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

Operational Information Systems:Turning Acronymic into Capability

Presentation to Patient Administration Course

CDR A. P. Spencer, NC, USN

Revised 13 Jul 2006

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Pop Quiz

Please answer the following:• True/False: Information systems are all gobbledygook

between acronyms, technical jargon, and technical talk that real people can’t understand.

• True/False: In an increasingly joint world, the service role in information systems is decreasing.

• True/False: Life was better with a paper record—fewer data calls.

Although acronyms are used, the focus is not the HOW but the WHAT needs to be done. What is the required capability??

Look at Title X. The Services still are required to fund and support non- Defense Health Programs (P-8) activities, which is nearly all operational healthcare.

Those who were there remember considerable time manually aggregating results of log books for one query and considerable manual time spent collating data that could not be verified (roll-ups only).

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Objectives

Upon completion of the period of instruction, the learned shall be able to perform the following:

• List and discuss the components of a capability• Discuss four major operational programs (capabilities,

how fielded)• Discuss major capability sets of operational IM/IT• Discuss how the learner may obtain a needed

operational IM/IT capability• Discuss resources to assist the learner

If I do my job correctly…

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The Instructor

• Current position– Navy Medicine Chief Information Officer Theater Systems Lead

• Navy lead for Theater Medical Information Program Joint, Maritime• Navy Medicine Individual Medical Readiness IM/IT lead• Yada…yada

• Jun 2006, left three years as:– MARFORPAC/MARCENT Deputy Surgeon and FHP Officer

– Included multiple deployments ISO OIF/OEF

• Naval Medical Information Management Center survivor– Theater Systems Dept. Head

• Education– Masters in Nursing Informatics and Administration

– Graduate of Marine Corps Command and Staff College

• And so on…

Who am I to teach this subject?

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Why Is This Important to the PAD Community?

• Semper Administration– Meet reporting requirements– Meet tracking requirements– The electronic medical record (to be)

• In garrison how often does your area– Use CHCS– Use TRAC2ES– Use JPTA

• To your existing daily joys, please add– Daily reporting for Higher HQ (Service and Joint)– A whole lot more ad hoc needs– Poor NIPRNet access– Frequently no DSN access– Absence of existing infrastructure– A deployed service helpdesk that doesn’t understand medical– Absence of fixed support and infrastructure, rapid change over

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Why A Capability?

• A capability consists of the following:– Personnel [system administrator, trainer, helpdesk]– Equipment [servers, communications, networking equipment]– Training [initial, sustainment, pre-deployment]

• It also includes the following:– Updates

• New capabilities/versions• Security patches for Information Assurance Vulnerability Alerts

(IAVAs)• Coordination for ports and protocols• Reachback support• Logistics support (user manuals, spares, integration into supply

system)• Permission to use on network (Authority to Operate)• Funding for support

• A capability is service-blind and mission focused

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Why Can’t I Just Use Access® and Excel®?

• For one site, access may be easy…provided:– You have someone who can support and maintain it– You don’t exchange data with anyone– You know and have all applicable standards—and people savvy

enough to articulate them – It is for a small time-frame

– The Line communicators Navy/Joint/Staff/General-6 owns the network, devices, communications, and means.

– You will be held to the same standards as everyone else—often shifting sands…

– Listen, learn, and use a “what do I need to do” attitude

• Isn’t Medical Different? Why is the Line Involved?

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Major Areas of Capability

• Clinical Documentation• Individual Medical Reference• Command and Control (C2)• Medical Logistics• Medical Reference• Research and Development• Resource Systems• Other Service Programs

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Major OperationalMedical Programs

• Theater Medical Information Program– Program of programs– Lead by TRICARE Management Activity (TMA)– Two stage program:

• Joint program fields software (like Microsoft)– Software is taken from other TMA programs and “packaged”/integrated

for theater use

• Service programs integrate, place on hardware, train, and support (like Dell)

– Navy: TMIP—Maritime– USMC: separate part of TMIP—Maritime – Army: Medical Communications for Casualty Care (MC4)– AF: TMIP Air Force

Clinical DocumentationIndividual Medical ReferenceCommand and Control (C2)Medical LogisticsMedical ReferenceResearch and DevelopmentResource SystemsOther Service Programs

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TMIP

• Coordinates programs along 5 major pillars:– Healthcare Delivery– Medical Logistics (including Blood)– Patient Movement– Command and Control– Personnel and Administration (Service programs)

• Started fielding 2003 to Army ISO OIF/OEF– Limited fielding to USMC in Iraq– Navy evaluating

• Clinical documentation– CHCS II-Theater

• Roughly a 2003 version of CHCS II• Does not meet Joint Trauma documentation standards• Does not transmit all information• Supports templates• Send encounter to Clinical Data Repository


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TMIP

• Battlefield Medical Information System-Telemedicine (BMIST)– HP IPAQ Personal Digital Assistant– Collects SF-600 and DD-1380 (casualty tag)– Feeds CHCS II-T– Fielded by DoD,

SpecOps, FEMA,7 other countries

– 35,000 deployed– Also has:

• Vet module• Pre/Post Depl

Assessment• Blood Mgt• Wireless sensors• Travax® integration


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Larger Architecture: TMIP Data Exchange

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Dental

• Navy and Marine Corps– DENCAS (http://dencas.med.navy.mil) used for workload,

scheduling, and readiness status– Includes a remote (non-web) capability and soon to be PDA

version– Some dental status’s kept in SAMS (if no dentist aboard)

• Army/AF– Use Clinical Dental Application

• In mid-2007, AHLTA dental module (a/k/a “the Big Tooth”) will come online, to follow into CHCS II-T

• Will include clinical documentation, procedures, a dentist's delight!!


http://dencas.med.navy.mil/

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IMR

• TMIP and AHLTA not ready to meet full needs of IMR• Currently use Service systems

– Navy (AD)• SAMS (ships)

– Integrates medical encounter, IMR, supply, and radiation health• SAMS AHLTA (MTFs)• AHLTA and SAMS data flow to Navy Medicine Online

https://nmo.med.navy.mil/imr• POC Elaine Shorkey (301) 319-1310 DSN 285

– Navy Reserve and USMC• Medical Readiness Reporting System

– Web-based administrative system that collects all medical readiness– Now able to order and result HIVs– Ties to unit personnel feeds and TYCOM readiness system

• POC: USMC HM1 Sauseda (504) 678-0453• POC: Navy HMC Kloaka (504) 678-5413

– Army• MEDPROS

– Air Force• AFCITA (Clinical Immunizations Tracking Application)


https://nmo.med.navy.mil/imr

https://nmo.med.navy.mil/imr

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Command and ControlSystems

• Medical Analysis Tool– Medical plans and requirements generator used by POMIs

– Part of TMIP

– Stand-alone

• Joint Medical Workstation (JMeWS)– NIPRNet: https://fhp.osd.mil

– SIPRNet: https://fhp.smil.mil

– Integrates situational awareness, medical surveillance, and analysis

– Mandated reporting & use in OIF/OEF

• Joint Planning and Execution System (JOPES)– Used by G-3/5 planners to access the Time Phased Force Deployment

Database (TPFDD) (movement into/out of theater)

• Global Command and Control System (GCCS)– Larger systems of systems on SIPRNET

– Plug and play component


https://fhp.osd.mil/

https://fhp.osd.mil/

https://fhp.smil.mil/

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Medical Logistics

• Defense Medical Logistics Standard System (DMLSS)– Used in MTFs and some deployed environments– USMC evaluating now for use at Medical Logistics Companies

• Defense Blood Standard Support (DBSS)– FDA approved program that is used at blood distribution sites

and MTFs– Painful to use and maintain, considered a medical device– Often spreadsheets used at low levels– Call the JTF or CoCom Blood officer

• SAMS– Used for afloat medical supply and logistics– Some roll-up available at Navy Medicine Online– Has a Palm PDA application


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Medical Reference

• Virtual Naval Hospital– Http://www.vnh.org

• Navy Medicine Online– https://nmo.med.navy.mil– Click on left Resources– Connects to NMIMC CD Resources– Contains 30,000+ CMEs

• Micromedix and Stat Ref! located in TMIP


https://nmo.med.navy.mil/

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R&D Systems

• Joint Theater Combat Trauma Registry– Program out of Army Institute of Surgical Research– Used by Army, Navy programs feeds– Focus is surgical technique and care delivery

• Navy/Marine Corps CombatTrauma Registry– Run by Naval Health Research

Center– Web-based form in theater

collects DNBI and trauma data

– Provides detailed analyses

• TACMED CS (RF-ID)– Dog-tag and name band

for wireless tracking and ID– Joint venture by NHRC and

Marine Corps Warfighing Lab– Will migrate to BMIST


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Resource Systems

• Centralized Credentials and Quality Assurance System (CCQAS)– Web-based program at DISA San Antonio TX– Usually done by Professional Affairs Coordinator (PACs) in MTF– Inter-facility Credentials Transfer Brief (ICTB) still needed in

deployment

• Defense Occupational Environmental Health Reporting System (DOEHRS)– Hearing Conservation module used in audio booth is mature– Emerging syst


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Other

• Defense Messaging System• Outlook and E-mail• Teleradiology

– Computed radiography on ships and some deployed locations (EMF Djibouti) sent to NNMC Bethesda and NMC San Diego to be read by a radiologist

– Often results in less than a business day– Currently using commercial product of RADWORKS, but shifting

to MedWeb– USMC digital radiology product not capable of transmitting for

remote reads– Highly complex program—many participants and funding

streams– POC Lee Larson (301) 319-1091 DSN 285


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Line Networks: What’s Important

• Navy/Marine Corps Intranet (Navy)• Navy/Marine Corps Intranet (Navy)• Integrated Shipboard Network System (ISNS or IT-21)

• Non-classified Internet Protocol Router Network (NIPRNET)

• Secure Internet Protocol Router Network (SIPRNET)• Commercial Internet

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Prime IM/IT Conflicts of the Day

• IT as acquisition• Tasking to Service with reducing service IM/IT budgets• Increased IM/IT oversight (BMMP)

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Things to Think About Information Management

• You have tons of information– Systems– Databases– E-mail– Post-it notes– Paper..tons of lovely paper

• All of it needs to be managed– Archived– Sorted– Protected– Analysed?– Maintained

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Who Do I Reach Back To?

• Formal– If you are on a Joint Manning Document or a direct report to a

Joint Task Force (JTF), your reach-back is through the Combatant Commander Joint Staff Service tasking

– If you report to a service component, then through the component service HQ

• Informal– Who do you know– Me…

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Key Take Aways

• The deployed N/J/S/G-6 owns the network, communications, and devices. There are not exceptions for medical. Be prepared to play by the rules.

• IT isn’t hard to understand—just focus on WHAT you need more than HOW to get it

• Training, integration, and use are not IT issues, they’re yours

• Ask the hard questions– What do I fund– What do I have to do now and later– Who maintains– How is my -6 involved?– How will my relief be prepared for this?– Is this a program of record?

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Learning Objectives

Upon completion of the period of instruction, the learned shall be able to perform the following:

• List and discuss the components of a capability• Discuss four major operational programs (capabilities,

how fielded)• Discuss major capability sets of operational IM/IT• Discuss how the learner may obtain a needed

operational IM/IT capability• Discuss resources to assist the learner

If I did my job correctly…

POC

CDR A. P. Spencer

[email protected]

(757) 953-6878 DSN 377

mailto:[email protected]

Back-up Slides

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Program POCs

Program Organization Type E-mail

Web

Phone

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New requirements submission

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POCs

Documents

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