M2VA 18.5 (November/December 2014)

Dedicated to the Military Medical & VA Community

Benefits Deliverer Dr. George Jones Chief, Pharmacy Operations Division Defense Health Agency

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November/December 2014 Volume 18, Issue 5

Exclusive Interview with:

Colonel (Dr.) Michael D. Wirt Commander U.S. Army Institute of Surgical Research

Pharmacy Automation O Medical Simulation EHR Roundtable O Health Care Analytics O Careers in Health

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Military medical & Veterans Affairs Forum

Nov/Dec 2014 Volume 18, Issue 5

Cover / Q&A

Features

10

24

Health Analytics

Inside the USAISR

Collecting, sharing and analyzing data can help health care providers deliver more efficient care to beneficiaries.

By Brian O’Shea

Colonel (Dr.) Michael D. Wirt, commander of the U.S. Army Institute of Surgical Research, discusses the advanced medical research performed by his command.

16 Dr. George Jones

Chief, Pharmacy Operations Division Defense Health Agency

6

Careers in the Health Sciences Civilian careers in the health sciences are often a natural extension of military training for many veterans who have left the services. Many schools offer reduced tuition for veterans in addition to college credit for previous military experience.

By Chris McCoy

12

Pharmacy Automation One of the areas of focus within pharmacy services is looking at ways to consolidate existing requirements and contracts for pharmacy automation to improve services at military treatment facilities.

By Brian O’Shea

Departments

20

Replacing AHLTA M2VA reached out to leaders in the field of electronic health care records who are interested in providing a replacement for AHLTA.

23

Medical Simulation M2VA offers a guide to some of the top companies in medical simulation.

Industry Interview

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

Rob Harris M.H.A, F.A.C.H.E.

Government Sales Executive Xenex Disinfection Services

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We specialize in unique military gear designed to specifically meet deficiencies in current equipment.

WWW.MATBOCK.COM

“Controlling pharmacy costs is always an uphill battle. But keep in mind that, when appropriately used, pharmaceuticals are an excellent investment in health.”

— Dr. George Jones

EDITOR’S PERSPECTIVE

Military Medical & Veterans Affairs Forum

Volume 18, Issue 5 • November/December 2014

Dedicated to the Military Medical & VA Community Editorial Editor

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Recently, the Department of Veterans Affairs’ Center for Women Veterans joined in a memorandum of agreement (MoA) with the Center for American Women and Politics, part of the Eagleton Institute of Politics at Rutgers, The State University of New Jersey.

According to the VA, the aim of the MoA is to “increase women veterans’ leadership and career opportunities, which will benefit the nation’s workforce and address women veterans’ growing needs.”

Helping women veterans develop skillsets for public and community service opportunities is the focus of the memorandum.

“Women veterans often contact us for information about how they can Christopher McCoy Editor continue serving,” said Elisa M. Basnight, director of the Center for Women Veterans. “This MoA with the Center for American Women and Politics presents a prime opportunity for the center to help prepare them for other forms of public service, as it responds to a persistent need women veterans tell us they have—the desire to continue to make a difference after the uniform.”

Additionally, a recent article on health.mil described the many challenges military women have when they quit smoking. Some of the specific tobacco-related threats to women’s health include: • Smoking is even more harmful for women using oral contraceptives (especially women over age 35), which is more common among military women than civilians.

• Smoking is linked to menstrual symptoms such as premenstrual tension, irregular periods, heavy periods and more severe period pain than nonsmokers.

• Smoking is a risk factor for low-fertility gestational complications, birth complications and perinatal problems.

• Smoking is linked to premenopausal signs of osteoporosis among women, likely due to estrogen deficiencies among female smokers.

• Women metabolize nicotine more rapidly than men. A higher metabolic rate and nicotine clearance can lead to increased smoking.

• Although more women are diagnosed with breast cancer than lung cancer, lung cancer (primarily caused by smoking) results in more deaths among women.

As usual, feel free to email me with questions or comments for Military Medical & Veterans Affairs Forum.

Data Specialist

Raymer Villanueva raymerv@kmimediagroup.com

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PROGRAM NOTES

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VA Expands Fry Scholarship to Surviving Spouses of Servicemembers Who Died on Active Duty The Department of Veterans Affairs announced it has begun accepting applications by mail for the Fry Scholarship under newly expanded eligibility criteria to include surviving spouses. The expanded criteria for the Fry Scholarship is the latest in a series of VA actions to implement provisions of the Veterans Access, Choice and Accountability Act of 2014 (Choice Act).

Specifically, Section 701 of the Choice Act expands the Fry Scholarship to include the surviving spouses of servicemembers who died in the line of duty after September 10, 2001. Prior to this expansion, only children of those who died in the line of duty were eligible for this benefit.

“We can never fully repay the debt we owe to these families who have lost a loved one,” said VA Secretary Robert McDonald. “It is a privilege to provide educational benefits that will make a positive difference in their lives.”

The Fry Scholarship was created to honor Sergeant John David Fry, 28, of Lorena, Texas. Fry had one week left in his tour in Iraq in 2006 when he volunteered to continue working for seven more hours disarming explosive devices, despite having already sustained an injury to his hand.

He made the ultimate sacrifice on March 8, 2006, in Anbar Province, Iraq, when an improvised explosive device detonated. He left behind a widow and three young children.

The Fry Scholarship will entitle eligible spouses to up to 36 months of the full, 100-percent level of the Post-9/11 GI Bill, which includes a tuitionand-fee payment, a monthly housing allowance and a stipend for books and supplies. Some spouses currently eligible for or already receiving benefits under the Survivors’ and Dependents’ Educational Assistance (DEA) program may now be eligible for the Fry Scholarship. All surviving spouses eligible for DEA and the Fry Scholarship must make an irrevocable election for terms beginning on or after January 1, 2015.

VA will identify surviving spouses eligible for both programs and send them a letter with comparative information on the benefits available and instructions on how make an election. Information about these two programs is available on VA’s website and the GI Bill website, www.benefits.va.gov/gibill. The VA call center (888-GIBILL-1) also will be able to help individuals understand the differences between the two programs.

New Telehealth Scheduling System Representatives from the Department of Veterans Affairs met with Veteran Service Organizations (VSO) at the Washington VA Medical Center for a hands-on demonstration and discussion about VA’s telehealth programs and services.

The hands-on demonstration included a presentation of VA’s new Clinical Video Telehealth scheduling software, which launched last month and is intended to improve how VA employees schedule telehealth appointments.

“As we launch new programs and services, it is important to include our VSO partners,” said VA Secretary Robert A. McDonald. “Today’s demonstration is an important part of our collaborative process. We welcome our VSOs’ feedback. Like us, their goal is to ensure veterans have the access to the quality care and services they have earned.”

Telehealth is rapidly becoming a popular option, particularly for veterans who do not have a VA health care facility close to home. In FY14, VA’s national telehealth programs served over 690,000 veterans and accounted for more than 2 million virtual visits.

PEOPLE Navy Captain Linda R. Wackerman has been selected for the rank of rear admiral (lower half) and will be assigned as Reserve deputy director, Assessment Division, Office of the Chief of Naval Operations, N81R, Washington, D.C. Wackerman previously served as commander, Navy Emergency Preparedness Liaison Officer Program, Washington, D.C. David C. Hassell, Ph.D. has been appointed to the Senior Executive Service and is assigned as the deputy assistant secretary of defense (chemical and biological defense), Office of the Under Secretary of Defense (Acquisition, Technology and Logistics), Washington, D.C. Hassell previously served as the

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Compiled by KMI Media Group staff

program management officerassistant director with the FBI, Quantico, Va.

Major General Jimmie O. Keenan

Major General Jimmie O. Keenan, commanding general, Southern Regional Medical Command; market manager, San Antonio Military Health System; chief, U.S. Army Nurse Corps, Joint

Base San Antonio, Texas, has been assigned as deputy commanding general (operations); chief, U.S. Army Nurse Corps, U.S. Army Medical Command, Joint Base San Antonio.

Brigadier General Dennis D. Doyle, commanding general, Pacific Regional Medical Command; U.S. Army Pacific Surgeon; senior market manager, Hawaii Enhanced Multi-Service Market; chief, U.S. Army Medical Service Corps, Honolulu, Hawaii, has been assigned as deputy chief of staff for operations, U.S. Army Medical Command, and chief, U.S. Army Medical Service Corps, Falls Church, Va.

Brigadier General Barbara R. Holcomb has been assigned as commanding general, Southern Regional Medical Command, and market manager, San Antonio Military Health System, Joint Base San Antonio, Texas. Holcomb most recently served as command surgeon, U.S. Army Forces Command, Fort Bragg, N.C. Brigadier General Patrick D. Sargent, deputy chief of staff for operations, U.S. Army Medical Command, Falls Church, Va., has been assigned as commanding general, Pacific Regional Medical Command; U.S. Army Pacific Surgeon; and senior market manager, Hawaii Enhanced MultiService Market, Honolulu, Hawaii.

M2VA 18.5 | 3

PROGRAM NOTES VA to Accept Proposals for New Scheduling System As part of the Department of Veterans Affairs’ ongoing effort to improve veterans’ access to health care, VA announced it has issued a request for proposal (RFP) for a new Medical Appointment Scheduling System (MASS). The new MASS technology will help improve access to care for veterans by providing schedulers with state-of-the-art, management-based scheduling software.

The new system will replace a legacy scheduling system that has been in use at VA since 1985. VA’s acquisition approach for the new scheduling solution remains full and open; any qualified vendor may compete. Potential bidders are not required to have prior experience working with VA. Proposals are due January 9, 2015.

VA released a draft “performance work statement” to maximize industry and stakeholder input.

The feedback received from industry has been used to refine the requirements included in the final RFP. The RFP requires industry to demonstrate technical capabilities via two methods: submission of a written proposal and participation in a structured product demonstration to evaluators (which include VA scheduling staff). VA expects to award the contract by the spring of 2015. The selected bidder will be tasked to provide a system that focuses on an achievable schedule to deliver core capabilities to all VA medical facilities within the first two years of the contract. Remaining capabilities will be implemented nationally in a series of incremental enhancements throughout the contract period of performance. In addition to industry and stakeholder engagement, VA officials also worked with Veteran Service Organizations and the Northern Virginia Technology Council to better understand the needs of veterans and incorporated the group’s feedback in the design of the RFP.

Compiled by KMI Media Group staff

New VA IT Campus Launched In 2013, IT Workforce Development Director Terri Cinnamon envisioned creating a virtual classroom environment where live instructors interact with VA’s Office of Information and Technology (OI&T) employees, delivering career development training from the field to the field—wherever they are. After a wildly successful pilot program, Cinnamon and her VA IT Workforce team are now ready to deliver a comprehensive new virtual training platform.

“Virtual technology is the future of employee training, conferences and meetings at VA,” said Cinnamon. “With VA IT Campus, OI&T employees have access to training 24/7, 365 days a year from wherever they have an Internet connection and a computer or mobile device. This is a terrific way to provide high-quality training while saving time and travel dollars.”

Training via VA IT Campus is dynamic and interactive, with several tools available to keep participants connected to the instructors and their peers.

The VA IT Campus studio incorporates green-screen technology to bring true-to-life video broadcasts to participants. Instructors are free to express their personal teaching style, moving around the stage or teaching from a stationary point as they would in any live session. Virtual video makes course participants part of the live experience.

Social media plays a crucial role in the high level of interactivity. The chat capability keeps participants engaged in the course material, enabling them to interact live with other attendees. With the Ask the Presenter feature, students submit questions during the presentation. If the presenter can’t answer during the live session, questions are captured and answered at a later time. Polling is a fun and quick way for students to see how their peers answer questions posed by the presenters and how their responses match up.

Live training is wonderful, but what happens when someone misses a training event?

Employees simply access the on-demand section, where they can view previously recorded training and submit questions.

Central Alabama VA Health Care System Director Removed The Department of Veterans Affairs formally removed the director of the Central Alabama Veterans Health Care System (CAVHCS) from federal service. This decision followed an investigation by the Office of Accountability Review (OAR) in which allegations of neglect of duty were substantiated.

This removal action underscores VA’s commitment to hold leaders accountable and get veterans the care they need. OAR, which reports directly to the secretary of

Veterans Affairs, assists VA facilities in accelerating leadership accountability actions and ensuring that such actions are applied consistently across the department.

The Veterans Health Administration will begin recruiting a director for CAVHCS. To ensure continuity of care for veterans and leadership for VA employees during the recruitment period, Dr. Robin Jackson, deputy network director, VISN 7, has been designated acting CAVHCS director.

VA Telehealth Services Served Over 690,000 Veterans in Fiscal Year 2014 The Department of Veterans Affairs announced that its national telehealth programs served more than 690,000 veterans during FY14. That total represents approximately 12 percent of the overall veteran population enrolled for VA health care, and accounted for more than 2 million telehealth visits. Of that number, approximately 55 percent were veterans living in rural areas with limited access to VA health care. With more veterans seeking health care, telehealth is rapidly becoming an attractive option, especially for those veterans who don’t have a VA health care facility close to home.

“We have to adapt to meet veterans wherever their needs are,” said VA Secretary Robert A. McDonald. “A brick-and-mortar facility is not the only option for health care. We are exploring how we can more efficiently 4 | M2VA 18.5

and effectively deliver health care services to better serve our veterans and improve their lives. Telehealth is one of those areas we have identified for growth.”

Currently, there are more than 44 clinical specialties offered to veterans through VA’s telehealth programs. One program at the Miami VA schedules close to 90 clinic connections every week for dermatology, eye exams, the women veterans program, podiatry, mental health and other clinical specialties.

One tangible example of the success of VA’s telehealth program is its burgeoning TeleAudiology program because of the large population of veterans living with hearing loss. The TeleAudiology program has grown from 1,016 veterans in FY11 to more than 10,589 in FY14. www.M2VA-kmi.com

PROGRAM NOTES

Compiled by KMI Media Group staff

The 1st Area Medical Laboratory Deploys to Liberia “The 1st Area Medical Laboratory (AML) is a one-of-a-kind U.S. Army unit made up of soldier scientists who serve as microbiologists, biochemists and laboratory specialists,” said Brigadier General J.B. Burton, commanding general of the Aberdeen Proving Ground, Md.-based 20th CBRNE Command, in an exclusive interview with M2VA. “In support of joint and combined operations, the 1st AML deploys worldwide to protect U.S. forces through surveillance and testing of environmental samples to determine threats and environmental health hazards.

“They will join a team of soldiers, doctors and scientists who have come together to

support the U.S. Agency for International Development.”

The general continued, “The 1st AML will deploy state-of-the-art analyzers and highlytrained soldiers to enhance the identification of the disease using the most advanced protocols.”

When asked about some of the challenges involved in working in such a diverse multi-partner environment, Burton had the following response.

“Units from the 20th CBRNE Command (Chemical, Biological, Radiological, Nuclear, Explosives) train and operate with joint, interagency and allied partners around the globe

every day. The 1st Area Medical Laboratory has previously deployed to Iraq and Afghanistan.”

In reference to the technologies that the 1st AML will bring to the battle against Ebola, Burton said, “[that] with its mobile laboratories, [the] 1st AML brings unique capabilities to our nation’s efforts in support of this mission and will play a vital role in enabling the understanding of this disease as a part of a larger joint and interagency enterprise.”

When asked about safety protocols with regard to personal protection, Burton said, “Our soldiers are trained, equipped and ready.

Soldiers from [the] 1st AML train year round for their expeditionary laboratory mission, and held a certification exercise at Fort Bragg, N.C., in August. Prior to their deployment, the team conducted 72 hours of Level 3 training with the U.S. Army Medical Research Institute of Infectious Diseases at Fort Detrick, Md.” At this time, no other 20th CBRNE Command units have received deployment orders. However, the 20th CBRNE Command states that “[it] is prepared and ready to support the mission in any way necessary.”

In a closing statement, Burton said that the 1st AML is a battle-tested command that continuously deploys around the world to perform analytical testing and health hazards assessment of environmental, occupational, endemic and CBRNE hazards.

“1st AML is a one-of-a-kind formation, like the rest of the 20th CBRNE,” he said.

U.S. Air Force Langley Hospital Adds Ebola-Zapping Robot to Inventory The 633rd Medical Group (MDG) received a germ-zapping robot, nicknamed “Saul,” which harnesses the power of technology to kill off viruses—including the Ebola virus. Airmen were given a demonstration of the robot’s functions and capabilities from Geri Genant, the Xenex Healthcare Services implementation manager.

The hospital staff partnered up with Xenex, the company that created Saul, as part of a response

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plan designated to ensure the 633rd MDG is equipped to handle viruses like Ebola. “We are very proud to be the first Air Force hospital to have this robot,” said Colonel Marlene Kerchenski, the 633rd MDG surgeon general chief of nursing services. “Saul will provide an extra measure of safety for both our patients and our intensive care unit staff.” According to Genant, after patient and operation rooms are cleaned, the robot uses pulses of

high-intensity, high-energy ultraviolet rays 25,000 times brighter than fluorescent lights to split open bacterial cell walls and kill dangerous pathogens commonly found in hospitals. Although each room is cleaned by hospital staff wearing proper protection equipment and using cleaning chemicals, harmful bacteria, viruses and fungi still linger in some areas, especially those human hands can’t reach. As an additional

patient safety measure, the Xenex robot can then disinfect a room in five minutes and destroy Ebolalike viruses on any surface in two minutes, according to Dr. Mark Stibich, Xenex’s founder and chief scientific officer, as reported by CBS Houston. “Xenex has tested its full spectrum disinfection system on 22 microorganisms, studying nearly 2,000 samples in several independent labs all over the world,” Genant said.

M2VA 18.5 | 5

A variety of civilian careers exist for those intent on capitalizing on their military medical training.

By Christopher McCoy, M2VA Editor Civilian careers in the health sciences are often a natural extension of military training for many veterans who have left the services. Many schools offer reduced tuition for veterans in addition to college credit for previous military experience.

Nova Southeastern University Nova Southeastern University (NSU) is the ninth-largest, not-for-profit, independent university in the United States. NSU was established in 1964 as Nova University of Advanced Technology and merged with Southeastern University of Health Sciences in 1994. Today, NSU’s 314-acre main campus is in Fort Lauderdale, Fla., with distance sites throughout the state of Florida, the United States and nine other countries.

NSU houses 18 different schools/colleges (Medical Sciences, Psychological Studies, Pharmacy, Arts and Sciences, Dental Medicine, Education, Law, Optometry, Computer and Information Sciences, Humanities and Social Sciences, Nursing, Business, Oceanography, College Preparatory, Early Childhood Education, Health Care Sciences, Human Service/Health and Justice, and Osteopathic Medicine) and 6 | M2VA 18.5

science in regards to health informatics, offers a number of different undergraduand the business/management of HIT. Parate, graduate and professional degrees. The ticularly, a multitude of skills-based elecbiomedical informatics program is housed tives allow an interprofessional student in the College of Osteopathic Medicine. Curbody to tailor its studies.” rently, the biomedical informatics program Online or on-site courses allow for is in the process of developing a Ph.D. proworking professionals, including physigram in the field and a master’s degree in cians, nurses, pharmacists, physical therinterprofessional clinical informatics. apists, medical technicians, coders, IT “Currently offering a Master of Science professionals, business/management proin biomedical informatics, graduate cerfessionals, educators, researchers and othtificates in medical informatics and public ers, to earn a degree or certificate without health informatics, an AMIA 10x10 certificareer disruption. cate, and an MSN in nursing informatics, “Types of jobs include chief medical the biomedical informatics program preinformation officers (CMIOs), nursing inforpares students for a number of different mation officers, chief information officers career opportunities in hospitals, health (CIOs), project managers, implementation care delivery systems, health IT (HIT) specialists, systems analysts, systems vendors, e-health project designers, researchcompanies, insurers, pharers, template writers, educamaceutical companies, tors/trainers [and] others,” public health agencies and said Nelson. “The program’s academic institutions,” said students and alumni have Christine Nelson, program been hired or promoted by manager for the biomedical Cerner Corporation, Centers informatics program. “The for Medicare & Medicaid Serprogram’s curriculum is vices (CMS), Cleveland Clinic designed with focal areas in Florida, Kaiser Permanente, clinical informatics (specifiChristine Nelson Aetna Life Insurance Co., cally application and evaluDELL, Community Health ation of HIT), computer cn71@nova.com www.M2VA-kmi.com

Systems, Memorial Healthcare Systems, Baptist Health South Florida and Broward Health, among others.”

In addition, NSU assists veterans in taking advantage of their educational benefits and providing them and their families with opportunities for educational and career growth.

“NSU partners with the United States Department of Veterans Affairs for the Yellow Ribbon program,” said Nelson.

A.T. Still University A.T. Still University was established in 1892 by Andrew Taylor Still, D.O., the founder of osteopathic medicine. Consequently, ATSU became the founding institution of osteopathic medicine and has evolved to encompass two colleges and four schools across two campus locations, as well as offering online programs.

“ATSU is home to the Kirksville College of Osteopathic Medicine, College of Graduate Health Studies, Missouri School of Dentistry & Oral Health, Arizona School of Dentistry & Oral Health, Arizona School of Health Sciences and the School of Osteopathic Medicine in Arizona,” said Public Relations Specialist Karen Scott.

ATSU offers master’s degrees across allied health disciplines and doctorates in athletic training, audiology, health administration, health education, health sciences, occupational therapy, physical therapy, dental medicine and osteopathic medicine.

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“At ATSU, our students and faculty are part of a distinguished osteopathic heritage based on an integrated approach that includes the body, mind and spirit,” said Scott. “Each program receives special emphasis on preventive medicine and outreach to underserved populations with the hope that graduates will choose a path to become a health leader in their community. All students are empowered to better understand the growing needs of domestic and global health and wellness issues.

Through community-based learning, students gain firsthand knowledge of what it is like to work at the community level.”

Students at ATSU’s Arizona School of Dentistry & Oral Health (ASDOH) lead or participate in more than 100 community outreach events, serve more than 5,000 underserved individuals and engage with nearly 60 organizations.

In 2013, ATSU’s newest school, the Missouri School of Dentistry & Oral Health (MOSDOH), was granted initial accreditation from the Commission on Dental Accreditation and opened its doors to an inaugural class of 42 students. ATSU-MOSDOH places emphasis on graduating dentists who have an in-depth understanding of and a desire to serve populations in need.

ATSU’s School of Osteopathic Medicine in Arizona wields a curriculum where students study on the Arizona campus for their first year only. After year one, students spend their second, third and fourth years of osteopathic medical training in the clinical milieu of a community health center

and the hospitals located in the catchment area of these health centers. This model enables students not just to learn about the scientific and clinical principles of medicine, but also to experience how legislation such as the Affordable Care Act plays out in clinical practice.

“ATSU is approved by the U.S. Department of Veterans Affairs for the certification of students eligible to receive VA educational benefits. Our personnel are aware and committed to working with veterans and active duty soldiers to ensure student success,” said Scott.

On April 27, 2012, President Obama signed Executive Order 13607, establishing the Principles of Excellence for Educational Institutions Serving Service Members, Veterans, Spouses and Other Family Members. ATSU fully complies with the seven principles and is dedicated to helping veteran and non-veteran students succeed.

“All students at ATSU are provided access to tools that will support their wellbeing: mind, body and spirit. Everything is provided, from tutoring and guidance, to learning resources and counseling services, to a complete focus on wellness through the university’s Still Well programs,” said Scott.

Kaplan University “Kaplan University was originally the American Institute of Commerce [when] founded back in 1938; it focused on education for female students at a time when

M2VA 18.5 | 7

college access for women was quite limited,” said Scott A. Kilgore, senior vice president of military affairs. “Providing educational opportunities to non-traditional students has been a hallmark of our school ever since. Today, that includes working adults, those families serving our country, those in remote areas—anywhere there is talent, which is everywhere. Our namesake, Stanley Kaplan, believed [that] ability, not birthright or social standing, should define educational opportunities. Thus, the pillars of accessibility and opportunity are what Kaplan University stands for.”

Currently, Kaplan University is expanding the number of military occupations that are mapped into college credit. This can significantly accelerate the path to a degree.

“It just makes sense to make the most of the incredible training our military members already have,” said Kilgore. “That requires a very specific mapping of course outcomes with military training outcomes to ensure all gaps are covered. These are not shortcuts to a degree in regard to what is learned—rather, it ensures all elements included in the degree are covered and validated. Our military students wouldn’t have it any other way—they don’t want to cut corners, but they don’t want to wait for others to catch up to what they already know, either.”

The university offers over 180 degree and certificate programs. However, for the readers of Military Medical & Veterans Affairs Forum, the most relevant are health science programs, in which up to 73 percent of the coursework can be earned through military training.

“Our associate program is the first step and positions them to continue their education in a broad spectrum of health care fields, including telemetry, health care administration, office management, information management and other allied health specialties,” said Kilgore. “For many of these careers, we encourage our associate-level graduates to continue in one of our bachelor programs. The good news is there may be additional credit applied toward their bachelor’s degree and even a master’s degree.”

The university offers reduced tuition—55 percent for active duty members to minimize their out-of-pocket expenses. It also recognizes the role the military family plays and has awarded over $5 million dollars in scholarships for military spouses and dependents.

8 | M2VA 18.5

Nova Southeastern University assists veterans in taking advantage of their educational benefits and providing them and their families with opportunities for educational and career growth. [Photo courtesy of Nova Southeastern University].

“The work we do to recognize occupational skills is extremely well-received within the military,” said Kilgore. “Specifically, we recognize medical occupations, combat arms, military police and legal specialists, and the list continues to expand.

Even if a member’s occupation has not been mapped, we analyze all military transcripts for credit. We also support our military students with special military leave policies and military-focused advisors.”

Walden University For more than 40 years, Walden has been serving a diverse community of working adults to provide them with the opportunity to transform themselves as scholar-practitioners so that they can advance their careers and effect positive social change.

The School of Health Sciences is part of Walden University’s College of Health Sciences along with the School of Nursing. The degree programs in the School of Health Sciences are aimed at helping students develop the critical and creative thinking skills required to address the health needs of individuals as well as local and global communities through health care services, research and education.

“We offer a variety of health sciences programs in our school, from bachelor’s to Ph.D. programs. A few include: B.S. in public health, B.S. in healthcare management, Master of Public Health (MPH), Master of

Healthcare Administration (MHA), M.S. in clinical research administration, M.S. in health informatics, Ph.D. in public health and Ph.D. in health Services,” said Dr. Jörg Westermann, the associate dean for the School of Health Sciences and the interim associate dean for the School of Public Policy and Administration at Walden University. “We create degree programs with an eye to emerging needs and long-term trends. We look at what society needs, what the workforce is demanding and what opportunities students are seeking. As a result, we recently added a M.S. in health education and promotion program as well as a professional doctorate in public health (DrPH) program.”

The M.S. in health education and promotion is targeted toward students who are looking for a health education-oriented degree and are not necessarily interested in a more science-oriented MPH degree that requires biostatistics and epidemiology. The program provides students with the skills and knowledge needed to assess community health needs; plan, implement and evaluate health programs; coordinate health education services; and advocate for specific health issues. Upon graduation, students in the program will have the skills and experiences to work in a variety of settings including, but not limited to: nonprofit organizations, community health agencies, colleges and universities, business and corporations, and faith-based organizations. www.M2VA-kmi.com

The DrPH is an applied doctoral degree and might be of interest to people who are looking for a degree that is practiceoriented and puts more emphasis on management and leadership skills instead of research skills.

“Students gain advanced skills to assume new leadership responsibilities, [learn] application and design of practice-based research to inform public health practice and gain a better understanding of policy and advocacy skills required by leaders in public health settings,” said Westermann.

The program prepares students for public health leadership careers in health departments, managed care organizations, community-based organizations, hospitals, consulting firms, international agencies, state and federal agencies, and clinics, among others.

“Our programs prepare students for a number of exciting careers in health care and the public health field,” said Westermann. “The MHA program prepares our students for a career leading to executive leadership positions in the health care

industry and is designed to enhance management, interpersonal and organizational skills and abilities. The Walden program is also designed to instill self-development, critical thinking and a desire for lifelong learning into our students.”

The career options for MHA graduates include group practice administration, urgent care facilities, research facilities, health services, medical information management, long-term care, international care organizations and health insurance carriers, among many others.

“At Walden, we also offer a generalist MPH degree that focuses on both the core and interdisciplinary areas essential to the practice of public health. Students attain knowledge and skills in disease prevention and health promotion in order to improve the health of communities,” said Westermann.

“The MPH degree prepares students for a variety of jobs in such areas as chronic disease prevention, health promotion, public health administration, epidemiology and environmental health. Some of the types of

places where our graduates may be employed include local and state health departments/ health ministries, federal government agencies, nonprofit organizations, communitybased agencies and private industry.”

The university’s Ph.D. in public health prepares students who seek a career as faculty and/or conducting research at a college or university or other settings to protect the health of communities, inform public health issues/problems and become advocates for change in their communities.

Conclusion Altogether, the wide variety of career training in the health sciences offered by schools such as Nova Southeastern University, A.T. Still University, Kaplan University and Walden University are programs of interest for veterans transitioning into a civilian career. 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.

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M2VA 18.5 | 9

The military provides more efficient health care using data.

By Brian O’Shea, M2VA Correspondent

Collecting, sharing and analyzing data can help health care providers with the decision support to deliver more efficient care to beneficiaries. Making use of data in this manner allows commanders of military treatment facilities (MTF) to determine how many primary care providers, how many surgeons and what type of resource planning they need to execute in order to support their beneficiaries, said Captain Jamie Lindly, chief of the analytics division at Defense Health Agency (DHA), the centerpiece of the military health system (MHS).

“We are the foundation for a lot of the central processing of our enterprise data,” said Lindly. “We’re the ones that write the functional specifications, and there are multiple roles in how we use health care analytics. Part of that, from an enterprise responsibility, is making sure those central systems at MTFs have good data to make decisions.”

Some examples of this data analysis supported inside MHS include how much utilization a patient has at a facility or how much purchased care a particular service has consumed for their enrollees in a given period.

“So we’re the back end of the central algorithms that go to support decisions across the enterprise,” said Lindly. “Just like the planning at an MTF, scale that up into an enterprise as a whole. One of the important things is that when we develop that number or methodology, it’s the same methodology we would [use] for a facility in Oak Harbor [Washington] that we would apply for any Army facility in the country, or the world. There’s standard methodology and there’s standard processing of our central data.”

These standard methodologies are determined by a functional proponency group, which includes a representative from each service, said Lindly. These service reps propose a methodology or processing specification and then have the ability to agree, disagree or come up with amendments to those processes. It’s an evolving activity because things are constantly changing, and MHS is re-releasing data as changes are made to the process.

“It can change,” he said. “We do retrofits of the same data as well.

We’ll say, ‘You know what? This variable isn’t populating the way it should. Let’s make this change and then reprocess a lot of the old data.’”

Being an analyst and looking at data is one thing, but the actual processing and ownership of the hardware, the actual day-to-day processing, is handled by the health information technology (HIT) people in the program office, said Lindly.

“We say here’s how you should process this data,” he said. “Then we write that specification and give it to HIT, who then build it into the weekly and monthly processes as we get more data from the CHCS [Composite Health Care System] host in these markets, or 10 | M2VA 18.5

from other sources. One of the frustrations is that an analyst will always have a bigger appetite than the HIT folks can either execute or are budgeted for. That prioritization of analytic approaches or projects is probably the biggest challenge.”

Lindly added that he feels health care analytics will become timelier over the next five years.

“There are significant lags from a central point of view,” he said. “I basically have a 90-day lag before I can tell you with confidence what the enterprise looks like. I think that window is going to shorten.”

The lag is due to data maturity. For example, when a CHCS has an inpatient, they will send Lindly their inpatient data records once a month when they’re completed. If someone was in the hospital on the 15th of the month, but their records weren’t coded until the fifth of the following month, Lindly wouldn’t get that completed data until 45 to 50 days later. After it’s coded, it will be sent for central processing, causing the 90-day delay.

DHA is fed data from multiple sources and needs to standardize the analysis of this data.

“We take that data and look at all of the elements, and we try to process that in a way that’s common with the other feeds that we’re getting,” said Lindly. “We get feeds from the DMDC [Defense Manpower Data Center] for who’s eligible for care, we get feeds from Aurora [Health Care] that tell us what claims we paid, we get feeds from facilities from PDTS [Pharmacy Data Transaction Service]; we have all of these different feeder systems routinely giving us data on a scheduled basis. We process it in a way that’s similar across all [systems].”

One of the leading providers of health analytics to the military is SAS, which specializes in having a standardized process for receiving and storing data, as well as making data available to users. Their solutions and technologies encompass applicable analytic capacities available to the DHA, Department of Veterans Affairs and other military health units. SAS’ expertise in health analytics has been developed over decades in both the private and public health sectors, said Rick Ingraham, health intelligence officer, SAS Federal. He added that the objectives of military and veteran health are the same. Analytics should help improve care quality, care effectiveness, care readiness and managing care costs. SAS directly impacts clinical performance and patient outcomes across a wide spectrum of focus areas—from enabling increased insight into clinical factors (and non-factors) driving readmissions to analyzing huge volumes of structured and unstructured clinical and operational data to uncover variables impacting the delivery of care, as well as zeroing in on patient safety signals.

SAS has been involved in several health care analytic projects that are changing the nature of health quality and outcomes, care delivery, www.M2VA-kmi.com

risk and incentives, and potentially avoidable care and costs, expediting the operationalizing research findings and enabling care financial sustainability via episodic care analytics.

SAS health analytics utilize previous investments in data to capture both internal military and external data sources, said Ingraham.

SAS draws upon transactional care records within existing electronic health records, patient data, physician (both staff and purchased care) data and any other external data sources and metrics that would increase opportunities to view the efficacy and efficiency of current care operations in a different and more informed light.

SAS analytic software can be installed on site, or can be used via cloud-based and software-as-a-service approaches to gain the most analytic strength from SAS’ Center for Health Analytic Insight.

Advanced analytics include modeling and forecasting capabilities to go beyond simple statistical summarizations of past activity to better anticipate the future and take actions in anticipation of expected health care performance. Their analytics shifts analysis perspective from hindsight to foresight. This entails an analytic maturation process that moves an organization from addressing the “what?” and “so what?” of health care benchmarks and trends through statistical analysis to now addressing “what if?” via forecasting and predictive modeling and “what now?” via optimization techniques.

The discipline of health analytics covers every facet of the health ecosystem’s operational processes, said Ingraham.

“The opportunities for tangible benefits are now being realized in ways heretofore unimagined. Certainly, the HITECH [Health Information Technology for Economic and Clinical Health] Act funding of electronic medical records has triggered more rapid conversions to digital records,” he said. “These investments have been significant, but can be at-risk if the health community expects outcomes and quality to improve solely from digitizing the data surrounding care transactions. Rather, the use of advanced analytics can aid in quicker ROI via insights that will both impact costs and quality.”

SAS has been focusing on the gap these products raise as clinical and operational staff struggle to convert volumes of data into understandable insights and changes to care delivery. A recent collaboration between SAS and a national integrated health provider used an analytics-as-a-service approach to identify opportunities to reduce readmissions, target (initially) congestive heart disease and sepsis for best-practice determination, manage pharmacy costs and outcomes and create tools to improve each patient’s experience.

“As both the public and private health sectors are exploring avoidable care costs and more value-based payment approaches, we have been aggressively developing an episodic analytic solution focused on better understanding efficiency, a patient-centered focus, cost management and increased quality of care,” said Ingraham.

He added that some of those specific areas include episodes of care measured by condition signals, the entirety of care across an episode of care, potentially avoidable complications relevant to a condition, clinical associations between episode identification, patient-severity/ risk-adjusted cost comparisons and accurate calculation of true episode costs.

There are challenges associated with analyzing this magnitude of data. The challenge is less of development and more of adoption, said Ingraham.

“Moving advanced health analytics into the mainstream of the military and veteran health care organizations has followed a course similar to other private and public health organizations,” he said. “In fact, the health industry has lagged behind others as far as adoption www.M2VA-kmi.com

of advanced analytics as a cornerstone for operational excellence. It is not uncommon to hear health management leaders discuss electronic medical records without mentioning methods to analyze care data. This would be a tremendous missed opportunity.”

Ingraham said SAS has observed two significant barriers to accelerating analytic adoption rate. The first barrier is that organizations tend to have one of two cultural mindsets around data and technology: scarcity or abundance. A scarcity environment tends to be constrained by data and technology, be process-oriented, be focused primarily on cost control and operate with an “everything is forbidden unless permitted” standard that hinders innovation.

An abundance environment, conversely, leans toward empowerment from data and technology, being discovery-centric, having a focus on value and operating with an “everything is permitted unless forbidden” standard to drive innovation, said Ingraham. He added that patient privacy and data security need not be a victim of this standard.

“Identifying where an organization stands in the analytic maturation process is a critical first step to making changes,” he said. “SAS has developed very precise business analytic management assessments that can aid in the transition from a culture of scarcity to abundance and assisted health management.”

The second challenge Ingraham sees is that some organizations are better at interpreting analytics results than others.

“Advanced analytics has often been met with hesitancy among management to adopt the full scope of techniques,” he said. “Why? It’s primarily because of difficulty in interpreting results. Health organizations have addressed this via new data scientist positions as well as investment in clinical informatics and economics units. However, it remains critical that managers responsible for using analytic health care insights to change care procedures can easily use the insights surfaced via analytics.”

SAS has worked toward empowering these “change managers” through the use of SAS Visual Analytics and Visual Statistics and via delivery to common personal devices such as the iPad. Ingraham feels health analytics will evolve in several ways over the next several years.

“While it may not be restricted to five years, I anticipate the discipline of health analytics to include an increasing number of data sources and observations,” he said. “Partly driven by the Affordable Care Act’s focus on accountable care organizations and value-based reimbursement (moving away from fee for service), there must be even further exploration of the factors that either directly, indirectly or subtly impact care outcomes, care quality, patient engagement and costs. This cannot be done without advanced analytics.”

He added that he expects increasing diligence in addressing the identification and reaction to gaps in patient care as they initially happen (signal detection), identification of in-patient/out-patient care variables impacting readmission, reoccurrence and errors, and further understanding of patient and family-caregiver acuity to develop more individual engagement methods to impact medical directive adherence.

“If we do this right, health providers will come to utilize analytic results on a daily, if not minute-by-minute (and patient-by-patient) basis,” said Ingraham. 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 18.5 | 11

Automating workloads to increase safety and minimize costs.

By Brian O’Shea, M2VA Correspondent Within the Defense Health Agency (DHA), a pharmacy shared services working group was created with the vision of improving patient outcomes by reducing overall health costs on the delivery of optimal pharmacy care, said Henry Gibbs, branch chief of Pharmacy Informatics Branch, Pharmacy Operations Division, DHA. “One of the areas of focus within the shared services is looking at ways to consolidate existing requirements and contracts for pharmacy automation, with the idea of improving services at the MTFs (military treatment facilities) and ultimately achieving cost savings,” he said.

He added that the biggest benefit is enhanced patient safety by utilizing

12 | M2VA 18.5

technologies like barcoding, robotics and accounting technology. Another benefit is the improved workflow within the pharmacy. There are efficiencies that can be gained through automation as well.

Challenges of pharmacy automation often deal with meeting requirements to access the DoD network.

“For DoD, the biggest challenge is always information assurance,” said Gibbs.

Information assurance is basically network security, so there are requirements that a vendor has to comply with in order to connect to the DoD network. Gibbs said it’s always a bit challenging because it’s an arduous process. It takes time to help them navigate through that process if they are not familiar with it.

Other challenges include the different variations in workflow at each pharmacy, as well as having pharmacy automation that’s modular, meaning being able to scale up and down depending on the footprint of the pharmacy. Within MTFs there are varying sizes of pharmacies; some have very small footprints and some very large. Having the ability to go from the smallest to the largest and in between is a challenge.

Gibbs said he predicted a focus on pharmacy workflow over the next couple of years to improve pharmacy automation.

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• Communicating with supply chain “It’s difficult to say, but I think really entities quickly and more frequently the continued focus is going to be on • Responding faster in case of adverse improving the pharmacy workflow through events the software,” he said. “If you look at 10 • Fulfilling compliance requirements years ago, the focus seemed to be more on from authorities like the FDA accounting technology and robotics. While • Enhancing patient safety by validating they’ve made improvements through both the origin of the drug of those, through speed and accuracy, I • Reducing shipment/dispensing errors think over the years they’ve started to look at trying to integrate more [software] into While there are many benefits to pharthe pharmacy workflow, and I think that’s macy automation, it does not come withwhat they’re going to continue to drive out its challenges. toward.”

“Pharmacies operate in Infosys is one of several a decentralized setup with leaders in this arena offering varied IT landscapes,” said solutions and services in the Chougule. “In such situadomain of inventory mantions, there are significant agement and patient safety, challenges in integrating said Ramesh Chougule, these solutions with other associate vice president, life existing technologies in sciences and services. They the pharmacy value chain. have experience in impleAlso, these solutions intermenting enterprise resource Ramesh Chougule act with multiple third planning (ERP) solutions for parties. There are technothe pharmacy chains, which logical challenges in making them work help manage the inventory better. Infosys in a seamless fashion. Also, pharmacy staff offers solutions for inventory planning, needs to be trained to use these solutions safety stock management, replenishment effectively. Infosys provides an organizaand order management using ERP. tional change management service to help They also have a compelling solution with faster and smoother adoption of these for patient safety which acts against the technologies.” risk of counterfeit. Their serialization soluChougule said he sees pharmacy autotion can help to trace back each pack of mation evolving on the following fronts: a medicine to the manufacturer in the Patient database management: Intesupply chain, helping with identifying the grating patient data with multiple agenauthenticity of the product. Pharmacies cies like hospitals, insurance providers can scan the pack and verify the history of and research labs will be a key area going its movement. This solution complies with forward. The adoption of an integrated the e-pedigree law requirements in the framework for patient information with United States. one source of truth and in compliance “Our solutions work on ERP technolowith the Health Insurance Portability and gies like SAP (systems, applications and Accountability Act (HIPAA) requirements products),” said Chougule. “The solutions will also be an important focus area. are pre-configured for the pharmacy chain Patient safety management: Impleneeds. Infosys implements these solutions mentation of U.S. e-pedigree law is proby tailoring them to the business process gressing at a definite pace. Though the requirements within the pharmacies. SAP timelines for manufacturers have shifted solutions are integrated with a variety of a few times, regulators are looking at the technologies within the pharmacy orgacompliance needs to reach point of dispennizations as well as other parties in the sation as an important aspect of controlsupply chain to exchange the data almost ling counterfeits and enhancing patient in real time.” safety.

Chougule said there were several benNear-close personalized medicines: An efits to pharmacy automation, including: increased share of personalized medicines will pose challenges in making the supply • Optimizing the store inventory and chain nimble in the life sciences industry. reducing inventory carrying cost Pharmacies will also go through a gradual • Balancing supply and demand in the change in their processes to respond to supply chain www.M2VA-kmi.com

these needs. The small batch size needs of such medicines will require pharmacies to carry low inventories and avoid the risk of unavailability. Pharmacies will have to be much more responsive in operations and be open to adopting the new generation of information technologies to respond to these needs.

Integrated drug, device and service businesses: With drugs, devices and patient service businesses coming under one roof in the case of certain life-threatening diseases, pharmacies will have to work closely with the manufacturers by shortcutting the distribution supply chains. They will have to adapt to a different level of responsiveness, communication and software technologies.

Operational automation: With pharmacy operations undergoing changes with enhanced automation and accuracy, pharmacies will have to adapt to these new technologies. Man-to-machine interface technologies will evolve in certain areas of pharmacy operations and pharmacies will have to adopt these technologies.

Pharmacy automation advancements will affect the health care provider’s role.

Physician-to-pharmacist interactions are constantly evolving, said Chougule. Information technology has helped in reducing the lead time for patient service, enhancing automation and eliminating communication errors. This space will further evolve into a single source of fully integrated systems with a few steps moving to the cloud, given the enhanced security confidence.

With the global nature of pharmaceutical distribution, the supply chain interactions have also changed significantly, and pharmacies will interact with distributors for better information management in the last mile of operations. Pharmacies will see the increased need for responding to distributors’ technologies for supply management; similarly, distributors will see a more demanding technological response for pharmacies’ technological changes in demand management.

“We also envision changes in the technology landscape for communication with payers and expect this to impose demands of advancing the billing systems in pharmacies,” said Chougule. 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 18.5 | 13

VITAL SIGNS Bacterial “Communication System” Could Be Used to Stop Cancer Cells Cancer, while always dangerous, truly becomes life-threatening when cancer cells begin to spread to different areas throughout the body.

Researchers at the University of Missouri have discovered that a molecule used as a communication system by bacteria can be manipulated to prevent cancer cells from spreading. Senthil Kumar, an assistant research professor and assistant director of the Comparative Oncology and Epigenetics Laboratory at the MU College of Veterinary Medicine, says this communication system can be used to “tell” cancer cells how to act or even die on command.

“During an infection, bacteria release molecules which allow them to ‘talk’ to each other,” said Kumar, the lead author of the study. “Depending on the type of molecule released, the signal will tell other bacteria to multiply, escape the immune system or even stop spreading. We found that if we introduce

the ‘stop spreading’ bacteria molecule to cancer cells, those cells will not only stop spreading; they will begin to die as well.”

In the study published in “PLOS ONE,” Kumar and co-author Jeffrey Bryan, an associate professor in the MU College of Veterinary Medicine, treated human pancreatic cancer cells grown in culture with bacterial communication molecules. After the treatment, the pancreatic cancer cells stopped multiplying, failed to migrate and began to die.

“We used pancreatic cancer cells because those are the most robust, aggressive and hardto-kill cancer cells that can occur in the human body,” Kumar said. “To show that this molecule cannot only stop the cancer cells from spreading, but actually cause them to die, is very exciting. Because this treatment shows promise in such an aggressive cancer like pancreatic cancer, we believe it could be used on other types

Premium Point-of-Care Ultrasound System Mindray recently announced the new M9 premium compact ultrasound system, the next generation in point-of-care ultrasound technology. A powerful, versatile and mobile system, the M9 is designed to provide physicians with fast, superior-quality imaging for immediate clinical management and decision-making.

The introduction of point-of-care ultrasound into the front line of emergency and critical care medicine has a significant impact by bringing the service to the patient. The M9 is intuitive and easy to use. It also offers expanded flexibility, including broad general imaging and comprehensive cardiac applications appropriate for the fast-paced and demanding emergency department environment. Backed by advanced signal processing and newly designed adaptive algorithms, the M9 incorporates power, smarts and simplicity, allowing both novice and experienced clinicians to make decisions with confidence.

Additionally, the M9’s single-crystal transducer with 3T technology provides deeper penetration and sharper image quality, giving physicians confidence. This unique technology also supports the M9’s significantly improved cardiac tissue tracking accuracy and effectiveness for real-time quantitative assessment of myocardial function. In the M9, enhanced technology is coupled with enhanced mobility; there is a seven-second start-up from standby and more than three hours of battery life, all within a slim-profile ergonomic cart.

“Mindray is already a leader in point-of-care ultrasound solutions, but the introduction of the M9 responds to the demands of physicians at the most challenging points, in the emergency department and critical care,” said George Solomon, president of Mindray North America. “The integrated package, with its premium image quality, has received very positive feedback from physicians, as it helps ensure diagnostic confidence while also containing costs.”

14 | M2VA 18.5

of cancer cells, and our lab is in the process of testing this treatment in other types of cancer.”

Kumar says the next step in his research is to find a more efficient way to introduce the molecules to the cancer cells before animal and human testing can take place.

“Our biggest challenge right now is to find a way to introduce these molecules in an effective way,” Kumar said. “At this time, we are only able to treat cancer cells with this molecule in a laboratory setting. We are now working on a better method which will allow us to treat animals with cancer to see if this therapy is truly effective. The early-stage results of this research are promising. If additional studies, including animal studies, are successful, then the next step would be translating this application into clinics.”

Nathan Hurst; hurstn@missouri.edu

FDA-Approved Treatment for Sleep Apnea Now Available Advanced Brain Monitoring Inc. announces the U.S. launch of Night Shift, a new therapy recently cleared by the U.S. Food and Drug Administration for the treatment of positional obstructive sleep apnea and snoring in patients who are significantly worse when sleeping on their back.

Worn on the back of the neck, the Night Shift begins to vibrate when users begin to sleep on their back, and the vibration slowly increases in intensity until a position change occurs. Unlike conventional position therapies (e.g., tennis balls sewn into night clothing or padding to restrict back sleeping), Night Shift delays the start of therapy to allow the user time to fall asleep in any position. Night Shift is also an intelligent, interactive monitor that tracks the user’s response to the therapy and measures its impact on snoring and sleep quality.

www.M2VA-kmi.com

Compiled by KMI Media Group staff

Tactical Earplug Addresses Top Service-Related Disability Hearing loss and tinnitus are the two most common service-related disabilities, according to DoD’s Hearing Center of Excellence (HCE). To give troops and their commanders more options for protecting hearing while maintaining a degree of environmental hearing, 3M is introducing the Peltor Tactical Earplug for military and law enforcement applications. It is available now for U.S. Army Tactical Communications and Protective Systems (TCAPS) applications and law enforcement.

The 3M Peltor Tactical Earplug is an in-ear digital earplug designed to help protect users’ hearing from high levels of steady-state and impulse noises. At the same time, the device has soundamplification capabilities for situational hearing and can help troops better hear mission-critical verbal communications in quiet environments. Existing devices, such as the 3M Peltor ComTac III Tactical Communications Headset, provide similar capabilities in an over-the-ear design. However, the availability of an in-ear device provides more options to satisfy troops’ personal preferences and accommodate a greater range of mission demands and head-borne equipment.

The Peltor Tactical Earplug is ruggedized for military and tactical environments, and helps protect hearing against sustained noises, such as loud generators and vehicle engines, and impulse noises, such as gunfire and blasts. Sound amplification settings can be activated by using a single button. Rechargeable batteries provide up to 16 hours of continuous operation.

“Smart” Bandage Emits Phosphorescent Glow for Healing Below Inspired by a desire to help wounded soldiers, an international, multidisciplinary team of researchers led by Assistant Professor Conor L. Evans at the Wellman Center for Photomedicine of Massachusetts General Hospital and Harvard Medical School (HMS) has created a paint-on, see-through, “smart” bandage that glows to indicate a wound’s tissue oxygenation concentration. Because oxygen plays a critical role in healing, mapping these levels in severe wounds and burns can help to significantly improve the success of surgeries to restore limbs and physical functions. The work was published in the Optical Society’s open-access journal “Biomedical Optics Express.”

“Information about tissue oxygenation is clinically relevant but is often inaccessible due

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to a lack of accurate or noninvasive measurements,” explained lead author Zongxi Li, an HMS research fellow on Evans’ team.

Now, the “smart” bandage developed by the team provides direct, noninvasive measurement of tissue oxygenation by combining three simple, compact and inexpensive components: a bright sensor molecule with a long phosphorescence lifetime and appropriate dynamic range; a bandage material compatible with the sensor molecule that conforms to the skin’s surface to form an airtight seal; and an imaging device capable of capturing the oxygen-dependent signals from the bandage with a high signalto-noise ratio.

Angela Stark; astark@osa.org

Advanced Bio-filtration Device Aethlon Medical Inc. announced the first use of Hemopurifier therapy on a patient infected with the Ebola virus. The treatment was administered to a Ugandan doctor at the Frankfurt University Hospital in Germany. The patient, who is also a World Health Organization (WHO) worker, contracted the virus in Sierra Leone.

The Aethlon Hemopurifier is a first-in-class bio-filtration device that targets the rapid elimination of viruses and immunosuppressive proteins from the circulatory system of infected individuals. At present, no antiviral therapy or vaccine has proven to be effective against Ebola virus infection in humans.

The largest Ebola virus epidemic in history is now spreading on a global basis, with more than 4,000 deaths being reported by the WHO. “We thank the physicians in Frankfurt for allowing us the opportunity to treat this advanced-stage patient,” stated Aethlon founder and CEO Jim Joyce. “Details related to the patient’s response to therapy will be disclosed once hospital officials deem it appropriate to report an update on the condition of this individual.”

In the care of Ebola-infected individuals, the Hemopurifier targets two unmet medical needs: the rapid elimination of circulating Ebola to inhibit continued progeny virus replication and the direct targeting of shed glycoproteins that overwhelm the host immune response. The device can be deployed for use within the global infrastructure of dialysis and continuous renal replacement therapy machines already located in hospitals and clinics.

James A. Joyce; jj@aethlonmedical.com

M2VA 18.5 | 15

Benefits Deliverer

Q& A

Pharmacy Success During DHA Year One Dr. George E. Jones Jr., PharmD, M.S. Chief, Pharmacy Operations Division Defense Health Agency As leader of the Defense Health Agency (DHA) Pharmacy Operations Division (POD), the primary responsibility of Dr. George E. Jones, Jr. is management of the multifaceted Department of Defense pharmacy benefit.

A senior policy advisor to the Assistant Secretary of Defense for Health Affairs, Jones manages a $9.7 billion pharmaceutical program, and develops policies and implements programs to meet the clinical and pharmaceutical needs of beneficiaries and optimize DoD resources. He has corporate management and compliance oversight responsibility for the DoD pharmacy program, which covers 9.5 million beneficiaries. The POD coordinates with military treatment facility (MTF) pharmacies and a contract network of 57,000 retail and mail-order pharmacies to ensure delivery of uniform, consistent and sustainable pharmacy services.

Before retiring from the U.S. Air Force in 2013, Jones served as deputy chief of the former TRICARE Management Activity (TMA) Pharmaceutical Operations Directorate. He led the TMA/Tri-Service Pharmacy Shared Services working group in developing the structure and way forward to fully integrate pharmacy benefit delivery operations into the DHA. His team achieved initial operating capability of pharmacy shared services under DHA on Oct. 1, 2013, one year ahead of the original target date.

Additionally, while on active duty, Jones led multiple ambulatory, inpatient and medical center pharmacy operations, and held medical squadron command positions. He deployed in support of operations Desert Shield/Desert Storm, Provide Comfort and Restore Hope, and led medical readiness training exercises to Peru and Nicaragua. Jones also led a team of six different medical specialties to provide emergency earthquake relief to Pisco, Peru, delivering care and supplies to 11,000 patients.

Q: How do you see the responsibilities of the chief of the DHA Pharmacy Operations Division?

A: As an amazing challenge! The DHA is first and foremost a combat support agency. Our mission is to enable the services to provide a medically-ready force and a ready medical force. Everything we do in the DHA is focused on the soldiers, sailors, airmen and Marines who are deployed around the world, in peacetime and in war. My job is to continuously improve how the Military Health System (MHS) delivers the pharmacy benefit by building on our successful past.

Our first priority is ensuring that deployed servicemen and women have access to the prescription medications they require.

The DHA Pharmacy Operations Division is responsible for managing DoD’s pharmacy benefits and achieving full integration of pharmacy services across the MHS. A key part of my job has been 16 | M2VA 18.5

identifying opportunities for efficiencies and improvements for delivery of the MHS pharmacy enterprise benefit worldwide.

Q: Can you describe the organizational structure of the DHA? A: The DHA seeks to better integrate and coordinate health care across the entire MHS, a lesson we’ve learned from the battlefield where joint medical teams cared for injured servicemembers in an integrated manner from the point of injury to their recovery and rehabilitation back home.

We have a three-star Air Force general—Lieutenant General Doug Robb—as our boss. It’s important that we have a military officer at the head of this agency to remind us, and our customers, that we are first and foremost a military organization responsible for the medical readiness of the force. There are six directorates within the agency, and Pharmacy sits underneath the Health Care Operations directorate, led by Army Major General Richard Thomas. The other five directorates are: Research, Development and Acquisition; Health IT; Education and Training; Budget and Resource Management; and the National Capital Region Medical Directorate (which includes both Walter Reed National Military Medical Center and Fort Belvoir Community Hospital).

The services and the combatant commands are our customers and also our staff. Our organization includes both civilians and www.M2VA-kmi.com

uniformed medical personnel from the Army, Navy and Air Force medical communities, as well as representatives from the Public Health Service, Coast Guard and several foreign liaison officers.

The DHA provides the framework for bringing together a number of activities—or shared services—that the secretary [of defense] and the services determined over two years ago would benefit from greater integration, greater interoperability and an enterprise-wide perspective. Pharmacy is one of those shared services.

Just as the services were a critical part of designing and building the DHA, they continue to work as full partners in identifying and implementing these initiatives. We work in the same building together; we have a number of joint working groups focused on our various initiatives; and we have candid, direct discussions about our approach before we move to execution. It’s an exciting time to be working in military medicine.

Q: How has the program changed in the last year?

A: I have to tell you—the pharmacy program has always been one of the more integrated functions in the MHS, so we are building from an exceptionally strong foundation. In the past, the TRICARE Management Activity (TMA) pharmacy staff largely focused on contract management of our major pharmacy programs—our civilian network pharmacies and our mail-order operation, while each service implemented its specific pharmacy program. Our new enterprise pharmacy structure under DHA is developing and implementing pharmacy delivery guidance for the whole system. For me, this means taking a broader view of the pharmacy benefit and thinking about how pharmacy can provide enhanced value to the MHS and the services. Being a shared service means being responsive to new stakeholders and making sure that the pharmacy team is oriented to meet these new challenges.

Q: What does DHA Pharmacy offer to the services?

A: The services provide excellent medical care to their patients in the MTFs. The predecessor to the DHA (the former TMA) focused most heavily on the purchased care network. Although we had effective collaboration, neither had good visibility into the entire program. Sometimes DoD or service-level guidance unintentionally generated second-order effects not in the best interest of the overall enterprise. DHA can look across the services and the support contracts—in other words, across the entire MHS—to ensure alignment of objectives, identify economies of scale and share best practices. We have a new ability to develop metrics-based, resultsoriented process improvements for the whole enterprise.

This is a boon to DoD from an efficiency standpoint, and to beneficiaries who can look forward to getting the same high standard and scope of care whether they are in an Army, Navy or Air Force facility, or accessing their TRICARE pharmacy benefit downtown.

In just over one year since the DHA stood-up, the pharmacy operations division has implemented several enterprise-wide initiatives to increase efficiency and standardization and, through service execution, improve services at military pharmacies while working to hold down costs. On the customer service side, the “you write it, you fill it” policy requires that when an MTF provider writes a prescription, the medication needed to fill that prescription is available at the facility’s pharmacy. This policy is both convenient for beneficiaries and good for the MHS, since it keeps prescriptions out of the retail www.M2VA-kmi.com

network. DoD saves an average of about 30 percent on a brandname prescription filled at an MTF pharmacy instead of a civilian retail pharmacy. Newly developed metrics allow us to identify MTF prescriptions written by MTF providers but filled in downtown retail pharmacies, and to address these issues through service channels.

We also implemented a standardized prescription transfer policy across all MTF pharmacies. It was current practice for MTFs to accept prescription transfers from providers external to that specific MTF, but there wasn’t a standard enterprise-wide policy. Some MTFs varied in their interpretation of transfers, meaning that some beneficiaries may have been required to get new prescriptions—and make another visit—before an MTF would fill it. This posed a hurdle for beneficiaries who were moving, traveling or on temporary duty (TDY). Besides, it is standard civilian industry practice to transfer prescriptions when authorized refills remain without requiring a new prescription. Standardizing transfers is an example of how DHA pharmacy shared services coordinated action with the services to improve the patient experience across the entire MHS. On the cost management side, DHA pharmacy shared services used enterprise data analysis to improve national contract purchasing compliance and brand-to-generic transition initiatives at military pharmacies, saving a combined $34 million for fiscal year 2014. Additionally, through uniform implementation, we were able to leverage our Pharmacy and Therapeutics Committee formulary recommendations into more than $100 million in savings during the same period. Before the DHA, we would not have had the ability to align these initiatives as effectively or to measure the impact with the same degree of accuracy. MTF pharmacies have done a tremendous job during 2014.

Another example of pharmacy enterprise success is the implementation of a congressional mandate. In March 2014, DHA pharmacy kicked off the TRICARE For Life (TFL) Pharmacy Pilot mandated by the 2013 National Defense Authorization Act. The pilot requires Medicare-eligible TRICARE beneficiaries who get certain maintenance medication prescriptions to move those prescription refills from retail pharmacies to TRICARE Home Delivery or to military pharmacies. DHA Pharmacy was able to track the increase in TFL patients at military pharmacies enterprise-wide and identify the installations where the pilot was increasing prescription volume.

We were able to use this analysis to make recommendations to the services about installations that might require additional pharmacy staff. The data supported and the savings enabled adding staff to those locations, which we would not have been able to do previously.

Already, this initiative has improved customer service for our beneficiaries, and to date has led to almost $50 million in cost savings.

Q: What steps is DHA Pharmacy taking to balance rising prescription costs?

A: Controlling pharmacy costs is always an uphill battle. But keep in mind that, when appropriately used, pharmaceuticals are an excellent investment in health. New drugs come on the market every year that offer improved therapy and can help keep patients healthier and out of the hospital. Now, new medications aren’t cheap. Just this year, the MHS spent more than $100 million on new medications to treat hepatitis C. Yet, these new medications, while expensive, have greatly improved cure rates and patient tolerability over previous options, which makes them a good investment in the future health of our beneficiaries.

M2VA 18.5 | 17

DHA pharmacy shared services had an ambitious goal to save DoD $160 million in FY14. I am pleased to say we met and exceeded that goal. At this point, pharmacy shared services initiatives saved DoD $209 million in FY14, and we have not concluded our final review of claims data—which could take that number higher. We had four primary savings initiatives: channel management—moving maintenance medication refills from retail to military pharmacies or TRICARE Home Delivery; formulary management; brand-to-generic transitions; and contract compliance. Each of these initiatives offered significant cost-savings to the MHS. Channel management was projected to yield the biggest savings for the MHS in 2014 through the TFL Pharmacy Pilot, which I mentioned earlier. On average, a brand-name medication moving from a retail pharmacy to TRICARE Home Delivery or an MTF saves DoD about 30 percent. And it saves patients money too—home delivery saves beneficiaries about 75 percent in copay costs over retail pharmacies for a 90-day supply of brand-name medication.

The effectiveness of the other three initiatives was greatly enhanced through the stand-up of DHA pharmacy shared services.

Through close collaboration with the services, we made sure that MTFs were fully aware of formulary decisions and national drug contracts. The DHA structure enabled a more effective partnership with the Defense Logistics Agency—the agency that manages the actual negotiations with pharmaceutical vendors—and we increased performance visibility. Being able to view and communicate this information enterprise-wide helped increase national contract compliance by 15 percent from our October 2013 baseline and more than tripled the projected savings from the brand-to-generic transition initiative.

Our success in these areas flows directly from our role supporting the services. DHA Pharmacy is able to build metrics, set baselines, share best practices and provide a high-level vision of MHS pharmacy operations. We facilitate the ability of the services to efficiently manage their pharmacies, coordinate their activities with our contract pharmacy partners and align initiatives to deliver the best value for the MHS. These initiatives represent only the start of pharmacy improvements made possible by the DHA, not the end. Every one of us on the pharmacy team recognizes that the stand-up of the DHA is a major step forward—and a once-in-a-generation opportunity for the military medical community to improve our operations. We aim to provide a better health care experience for our beneficiaries and be a streamlined organization that spends taxpayer dollars in the most efficient manner possible. I look forward to the opportunities ahead.

Q: What have been your major priorities in year one of the DHA? A: My top priority during DHA year one has been to emphasize the pharmacy division’s value to the organization and the services and to support our MHS Quadruple Aim: improved readiness, better health, better health care and lower costs. The major goal to achieve that priority was to operationalize the pharmacy shared services structure.

I’ve already spoken a fair bit about how we are fully operational and are exceeding our savings goals. Establishing processes that ensure full and open collaboration across the MHS enterprise for the delivery of pharmacy has been a critical task. We accomplished that, and our goal now is to further improve those processes. This effort is reinforced by the DHA governance structure. There are collaborative operation groups representing the services and DHA providing active input to current and future initiatives.

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Another priority in 2014 was to increase use of the TRICARE pharmacy vaccination benefit. I am pleased to report that in 2014, TRICARE covered more vaccines administered in retail pharmacies than ever. Many vaccinations are administered at the doctor’s office or a hospital, but we are seeking to improve access to vaccines by promoting the retail pharmacy vaccine option. Last year during flu season, TRICARE covered flu vaccinations for more than 453,000 beneficiaries through the pharmacy benefit. I expect this number to climb even higher this season, since many beneficiaries are getting vaccinated earlier. Last fall and winter, more than 50,000 adults also received the shingles vaccine at retail pharmacies, and over just the past five months, almost 22,000 more beneficiaries were also vaccinated. TRICARE purchased care claims for vaccines have increased almost 11 percent in the past 12 months. In the past six months, TRICARE also helped prepare children for school by covering about 8,400 vaccines against tetanus, diphtheria and whooping cough, and more than 400 vaccines for measles, mumps, rubella and chickenpox at retail pharmacies.

Overall, TRICARE covered nearly 14,000 vaccines for children 0 to 18 years of age through this program.

Increasing vaccination rates is both an investment in better health for our beneficiaries and a long-term cost savings. Healthier beneficiaries mean fewer costly hospitalizations or emergency room visits for preventable diseases. This type of savings doesn’t show up in the pharmacy bottom line at the end of the year, but it makes a real difference to our beneficiaries and significantly decreases overall MHS costs.

Q: You joined the DHA in May 2014 after serving in the old TMA. What have you learned in your first six months on the job?

A: That I made the right choice to continue to work to serve the greatest group of patients, our beneficiaries, in the world. The TMA/Tri-Service working group that framed the structure for pharmacy shared services got it right. Even though they got it right, I’m also glad they didn’t get it perfect, because that gives the DHA pharmacy team an opportunity to define and deliver improvements. I have learned in this new job that a longstanding belief was correct—we should thank a long line of visionary pharmacy leaders for the opportunities we have today. None of this would be possible without the hard work of the service pharmacy consultants past and present, the talented hard work of the folks who stood up TMA and crafted the first contracts, and the leaders who applied their observations and experience to process improvements. I have learned that my parents are pretty smart and taught me skills that enabled me to successfully serve in the Air Force and now in this inspiring opportunity. Also that my wife Kristine continues to support my efforts to improve pharmacy services, an absolute requirement! I have learned that this is an exciting time for me and for DoD pharmacy!

Q: What unexpected challenges have you faced this year?

A: We have had some staff turnover that I did not expect. As we have a blend of active duty military, Public Health Service, government civilians and contract staff, turnover is to be expected and is healthy. However, there can be surprises. I did not fully expect some of the challenges growing a new organization would present.

The adoption of new organizational procedures and new processes www.M2VA-kmi.com

for decision-making took some time to fully iron out any kinks.

However, I have been pleased with the process improvements implemented by the organization in just the short time I have been in this job. The governance process has quickly established an improved battle rhythm.

When you take a step back, we’ve accomplished sweeping integrated enterprise initiatives in a very short of time. Before DHA, this would have taken years to achieve—if it was achievable at all.

I have to say the myriad of other challenges were expected. Also expected, and realized, is the talented team of professionals I have as a staff. They are making it all happen.

Q: How is the DHA looking to implement new or emerging technologies in the pharmacy space?

A: One of the most exciting is enabling MTF pharmacies to receive electronic prescriptions from civilian prescribers. Beginning in September 2014, we are rolling out electronic prescribing capability to MTF pharmacies across the country (and in Guam and Puerto Rico). A pilot began at Naval Hospital Bremerton, Wash., in March 2014 and we plan to have the full capability deployed to all MTFs by Dec. 31, 2014. We’ve been working towards deploying this capability for a long time. Internally, MTF staff members have been electronically prescribing to MTF pharmacies for a number of years. Now, electronic prescribing is fast becoming the industry standard for civilian prescribers and pharmacies. The Centers for Medicare and Medicaid Services incentivize health care providers to use it. As we try to recapture treatment back into the military direct care system, it’s important for us to implement this technology and remove a potential barrier for beneficiaries to use military pharmacies. Electronic prescribing also has the potential to improve patient safety by eliminating translation and transcription errors associated with handwritten prescriptions. I’m also interested to see if deploying a technology like electronic prescribing can encourage customer service innovation within our military pharmacies.

Q: Are there any major trends in pharmaceutical operations we should watch?

A: One trend we are watching closely is MHS spending and utilization for specialty drugs. We are expecting to see several advances in the specialty drug market over the next year, with breakthrough therapies being approved not only for hepatitis C, but also in cancer chemotherapy, diabetes, cholesterol management and some rare diseases. Spending for specialty medications continued to rise in FY14. In the MHS, these products account for one-quarter of the total spending for drugs billed through the pharmacy benefit, but account for around 1 percent of total volume. The top three specialty classes when ranked by total spending—cancer, inflammatory conditions and multiple sclerosis—accounted for 60 percent of the total spending for specialty medications. We continue to evaluate and monitor these classes for formulary placement and site of care to ensure continued appropriate, safe and effective use of specialty medications for all TRICARE beneficiaries.

We also need to be agile as an organization. Advances in technology, in evidence-based practice and in the ability to focus on optimizing patient outcomes will need to be evaluated and rapidly implemented to ensure the best, most cost-effective pharmaceutical care is accessible for our beneficiaries. www.M2VA-kmi.com

Q: The Drug Enforcement Agency recently changed its rules to allow more institutions to operate drug take-back programs. Does the MHS plan to participate?

A: Yes, we are. Getting unused medications out of medicine cabinets is an important step to enhance patient safety and contributes to suicide prevention efforts. In 2012, DoD suicide event reports found that nearly 33 percent of suicide attempts among servicemembers that year involved a prescription medication. The MHS has often participated in take-back events organized by the DEA and supported by law enforcement. At the most recent event in September 2014, 87 military sites collected almost 13,000 pounds of unused medications.

The DEA rule allows non-law enforcement entities to collect controlled substances for proper disposal. We plan to give our beneficiaries collection opportunities at all of the military pharmacies nationwide through at least one of the mechanisms allowed by the DEA: mail-in envelopes, receptacles or take-back events. We have recently published a request for information to ensure we are aware of best commercial practices as we shape the way forward.

Q: What are your priorities for 2015 and beyond?

A: A top operational priority is to build on our initial success. We need to have a deliberate process in place to seek out new opportunities and apply continuous improvement to ongoing initiatives.

A particular focus on new therapies and specialty pharmaceuticals will be essential. Ensuring DoD beneficiaries can access information, education materials and other tools available to patients that support medication adherence and optimize therapy outcomes is essential and not fully optimized by the MHS. Along that line, a priority for 2015 is exploring ways to partner with pharmaceutical manufacturers by leveraging their often extensive patient support materials in a performance-based framework that facilitates successful therapy experience for the patient and return on investment for the government.

A big challenge for the coming year is evolving from the standup of a new organization, specifically pharmacy shared services, to performance-driven operation of the DoD pharmacy enterprise.

Striving toward fully integrated pharmacy benefit delivery, optimal interoperability and driving efficiencies through uniform implementation of best practices is a foundational priority. A personal priority in this job is to work to ensure I am enabling the talented staff to fully contribute to the mission. We have just implemented a new organizational structure to help ensure alignment of our resources to the mission and to facilitate our own internal interoperability.

We are using cross-functional teams to ensure the right expertise is applied to each objective. Continuing to evolve the implementation of our structure and the management tools we use is vital for 2015.

Fully embracing clinical pharmacy practice across the enterprise during 2015 aligns nicely with MHS strategic priorities. Pharmacy will contribute to driving improved quality and safety, managing cost and enhancing the patient experience through integrated clinical pharmacy initiatives. Engagement with patient-centered medical home practice structures, delivering medication therapy management and driving evidence-based therapy are pharmacy targets for 2015. Equally important is our focus on developing and communicating the data and supporting metrics to assess and facilitate progress.

Our priorities are to keep focused on the patient, work to continuously improve quality and support a fully integrated pharmacy enterprise. That will deliver success for 2015 and beyond. O M2VA 18.5 | 19

M2VA reached out to leaders in the field of providing a replacement for AHLTA.

electronic health care records who are interested in

Steve Comber Group President Leidos Health Global experience and proven innovation DoD can trust to help modernize defense health The Leidos Partnership for Defense Health was created to help DoD achieve the goals of the Defense Healthcare Management Systems Modernization (DHMSM) initiative—an undertaking that will set new standards for health data sharing nationwide amidst the current environment of rapidly evolving health technologies. Our team brings together the collective strengths, insights and proven approaches of Leidos, Accenture and Cerner: three global leaders in health IT, interoperability and military electronic health records (EHR).

The mission of DHMSM is to enable better health and wellness for our men and women in uniform and their families, while also ensuring the medical readiness of our troops, wherever they may be, from forward-operating bases with little or no connectivity to deployed fleet vessels and aircraft. DoD’s unique mission and operating environment were at the forefront of our planning as we designed an EHR solution that has the worldwide reach, connectivity and flexibility needed to meet DoD’s needs today and for generations to come.

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Our health IT experts are already supporting military health facilities worldwide and are ready to rapidly deploy our modern and open EHR solution that will provide standardized health care data and semantic interoperability—meaning the health information shared between systems will be consistent, accurate and meaningful. Our solution leverages Cerner’s proven, innovative electronic medical record (EMR) technology that was rated the highest in interoperability and configurability categories in the 2013 KLAS EMR Technology Perception Report. This “best of suite” system will allow for communications across the continuum of care, including military treatment facilities, VA, and commercial hospitals and clinics. It will also create easy-to-use, accessible, portable health records that can help our servicemembers and their families better manage their health care.

The Leidos Partnership for Defense Health recognizes that a smooth and efficient transition to our DHMSM solution is essential to minimize any disruption to patient care and military treatment facility operations. In this regard, our team’s expertise in both commercial and government health markets sets us apart.

We have implemented thousands of health IT systems worldwide on time and on budget for some of the largest organizations facing some of the most complex challenges. Leidos has provided global EHR design, development and sustainment services to health IT programs within DoD, including its largest health IT system.

Accenture is the world’s largest global systems integrator and has implemented nationwide EHR systems for the countries of Singapore, Australia and Norway.

www.M2VA-kmi.com

We are also well-positioned to smoothly facilitate an interoperable MHS/VA solution, given our combined experience with MHS, VA legacy and the VA modernization. Our EHR platform is ONCcertified and fully compliant with industry standards supporting broad interoperability with existing health systems in military health, VA, and commercial/civilian health care organizations.

Our open and modern system was designed to give DoD the flexibility to expand the scope of its solutions as new technologies emerge. And, as some of the largest EHR providers and system integrators in the private sector, including Cerner’s role as a

Carl Dvorak President Epic The best value and lowest-risk choice DHMSM is an unprecedented opportunity to transform the way MHS delivers and manages care, both to support the well-being of beneficiaries and to help ensure ongoing military readiness. With our partners at IBM, we have assembled the strongest team of industry leaders for the DHMSM project. Some of our strengths include demonstrated large-scale experience; openness and interoperability; scalability; and long-term value from the only acute EHR no hospital has ever chosen to replace. It is an honor to take part in this landmark transformation.

Reducing project risks through a team of well-respected industry leaders

www.M2VA-kmi.com

founder of the CommonWell Health Alliance, we will continually strive to bring forward best practices and proven innovations.

The Leidos Partnership for Defense Health offers experience and expertise DoD can count on to successfully implement and deliver on the important mission of the DHMSM program. We are honored to have the opportunity to partner with DoD to continue a leadership path in health technology standards and innovations and, most importantly, provide DoD clinicians with the technology and support they need to improve the health, well-being and readiness of our U.S. military and their families.

IBM is one of the largest leading systems integrators with extensive large-scale MHS project experience. Epic has the #1 overall COTS EHR suite according to KLAS Enterprises. Our customer community serves 54 percent of the U.S. population and includes more large and leading care organizations than that of any other COTS EHR vendor. Our team includes Lockheed Martin, the dominant government cybersecurity solution provider, and Impact Advisors, KLAS’ #1 ranked implementation consultant. Dozens of other team members provide subject-matter expertise in theater and garrison operations, legacy MHS software and successful EHR deployment.

Together, we offer the best-integrated EHR solution that meets all DHMSM requirements, supports low/no communication environments, is 100 percent developed in the United States, and positions MHS for success today and in the future with population management, personalized medicine, predictive analytics and research.

The vital importance of open and interoperable software Interoperability is a key DHMSM success factor. With about 60 percent of MHS beneficiary care provided by commercial partners,

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simple and secure patient data exchange with third-party EHRs is essential.

Interoperability is an area that has been measured through independent research, and Epic has been recognized as the leader. KLAS’ Health Information Exchange (HIE) 2014 report ranks Epic #1. This is a performance report based on input from vendors’ live customers. It provides a better-informed comparison than perception reports that are the opinions of non-users.

Epic exchanges more patient data with the VA than any other COTS EHR according to Healtheway, the public-private collaboration that runs the eHealth Exchange. Epic also connects with more than 600 third-party systems and provides web services and APIs so that customers can link third-party modules to the Epic suite.

The only system with demonstrated scalability and strong performance at the MHS’s volumes We have the only COTS EHR system operating at DHMSM’s volumes. In addition, our system delivers fast response times.

The largest civilian EHR implementation, at Kaiser Permanente,

Dean Mericka Senior Vice President, Sales and Services Allscripts Interoperability and Clinical Expertise Will Lead the Modernization of DoD’s Health Model DoD is planning an $11 billion transformation of its health delivery model. Since the implementation of the healthcare.gov website, this may be the largest system overhaul in the U.S. health system. Given the magnitude of this project, it’s no surprise that all eyes are on DoD and the companies that have participated in the bid. What DoD is looking for is a partner that understands how to deliver an integrated, connected, open and interoperable system that is designed to effectively and seamlessly serve the varying and unique needs of servicemembers and their families. But there are some nuances that make this program different from others in the past, requiring a new approach for success.

• An open, interoperable platform to connect information from disparate systems: Undoubtedly, DoD has unique needs, where a soldier can travel from an intensive care unit in a military aircraft to a base in the most untouched geography of the world, a VA hospital and then private care. The patient’s medical data is stored across disparate systems, and connecting these can be a challenge. Add to that the fact that DoD is supporting roughly 1.6 million active duty members and 9.8 million beneficiaries—children, spouses and veterans among them. Today, over two-thirds (77 percent) of DoD members receive private care. This presents the immediate issue of ensuring that all patient information can be seamlessly transferred to clinicians when they need it most. To manage care transitions across geographies and disparate systems, DoD will require a core EHR system that has the ability to pull patient information from any system and any 22 | M2VA 18.5

uses Epic to support over 9.6 million patients and over 95,000 concurrent users. This architecture reduces project risks as DHMSM scales from IOC to global deployment.

The best long-term value Our team offers: 1. The industry’s strongest history of large-scale project success. Hospitals using every other major COTS EHR system have chosen to move to Epic. No hospital has ever chosen to replace Epic’s acute EHR. 2. The peer group most beneficial to the MHS. Groups such as the Cleveland Clinic, Johns Hopkins, Kaiser Permanente, Stanford, Partners Healthcare and Yale collaborate on innovations and share best practices in ways that advance the whole community.

3. A lifetime license. We never sunset systems and require customers to purchase replacements.

vendor. This data will allow caregivers to access a holistic view of the patient’s medical history—across VA systems, military records and private care—allowing them to make more informed clinical decisions at the most critical time.

• Expertise from commercially successful partners: Although the health care industry is still in the early stages of truly appreciating the impact of data from EHRs, there are success stories from health systems that have used this data to transform care and patient outcomes. One such example is University of Pittsburgh Medical Center (UPMC), one of the largest health systems in the country, with 22 hospitals, more than 400 outpatient locations and nearly 3,500 employed physicians. The health system also manages its own health plan, which serves more than 2 million patients through a network of 125 hospitals and over 11,500 physicians. UPMC has leveraged strong population health analytics and EHR technologies to aggregate patient data from 48 major clinical systems, analyze it to provide more personalized care, and develop preemptive treatment options.

This experience and expertise can be monumental in implementing a similar commercially successful and sustainable model for DoD. While DoD may want to adopt industry best practices, it is managing a health system that includes battlefields and humanitarian efforts, something that is unprecedented in commercial health care. No single vendor can bring about an overnight transformation, but it is inspiring to see the commitment toward bringing change. And with partners who are willing and “in it for the long haul,” this will be a positive transformation for our servicemembers and their beneficiaries. 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.

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Innovative medical simulation solutions are offered by an array of private companies in the United States and abroad. Many of the companies listed here are common names to those involved in the field of medicine within the military and veteran health care system.

As the drawdown in Afghanistan continues, future military medical professionals may have to rely more heavily on simulated medical training. Currently, there is a trend towards simulated training in the military as a whole as technology continues to progress and the cost of simulation technologies decreases.

Agilent

Dedicated Computing

MYMIC LLC

Defense Logistics Support Inc.

Nasco

Design Interactive Inc.

NGRAIN

Diamond Visionics

Operative Experience

Engineering & Computer Simulations

Strategic Operations

Aptima Matt Puglisi Executive Vice President Aptima’s measurement platform unobtrusively collects and analyzes data about team workload during medical simulations, giving trainers the ability to monitor and modify scenarios on-the-fly to maximize individual and team learning.

202-552-6121 mpuglisi@aptima.com

Simbionix USA Corp.

General Dynamics Information Technology

Simetri

IngMar Medical

SIMmerion LLC

B-Line Medical

Kratos Defense & Security Solutions Inc.

Simulab Corp.

Bohemia Interactive Simulations

Laerdal Medical

Cae Healthcare

Leidos

Cera Products

Lockheed Martin

CHI Systems, Inc.

Medical Simulation Corp.

CSC

Medical Training Consultants

CSE Software Inc.

Mimic Simulation

www.M2VA-kmi.com

Smooth-On Inc. Strategic Operations Inc. Syndaver Labs Vcom3D Inc Virtual Heroes Virtual Reality Medical Center

M2VA 18.5 | 23

Colonel (Dr.) Michael D. Wirt discusses the advanced medical research performed by the U.S. Army Institute of Surgical Research.

Colonel (Dr.) Michael D. Wirt was commissioned as a second lieutenant in the Chemical Corps in 1986 after graduating from U.S. Army Officer Candidate School in Fort Benning, Ga. Following graduation, he served on active duty with the 1-70th Armor Battalion, 5th Infantry Division, and in multiple subsequent assignments as a chemical officer in the Army Reserves until 1994. During this period, Wirt completed a master’s degree and doctorate in bioinorganic chemistry at Georgetown University, followed by a post-doctoral fellowship in magnetic resonance at Albert Einstein College of Medicine. Wirt is also a 1998 graduate of Albert Einstein College of Medicine, where he obtained his Doctorate of Medicine degree, followed by completion of an internship in general surgery and his residency in diagnostic radiology at Tripler Army Medical Center, Honolulu, Hawaii, in 2004.

Wirt completed fellowship training in neuroradiology at the University of California, San Francisco from 2004 to 2006 and was subsequently assigned as the chief of radiology at William Beaumont Army Medical Center from 2006 to 2009. In 2009, Wirt was selected to serve as the brigade surgeon for the 502nd Infantry Regiment, 101st Airborne Division (Air Assault). He deployed to Kandahar Province, Afghanistan, in 2010 as the combined task force strike surgeon, Regional Command South, Interna24 | M2VA 18.5

tional Security Assistance Force, where the task force earned the Presidential Unit Citation. Upon redeployment in 2011, he was assigned as the deputy commander for Clinical Services at Blanchfield Army Community Hospital, Fort Campbell, Ky., home to the 101st Airborne Division (Air Assault).

Wirt is board-certified in both diagnostic and neuroradiology and serves as the radiology consultant to the army surgeon general. He holds an appointment as an assistant professor of radiology at the Uniformed Services University of the Health Sciences and is a senior member of the American Society of Neuroradiology. Wirt also serves as the Army liaison to the American College of Radiology. He is a graduate of the Army Command and General Staff College, the Army Flight Surgeon course, and the Army Airborne and Air Assault schools. His awards and decorations include the Bronze Star Medal (1 OLC), Meritorious Service Medal (4 OLCs), Army Commendation Medal (3 OLCs) and Army Achievement Medal (1 OLC). He is a recipient of the Combat Medical Badge, Flight Surgeon Badge, Parachutist Badge and the Air Assault Badge. He holds the Army Surgeon General’s “A” Proficiency Designator and the German Armed Forces Badge for Military Proficiency (Gold) and is a member of the Order of Military Medical Merit.

Q: Colonel Wirt, what are the key elements of your commander’s guidance? www.M2VA-kmi.com

A: First of all, I would like to say that it is a great honor to be given the opportunity to lead a prestigious command like the U.S. Army Institute of Surgical Research. The key element of my guidance for the staff members of this institute is simple: Our driving focus remains in support of our mission statement, ‘optimizing combat casualty care.’ Our mission has been and will continue to be in the forefront of our research efforts. We continuously strive to improve the delivery of medical care to combat casualties throughout the continuum of care from the point of injury to their arrival in the United States for definitive care and rehabilitation. For more than a decade, the staff at this institute has been dedicated to care for wounded warriors who require a multidisciplinary approach to their treatment. This collaborative and integrated research platform offers the ability to translate science into improvements in combat casualty care and then deliver these improvements to the battlefield.

Q: In order to implement your commander’s guidance, have any changes been made at USAISR? A: I am fortunate to have taken command of an institute that has a long history of remarkable leaders. So no, there have not been any significant changes made in order to implement my guidance. Previous commanders established a vision for this institute ‘to be the nation’s premier joint research organization planning and executing registry-based and translational research providing innovative solutions for burn, trauma and combat casualty care from the point of injury through rehabilitation.’ My goal is to continue fostering this vision through dedicated research for the combat wounded.

This staff nurse at the U.S. Army Institute of Surgical Research Burn Center Intensive Care Unit (BICU), was one of the first burn center staff members to use the Burn Navigator once it was implemented in the BICU. [Photo courtesy of the USAISR/by Steven Galvan]

Q: What are some current programs under way at USAISR? A: The USAISR is one of six research laboratories within the U.S. Army Medical Research and Materiel Command and is the Army’s lead research laboratory for improving the care of combat casualties. The USAISR meets this challenge through innovative research efforts spanning the continuum of military care.

In particular, the institute has substantial research programs in hemostasis, hemorrhage and blood research; regenerative medicine; craniomaxillofacial, extremity and ocular trauma; out-ofhospital research; intensive and critical care research; trauma and burn research; and dental and pain research. The key to providing research-driven solutions for trauma is through a thorough understanding of the clinical care gaps. The gaps frequently cut across our research programs, and we are invested in leveraging our collective expertise to work together to provide integrated solutions to the clinical problem.

Q: How does USAISR optimize combat casualty care?

A: Every member of the ISR staff is aware of and supports our mission to ‘optimize combat casualty care.’ We are able to accomplish www.M2VA-kmi.com

this through three unique missions: (1) provide requirementsdriven innovations in combat casualty care to advance medical care for injured servicemembers; (2) as the only burn center in the Department of Defense, provide state-of-the-art burn, trauma and critical care to injured warfighters and DoD beneficiaries around the world; and (3) through the Joint Trauma System, provide a performance improvement system dedicated to ensuring that the right patient gets the right care at the right time and in the right place.

The three primary missions of the ISR work synergistically to improve care for the combat wounded. The Joint Trauma System evaluates the current delivery of military trauma care, identifying opportunities for improvement. This information in turn provides a picture of relevant battlefield medical problems, which generate data-driven questions. The questions feed into requirementsdriven combat casualty care research, developing products to improve care of combat wounded. Finally, innovations in combat casualty care research are returned to the battlefield. These innovations return either through the Joint Trauma System, informing clinical practice guidelines, or through the burn center.

This approach enables us to keep a finger on the pulse of current combat medical problems, develop solutions through research and return these solutions to benefit the warfighter.

M2VA 18.5 | 25

Q: What kinds of research are carried out by the Coagulation and Blood Research Task Area at USAISR? A: The Coagulation and Blood Task Area is dedicated to developing improved resuscitation products to treat hemorrhage, the number-one cause of preventable death on the battlefield. The task area’s work is currently focused on developing improved platelet storage technologies to improve the safety and efficacy of platelets, which are critical to hemorrhage control; identifying promising diagnostic and therapeutic approaches to treating acute traumatic coagulopathy, a major exacerbating factor in battlefield hemorrhage; developing blood pathogen reduction technologies to reduce the disease transmission risk of transfusions; developing approaches to manage bleeding and clotting problems that arise in patients who require Extracorporeal Life Support; and developing stem cell thera- The French Lyophilized Plasma (FLyP) has been used to successfully resuscitate critically injured U.S. special forces combat casualties.

FLyP is a universal product that is compatible with any blood type. [Photo courtesy of the USAISR/by Steven Galvan] pies to support the acute management of inflammatory complications of trauma as educated calculations to determine the total burn surface area of well as wound healing and tissue repair applications. the patient. Woundflow automatically calculates the total burn surface area from data entered by the care provider. Woundflow Q: Could you tell us about the U.S. and French partnership to also has the potential to be a device capable of plotting the trajecexpand freeze-dried plasma production? tory of burn wound healing. Both these devices were constructed to improve care given to military burn casualties, but have the A: In 2011, the U.S. and French armies entered into a partnership potential to impact civilian burn care as well. in which the French Army would supply the U.S. Army Special Operations Command with freeze-dried plasma (FDP) for use in Q: What makes the USAISR Burn Center differ from typical civiltrauma resuscitation in far-forward-deployed settings. The product ian burn centers? is approved in France. The plasma would be administered under a Food and Drug Administration and ISR Internal Review BoardA: The ISR Burn Center is different from a typical burn center supervised Expanded Access Investigational New Drug protocol. because our primary mission is the care and prevention of miliEvery soldier potentially receiving the product signs an informed tary burn casualties. All research and performance improvement consent form prior to deployment. The product has been used sucactivities support this mission. Also, this is the only burn center cessfully to save the life of at least one U.S. Army Ranger injured with a specialized aeromedical evacuation team (burn flight team) in Afghanistan. Currently, the ISR is working with the U.S. Army capable of evacuating burned military casualties from anywhere Blood Program to expand the FDP program using plasma collected in the world. on U.S. military bases and sent to France for processing.

Q: Considering that the only DoD burn center is a component of your command, could you tell our readers what new technologies are currently in demand in military burn care?

A: The technologies in demand in military burn care are the Burn Resuscitation Decision Support System (BRDSS) and Woundflow.

The BRDSS is a handheld electronic device that tracks fluid resuscitation on a burn patient and gives recommendations to the care provider to help guide them with fluid management. This device is helpful for a care provider who does not have experience in burn care and is intended to be used in a war zone where burn care specialists may not be readily available. Woundflow is a computer program that is used to map out burn and soft tissue wounds. The traditional method was using paper and colored pencils to map out the wounds. The care provider would then have to make some 26 | M2VA 18.5

Q: Is there anything else you would like to add that was not discussed?

A: We strive to do everything that we can to save the lives of our warfighters wounded on the battlefield. This institute was instrumental in deploying tourniquets, hemostatic agents and hypothermia prevention kits to the battlefield. We will continue partnering with our higher command, USAMRMC, academia and industry to identify the needs on the battlefield and then develop and test potential products to fill capability gaps. We live and strive to accomplish our mission every day for our combat wounded. 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.

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Nova Southeastern University ���������������������������������������������������������������������������������������������������� 7 www.medicine.nova.edu/msbi RDT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C4 www.rdtltd.com ZOLL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C2 www.zoll.com

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M2VA 18.5 | 27

INDUSTRY INTERVIEW

Military Medical & Veterans Affairs Forum

Rob Harris, M.H.A, F.A.C.H.E. Government Sales Executive Xenex Disinfection Services care facilities, including VA and DoD. Since implementation at Langley, other DoD MTFs and foreign governments have contacted Xenex about utilizing our robots as part of their HAI reduction and Ebola preparedness strategies.

A board-certified health care executive, Rob Harris is a graduate of the U.S. Air Force Academy and retired as a USAF medical service corps officer.

Q: Could you tell our readers about some of the solutions Xenex offers to the military and other government contractors?

A: Xenex offers the fastest, safest and most cost-effective method for the disinfection of health care facilities such as patient rooms, operating rooms and intensive care units.

Xenex’s germ-zapping robots use xenon ultraviolet (UV) light to destroy viruses, bacteria and bacterial spores that cause health care associated infections (HAIs).

Xenex robots are scientifically proven to be effective against the most dangerous pathogens, including Clostridium difficile (C. diff), Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococcus (VRE) and the Ebola virus.

Xenex robots are considerably faster, safer and greener than other automated cleaning and infection control methods, including toxic mercury UV and hydrogen peroxide-based systems, which can take multiple hours to achieve the same level of disinfection.

Q: What unique benefits does Xenex provide its customers in comparison with other companies in your field?

A: UV light has been used for disinfection for decades. Xenex has developed a new way to make UV light that is far more powerful and effective than existing UV technologies. Our germ-zapping robot uses xenon to make UV light that is 25,000 times more intense than sunlight—and capable of destroying the Ebola virus in less than two minutes. Xenex robots can disinfect a hospital patient room in just five to 10 minutes. Most importantly, hospitals using Xenex robots are reporting fewer HAIs and have published their infection reduction success in peer-reviewed journals. No other UV technology has peer-reviewed studies demonstrating the 28 | M2VA 18.5

Q: What are Xenex objectives in 2015 for the government market?

impact of the technology on actual patient infection rates.

Q: What are some interesting new programs or initiatives at Xenex?

A: U.S. Air Force Langley Hospital was the first military hospital to procure a Xenex robot for disaster preparedness.

Xenex robots can be used to disinfect all areas where an infected patient will be transported or treated [aircraft, ambulances, hospitals and personal protective equipment (PPE)]. This innovative use of the Xenex technology was in response to the Ebola outbreak in West Africa and the fact that Langley Air Force Base was scheduled to receive military personnel returning from operations in that area.

Nellis Air Force Base (Mike O’Callaghan Federal Medical Center) was our first DoD customer, and we recently deployed a robot at Madigan Army Medical Center, the first U.S. Army facility to adopt our technology.

An exciting advancement is our ability to disinfect PPE such as the gowns and face shields of health care workers.

The workers are vulnerable when they are removing their contaminated equipment after treating an Ebola patient. Our robots can be used to quickly disinfect PPE prior to removal so the workers are protected.

Q: How is Xenex positioned in the market for expansion?

A: Xenex robots are in use in more than 250 U.S. hospitals and 35 federal health

A: The Xenex mission is to save lives and reduce suffering by destroying the pathogens that cause HAIs. In 2015, our goal is to ensure that every in-patient government health care facility operationalizes our technology. Servicemembers, their families, retirees and veterans deserve the highest standard of care available. Xenex provides a cost-effective method that is proven to improve the environment of care. Not only does Xenex support the recent Presidential Executive Order “Combating Antibiotic-Resistant Bacteria,” it would also be an outstanding course of action for MTFs that need to improve their infection prevention strategies per the secretary of defense-directed military health system review.

Xenex robots should be incorporated into our nation’s disaster preparedness plan. The Xenex robot is lethal to biological agents and can be utilized for hazard mitigation in response to both natural and man-made biological events. Xenex can be used for disease containment, site remediation and as a risk mitigation strategy. Additionally, we plan to deploy Xenex devices to West Africa as part of our nation’s response to the Ebola crisis.

Q: Is there anything I haven’t asked that you’d like to discuss?

A: HAIs take the lives of more than 75,000 patients every year. These infections are preventable. Deploying xenon UV technology across the federal health care system would save thousands of lives and save our government millions of dollars every year. O rob.harris@xenex.com www.M2VA-kmi.com

NEXT ISSUE

March 2015 Volume 19, Issue 1

Dedicated to the Military Medical & VA Community

Carmen J. Spencer JPEO Chemical and Biological Defense

Features Leadership Outlook 2015 The highest offices of military medicine discuss what the year has to offer for the 9.6 million beneficiaries of the military health system.

Nursing Informatics Health informatics brings together elements of social science, health care and the other hard sciences.

Training for nurses in this growing field is provided by several military-friendly schools.

Medical Training Training for combat medics changed over the course of wars in Iraq and Afghanistan. The reemergence of the tourniquet as a vital element of casualty care is one such example.

Vital Signs Monitors Several medical companies compete to provide the military with the best vital signs monitoring systems.

Special Section: Future CBRN Threats The improvised technologies of today’s terrorist threats are constantly evolving in order to successfully launch a chemical, biological or radiation attack.

Bonus Distribution: • •

Joint Civil & DoD CBRN Symposium AUSA Global Force

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