management

tradeshows MHSRS/ATACCC*

closing date July 22

PUBLIC HEALTH focus Arthritis

HEALTH IT focus Interoperability

features Traumatic Brain Injury Tissue Injury & Wound Care

Advanced Burn Life Support

Theater Medical Systems

Health Care Careers

tradeshows

tradeshows

tradeshows

Modern Day Marine*

Joint Forces Pharmacy*

I/ITSEC

AUSA

AMSUS

closing date

closing date

August 29

October 10

Emergency Communications SOF CASEVAC

SOMA* SOMOS

closing date November 14

closing date May 15

This editorial calendar is a guide. Content is subject to change. Please verify advertising closing dates with your account executive. *BONUS DISTRIBUTION

Military medical & Veterans Affairs Forum

Cover / Q&A

Features

7

April 2013 Volume 17, Issue 2

Special Section: Facing Type 2 Diabetes

12

Type 2 Diabetes rates have risen in the United States for the past 20 years. This public health issue especially threatens the health of veterans, more so than the civilian population.

By Peter Buxbaum

Electronic Health Records Roundtable Discussion Three EHR vendors explain how they are positioned to meet DoD’s need for a new EHR system.

16 Colonel Jeff Clark

Commander Europe Regional Medical Command Command Surgeon U.S. Army Europe

4

10

22

Radio frequency identification and other technologies allow precise locating of equipment, which enables greater logistical flexibility and inventory tracking in health care facilities.

By Scott Gourley

The Veterans Affairs Department recently awarded a $5.3 billion contract to Alliance Technology Group, Red River Computer Co. and Valador.

By Chris McCoy

Recent changes to USSOCOM’s Special Operations Combat Medic Course involve a shift to include more clinical and dental skills and a lengthening of the medic course from 26 to 36 weeks.

By Colonel Sean K. Lee

Real-Time Location Systems

VA Commodities Enterprise Contract

Departments

24

Charting a Course for the Future

Keeping Watch on the Bio Front The U.S. government and a number of companies are developing innovative detection and diagnostic technologies to quickly identify biological threats.

By Hank Hogan

Industry Interview

2 Editor’s Perspective 3 Program Notes/People 14 Vital Signs 27 Resource Center

Kyle G. Johnson

President and CEO Onsite OHS Inc.

28

Military Medical & Veterans Affairs Forum Volume 17, Issue 2 • April 2013

Dedicated to the Military Medical & VA Community Editorial Editor Chris McCoy chrism@kmimediagroup.com Managing Editor Harrison Donnelly harrisond@kmimediagroup.com Online Editorial Manager Laura Davis laurad@kmimediagroup.com Copy Editors Sean Carmichael seanc@kmimediagroup.com Laural Hobbes lauralh@kmimediagroup.com Correspondents JB Bissell • Peter Buxbaum • Henry Canaday Scott Gourley • Hank Hogan • Kenya McCullum

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EDITOR’S PERSPECTIVE Since our next issue of Military Medical & Veterans Affairs Forum deals with veterinary medicine, I’d like to take this opportunity to devote some time to discussing animals and their role in psychological therapy.

Recently I’ve read several press releases on the effect pets can have on veterans suffering from PTSD and depression. I’ve also witnessed this effect on some of the veterans that I’ve know from the recent wars in Iraq and Afghanistan. Most of the coverage has centered on dogs; however, I’ve noticed that cats can have a similar effect as well.

In the civilian sphere it is quite common for parents to buy a pet for their children if they are struggling with psychological issues such Christopher McCoy Editor as depression. I’ve witnessed this too. The unconditional love of a dog or another pet can go a long way in helping a child or anyone else suffering extreme emotional duress.

Studies have shown that animals, such as the dogs that aid soldiers in the search for IEDs, also appear to suffer from the psychological trauma of warfare much like our veterans. Specifically, it appears that many dogs used in combat have developed a form of PTSD. Having worked at a veterinary clinic and animal shelter as a tech during school, I’m not surprised by some of these more recent findings. I own a rescued shelter dog myself and have significant experience with dogs and other animals that have suffered emotional trauma through the many forms that abuse can take.

Right now there are several groups that work to place animals with persons suffering from psychological issues. The group, Pets for Vets, is one organization that is working to connect shelter dogs with veterans suffering from PTSD. Among my friends and acquaintances while working at home and abroad, I have noticed the effect animals can have on those dealing with psychological trauma. I imagine that many of you reading this editorial note have witnessed this as well. In light of recent studies, it now appears that animals and our veterans who have suffered can help each other.

As usual feel free to e-mail me with questions or comments for Military Medical & Veterans Affairs Forum.

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PROGRAM NOTES

Compiled by KMI Media Group staff

Tripler Takes Home DoD’s First National Award For Healthy Workplace Tripler Army Medical Center has been named a top Psychologically Healthy Workplace for 2013 by the American Psychological Association. Tripler is the first organization within the Department of Defense to be honored with the national award since the program began in 2006.

Each year, only four organizations within North America receive the award.

Tripler won in the government/military/ educational institution category. The annual awards are designed to recognize organizations for their efforts to foster employee health and well-being while enhancing organizational performance.

Applicants are evaluated on their efforts in the following five areas: employee involvement, work-life balance, employee growth and development, health and safety, and employee recognition.

“Forward-thinking employers such as Tripler Army Medical Center are taking steps to create a positive work environment where employees can thrive,” said Dr. David Ballard, head of American Psychological Association (APA)’s Center for Organizational Excellence. “In turn,

employees are more engaged and committed to the organization’s success.

This shared responsibility for creating a psychologically healthy workplace promotes an organizational culture that values wellbeing and performance and delivers results on both sides of the equation.”

Some of the programs and services that make Tripler an employee-friendly place to work include employee fitness rooms, resiliency classes, on-site daycare, numerous training opportunities, and benefits such as tuition reimbursement, which are available to its more than 4,000 uniformed and civilian employees.

PRMC’s Care Provider Support Program, which offers a variety of resiliency classes and resources, was also recognized as a Best Practices honoree for 2013 for its employee growth and development efforts.

This isn’t the first year APA has recognized Tripler for fostering employee health and well-being while enhancing organizational performance. In 2011, Tripler’s Department of Psychology was recognized as a national- and state-level Best Practices honoree.

Health Care Firm Rated #1 by KLAS for Second Year in a Row The health care IT research firm KLAS recently published its annual report, 2012 Best in KLAS Award: Software & Services. The report shows that for the second year in a row, ScriptPro customers ranked SP Central Pharmacy Management System #1 in the category of Software SolutionsPharmacy-Outpatient (Retail).

Reports compiled by KLAS represent the opinions of people in organizations who actually use the products being evaluated. Users evaluate software providers, products and services based on the needs of their organizations. The Best in KLAS Awards recognize the best-performing software and services vendors based on input from customers.

“Providers recognize the critical nature that vendors play in improving health care delivery,” said Adam Gale, KLAS president. “Thus, a growing number of providers are weighing in on vendor performance. It speaks volumes that providers want to be heard and be counted. And vendors are listening.”

Mike Coughlin, president and chief executive officer of ScriptPro, said, “We really value the KLAS ratings. They give us objective information on how we’re doing from the perspective of our customers. They also help focus the attention of our team on the all-important mission of continuously improving, and providing products and services that we can all be proud of.”

PEOPLE

Compiled by KMI Media Group staff

Medical, Bethesda, Md., will become commanding general of U.S. Army Medical Department Center and School, Joint Base San Antonio, Texas.

Roger Baker, the former assistant secretary for information and technology and CIO for the U.S. Department of Veterans Affairs, has joined Chantilly-based Agilex as the company’s chief strategy officer.

Army Major General Ming T. Wong, commanding general, Southern Regional Medical Command/Brooke Army Medical Center/chief, Dental Corps, Joint Base San Antonio, Texas, will become commanding general of Northern Regional Medical Command/chief, Dental Corps, Fort Belvoir, Va.

Army Major General Stephen L. Jones, commander, Joint Task Force-National Capital Region

Navy Reserve Captain Christina M. Alvarado has been nominated for appointment to the rank of rear

Roger Baker

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admiral (lower half). Alvarado is currently serving as deputy chief of staff, Navy Medicine East, Norfolk, Va. Navy Reserve Captain Priscilla B. Coe has been nominated for appointment to the rank of rear admiral (lower half). Coe is currently serving as reserve affairs officer, Bureau of Medicine and Surgery, Falls Church, Va. Navy Reserve Captain Victor W. Hall has been nominated for appointment to the rank of rear admiral (lower half). Hall is currently serving as commanding officer, Naval Reserve Navy Medicine

Education and Training Command, Jacksonville, Fla. Navy Reserve Captain Brian S. Pecha has been nominated for appointment to the rank of rear admiral (lower half). Pecha is currently serving as force surgeon, U.S. Marine Forces Reserve, New Orleans, La. Air Force Colonel Dorothy A. Hogg has been nominated for appointment to the grade of major general and for assignment as chief of the Air Force Nurse Corps, Office of the Surgeon General, Headquarters U.S. Air Force, Falls Church, Va.

M2VA 17.2 | 3

Medical advancements in active tracking technologies.

By Scott R. Gourley, M2VA Correspondent

procedures and our workflows,” offered Kimberly Brayley, direcA key set of integrated capabilities being implemented by tor of the VHA RTLS Project Management Office. “When I think the Department of Veterans Affairs and soon to be implemented of it from a veteran’s perspective, we feel that the technologies by the U.S. Navy medical community involves real-time locawill allow each facility to optimize their processes for their delivtion system (RTLS) technologies. Designed to provide hospital ery of care to patients. When we can increase the automation and automation and efficiency improvements, the use of RTLS will effectively manage our assets and our processes, we can be more further advance the quality of health care, improve patient and efficient and more effective. That, in turn, will employee safety, and reduce overall costs. lead to better quality of care, timeliness and safety.

The Veterans Health Administration (VHA) And we think in the end it will provide a positive National RTLS Project Management Office, within impact on the veteran’s satisfaction with the VA.” the Office of Healthcare Technology Management, “I think the overall goal is to create a richer, has been charged to assist veterans integrated more effective and promising experience for our service networks (VISNs), Veterans Affairs medical patients,” she added. centers (VAMCs), and consolidated mail outpatient VA plans call for the incremental rollout of pharmacies (CMOP) with the selection, deployRTLS, with initial implementation at VISNs 10 ment and sustainment of RTLS technologies. and 11 and a CMOP (Charleston), followed by Those technologies include: active tags—small VISN 23 (eight facilities), VISNs 5, 20, 21, 22 and tags that continuously transmit location informaDebbie Elgot the remainder of the VISN 23, and then VAMCs. tion through the medical center’s wireless network In 2012, the Department of Veterans Affairs and supplemental networks where needed; passive announced award of a contract to Hewlett-Packard’s HP Entertags—similar to barcode labels, these are activated to transmit prise Services (HP ES) LLC for the procurement and deployinformation by passing through portal antennas or by handheld ment of a nationally integrated RTLS over the next five years. readers; instrument tracking systems—2-D barcodes that are The award process had included an industry protest to the GAO, physically etched into surgical instruments; and temperature which found merit in the protest and called for reconsideration. probes—strategically placed in refrigerators, freezers, or rooms The VA subsequently re-evaluated the proposals in late 2012 and and hardwired to small active tags that continuously transmit re-awarded to HP ES shortly before the end of last year. temperature information back to an RTLS server.

“We’re putting in place an RTLS infrastructure, which “The way we view RTLS technologies is that they are there to includes hardware and software,” explained Debbie Elgot, RTLS advance the quality of health care, improve patient and employee portfolio manager, U.S. Public Sector, HP Enterprise Services. safety, and to help us, hopefully, reduce our overall costs through “There is RTLS platform software, which is the base software better understanding of [how] we are managing our assets, our 4 | M2VA 17.2

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that all of the other stuff runs on, and then you plug into that for the different applications that the VA wants.”

According to Elgot, “The initial rollouts and the initial VISN get the base use cases first,” she said. “And those use cases are asset management, cath lab [cardiac catherization] supply management, automated temperature and humidity monitoring, and sterile processing workflow.”

“Some items are actively tagged, which means the staff can locate them in real time at all times. Assets that are active tagged are typically high-value medical equipment that moves location, for example IV pumps. Other less expensive assets will be tagged with passive tags,” she added.

HP ES RTLS hardware and software partners include companies like CenTrak, OATSystems, Intelligent InSites and WaveMark.

She noted that the contract re-award (following re-evaluation) in December 2012 was also accompanied by the award of the task order for VISN 23 as well as the Enterprise System Engineering task order to build interfaces to other legacy VA systems.

“For instance, VistA [Veterans Health Information Systems and Technology Architecture]; AEMS/MERS [Automated Engineering Management System/Medical Equipment Reporting System], which is where they keep their asset inventory; and GIP [Generic Inventory Package], which is where they have their supply inventory. And [RTLS] also interfaces with some third-party systems, like the hemodynamic monitoring systems that they have in the cath labs,” she said. “We will interface with those too and those interfaces are currently being built. We have that task order. And they will be awarding additional task orders for additional VISNs to be implemented in a phased rollout through the rest of the year.”

While current efforts focus on tagging assets, she added that future expansion could include patient tagging “so you can track them in the flow as they go through the hospital. That can then help with a lot of things.”

“And then all this data is going to be collected at the medical center level, the VISN level and the enterprise level,” she continued. “Then they will be able to take that data and the data they already have in their corporate data warehouse with clinical data. And there will be task orders in the future to design what they are calling the National Data Repository, where we will have all this data that we can analyze and hopefully use for improving patient outcomes.”

As evidenced by the GAO protest/ruling process, HPES and their team members are hardly alone in the introduction and implementation of RTLS technologies and solutions into the market over the past few years.

IBM, for example, has partnered with Sonitor in one integrated RTLS health care solution. Other companies, like Awarepoint and AeroScout (now part of Stanley Healthcare), also offer elements or completely integrated RTLS solutions optimized for medical environments.

As these pages go to press, many of those technologies have likely been offered toward a RTLS requirement now in active procurement by the U.S. Navy’s medical community. As described in its original May 2012 synopsis, the Navy’s RTLS requirement is “for asset tracking/management to supplement the automated information logistics system, Defense Medical Logistics Standard Support.” www.M2VA-kmi.com

M2VA 17.2 | 5

Stanley Healthcare’s Deployed RTLS Solutions While Veterans Affairs and the Military Health System (MHS) continue to advance the use of RTLS at an enterprise level, active technologies have already been deployed at many facilities, successfully demonstrating the credibility of RTLS in improving patient safety, clinical workflow, and environmental monitoring as well as enabling many other operational efficiencies. Stanley Healthcare, a KLAS Category Leading RTLS solutions provider, is the company behind brands such as AeroScout, Hugs, RoamAlert and WanderGuard.

According to Bert Davis, president of Stanley Healthcare, the company has widely deployed solutions across the VA and MHS, improving patient and staff safety, temperature monitoring, and infant and pediatric security. “There is a critical focus on improving the quality and efficiency of patient care, and reducing the cost of care as we aim to better serve our active duty military, veterans and other government personnel. For example, our patient elopement

solutions are now in place at 52 sites across the VA, accurately detecting the location of patients; a similar capability enables the deployment of staff duress solutions to ensure personnel can immediately call for assistance in an emergency.”

At VISN 23 in Omaha, Stanley Healthcare has deployed over 200 temperature tags; the system features several hundred complex alerts to notify personnel of a power outage or other irregularity that could threaten pharmaceuticals and other high-valued assets.

And the opportunities to advance the use of RTLS technologies seem endless. As Stanley Healthcare and other providers continue development of 802.11 WiFi-enabled systems, healthcare facilities will benefit from improved flexibility and reach at a reduced cost.

Products will become “smarter,” facilitating new capabilities that improve information flow and accuracy, and will bring additional operational efficiencies to our nation’s health systems.

“The ability to access and track assets through facilities is vital to ensure timely scheduled preventive maintenance, accurate inventory capture, and efficient allocation of assets for patient care,” it stated, adding, “Initial RTLS requirements will focus on asset tracking to facilitate preventive maintenance and inventory management.”

The interested vendors list for the Navy RFP includes more than two dozen large and small companies with names like IBM Corporation, Lockheed Martin Corporation, Cisco Systems Inc., Stanley Healthcare, InforMD Inc., Apptricity Corporation and Intelitrac Inc. Possibly reflective of the VHA RTLS protest actions, at least one of the Navy interested vendors’ listings also self-identified as a “bid protest attorney.”

Industry quotes for the Navy RFP were due in late August of last year. Recently asked for clarification on several aspects of the planned Navy implementation, Naval Medical Logistics Command identified RTLS as “an active procurement status,” with a command representative acknowledging only, “We are barred by federal regulations from releasing any information about an active procurement as the details concerning RTLS are procurement sensitive.”

Meanwhile, the Department of Veterans Affairs is looking toward the future with its own implementation of RTLS. Emphasizing that there is a definite future for RTLS, the VHA’s Brayley carefully described a message to industry about that future.

Focusing her message on real-time, active-tracking technologies, she said, “We have seen that active technology is effective.

And we have seen it implemented in all sorts of business cases and industries. The VHA looks to really engage, in that we want to see more developments and products on the active side. We have a unique environment that deals with things like sterilization of tiny instruments—items that may not move consistently throughout a facility but do provide care. We want to receive those benefits of utilizing real time versus a passive-type technology.”

“And that’s where I think the health care industry needs to start laying some focus—on those areas,” she said. “Health care is reforming itself. We are constantly looking at how we can do better, see better, perform better—whether it is the management of processes, assets, workflows, or patient and staff safety. Being able to look at our fiscal environment and our health care budgets tightening, if industry can look hard at how they can help us manage those costs and identify those efficiencies through the automation of this information, really does drill down into the type of active technology that’s offered to us and how we can utilize it. I think that’s the direction industry needs to go.”

Asked how she sees the VHA RTLS program expanding or evolving over the next five years, she added, “I think we’ve been pretty open with at least the base type of applications that VHA is hoping to have at all of our medical facilities. We know we want to concentrate on asset tracking, supply management, workflow in a sterile processing department, or automated environmental monitoring, which some might better know as temperature monitoring. But we know that once we have achieved that, the needs and requests will continue to grow. We are already working on possible applications for hand hygiene effectiveness; clinical workflow, whether in an [emergency room], surgical area, or clinic area; and also patient movement and wandering applications. To be honest, I just see those types of independent applications continuing to grow through all of our workflows within the VHA so that we can get and retain the information to show what’s working, where it’s working, how and what it is interacting with.

And when we know that, that’s when we can really start gaining efficiencies and truly looking at how we are delivering care and how we can improve that.”

“So I think we will continue to grow over the next five years with where we look to expand our use of the technology,” she concluded. O

6 | M2VA 17.2

For more information, contact M2VA Editor Chris McCoy at chrism@kmimediagroup.com or search our online archives for related stories at www.m2va-kmi.com.

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Special Section: Diabetes

Confronting the disease and changing your lifestyle.

News headlines in recent years have trumpeted an epidemic of diabetes in the United States. Among U.S. military personnel and veterans, the story is twofold. The incidence of diabetes among uniformed personnel has not grown at the same high rate as among the general population. Veterans, on the other hand, have a higher incidence of diabetes than Americans at large.

The suppressed level of diagnosed diabetes cases among military personnel is likely attributable to the fact that diabetes disqualifies individuals from entering active military service in the first place. Also, because servicemembers face mandatory medical examinations and have free access to health care, uniformed personnel are exposed to diabetes prevention and treatment measures at higher rates and earlier on in the progression of the disease than people in the general population.

The veterans’ health system includes a vigorous campaign to prevent and treat diabetes. But the population of veterans www.M2VA-kmi.com

By Peter Buxbaum M2VA Correspondent

is skewed in favor of groups, such as the elderly and some racial minorities, that are more vulnerable to developing cases of diabetes. This explains the somewhat higher incidence of diabetes among veterans, despite their exposure to diabetes prevention information.

Diabetes mellitus is a chronic disorder caused by a decreased ability to produce or use insulin that leads to abnormally high levels of glucose in the blood. Type 1 diabetes is typically first diagnosed before age 20. Type 2 diabetes is usually diagnosed later in life. Studies by the Centers for Disease Control and Prevention have noted that diagnosis rates of Type 2 diabetes have increased in recent decades in the general U.S. population.

The Armed Forces Health Surveillance Center published a 10-year study in 2009 that surveyed the cases of diabetes among servicemembers aged 17 to 40. According to the study, between 1997 and 2007, 8,781 cases of diabetes were reported among that age group. Less than 6 percent of the cases were Type 1.

M2VA  17.2 | 7

Special Section: Diabetes veterans have Type 2 diabetes,” said Dr. Linda KinsOverall, rates of Type 2 diabetes among seringer, VA’s chief consultant for preventive medicine vicemembers 17 to 30 years old remained stable in the Office of Patient Care Services in the Veterans during the period studied. Among those over 30, Heath Administration. incidence rates increased from 1998 to 2002 and “Our population is older than the general poputhen remained stable thereafter. African-Americans, lation and includes members of more minorities Asians and Pacific Islanders had Type 2 rates higher who are more disposed to diabetes,” said Dr. Leonard than those of the overall military population.

Pogach, M.B.A., national director of medical service, According to the American Diabetes AssociaOffice of Specialty Care in the office of Patient Care tion (ADA), 25.8 million Americans—or 8.3 percent Services in VHA at VA Central Office. of the population—had diabetes in 2010, the last VHA’s preventative medicine apparatus develyear for which numbers are available. That figure Col. Steven Cersovsky ops policies and programs for training VHA staff increases to 11.3 percent of people age 20 years or around health promotion and disease prevenolder and to 26.9 percent among people age 65 years tion. “Our interest is largely in the prevention of or older. the onset of diabetes,” said Kinsinger, “by improvPrediabetes, defined by abnormally high but ing healthy behaviors and encouraging veterans not diabetic blood sugar levels, affects 79 million to be active, to eat right and to strive to achieve a Americans. healthy weight.”

The total cost of diabetes in the United States The Department of Veterans Affairs recently in 2007 was $218 billion, according to the ADA. In announced the inauguration of a pilot of the Diaaddition, “average medical expenditures among peobetes Prevention Program (DPP), which is related ple with diagnosed diabetes were 2.3 times higher to the VA’s existing Move! weight management prothan what expenditures would be in the absence gram. DPP will seek to help veterans identified with of diabetes.” Diabetics also suffer heart attacks Dr. Linda Kinsinger prediabetes, while Move! is open to all veterans with and strokes at rates between two to four times weight problems. higher than adults without diabetes. High blood DPP was preceded by a clinical research study pressure, blindness, kidney disease and nervous aimed at discovering whether modest weight loss system disease, which sometimes leads to amputathrough dietary change and increased physical activtions, are among the other complications associated ity could prevent or delay the onset of Type 2 diabewith diabetes. tes among prediabetics. “Results showed those who “The diabetes rate in active duty soldiers has lost a modest amount of weight through dietary been and continues to be lower than that of the comchanges and increased physical activity sharply parable civilian population,” said Colonel Steven reduced their chances of developing diabetes,” Cersovsky, a physician and director for epidemiolsaid Kinsinger. ogy and disease surveillance at the U.S. Army Public Through DPP, veterans who are at risk for diaHealth Command. “The Army has not seen the sharp Dr. Leonard Pogach betes voluntarily attend a series of group sessions rise in diagnosed cases among soldiers that has been and will be given weight loss and physical activity seen in the civilian population in the last 15 years.” goals. The VA has found that group sessions help On the other hand, retirees and family members patients both on the prevention and the treatment who are Army beneficiaries reflect the figures persides of disease management, according to Pogach. taining to the U.S. population at large.

“Repetition can reinforce the message,” he said. The According to Cersovsky, the relatively low inciDPP pilot is taking place in Minneapolis, Baltimore dence of diabetes among soldiers is likely due to the and Los Angeles. screening policies and physical fitness requirements Army Medicine is shifting from a system associated with military service. “Individuals with that focuses on healing and rehabilitation to one pre-existing diabetes are disqualified from entry into that focuses on preventing and mitigating the military service,” he said, “and strict physical fitness causes of disease, injury and disability, noted Cerand height and weight standards prevent most solRem Laan sovsky. “The conceptual framework Army Medidiers from becoming overweight, one of the imporcine is using to focus the shift is the performance tant risk factors for developing Type 2 diabetes.” triad,” he said. “Army Medicine has identified activity, nutriAmong retirees and family members, the causes of diabetes are tion and sleep as the three elements of the triad. Activity and the same as for the rest of our nation’s civilian population: excess nutrition directly impact diabetes prevention and mitigation. weight, physical inactivity, older age, ethnic background and a famThe Army Public Health Command supports prevention proily history of the disease. “The first two can be prevented or mitigrams that target lifestyle behaviors and produces program gated through education and behavior change,” noted Cersovsky, educational materials.” “which would have a direct impact on the rate of Type 2 diabetes.”

Army Medicine also operates an assessment program that Veterans have Type 2 diabetes at a rate over twice that of the helps installations assess their environment in order to encourage general population above age 20. “Approximately 24 percent of 8 | M2VA 17.2

www.M2VA-kmi.com

increased activity and better food choices. “Planning for walking paths, bike lanes and on-post eateries that offer healthy foods all enhance the installation population’s opportunities for making healthy choices,” said Cersovsky.

The treatment of Type 2 diabetes proceeds through several levels. At the first level patients are asked to lose weight and get more exercise.

“Diet and exercise in concert can be sufficient,” said Pogach.

“If that proves not to be the case, oral medications may become necessary. For those with diabetes for many years, the introduction of insulin may be necessary.”

Roche Diabetes Care has a number of pharmaceutical products addressing diabetes in various stages of development. “These new drugs, once they enter the market, will have the effect of lowering blood glucose,” said Rem Laan, the company’s vice president for external affairs.

Roche also markets glucose meters and insulin pumps. “What we try to do is to create a virtuous cycle,” said Laan. “What we have tried to do is to engage patients in the management of the disease and to provide physicians, not just with blood glucose values, but also with contextual information to help them understand what is going on with their patients on different days and at different times of the day.”

Blood glucose monitors help patients and clinicians understand patients’ response to food so that insulin intake can be adjusted to help blood sugar stay in the normal range. “It’s important for folks who have diabetes to have an extensive feedback system,” said Dr. Robert Morin, a board-certified endocrinologist and medical director for product development and regulatory affairs at Bayer HealthCare. “People have different sensitivities to different insulins at different times of the day. If blood sugar gets too high it can do damage. If it gets too low a patient can get confused or pass out.

“Even people with longstanding Type 2 diabetes don’t know what their blood sugar level is,” Morin added. “You can’t tell what your blood sugar level is by how you feel.”

Roche introduced the latest version of its Accu-Chek glucose meters last year. The Accu-Chek Nano SmartView product offers greater accuracy while testing only a small drop of blood. The device provides a blood glucose reading within five seconds.

Bayer HealthCare also introduced a new blood glucose monitoring system to the U.S. market last year. The company’s Contour Next EZ includes Bayer proprietary blood glucose sensor technology that delivers advanced accuracy. “There are three aspects to our technology which help deliver accurate results,” said Morin.

“We use an enzyme that specifically sticks to blood glucose.

We use a mediator that is specific to the output of that enzyme without being interfered with by other substances in the blood.

The pulse frequency that is used only measures the electric current appropriate to the message from the mediators while others are ignored.”

Treatment of diabetes also involves dealing with the disease’s complications. “There are two types of complications resulting from diabetes: cardiovascular and microvascular,” said Pogach.

“Cardiovascular complications include heart attacks, angina and strokes. Microvascular complications include eye disease, kidney damage and diabetic neuropathy, often leading to foot ulcers and www.M2VA-kmi.com

amputations. We have a surveillance program in the VA to identify people at risk for lower extremity complications.”

Over 60 percent of non-trauma related lower-limb amputations occur in people with diabetes, according to the ADA. In 2006, 65,700 lower-limb amputations were performed in people with diabetes.

“Diabetics are prone to foot complications,” said Brian Lane, director of education and customer service at Dr. Comfort. “There are staggering statistics about the exorbitant costs related to diabetes wounds, many of them relating to improperly fitting shoes.”

Dr. Comfort makes special shoes for diabetics as well as inserts such as toe fillers to allow shoes to fit properly on those who have suffered toe amputations. Therapeutic shoes require a closure system in the form of laces, buckles or Velcro to secure the foot in place. The shoe upper is made of soft leather or another soft material to assure comfort for those suffering from curled-up or hammer toes, and the toe box is generally wider than average to accommodate feet with bunions or sores.

In the 1990s, Congress passed a special law that allows Medicare beneficiaries one pair of therapeutic shoes every year.

“Statistics show that it costs between $25,000 and $75,000 per amputation,” said Lane. “Congress was willing to provide the extra benefit to prevent future complications from occurring.”

The military and veterans health systems also cover shoes and accessories for those suffering from foot complications related to diabetes. Last year, the CDC identified therapeutic footwear as one tool to reduce diabetes-related amputation rates.

Both the military and veterans health systems continue to innovate better care for diabetics. “The problems of [excess] weight and obesity are shared by public health experts at the national and state levels and in academia,” said Cersovsky. “We are collaborating with experts in other government agencies like the VA, private sector organizations like the American College of Sports Medicine, and academia. We hope these cooperative efforts will lead to effective solutions from which not only the Army, but the U.S. population as a whole, can benefit.”

Within the last couple of years, noted Kinsinger, every year VA medical center has a health behavior coordinator on staff. These are psychologists that support staff and patients and encourage the latter to make healthy behavior choices. The VA is even introducing a new mobile app to help veterans in their preventive efforts. “The app will be interactive,” said Kinsinger, “allowing veterans to input information about their eating behavior and physical activity and allowing clinicians to provide feedback and advice.”

The biggest sticking point in diabetes prevention and treatment, for Pogach, is a problem faced by millions of people all over the world: keeping weight off. “Even in trials with motivated volunteers,” he said, “many people regain the weight they lost. [Finding] better ways to sustain weight loss would be a major advance we can make for public health in the case of Type 2 diabetes.” O

For more information, contact M2VA Editor Chris McCoy at chrism@kmimediagroup.com or search our online archives for related stories at www.m2va-kmi.com.

M2VA 17.2 | 9

VA Commodities Enterprise Contract T V A . hree companies are awarded a five year

eterans

ffairs contract

Photo by Jeff Mauritzen

software engineering. The company makes On March 19, 2013, the U.S. Department use of automated standard operating proof Veterans Affairs announced the award of a cedures and 3-D immersive visualization $5.3 billion ceiling commodities enterprise in order to meet challenges relating to syscontract (CEC) to three companies. The tem integration, decision support, strategic award went to Alliance Technology Group planning, risk management, LLC of Hanover, Md., Red assessment of alternatives and River Computer Co. Inc. of information security.

Claremont, N.H., and Valador Speaking on behalf of Red Inc. of Herndon, Va. River, Jim Dunn, vice presiThis contract has a ceiling dent of strategic programs value of $5.3 billion over a said, “Red River has the abilfive-year period. The contract ity to serve the VA on a largeis focused on contracting the scale capacity that is unique services of small companies for a company of our size. and is for supplying the VA This particular vehicle is a with IT hardware and IT serJim Dunn great fit for Red River, as this vices. Laptops, mobile tablets, hits at the heart of what we do, what we networking gear, servers, routers and secuprovide and how we bring top-level service to rity platforms are among the items included. our customers.” Dunn said, “We have years The contract supports the standardization of of serving this particular market, and we’re the VA’s intricate IT architecture. here to help the VA secure the solutions and “The VA has made great progress over the services they need at the best possible prices. past few years in improving the level of serThe scope of this contract is everything we vice and responsiveness to veterans. CEC will do—enterprise networking and large-scale continue this progress by providing for coststorage is Red River’s business.” competitive access to ongoing technology to Dunn added, “The VA CEC required our sustain a robust technology infrastructure, core competencies, and while it’s a vehicle and will continue to provide improved service reserved for the small business category, to veterans. This contract is about service to Red River has demonstrated expertise and is veterans,” said Kevin Mabie, president and currently performing at a volume level that chief executive officer of Valador. is consistent with some of the largest compaValador is a verified service-disabled nies in the industry. For example, on NASA veteran-owned small business that delivSEWP, a contract vehicle where we compete ers solutions for collecting, maintaining, with over 30 other companies of all sizes, visualizing and protecting its client’s inforwe’re second in total volume provided for this mation. Valador focuses chiefly on providfiscal year. We have the professional expertise, ing IT products and services, management years of experience, elite partnerships, and consulting, modeling and simulation, and 10 | M2VA 17.2

By Chris McCoy, M2VA Editor

resources such as a robust line of credit that enable us to provide unmatched service to our customers. So when you consider the size of the VA CEC, valued at $5.3 billion, our strong financial capabilities paired with streamlined operations enable us to support and process the VA’s IT requirements.”

Red River is currently expanding its health care specialization in both the private and public sector. “We never lose sight of essential priorities as we work with customers like the VA to leverage best-of-breed health care technology innovations, as well as optimize current assets to establish, maintain and protect an advanced medical computing infrastructure,” said Dunn. “This is particularly useful to the VA because health care is a major part of their organization, and we have the 360-degree knowledge of the solutions needed for understanding their operations.”

Alliance Technology Group is a systems integrator and IT solutions company that specializes in IT infrastructure, cloud computing and professional services. Among other services, Alliance Technology Group offers IT support services, cloud computing, data life cycle management, staff augmentation, network solution, big data storage solutions, and business continuity and disaster recovery. The company has 11 offices in eight states and has provided services in the public sector at the local, state and federal level. O

For more information, contact M2VA Editor Chris McCoy at chrism@kmimediagroup.com or search our online archives for related stories at www.m2va-kmi.com.

www.M2VA-kmi.com

Red River Named to VA Commodities Enterprise Contract Red River stands ready to help the VA meet its technology and mission goals through the Commodities Enterprise Contract.

Whether it’s implementing IT Solutions to increase agency efficiency and productivity, or assisting with the evolution of the VA Enterprise Architecture, we will use our more than 17 years of experience as a trusted IT hardware, integration, maintenance, and support services provider to deliver performance beyond expectations.

Learn more at www.redriver.com.

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Electronic Health Records Roundtable Discussion Three EHR vendors offer the reasons why their EHR solutions are a good pick for DoD.

The modernization of DoD’s electronic health record (EHR) system is a common topic of conversation in federal health IT circles. We reached out to several vendors and sought their responses to the following question: “How does your company’s electronic health record solution meet the Department of Defense’s need for a new EHR system?”

Leigh Burchell Vice President, Government Affairs | Allscripts The federal health care IT community is focused on opportunities for improving health care outcomes through information technology. Key to this effort is harnessing increasing volumes of data and converting it into meaningful decision support and analytics that can advance patient outcomes and better manage costs. Employing an open architecture is key to building a connected community of health that maximizes clinical, datadriven systems for the good of all patients.

Allscripts applauds these efforts and the approach being initiated. The federal medical community is positioned to embrace opportunities through the development of clinical and analytical technologies while allowing for greater focus on efficiently priced, high-quality care. The current federal efforts are focused on acquiring and deploying the right architectures and systems for succeeding with the value-based care requirements of the future in mind, rather than the volume-based implementations of the past.

Additionally, we support the current approach of leveraging the federal investment in place. Vendor lock-in creates risk, and the federal health care IT leadership seeks to mitigate those risks, whether they be those posed by closed-loop information systems or integration teams that do not embrace an “open” approach.

12 | M2VA 17.2

The military has evolved significantly in only a few years. It moves people frequently, and has drawn extensively from the civilian ranks, namely the National Guard. That flexibility is key to military success, but it also poses a new requirement of medical records—once home, many of our wounded are examples of the fact that it isn’t just surgery but rehabilitation that is critical, and the ability to move records around the world and between civilian and military systems is a must.

Just as the military has changed, so has the care delivery model. Military and VA providers rely on advanced technologies and collaborative care, and care coordination is now a requirement. Complex patients require teams to drive outcomes, and civilian health care trends will be critical for the military as well.

Patients move between the Military Health System, the VA and private sector, and physicians are required to manage the patient hand-offs through care teams. They need systems to track, manage and facilitate this communication—a health information exchange connecting the VA, DoD and the private sector.

History shows that open systems beat out closed every time.

Think about ATMs and banking. We are committed to providing the tools to treat patients seamlessly across the continuum of care. Allscripts believes that federal health IT executives can lead the market in embracing an open approach that will provide to health care the kind of value that DARPA did in the early decades of the Internet. www.M2VA-kmi.com

Atif Aleemi Vice President, Client Development | athenahealth Per the recent government RFI, DoD is seeking to deliver to the warfighter EHR system [EHRS] with the most capability in the shortest period of time for the least cost. Only a cloud-based EHRS can meet this requirement. A modern cloud-based EHRS architecture is inherently open and modular, based on industry standards, and uses non-proprietary interfaces.

Athenahealth’s cloud-based EHR service, athenaClinicals, is the anecdote to the antiquated software and technology models [MUMPS or even COBOL] that many legacy vendors are pushing. We believe the days of spending millions [or billions] on health care IT software and hardware are over. There is no longer the need to spend years in development and deployment, only to find that requirements and technology have evolved. This leads to millions wasted that could be used to care for warfighters and dependents. Why pay for delivery of software instead of paying when results or value is delivered?

The cloud model provides unprecedented visibility into activities at the provider, clinic or enterprise levels. Athenahealth can look across about 40,000 providers currently using our services

to see exactly how they are performing. We can rapidly introduce changes and see immediate behavior change at the point of care.

Moreover, our cloud-based services run on a single instance of software. Our clients do not have to worry about upgrading for meaningful use [MU]; we upgrade in real time and immediately all our users are on a MU-certified system. In fact, 96 percent of eligible providers on athenaClinicals have successfully attested to Stage 1 Year 1 MU—well above industry averages. Our clients can expect similar benefits for ICD10 and MU2.

In a best-of-breed scenario, athenaClinicals represents a revolutionary solution for DoD’s ambulatory EHR requirements and can deliver benefits beyond existing requirements. For example, the cloud can link the direct care system [MTFs] with the purchased care system [TRICARE]. Over 14,000 athena providers already care for DoD beneficiaries. Imagine DoD providers having visibility into whether a patient showed up for a referral in a commercial facility and instantly knowing the results. Or, whether the patient picked up their medication from the local pharmacy.

Yes, there are security considerations that can be overcome, but the benefits are numerous, including the ability to rapidly innovate in the cloud.

W.B. (Mitch) Mitchell Vice President, Federal Solutions | RelayHealth DoD has many unique and complex needs with regard to moving to a new EHR system. A few commercial EHR vendors could likely fulfill these needs, but the greater issue shared by both the military and civilian health care systems is the need to securely share health information across diverse systems and care settings.

With the appropriate solution in place, it is conceivable that DoD and the VA could share information across their current platforms and, with adherence to industry standards, leverage that connectivity with a suitable commercial solution should DoD move in that direction. In addition, with over 50 percent of the health care delivered outside the direct care system within DoD, military health providers could securely share information with network providers to enhance continuity and offer a fuller, more coordinated view of a patient’s care.

RelayHealth is focused on connecting patients, providers, payers, pharmacies and all organizations involved in delivering, paying for or managing health care through our intelligent networks. This helps our customers—and their patients—manage health care in an ever-changing industry.

RelayHealth currently provides interoperable secure messaging to TRICARE beneficiaries worldwide, who are seen within patient-centered medical homes at and near military treatment facilities. This messaging allows patient-provider and providerprovider electronic communications, in support of a more patientcentric care model that is being rolled out across the military www.M2VA-kmi.com

health system. RelayHealth’s established capability, in use today by over 400,000 TRICARE beneficiaries, spouses and dependents, connects more than 19,000 health care providers and care team staff within the Military Health System at more than 130 military treatment facilities, branch clinics, community-based medical homes and other care settings.

Use of the RelayHealth secure messaging platform is a key facet to achieving the National Committee for Quality Assurance certification for MTF and the clinic-based Patient-Centered Medical Home initiatives, and directly supports the tenets of the Military Health System’s Quadruple Aim. Through a flexible and scalable architecture, supplemented with a robust suite of web services, application programming interfaces, and adherence to industry standards for data exchange, we can also enable commercial core systems vendors and solution providers to better meet these goals.

RelayHealth can also provide secure health information exchange services that could help diverse EHR systems share data across care settings. RelayHealth is doing it for thousands of providers across the nation, including 67 health information exchanges. By delivering web-based, supportive applications designed to enhance care quality, manage patient populations and optimize reimbursement, RelayHealth helps our customers achieve better health for their businesses and for their patients. O For more information, contact M2VA Editor Chris McCoy at chrism@kmimediagroup.com or search our online archives for related stories at www.m2va-kmi.com.

M2VA 17.2 | 13

VITAL SIGNS Next-Generation Exoskeleton for Rehabilitation

Argo Medical Technologies has unveiled the newest generation of its ReWalk Rehabilitation exoskeleton that enables individuals with spinal cord injuries to walk again. The 2.0 system is designed to make it easier to treat multiple individuals each day. It also has new software features that support beginner users and new sizing that allows each system to fit a broader range of patients.

Argo currently offers two ReWalk models—the ReWalk Personal, currently available in Europe and pending FDA review in the U.S.; and the ReWalk Rehabilitation, which is now available in Europe, Israel and the United

States. Both models are designed to provide a customized user experience with on-board computers and motion sensors that restore self-initiated walking without needing tethers or switches to begin movement. The ReWalk uses patented technology with motorized legs that power knee and hip movement. It controls movement using subtle changes in center of gravity, mimics natural gait and provides functional walking speed. A forward tilt of the upper body is sensed by the system, which triggers the first step. Repeated body shifting generates a sequence of steps, which allows natural and efficient walking.

Enhanced Remote Service Capabilities for Clinical Laboratory Customers Siemens Healthcare Diagnostics announced the integration of Siemens Remote Services (SRS) into its existing product-level service model. Already available to Siemens Healthcare imaging diagnostics customers worldwide, SRS will now help create a more unified customer experience by maximizing uptime for Siemens’ clinical laboratory customers and boosting lab efficiency to meet today’s testing challenges.

Part of the Siemens Customer Care program, SRS is a powerful bidirectional data connection between customers’ installed systems and the Siemens service organization. It is designed to increase instrument runtime, prevent unscheduled downtime and ultimately help laboratories maintain normal departmental workflow. Maintenance services that formerly required onsite visits are now possible via data transfer, including error identification and repair. Additionally, SRS proactively monitors customers’ systems—detecting issues before they interrupt operations—and can be used to initiate remote desktop sharing sessions upon request. Plus, SRS continuously pushes software updates including anti-virus protection, ensuring systems are always protected.

Siemens Healthcare Diagnostics offers SRS for the Dimension Vista 500 and 1500 intelligent lab systems; Advia Centaur CP and XP immunoassay systems; Advia 1800 and 2400 clinical chemistry systems; and Immulite 2000 and 2000 XPi immunoassay systems. SRS is also available with Siemens’ Aptio Automation, Advia LabCell, Advia WorkCell and VersaCell System. Siemens expects to offer SRS with additional laboratory diagnostics systems in the future.

Advanced Microbiology Testing Solutions Pcl Alverno has signed a multi-year expanded agreement with Siemens Healthcare Diagnostics and finished implementing several new microbiology systems, becoming the first medical diagnostics laboratory in the U.S. to showcase Siemens’ full range of advanced microbiology testing solutions.

Now designated a Siemens Microbiology Innovations Center, Alverno will serve as a future reference site for other laboratories interested in exploring Siemens’ complete microbiology portfolio offerings.

“Designation of Alverno as a Siemens Microbiology Innovation Center means an enhanced contribution to the doctor-patient relationship,” said Dale Kahn, director of laboratory operations, Pcl Alverno. “Delivery of microbiology testing results in the most efficient, accurate way is a top priority.”

“Siemens is excited to partner with Alverno to showcase the tremendous advances in microbiology automation, both now and in the future,” said Jim McMenamin, vice president, Microbiology 14 | M2VA 17.2

and Molecular business unit, Siemens Healthcare Diagnostics. “Expanding the reach of our portfolio is an important component of Siemens’ Agenda 2013 initiative.”

Alverno is a full-service, community-based medical laboratory offering over 750 different tests in both clinical and anatomic pathology. Its new Siemens agreement includes the integration of several new solutions to Alverno’s existing state-of-the-art laboratory services, including the Copan WASP: Walk-Away Specimen Processor, available to medical laboratories through a Siemens-Copan partnership.

Designed to help laboratories streamline pre-analytical microbiology testing operations and free up staff resources, the WASP System fully automates the often tedious tasks of bacteriology specimen processing. Alverno has also implemented the Bruker Maldi Biotyper System—available to customers via a Siemens-Bruker partnership—

for faster, more accurate and cost-effective microorganism identification compared to current methods. Later this year, Alverno will be the first laboratory in the U.S. to implement WASPLab System, the next level of Copan automation.

WASPLab System is a barcode-driven and conveyorconnected specimen processing system that employs robotic plate management and image analysis.

Alverno has been a long time Siemens customer, currently using 10 MicroScan WalkAway Systems— Siemens’ signature microbiology testing solution featuring intelligent automation to help increase efficiency and reduce maintenance. To further streamline operations and expedite test results, Alverno has integrated Siemens’ LabPro Connect software into their operation. This networking solution enables technologists to manage nearly all aspects of specimen processing and reporting without leaving their bench, and supports supervisory activities with no interruption of daily workflow. www.M2VA-kmi.com

Compiled by KMI Media Group staff

Blast Monitoring System Captures Vital Data for Operations, Training and Research Blackbox Biometrics Inc. has introduced the Blast Gauge System. Providing immediate, quantitative data correlating with the forces of pressure and acceleration soldiers are exposed to from explosives, the Blast Gauge System provides a new capability for the military.

Traumatic brain injury (TBI) from an explosive blast remains a significant problem for military personnel, especially those involved in counterinsurgency operations. Mild to moderate TBI may be difficult to detect immediately post-event, with cognitive or motor deficits manifesting weeks or months later. This soldier-worn device, weighing less than an ounce, logs pressure and acceleration from exposure to a blast. The device automatically categorizes the exposure in the form of LED lights, providing immediate severity triage capability. A micro-USB connection allows full time-based data to be later analyzed by medical personnel. The compact device unobtrusively mounts on the helmet, gear and vehicles and withstands the harshest of environments.

The Blast Gauge System has been successfully fielded in Afghanistan,

providing critical exposure logging capability for triage and treatment of traumatic brain injury.

Traumatic brain injury has been recognized as the signature injury of modern day conflicts, yet most warfighters remain without blast exposure logging capabilities. The Blast Gauge System provides an immediate solution to capture soldier exposure to explosive blasts—guiding triage in the field and exposure tailored medical treatment for TBI.

First Autonomous Telemedicine Robot IRobot Corp. announced that the RP-VITA remote presence robot has received 510(k) clearance by the U.S. Food and Drug Administration for use in hospitals. RP-VITA is the first autonomous navigation remote presence robot to receive FDA clearance.

RP-VITA is the product of a joint effort between iRobot and InTouch Health. The robot combines the latest in autonomous navigation and mobility technologies developed by iRobot with state-of-the-art telemedicine and electronic health record integration developed

by InTouch Health. RP-VITA allows remote doctor-to-patient consults, ensuring that the physician is in the right place at the right time and has access to the necessary clinical information to take immediate action. The robot has unprecedented ease of use. It maps its own environment and uses an array of sophisticated sensors to autonomously move about a busy space without interfering with people or other objects. Using an intuitive iPad interface, a doctor can visit a patient and communicate with hospital staff and patients with a single click, regardless of their location.

The FDA clearance specifies that RP-VITA can be used for active patient monitoring

www.M2VA-kmi.com

in pre-operative, peri-operative and postsurgical settings, including cardiovascular, neurological, prenatal, psychological and critical care assessments and examinations.

RP-VITA is being sold into the health care market by InTouch Health as its new flagship remote presence device. IRobot will continue to explore adjacent market opportunities for robots like RP-VITA and the iRobot Ava mobile robotics platform.

“FDA clearance of a robot that can move safely and independently through a fast-paced, chaotic and demanding hospital environment is a significant technological milestone for the robotics and health care industries,” said Colin Angle, chairman and chief executive officer of iRobot. “There are very few environments as difficult to maneuver as that of a busy ICU or emergency department. Having crossed this technology threshold, the potential for selfnavigating robots in other markets, and for new applications, is virtually limitless.”

“Remote presence solutions have proven their worth in the medical arena for quite some time,” said Yulun Wang, chairman and chief executive officer of InTouch Health.

“RP-VITA has undergone stringent testing, and

we are confident that the robot’s ease of use and unique set of capabilities will enable new clinical applications and uses.”

M2VA 17.2 | 15

Health Provider

Q& A

How Europe Regional Medical Command Works as One Team in Support of its Units

Colonel Jeff Clark Commander Europe Regional Medical Command Command Surgeon U.S. Army Europe Colonel Jeff Clark is a graduate of Davidson College, East Carolina University School of Medicine, the U.S. Army Command and General Staff College and Army War College. Clark earned a Master of Public Health at the University of Washington and a Master of Strategic Studies at the Army War College. He is board-certified in family medicine.

Following a family medicine residency at Silas B. Hays Army Community Hospital, Fort Ord, Calif., Clark served as a family physician and flight surgeon, 543rd General Dispensary, Taegu, Korea from 1987-1989. While at Fort Bragg, he served as staff family physician at the 1st Corps Support Command Clinic, faculty and clinic director of the Womack Army Community Hospital Family Medicine Residency, and senior medical officer of C Co, 307th Medical Battalion, 82nd Airborne Division during Operation Desert Shield/Storm.

Clark served as 82nd Airborne Division surgeon from 1993-95. He commanded the 168th Area Support Medical Battalion, Korea from 1997-1999 and served as chief of primary care and family medicine at Womack Army Medical Center, Fort Bragg, from 1999 to 2001.

While assigned to the Wuerzburg MEDDAC/67th CSH from 2001 to 2004, Clark served as deputy commander for clinical services and as commander of Task Force Medical Falcon, Kosovo. While in command of the 21st Combat Support Hospital, 2005-2007, Clark led unit deployments to New Orleans in support of the Hurricane Katrina relief operation, and during OIF 06-08 as TF 21 MED provided detainee health care for the Iraqi theater of operations. Following his assignment as chief of preventive medicine for Darnall Army Medical Center, Fort Hood, Texas, Clark served as commander, 65th Medical Brigade/USAMEDDAC-Korea and as USFK/UNC/CFC surgeon from 2008-2010. He served as chief of Medical Corps Branch, Human Resources Command, Fort Knox, Ky., prior to commanding Landstuhl Regional Medical Center from 2011 to 2012.

Clark’s awards and decorations include the Defense Superior Service Medal, Legion of Merit, Bronze Star, Meritorious Service Medal, Combat Medical Badge, Expert Field Medical Badge, Flight Surgeon Badge, and the Parachutist’s Badge. He is a member of the Order of Military Medical Merit and recipient of the Republic of Korea Order of National Security Merit, Samil Medal.

Q: Could you give us an overview of Army Medicine in Europe?

A: Army Medicine in Europe is one team consisting of all U.S. Army MEDCOM units in Europe and the U.S. Army Europe Office of the Command Surgeon. Command Sergeant Major Robert Luciano and I lead a great team that provides health care across the full spectrum 16 | M2VA 17.2

of services and support. We are patient-centered. Our mission is to provide high-quality health care and support to all we are privileged to serve. We have an outstanding one team focused on our mission.

I work closely with the U.S. Africa Command [AFRICOM] surgeon, Captain David Weiss, U.S. European Command [EUCOM]; surgeon, Colonel John Mitchell; and our Navy and Air Force Medicine colleagues to ensure servicemembers, families and retirees receive the highest-quality health care and that our supported units have the health service support they need. In my role as USAREUR Surgeon, I coordinate closely with Colonel Jay Neubauer, U.S. Air Force Europe surgeon general. Our areas of responsibility overlap and provide many opportunities for collaboration in ensuring patient-friendly access to high-quality health care.

Army Medicine in Europe supports AFRICOM, EUCOM, U.S. Central Command [CENTCOM] U.S. Special Operations Command [SOCOM], State Department, NATO and non-NATO partners. Army Medicine in Europe builds medical capacity, enhances multi-national teamwork, shares best practices and fosters strong relationships with our NATO and non-NATO partner nations. These theater engagement and capacity building efforts include direct health care, medical logistics support, medical research, public health and force health protection support, as well as engagement missions throughout our supported combatant commands’ areas of responsibility. www.M2VA-kmi.com

To better understand who we are, I would like to share with you a small part of what Army Medicine in Europe does on a daily basis.

Today, thousands of pounds of medical supplies and equipment are being distributed to hundreds of locations over three continents.

These shipments provide myriad units, both garrison and operational, and 155 embassies the medical supplies they need to care for America’s sons and daughters serving in AFRICOM, CENTCOM and EUCOM areas of responsibility. Colonel Thomas Slade and Sergeant Major James Chambers lead a great team of soldiers, civilians and local nationals at the U.S. Army Medical Materiel Center, Europe.

Literally hundreds of critical medical support missions are made possible by these hard-working professionals. The USAMMCE team is also responsible for medical maintenance and produces more than 200 pairs of eyeglasses each day for soldiers, Marines, sailors and airmen serving in these COCOMs. USAMMCE’s proven responsiveness and medical logistics support to three combatant commanders is vital to our national interest.

Wounded warriors evacuated from Afghanistan arrive at Landstuhl Regional Medical Center daily where they receive the absolute finest medical care in the world. Landstuhl Regional Medical Center [LRMC] is the only overseas U.S. Level I trauma center and serves as the Role IV strategic evacuation center for AFRICOM, CENTCOM, EUCOM and SOCOM. It is the sole link between ‘down-range care’ and subsequent long-term care in the U.S. Since January 2004, LRMC has treated more than 14,000 battle injuries and 70,000 OIF, OND and OEF patients; nearly 1,000 of these patients have been coalition partners from 54 nations. More than 14,000 or 20 percent of the OIF/OND/OEF patients were returned to duty—that’s the equivalent of 35 battalions returned to the fight, one squad member at a time.

The medical center’s mission related to overseas contingencies is impressive, but is only part of the story. Over 75,000 servicemembers, families and others eligible for care receive patient-centered primary care in one of LRMC’s seven clinics in Germany, Belgium and Italy and at the Vicenza Health Center which also provides obstetrics and same-day surgery. Led by Colonel Barbara Holcomb and Command Sergeant Major Michael Gragg, the dedicated team of soldiers, Marines, sailors, airmen, civilians, local nationals and volunteers at LRMC also provide 245,000 beneficiaries specialty and surgical care. Since October 2005, this has amounted to more than 40,000 inpatient admissions and more than 2 million outpatient encounters for servicemembers and their families serving here in Europe. The new Rhine Ordnance Barracks Medical Center, scheduled to open in 2022 to replace the current aging LRMC structure, will continue to provide a world-class medical facility in support of AFRICOM, CENTCOM, EUCOM and SOCOM for the 21st century.

More than 1,500 dental procedures take place daily at 19 clinics operated by Europe Regional Dental Command [ERDC] throughout Germany, Italy and Belgium. With warrior-focused oral health care as their primary mission, they offer a full range of comprehensive and specialty dental services, and see hundreds of family members on a space-available basis each month. Under the leadership of Colonel William Bachand and Sergeant Major Mateo Alba, the ERDC team serves a key role in USAREUR soldier readiness. In fact, USAREUR has the highest Category 2 dental readiness rate in the Army. However, ERDC will move beyond mere dental readiness to dental health.

“Going First Class” focuses on achieving dental health [Category 1] rating for soldiers instead of settling for a Category 2 rating, which is the minimum needed to deploy. By using a single appointment for www.M2VA-kmi.com

the annual exam, cleaning and simple fillings, the ERDC team can effectively use one visit to achieve a Category 1 rating instead of three separate visits throughout the year. This is an excellent example of a patient-centered health initiative focusing on wellness. Instead of reacting to problems and providing fixes to reach readiness, ERDC will proactively achieve oral health and wellness preventing problems before they occur. This approach will reduce treatment needs of soldiers and reduce sick call numbers.

Today, many of our Army Medicine in Europe medics are preparing to deploy, are already deployed or are returning home. Many elements of the 30th MEDCOM are currently deployed. Led by Colonel Koji Nishimura and Command Sergeant Major Alexis King, the 30th MEDCOM headquarters is deployed as Task Force Medical-Afghanistan, providing mission command for all OEF medical support. The 8th Medical Logistics Company, the 254th Combat and Operational Stress Control Medical Detachment, and 160th Forward Surgical Team are also deployed to Afghanistan. The 212th Combat Support Hospital is preparing to go to Afghanistan and elements of the 421st Multifunctional Medical Battalion are preparing to deploy to Kosovo.

The capabilities of the 30th MEDCOM, deployed forward in Europe and thus responsive to contingency requirements of AFRICOM, CENTCOM and EUCOM, are impressive. The 30th can rapidly deploy an 84-bed combat support hospital, two forward surgical teams, and a multifunctional medical battalion with six separate units to any of these COCOMs. The 212th Combat Support Hospital provides Level III combat health support covering the entire spectrum of unified land operations. Their two forward surgical teams provide vital surgical capability to the warfighter as close to the point of injury as possible. The 421st MMB’s 8th medical logistic company is capable of supporting combat health logistics management and customer support with medical warehousing. Embedded in their Medical Logistic Company, they have biomedical equipment and maintenance capabilities, optical lens fabrication and repair, medical waste regulation, and contact repair teams to provide services. The 557th Area Support Medical Company provides ground medevac support, patient hold operations for up to 72 hours, and Level II medical capabilities. The 64th Medical Detachment provides veterinary support from small animal care to food inspection activities. The 71st Medical Detachment provides preventive medicine support for site surveys ensuring U.S. armed forces occupy suitable training areas and forward positions. Their medical threat analyses allow forces to safely adapt to their new surroundings. The 254th Combat and Operational Stress Control Medical Detachment is critical for sustaining tactical operations by providing behavioral health services wherever required.

When they aren’t downrange, 30th MEDCOM medics are engaged in valuable combined training with coalition partners such as the Germans, Latvians, Hungarians, British and others. Their interaction and training with coalition partners strengthens valuable relationships in the region. A good example of this took place last fall during “Rhino Serpent,” a joint military exercise involving 400 medical personnel from the 30th MEDCOM, the United Kingdom, Germany and Tunisia.

In the Warrior Transition Battalion-Europe [WTB-E], wounded, ill or injured soldiers are focused on healing. Some of their daily activities might include scuba diving, ropes courses, kayaking, jobs skills development or other activities designed to build skills and confidence whether these soldiers return to duty or transition to civilian life. WTB-E soldiers meet often with their care teams to set M2VA 17.2 | 17

goals and track progress. Thanks to the WTB-E team led by Lieutenant Colonel Doug Galuszka and Command Sergeant Major Eugene Chance, these soldiers are able to prepare to either return to duty or transition to their next career as a civilian. WTB-E plays a key role in OCONUS [outside the contiguous United States] Integrated Disability Evaluation System [IDES], compassionately and efficiently facilitating the MEB/PEB [Medical Evaluation Board/Physical Evaluation Board] process for USAREUR soldiers.

Colonel Daniel Jimenez and Sergeant Major Eric Holland lead an outstanding team of soldiers, civilians and local nationals at Public Health Command Region-Europe [PHCR-E]. The team at PHCR-E provides comprehensive public health and veterinary programs in support of garrisons and contingency/combat forces operating in AFRICOM, CENTCOM and EUCOM. The PHCR-E team conducts more than 40 installation food inspections on a daily basis. These inspections are critical to ensuring safe food for all those serving in these regions. Veterinary medicine professionals complete more than 200 veterinary animal health visits daily. PHCR-E operates one of the largest veterinary hospitals within DoD, providing Level IV veterinary care for military working dogs [MWDs] serving in AFRICOM, CENTCOM and EUCOM. MWDs are evacuated to the PHCR-E Dog Center in Kaiserslautern, Germany, where highly trained veterinarian teams work to save the lives of these four-legged warriors. Over the past 12 months, their team has provided Level IV critical care for 19 wounded MWDs evacuated from both Iraq and Afghanistan. They also provide veterinary support to coalition forces, most recently caring for MWDs from the Czech Republic, Great Britain and Australia.

PHCR-E personnel deploy to any location in the AFRICOM, CENTCOM or EUCOM areas of responsibility to conduct on-site assessments covering all areas of environmental science and engineering, and provide technical training or advice to deployed personnel. Environmental surveillance experts assess the occupational and environmental exposures that the deployed force may encounter, evaluate potential health risks and recommend countermeasures to commanders.

The U.S. Army Medical Research Unit-Europe [USEMRU-E] team develops effective behavioral health assessment for policy recommendations. Their insights are critical in assessing strategies that will lead to the best care we can offer our warriors before, during and after deployment. USAMRU-E’s research has impacted not only U.S. military medicine, but civilian behavioral health practices and that of many of our allies. Recently, the USAMRUE commander, Lieutenant Colonel Jeffrey Thomas, led a traveling contact team to Uganda to exchange information related to resilience training program development. Thomas and Dr. Amy Adler participated in an information exchange with the Uganda. People’s Defence Forces [UPDF] from February 19-22 at Junior Command Staff College in Jinja, Uganda.

The 22 UPDF participants were mental health experts, including psychiatrists, psychologists, psychiatric nurses and enlisted/warrant officer medical staff from across the force. The four-day exchange focused on lessons learned from the U.S. Army’s comprehensive soldier and family fitness program. USAMRU-E facilitated discussion related to developing resilience training across the deployment cycle and implementation strategies for initiating resilience training programs.

The USAMRU-E team is also studying the impact relocation and significant changes in a military community have on the wellbeing of soldiers, civilians and family members. While the Army has a history of transforming, little research has documented the 18 | M2VA 17.2

impact or provided evidence-based recommendations to leaders for how to mitigate any negative impacts. USAREUR is in the midst of significant changes. Traditional military communities are closing [such as Heidelberg] and other communities are growing [such as Wiesbaden]. USAMRU-E is working with senior USAREUR leaders to evaluate the impact of the transformation. Survey and interview data collection are expected to begin in summer 2013.

U.S. Army Medical Department Activity Bavaria’s [USAMEDDAC Bavaria’s] seven clinics throughout southwestern Germany provide the full range of primary care services to include optometry, physical therapy, lab, pharmacy and X-ray as well as behavioral health. The USAMEDDAC Bavaria delivers patient-centered quality health care to over 40,000 beneficiaries spread over 27,000 square miles. Led by Colonel Darrin Cox and Command Sergeant Major Napoleon Noguerapayan, the USAMEDDAC Bavaria provides health care support to rotational units from EUCOM, AFRICOM, NATO and European partner nations at the Joint Multinational Training Center [JMTC] in Grafenwoehr and the Joint Multinational Readiness Center in Hohenfels, Germany. They recently provided outstanding postdeployment support for the 172cd Brigade Combat Team and are currently working as one team with 2cd Cavalry Regiment to ensure their medical readiness for deployment.

In addition to my role as ERMC commander, I serve as the USAREUR command surgeon. The USAREUR Office of the Command Surgeon, led by Deputy USAREUR Surgeon Colonel Lance Cordoni and Sergeant Major Hoyt Williams, coordinates Army Medicine in Europe multinational training opportunities to ensure the sharing of medical tactics, techniques and procedures with our partners. We participate in more than 25 annual theater-wide training events to exchange doctrine, tactics, techniques and procedures, and build lasting partnerships. The crown jewel of training in Europe, the JMTC, is an extraordinary forum for medical exercises and pre-deployment training for NATO and non-NATO partners serving with U.S. forces in AFRICOM, CENTCOM and EUCOM areas of responsibility. Annually, hundreds of partner nation soldiers train at the Medical Simulation Training Center [MSTC] in the JMTC. We recently trained 40 Albanian and 20 Slovenian medics at the MSTC. We also train our medics in the Wiesbaden Viper Pit. The Viper Pit is an MSTC-like mobile capability that provides realistic hands-on training for U.S. servicemembers and our multinational partners. Recently we trained medics from Germany, Austria and Finland in our Viper Pit. Each fall we provide an opportunity to earn the coveted expert field medical badge [EFMB]. Soldiers, sailors and airmen from both U.S., NATO countries and other partner nations, participate in this great training event. These servicemembers begin training months in advance and spend the first week of the event focused on meeting the standards of the arduous tasks before testing begins. Last fall, nearly 25 percent of the more than 300 participants earned the badge, far above the MEDCOM average of 17 percent. Five of the 16 participants from Estonia, Great Britain, Germany, Italy and Poland earned the EFMB. This fall we are planning for over 200 U.S. participants and 100 medics from our NATO and other partner nations.

Other examples of partnership and capacity building include training and equipping soldiers from the Republic of Georgia to serve alongside U.S. Marines in Afghanistan; training Polish soldiers on combat lifesaver skills and assisting them in establishing their own combat lifesaver program; training and partnering with the German Bundeswehr on the employment and doctrine for rotary wing medical evacuation; and interoperability between U.S., U.K. and www.M2VA-kmi.com

German field hospitals. The numerous pre-deployment training events and deployment of patriot systems to Poland were successful in developing medical train the trainer capability in the military medical academy in Lodz, Poland. The result is a significant portion of this training can be trained in Poland and allows Poland to reach out to their regional force providers to offer this training as part of a regionally focused training package.

As you can see, the mission for Army Medicine in Europe is vast, covering a wide array of services and support in the AFRICOM, CENTCOM and EUCOM areas of responsibility. We have an impressive Army Medicine in Europe team focused on patient-centered care and support every day.

Q: What are the priorities of Army Medicine in Europe?

A: A conversation about Army Medicine in Europe priorities must be done in the context of U.S. Army MEDCOM Commander/Army Surgeon General Lieutenant General Patricia D. Horoho’s strategic vision:

Soldiers stabilize a simulated casualty during Operation Rhino Serpent at Sennelager Training Area, Germany. Rhino Serpent was a joint medical training exercise for U.S., British and German armed forces. [Photo courtesy of Captain Elizabeth Behring, 30th Medical Command Public Affairs U.S. Army]

Army Medicine in Europe has established the following priorities in order to achieve this vision:

about an equal number of family members; the number of airmen and their families will also decrease. Simultaneously, USAREUR will consolidate into fewer installations. Some will get bigger [Vicenza and Wiesbaden]; some will get smaller [Baumholder]; some will close [Heidelberg, Bamberg, Schweinfurt].

During this time of tremendous change, Army Medicine in Europe will do the following: We will ensure patient-centered care for all we are privileged to serve. We will always do this, but during this time it is especially important that our patients trust that whether their installation is getting larger, smaller or headed towards closure, we will be there for them. We will take care of our people during this time of change.

Many of our people and our families are impacted by transformation.

Positions are being reduced or moved; posts where we have lived and worked for decades are getting bigger, smaller, or are closing. This change must be synchronized with the school year; many of our people are making life decisions. We will take care of each other during this time of tremendous change. Last we will position Army Medicine in Europe for the future reality of September 30, 2014, and beyond.

As we accomplish our mission/take care of each other today, we will anticipate and posture ourselves for those we are privileged to serve in the future.

We remain patient-focused as we right-size. Despite moving towards permanently closing in July of this year, the Heidelberg Health Clinic continues [to maintain] patient satisfaction rates above 98 percent. The clinics at Bamberg and Schweinfurt are aggressively pursuing Patient Centered Medical Home/Soldier Centered Medical Home [PCMH/SCMH] right up until their planned closures in 2014 and receiving accolades from their communities.

In our transformation from a health care system to a system for health, Horoho has made it clear that we need to influence the health of our patients when they are not under our direct care. She calls it the lifespace:

Over about a two-year span and by September 30, 2014, the number of soldiers serving in Europe will decrease by about 11,000 plus

“With regard to Army Medicine, a soldier averages only 100 minutes per year with a health care provider, out of 525,600 minutes

“Army Medicine must look forward and chart a new course that will support the strategic resetting of the Army by increasing soldier readiness, improving the health of all of its beneficiaries and ensuring that medical diplomacy is a strategic Army asset. In the face of anticipated economic constraints, this transformation is critical to ensure Army Medicine continues to set the example for the nation and DoD in quality health care, wellness, prevention and collective health. Guiding and encouraging patients to make healthier choices when not under our direct care will increase the Army’s medical readiness and improve patient health outcomes.”

My commander’s intent, published in June 2012, is based upon her vision: “I have chosen September 30, 2014, as our strategic end state.

By this date, USAREUR Transformation will be complete, PCMH/ SCMH will be fully implemented and current overseas contingency operations will be winding down, ending a decade of wounded warrior care and AFORGEN support. We will take full advantage of the inherent opportunities during this time of tremendous change and new fiscal reality to efficiently and cost-effectively increase access and patient-centered services. Strategic reset will enable us to better serve our patients as we transform from a health care system to a system for health: standardize best practices across our region; maximize efficiency in organization, structure, systems and processes; excel in the “business” of medicine; and maximize utilization of our system for health for all who are eligible for care. Our patientcentered focus will endure as we adapt our goals and strategy to these new realities.”

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per year. This small snapshot of time and limited influence is not adequately addressing the challenge of enabling optimum health.

Army Medicine must influence the lifespace, the other 525,500 minutes of the year, in order to enable an agile and fully capable force.”

We currently have six clinics PCMH recognized by the National Committee for Quality Assurance [NCQA]. By September 2014, all of our primary care clinics will have implemented PCMH and received NCQA recognition.

The Patient Centered Medical Home/Soldier Centered Medical Home models make care more accessible, providers more approachable and the health experience more interactive. PCMH/SCMH will offer each of our patients a core team of caregivers who know them and deliver patient-centered care unique to the individual.

Access to care will become broader and easier for our patients and they will be encouraged to take an active role in their health. PCMH/ SCMH promotes communication between the patient and provider, opening the door for supplemental communication that takes place through nontraditional means such as video or secure [email] messaging. Secure messaging interaction will allow patients to see lab results and X-rays as well as send messages to their patient care team.

Secure messaging allows the patient care team to reach out to their patients, follow up, provide education and arrange appointments when needed. Good communication is closely related with continuity. ERMC has the highest PCM continuity, not only in the U.S. Army MEDCOM, but in the entire military health system. This high level of continuity is critical to delivering high-quality health care.

PCMH/SCMH are at the heart of transitioning to a system for health, but they are not our only areas of effort. We will synchronize medical, dental and wellness center care around the performance triad of sleep, nutrition and activity. I’ll talk more about this under ‘becoming a system for health.’

Our OCONUS Integrated Disability Evaluation System [IDES] is a key component of transitioning wounded, injured and ill soldiers and families to civilian life as service veterans. Our MTFs and our WTB-E work closely together to ensure an efficient and compassionate process, caring for each soldier and their family, one at a time.

In March we implemented changes in the way IDES is provided in USAREUR. All new IDES soldiers will remain assigned to their USAREUR unit. They will not have a PCS [permanent change of station].

They will go on TDY [temporary duty] and return to Womack Army Medical Center at Fort Bragg, N.C., to initiate their MEB/PEB and remain with their USAREUR unit until they separate from our Army.

USAREUR Lieutenant General Donald Campbell and Command Sergeant Major David Davenport provide excellent oversight and support for this critical program supporting soldiers and families.

Army Medicine in Europe plays a key role in the medical readiness of each individual soldier in the units we support. We work as one team with our supported units to optimize the health and readiness of each soldier. USAREUR medical readiness is among the highest in our Army. The individual and collective readiness of our Army Medicine in Europe team is also of the utmost importance. In Army Medicine in Europe, our leaders review the readiness and well-being of our soldiers on a quarterly basis. The Readiness and Well-Being Review focuses on our mission readiness, taking care of those entrusted to our care and taking care of each other. The objective measures we track are nested with the Ready and Resilient Campaign Plan and Army Medicine 2020 Campaign Plan. Each of us must be trained and ready for whatever we are asked to do next—that is part of our profession.

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Our current fiscal reality requires that we remain fiscally solvent and act as responsible stewards of our resources. We must do better with less. We will ensure that we are both efficient and effective in the use of our resources. This has always been important. The new fiscal reality makes it crucial. We continue to take the challenges in stride and remain patient-centered. Despite the hiring freeze, we continue to hire, with MEDCOM approval, those patient-centered, critical positions we need to accomplish our mission. We continue to accomplish our mission, take care of each other, and take care of our families during these fiscal challenges.

I consider individual and collective well-being of our people and our families the foundation of our priorities and of how we accomplish our mission. We must take care of ourselves and each other. We create conditions and encourage each other to prosper personally, professionally, spiritually, and in our families and relationships. The new fiscal reality creates a challenging environment with budget decrements, hiring freezes and employee furloughs. We remain compassionate when making the hard decisions that impact the lives of our people. Our individual and collective well-being is the foundation for how we care for those we are privileged to serve.

To promote individual and collective well-being, we created individual prosperity plan workbooks to assist them in setting and attaining goals. This simple resource encourages individuals to establish specific goals—personal, professional, spiritual and in their relationships. Our prosperity plan promotes engaged leadership. When used collaboratively, this tool helps supervisors become actively involved in assisting those they are privileged to lead to attain their goals.

Q: How have past assignments prepared you for your current role?

A: My previous assignments have greatly influenced what has become my command philosophy. In the mid-1990s I served as the 82nd Airborne Division Surgeon under [then] Major General Mike Steele. Steele, now retired said, “When accomplishing the mission and caring for soldiers and their families conflict, good leaders find ways to do both.” That concept has become a central part of my command philosophy: accomplish our mission, take care of each other, take care of our families, live up to our Army core values. Loyalty to those we are privileged to serve, our people and our families is fundamental to being a good leader.

I deployed during Operation Desert Shield/Desert Storm, served in Korea, Kosovo and deployed to Operation Iraqi Freedom. I have been blessed with a mix of operational and institutional assignments and to work with great leaders who have shown me what right looks like. I also had great opportunities to work in joint and combined environments. Working together as one team provides the best care and support to those we are privileged to serve.

Q: What role do host nation hospitals or clinics play in your command?

A: The quality of host nation health care in Europe is exceptional. We are fortunate to have great host nation partners in Germany, Italy and Belgium. Our host nation partners are an extremely important part of our overall health care team. Our beneficiaries can rest assured that whether they are seen on or off post, they are always our patient.

The main differences they will see when visiting a host nation provider involve language and culture. We have a dedicated team of host nation patient liaisons who speak the local language and know the www.M2VA-kmi.com

processes and procedures. Our host nation liaisons visit our patients admitted to local hospitals and assist with outpatient visits. We’ve had an outstanding relationship with our host nation health care partners for decades, and this will continue as we transform Army Medicine in Europe to a system for health. We couldn’t provide the high-quality health care and the highest patient satisfaction ratings in the Army without them.

Q: Are there any other special programs or initiatives within Army Medicine in Europe that you could share with our readers?

A: Becoming a system for health. Earlier I explained the lifespace concept which describes how, on average, our patients only spend 100 minutes per year with a health care provider. To impact health, Army Medicine must influence the lifespace—the decisions, habits and lifestyle that take place during the other 525,500 minutes of the year. In Army Medicine in Europe we have initiated a collective effort between ERMC, ERDC and PHCR-E to move forward as one team as we establish our system for health. One aspect of this initiative seeks to maximize the time we have to influence the health of soldiers. For example, dental visits are an opportunity to focus on wellness, above and beyond oral health. Our collective effort focuses on the performance triad of physical activity, nutrition, and sleep identified by our surgeon general as vital to well-being. Our one team will synchronize our message and processes at our medical treatment facilities, dental treatment facilities and wellness centers. We will transition from a health care system—as we focus on health and well-being—to a system for health.

Q: How will Army Medicine in Europe be affected by DoD force restructuring?

A: Europe will continue to play an essential role in our national defense. General Philip Breedlove, who has been nominated to be the next EUCOM commander, said, “We cannot rebalance or re-pivot toward Asia without Europe.” In Europe we train side by side with partners we have gone to war with. Our presence here is vital to promoting those relationships. Our strategic location means Army Medicine in Europe is a key player not only in Europe, but also AFRICOM and CENTCOM. There are three national strategic assets within Army Medicine in Europe. First, Landstuhl Regional Medical Center [LRMC] is the only overseas U.S. Level I trauma center and the Role IV strategic evacuation center for AFRICOM, CENTCOM, EUCOM and SOCOM. A replacement facility for LRMC is funded under the 2012 NDAA and we are on target to break ground in 2014. Second, U.S. Army Medical Materiel Center [USAMMCE] is the medical logistics platform in the region for all military and humanitarian operations in AFRICOM, CENTCOM and EUCOM and is critical to their success. Third, the Public Health Command Region-Europe Dog Center in Kaiserslautern, Germany, provides Level IV veterinary care for military working dogs serving in AFRICOM, CENTCOM and EUCOM. These three strategic assets will remain essential to our national defense, and to our allies, throughout the 21st century.

Q: Is there anything you would like to add?

A: In Army Medicine in Europe, we have some of the finest servicemembers, civilians, local national employees and volunteers you’ll www.M2VA-kmi.com

find anywhere. Recent recognition is indicative of who we are, what we do, and most importantly, how we do it. It is important that we retain the best soldiers in our Army.

Europe Regional Medical Command has led MEDCOM in retention for the past four years. In fiscal years 2010, 2011, 2012 and 2013 we were the first to achieve 100 percent of our retention goals. This is a testimony to the trust our soldiers have in their non-commissioned officers. Only four U.S. Army MEDCOM units have attained star status in our Army’s voluntary protection program [VPP]. All four are part of Army Medicine in Europe-Illesheim Army Health Clinic, Livorno Army Health Clinic, U.S. Army Medical Material Command Europe, and LRMC’s Military Transient Detachment. In addition, 100 percent of our units have achieved VPP Level I or above status—far ahead of the rest of MEDCOM. The Army has adopted VPP, the Occupational Safety and Health Administration’s safety management system, which is designed to help reduce accidents and injuries. For most units it takes anywhere from 18-24 months of work to attain star status, but it pays dividends. On average, VPP users are 52 percent below the industry average for accidents and injuries. Our safety manager, Master Sergeant Carol Fontanese, is setting the standard for our Army.

Our Warrior Transition Battalion-Europe recently received the Army Surgeon General’s first ever Maintain, Restore and Improve Health Award. Dr. Evan N. Steil, family physician serving with WTBE, was recognized as a 2012 MEDCOM Employee of the Year.

Landstuhl Regional Medical Center was honored by the Veterans of Foreign Wars with its 2012 VFW Armed Forces Award. The award is presented annually to recognize extraordinary achievement by members of the armed forces in a manner that reflects the highest traditions of service to the armed forces, the nation and to its national security. In presenting the award, VFW CommanderIn-Chief Richard DeNoyer said, “The VFW holds Landstuhl and its staff in the highest regard for their steadfast efforts, and we hope this expresses our gratitude to all that are involved in their immensely important operation. Landstuhl Regional Medical Center provides our American communities with hope and optimism with every servicemember they are able to send home safely to their families, and for that we in the VFW, and indeed all of America, are grateful.”

USAMMCE’s Major Aron Meadow was recognized with a Professional Medical Logisticians’ Leadership Award. These awards are presented to Army Medical Service Corps Officers for demonstrating exceptional skills and accomplishments in leadership, technical competence, professionalism, and patriotism. USAMMCE was also recognized with the Army Superior Unit Award for 2010-2011.

Sergeant Christopher Dettor, Hohenfels Health Clinic, part of the USAMEDDAC-Bavaria, represented our MEDCOM during the U.S. Army’s Best Warrior Competition last fall. Dr. Adler, chief of science at USAMRU-E, was recently recognized by the Bundeswehr for her support to the German Defense Psychology Department as they develop policies and procedures to support their soldiers before, during and after deployment.

Army Medicine in Europe is one team. We are patient-centered.

We provide health service support critical to the flexibility and mission success of not only U.S. Army Europe, but, to AFRICOM, CENTCOM, EUCOM, SOCOM, U.S. State Department, NATO and non-NATO partners. Command Sergeant Major Luciano and I could not be more proud to serve with this team-of-teams as we accomplish our mission, take care of each other, and take care of our families. O M2VA 17.2 | 21

Charting a Course for the Future The new and improved Special Operations Combat Medic Course.

By Colonel Sean K. Lee Colonel Sean K. Lee assumed command of the Special Warfare Medical Group (Airborne) on June 22, 2012. In this capacity he also serves as the dean of the Joint Special Operations Medical Training Center.

The Special Operations Combat Medic Course is conducted by the Joint Special Operations Medical Training Center at Fort Bragg, N.C. Special Operations Combat Medics (SOCMs) are considered the interoperable medics of the United States Special Operations Command (USSOCOM). Graduates of the SOCM course are assigned throughout USSOCOM to include the Army 22 | M2VA 17.2

Rangers, Navy SEALs, Civil Affairs, Special Operations Aviation Regiment and Marine Special Operations Command. U.S. Army Special Forces medics must complete the SOCM course prior to attending the Special Forces Qualification Course.

The fundamental premise of the SOCM course is to produce the best combat medics in the world, with the knowledge and www.M2VA-kmi.com

skill set USSOCOM desires. Therefore, feedback from the force is paramount when identifying course shortfalls and required curricular updates. Historically, trauma and initial stabilization skills were the main focus of training due to special operations units’ lack of level two medical support as well as organic medevac assets. However, during the past few years, units throughout USSOCOM have identified the need for more advanced clinical skills. The SOCM Critical Task List has increasingly shifted toward that of the 18D (Special Forces Medical Sergeant). The legacy 18D course was 50 weeks in length. The initial 26 weeks focused on medical fundamentals and trauma skills, while the last 24 weeks focused on clinical medicine, dental skills, surgery and anesthesia. The SOCM course mirrored the first 26 weeks.

In order to include the clinical and dental skills that SOCMs are now expected to possess, the SOCM course was increased to 36 weeks. This new course begins with a consolidated EMT-B phase taught as a single block. Previously, EMT-B and EMT-P sections were covered throughout the course alongside other advanced material, which necessitated “dumbing down” students prior to their taking the NREMT-B exam. This new distinct EMT-B course is 27 training days in length and has a 99 percent first-time pass rate on the National Registry exam, which is the highest in the country.

The next 12 weeks of training focus on clinical medicine.

During the six-week “Clinical Fundamentals” block, a systemsbased approach is used to teach anatomy, physiology and physical examination skills concurrently. This provides the students with the foundation required to assess and manage common pathologic conditions. This phase essentially replicates the “Medical Fundamentals” phase of the legacy SOCM course. The six-week “Clinical Medicine” block provides instruction on pathophysiology, pharmacology and diagnostic testing that focuses on common clinical conditions. Students also receive three days of dental training that includes dental trauma, anesthesia, oral disease and dental emergencies. Lastly, we added “sick-call” experiential training, where students spend a couple of mornings each week conducting military sick-call with physicians and physician assistants at clinics throughout Fort Bragg.

Following 18 weeks of EMT-B and clinical training, the students begin 14 weeks of three successive trauma blocks of instruction. This phase begins with lectures designed to provide the knowledge required to identify and manage multi-system trauma patients. Topics include ballistics, hemorrhage control, blood transfusions, shock, thermal burns and ultrasound applications. The students then receive training on trauma practical skills that include intraosseous line insertion, endotracheal intubation, needle decompression, nasogastric intubation, urinary catheterization, cricothyroidotomy, tube thoracostomy, venous cutdown, and vessel clamping and ligation. Additionally, ultrasound practical training has been added students are taught to conduct and interpret the Extended Focused Assessment with Sonography for Trauma (EFAST) exam. We were initially concerned about the students’ ability to master this training, but have found that these “digital natives” who have grown up with today’s video games are able to understand and learn ultrasound skills much faster than our “older” cadre.

After mastering these individual practical skills, the students receive instruction on how to evaluate and treat a traumatic www.M2VA-kmi.com

patient in a field environment. After learning the traumatic patient assessment sequence of a single patient, the students are required to consolidate all of their prior training and skills to successfully identify, evaluate, treat and evacuate a multi-system trauma patient. Standards of care are based on scenario-driven treatment prioritization in a semi-secure environment that requires rapid casualty evaluation and continuous, time-dictated patient movement to maintain security.

At this point, successful students are confident in their abilities to manage a single trauma patient in a field environment.

The final trauma phase builds upon these skills and challenges the students with multiple casualties as well as properly treats multipurpose canine patients. Additionally, students are required to perform as medical team leaders in a field hospital and direct the care of complicated multisystem trauma patients. This final phase culminates with a field training exercise that is designed to evaluate the knowledge and skills taught throughout the entire SOCM course.

Occuring during the final four weeks of the SOCM course is the clinical rotation field internship. Students complete these rotations in Richmond, Va., Tampa, Fla., or St. Petersburg, Fla. They train in both the prehospital setting with fire station emergency medical services and in various departments throughout the medical centers to include the emergency department, labor and delivery, operating room, and the intensive care unit. During these rotations students work under the supervision of a licensed provider and participate in the assessment and management of a wide range of ill and injured patients. They must complete a number of specified procedures as well as serve as medical team leaders and perform medical documentation and patient presentations.

At the end of the 36-week course USSOCOM units receive an enlisted medical professional with broad clinical, dental and trauma skills. He or she has passed 47 written and 29 practical exams and holds four civilian certifications (BLS, ACLS, PEPP, EMT-B). The SOCM course is a CoAEMSP-accredited paramedic course. As such, graduates are authorized, but not required, to sit for the National Registry Paramedic examination. Graduates are required to complete the USSOCOM promulgated Advanced Tactical Paramedic examination before they are able to deploy in a medical capacity.

The concept for the new SOCM course was developed in July 2010, which led to course design and lesson plan production throughout fiscal year 2011. The first iteration began on October 3, 2011, and graduated on July 25, 2012. The course is conducted eight times per year with 64 seats per class. The next challenge is to solidify an annual curricular update cycle that includes formal feedback from the units that utilize course graduates. O Colonel Sean K. Lee assumed command of the Special Warfare Medical Group (Airborne) on June 22, 2012. In this capacity he also serves as the dean of the Joint Special Operations Medical Training Center.

For more information, contact M2VA Editor Chris McCoy at chrism@kmimediagroup.com or search our online archives for related stories at www.m2va-kmi.com.

M2VA 17.2 | 23

Quickly detecting biological threats.

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By Hank Hogan, M2VA Correspondent

www.M2VA-kmi.com

Your next sniffle could be of interest to Jennifer Dabisch. As the Deputy Joint Product Director of Biosurveillance [BSV] in the Defense Department’s Joint Project Management Office for Chemical Biological Medical Systems, Dabisch knows that identifying a biological threat is vital to stopping it. The latter is easier to do if the event is caught before it really gets rolling. Whether a disease is of natural or human origin makes no difference to the detection technology and what needs to be achieved.

“One of the BSV goals is to support the transition of technologies that can detect pre-event or just when people start getting sick but before a pandemic,” Dabisch said in speaking of the objectives of the biosurveillance directorate, which addresses the biological warfare threat to the military. “Effective biosurveillance enables a rapid response,” she added.

Work to accomplish this is underway, with government agencies funding the development of innovative detection and diagnostic technologies and techniques that can indicate a threat sooner. There are a number of companies researching better biosurveillance, as this is of interest—and value—to public health officials as well as the military.

Biosurveillance: The Next Generation For instance, work is being performed to replace the Joint Biological Agent Identification and Diagnostic System used by the Department of Defense. The incumbent technology provides an indication of the presence or absence of specific microorganisms in 45 minutes, Dabisch said. Detection covers 14 different biological warfare agents, including anthrax, various forms of the flu, tularemia and other ailments.

Work on a replacement is actively underway, with a transition planned in fiscal year 2017. Dubbed the Next-Generation Diagnostics System, it will leverage commercial technology, offer greater capacity for simultaneous analysis and be easier to support logistically. It will enable identification of targeted organisms in those individuals exposed to biological hazards. This capability will supply health care providers with the clinical data needed for timely diagnosis and treatment of patients, Dabisch said. www.M2VA-kmi.com

General design principles for such systems include a low false positive and negative rate. These errors, particularly false negatives that mistakenly indicate no problem when there actually is one, are detrimental because they can lead to a delay in mounting the proper response.

Vigorous testing is done to minimize the occurrence of these false reports. Other important system design goals are the ability to handle emerging threats and ease of use by non-experts.

There are also other efforts that seek to improve biosurveillance. For instance, the Department of Homeland Security’s Science and Technology Directorate is field testing a new dual-sensor setup in the Boston subway. The system uses one set of sensors to trigger a second group, with the first collection of sensors specifically designed for response speed.

“Our triggers do not do a wet chemistry. They are just looking at optical properties. That is very rapid,” said Anne Hultgren, program manager.

This triggering approach is also very inexpensive and easy to automate, as all that’s needed is power. However, optical techniques do not currently do a good job of distinguishing innocent biologically based material from the dangerous kind.

That is why the system follows up the triggering sensors with more accurate detection methods for confirmation.

These confirmers make use of polymerase chain reaction (PCR) technology, which replicates small samples of DNA fragments. This is done to the point where the amplified DNA is numerous enough to determine if a match exists to a genetic snippet in a library. Normally this replication process can take hours, but the system has been engineered so it can run to completion in 20-30 minutes.

It does, however, require a supply of chemicals for the reaction.

In addition to bringing the confirming sensors to life, the triggering sensors could produce an alert that might prompt authorities to alter air flow or take some other, low-impact type of action to begin mitigation while waiting for the threat to be verified. The testing currently going on includes active challenges of the system at night when the subway is shut down. The success or failure of this type of dual-sensor approach should be known by this summer. Initial results look good.

The Razor Ex biological agent detection system from BioFire Diagnostics enables rapid, automated detection of a diverse range of the most widespread biological hazards used as bioterrorism operations.

Agents detected include brucella, anthrax, Q fever, e-coli, ricin, salmonella, plague, smallpox and other biothreats. [Photo courtesy of BioFire Diagnostics]

MAGPIX – A bead-based system from Luminex can simultaneously identify multiple bioagents using several distinct tests for each. [Photo courtesy of Luminex]

M2VA 17.2 | 25

Spores and Beads

Skowronski pointed out that smallpox, which has been eradicated in the wild, has a close symptomatic analog in monkeypox, which has not. There have been outbreaks of the latter in the U.S., caused by importation of exotic pets from Africa. Being able to quickly determine that someone has monkeypox and not the more dangerous smallpox is one possible application of the bead-based technology from Luminex.

BioFire Diagnostics of Salt Lake City has its own version of advanced biosurveillance technology. It’s based on PCR that has been simplified for use by minimally trained operators, said Biosurveillance Marketing Manager Lou Banks. Some of the company’s products have an error rate of less than 1 percent and are sensitive enough to spot a biothreat at concentrations of 1,000 colony-forming units per milliliter in a sample.

Broader Biosurveillance “It’s basically 1,000 spores,” Banks said.

The assays are designed to look for gene sequences that code Lastly, there is biosurveillance that is much more wide rangfor virulence and stability of the micro-organism in question. ing. The Centers for Disease Control, for instance, collects data If these regions are present, then during the detection process from emergency rooms across the nation. This information the DNA strands of the sample are replicated and tagged with a involves self-reported symptoms and not clinical data, said CDC fluorescent dye. Enough of an increase in fluorescence means a spokesperson Richard Quartarone. Thus, it is not definitive but pathogen is present. instead can provide an early overall picture.

The technology lends itself to multiplexing, with the company The CDC is on the second generation of this surveillance effort. getting FDA clearance in 2011 to test for as many as 20 different Today, it involves data feeds from thousands of health care providrespiratory illnesses at once. One advantage of having such a panel ers throughout the United States. This approach is useful when of tests is that a single visit to a clinic may be enough to accurately new diseases arise or when a pandemic is just emerging. determine which among a host of diseases is responsible for a set There are also other surveillance approaches that make use of symptoms. of social media, search engine queries, or other indications that BioFire Diagnostics’ earlier technology formed the basis for people are experiencing symptoms. The Department of Homeland part of the current generation of biosurveillance tools used by the Security, for example, has contracted with Arlington, Va.-based military. The company’s latest biothreat assessor is a candidate for Accenture Federal Services for a year-long trial run of an advanced the Next-Generation Diagnostics System currently being spun up version of this concept. The hope is that as much as a full week by the armed forces. Part of the reason why the military is keen to may be shaved off the time it takes to recognize a disease outbreak upgrade its technology has to do with the reasons why soldiers are has occurred, said Accenture Federal Services’ Managing Director put out of action.

John Matchette.

“More days are lost to infectious diseases within soldiers than Finally, there are efforts to extend this monitoring to other to battle wounds or anything like that. Diarrhea is very high on shores far removed from the continental U.S. A case in point the causes of lost days in the field for soldiers. In fact, it’s number comes from the Columbus, Ohio-based Battelle. The private, nonthree on their list,” Banks said. profit applied science and technology company runs a program Austin, Texas-based Luminex Corp. is also putting its own for the U.S. Defense Threat Reduction Agency in Tbilisi, Ga. This unique twist on biosurveillance. The company’s bead-based techis part of an effort to improve the early detection and reporting of nology uses microspheres coated with reagents that react to spepathogens of concern to the U.S. Given an interconnected world, cific bioagents. The color coding on the beads and the distinctive infectious agents can spread extremely rapidly, said Program Manfluorescence of the reagents after reaction combine to create an ager Richard Farnsworth. indicator that a given biothreat is present. The read time to do this He noted that there is a critical need to strengthen the pubis measured in minutes, although it may take hours for an assay to lic health infrastructure of large parts of South America, Africa, finish heating up, replication or other processing and Asia and states of the former Soviet Union so that cooling down. diseases and outbreaks are reported consistent with One individual test may be somewhat ambiguinternational guidelines. So too is the developous. However, running many different ones in paralment of appropriate diagnostic capabilities. Without lel that react to different segments of a pathogen’s these safeguards in place, the potential is there for genome leads to highly reliable results, said Amy pandemic threats to arise without as much warning Altman, vice president of biodefense. For example, as desired. there may be half a dozen assays created that light As Farnsworth said, “The vast majority of the up in response to different parts of the genome of world’s human and animal population, from which the bacteria that causes anthrax. A positive alert, known and emergent human and zoonotic pathothen, might only come if all tests come back signalgens would emerge, are in parts of the world where Evan Skowronski ing the presence of the bacteria. disease surveillance and biosurveillance networks “By using decision theory, you can come up with assay that for are not very robust. Essentially, two-thirds of the world’s populaall intents and purposes has a zero false positive rate,” Altman said. tion is not adequately surveilled.” O This sort of “wide spectrum yet highly accurate” test is important, particularly if it is also inexpensive, said Evan Skowronski, For more information, contact M2VA Editor Chris McCoy chief scientific officer of Incline Village, Nev.-based biosurveillance at chrism@kmimediagroup.com or search our and biotechnology consultants TMG Biosciences. The company is online archives for related stories at www.m2va-kmi.com. working with Luminex.

26 | M2VA 17.2

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Biofire Diagnostics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 www.bio-surveillance.com Red River Computer Company Inc.. . . . . . . . . . . . . . . . . . . 11 www.redriver.com ScriptPro. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C4 www.scriptpro.com

May 20-24, 2013 DoD/VA Healthcare 2013 San Antonio, Texas www.dodhealthcare.com

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September 24-26, 2013 Modern Day Marine Quantico, Va. www.marinemilitaryexpos.com/modernday-marine.shtml

M2VA  17.2 | 27

INDUSTRY INTERVIEW

Military Medical & Veterans Affairs Forum

Kyle G. Johnson President and CEO Onsite OHS Inc. Kyle G. Johnson is president and chief executive officer of Onsite OHS. He proudly states, “I owe everything that I have accomplished to the U.S. Navy. The Navy gave me the skills, the discipline, the confidence, the pride and professionalism, and the ‘can-do’ attitude to be successful.”

With over 15 years of experience in both corporate and managerial leadership, Johnson is a leader in the occupational health and safety industry. His pioneering ability is proven by his experience in founding two occupational medicine start-up companies, S.A.M.E.S. and Onsite OHS Inc. Q: What does Onsite OHS offer the U.S. military and Department of Veterans Affairs?

A: We are a full-service medical provider. We currently provide turnkey medical solutions for both the government and private contractors that are supporting the government.

We provide everything from simple staffing up to and including full capabilities for clinical operations of outpatient clinics around the world.

Q: What types of onsite medical services and support does Onsite OHS provide?

A: Right now, we do have one prime contract with the Air Force. We have numerous contracts with private companies that are supporting the military around the world.

We oversee more medical care in the country of Afghanistan than any other entity, other than the Department of Defense, where we support about 70,000 civilian contractors that are supporting the NATO mission in Afghanistan.

Q: How is Onsite OHS positioned in the market for expansion?

A: We made the INC 500 list this year at number 101. That means we are the 101st fastest-growing privately held company in the U.S. We were number one in Indiana and number eight in health care. It looks like we will continue that rate of growth for the next couple years at least.

28 | M2VA 17.2

A: As a presenting sponsor of Sky Ball OHS has assisted with raising $3.5 million for various veterans charities and initiatives.

These include: Heroes on the Water, Freedom Flight, Wounded Warriors Veterans Day Weekend in Las Vegas, Gary Sinise Foundation, and Snowball Express. OHS has also presented three Action Track chairs to wounded warriors at Walter Reed.

OHS is also a sponsor to the All Veteran Parachute Team.

Q: Can you provide a few success stories?

A: One of the things that we provide is U.S.-licensed providers; almost all of our contracts are for U.S. quality health care.

Out of our 150-175 health care providers in Afghanistan, 98 percent of them are U.S.licensed. That includes physicians, physician assistants, nurses practitioners, registered nurses, lab techs, X-ray techs, paramedics—pretty much the full gamut of clinical services. We also are actively recruiting veteran health care providers. Right now about 42 percent of employees throughout the company worldwide are veterans of the U.S. armed services.

We are one of the few civilian providers that are on the NATO emergency response team at Kandahar air field. We basically respond to any emergency that we get dispatched on by the NATO command there.

Q: How did Onsite OHS become the third largest job creator in Indiana?

A: This award was from Inc. magazine and looked at the numbers of employees added by private sector employers. Inc. separated the awardees further by state, industry, revenue range and percentage of job growth. Onsite OHS was ranked third in Indiana by creating 170 jobs. OHS also ranked second in percentage of job growth at 4,250 percent increase in jobs, as well as 10th in the $10-$20 million revenue category.

Q: Could you tell us about some of the charitable activities that Onsite OHS is involved in?

Q: What does it mean for Onsite OHS to receive The Joint Commission’s Gold Seal of Approval?

A: The accreditation from the Joint Commission is likely the most important discriminator between OHS and the competition.

None of our competitors have achieved this level of performance. The Joint Commission is an independent, not-for-profit organization. The Joint Commission accredits and certifies more than 20,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.

Q: Is there anything else that you would like to add?

A: I am a veteran myself, a former hospital corpsman in the U.S. Navy. That is what gave me the idea of starting this company.

To be able to support the military, as well as veterans, gives us the ability to keep giving back. We are also active in various veteran charities, including the Independence Fund, Sky Ball down in Fort Worth, Texas, through the Fort Worth Air Power Foundation, the Medal of Honor Foundation and various other things. We really like being positioned as a veteran-owned small business that continues to support the military in any way that we can. We value the experience and skills that veterans bring and will continue to expand our efforts to provide veterans with more employment opportunities. O www.M2VA-kmi.com

NEXTISSUE

May 2013 Vol. 17, Issue 3

Cover and In-Depth Interview with:

David Bowen

Chief Information Officer Military Health System Office of the Assistant Secretary of Defense for Health Affairs

Special Section: Mobile Health IT

The miniaturization of medical communications devices and mobile apps is facilitating better patient-doctor relations while efficiently communicating a wide range of health data to both doctors and patients.

Features: Sleep Disorders

Medical Staffing

Electronic Health Records

Polytrauma Rehabilitation

Shift work sleep disorder is a prevalent sleep disorder among active duty servicemen and veterans with work schedules that conflict with a normal sleeping schedule.

DoD is modernizing their electronic health record (EHR) system and weighing the advantages of adopting the Veterans Affairs Department VistA EHR system or other commercial EHR systems.

Army Dental Service

Dental practices and dental technologies are continually evolving within U.S. Army DENCOM.

In order to support the needs of the growing veteran population, it is common to contract work to medical staffing services at VA medical centers.

Serious injuries sustained in combat often require significant and intensive rehabilitation for our veterans.

Bonus Distribution:

DoD/VA Health Care 2013

Insertion Order Deadline: May 8, 2013 | Ad Material Deadline: May 15, 2013