AHLTA Clinical Advisory Board Theater Medical Information Program

AHLTA Clinical Advisory Board Theater Medical Information Program – Maritime (TMIP-M) Overview and Status Update 24 June 2008 Claudia Kiefer, TMIP-M Program Manager

Introduction » Theater Medical Information Program – Joint (TMIP -J) is the Do. D-wide solution to multiple legislative mandates: “…every Soldier, Sailor, Airman and Marine will have a comprehensive, life-long medical record…” Source: Special report of the Presidential Advisory Committee on Gulf War Veterans’ Illness, 1997 “The Secretary of Defense shall establish a system to assess the medical condition of members of the armed forces…who are deployed. ” Title 10; Section 1074 f (1997): Medical tracking system for members deployed overseas “Effective immediately, the Services will implement and use the approved TMIP-J application suite to capture healthcare-related data. ” ASD(HA) draft memo; 2008; Policy on World-wide Use of the Theater Medical Information Program-Joint (TMIP-J) 2

TMIP-J Operational View OV-1 Interoperability across the Continuum 3

TMIP-J Software Applications Suite AHLTATheater AHLTA Warrior AHLTAMobile Tele. Health TRAVAX EIC TMDS JMe. WS MAT/JMAT JTTR JPTA BHIE-T TMIP CHCS Caché (TC 2) DOEHRS - IH DCAM SAMS PMITS DMLSS TRAC 2 ES GEMS Mobile MEDIC T-DBSS GCSS Patient Movement Electronic Health Record Command & Control Medical Logistics Mission Pillars 4

Joint Military Needs » Expanding worldwide medical visibility requirements » Integration over: - Time & Space - Organizations (Levels of Care, Functions, Agencies, Coalitions) » A broad view of medical information to support operational and strategic decisions » Analytical tools and decision support systems » Visualization tools to display spatial and temporal relationship of information 5

Defense Health Information Management System (DHIMS) » Clinical Information Technology Program Office (CITPO) and Theater Medical Information Program Joint (TMIP-J) were consolidated on 2 June 2008 to form DHIMS ▫ CITPO developed and deployed clinical applications such as AHLTA, the MHS electronic health record ▫ TMIP-J developed and/or adapted solutions to support the Theater clinical business practice to include AHLTA-Theater » Benefits ▫ Develops solutions that are scalable across the enterprise ▫ Aligns objectives and goals for a seamless electronic health record ▫ Eliminates communication gaps from a functional, technical and operational perspective ▫ Eliminates redundancies and increase efficiencies 6

Defense Health Information Management System (DHIMS) Vision & Mission Vision Provide a world class health information management system to support the military’s Electronic Health Record (EHR) for our Warriors and their families Mission Provide a suite of health information solutions to capture, manage and share health data 7

Current TMIP Capabilities (Block 1) AHLTA Mobile Version 1. 9. 8 Ø First Responder Application Ø Electronic Field Medical Card TMIP CHCS Caché (TC 2) Version 1. 0. 0. 0 Ø Technical Refresh of CHCS-NT Ø Inpatient Treatment Documentation Ø Pharmacy, Laboratory, Radiology Support AHLTA-Theater Version 301. 3 Ø Outpatient Treatment Documentation Joint Medical Work Station (JMe. WS) Version 2. 2. 3. 1 Ø Command Control Ø Medical Surveillance Ø Classified/SIPR Theater Medical Data Store (TMDS) Version 2. 2. 3. 2 Ø Individual Theater Medical Encounters Ø BHIE-T Interface Ø Unclassified/NIPR 8

Current Logistics Capabilities in Theater DMLSS Customer Assistance Module (DCAM) Version 1. 1. 39. 0 Ø Stand alone MEDLOG application that enables users to electronically download catalog data, place orders, and obtain status information from their supply activity § Can be used by all medical personnel Ø Operates in austere communication environments Ø Capability to feed data to Joint Medical Asset Repository (JMAR) Patient Movement Item Tracking System (PMITS) Plexus. D Version 1. 0. 2. 0 Ø Ø Tracks air certifiable medical equipment evacuated with the patient Facilitates the management and distribution of PMI assets Stand-alone application which requires a modem to communicate Utilizes bar-coding and scanning technologies 9

Block 2 Release FY 07 (Formerly B 2 R 1) Originally Planned: Development Added to Block 1: Other Products: Ø TMIP Composite Health Ø Patient Movement Care System Caché (TC 2) Items Tracking System 1. 0. 0. 0 (PMITS) 1. 0. 2. 0 Ø TMDS with JPTA Ø Shipboard Non-tactical functionality 2. 2. 4. 0 Automated Data Ø DMLSS Customer Processing Program Assistance Module (DCAM) (SNAP) Automated 1. 1. 106. 0 Medical System * Newer Version Than Ø TRANSCOM Regulating (SAMS) 9. 02. 00 Planned and Command & Control Environment: Windows XP Professional/Server 2003 Oracle 10 g Evacuation System (TRAC 2 ES) Interface Sustain Block 1 until the Services migrate to Block 2 Ø AHLTA-Mobile 2. 0* Ø AHLTA-Theater 301. 9* Ø JMe. WS 2. 2. 3. 4* Ø Business Objects (Ad Hoc Reporting) 6. 5. 1 OT completed 5 February 2008/ FDDR planned for August 2008 To be released to Service Infrastructure Program Offices in July 2008 10

Block 2 Release FY 07 Highlights » AHLTA-Theater ▫ Alternate Input Methods (AIMS) Forms • Includes 111 standard templates ▫ MACE Forms ▫ SAMS demographic interface ▫ Limited inpatient capability for Forward Resuscitative (Level II) ▫ Off-line demographic verification » AHLTA Warrior (Phase 2) ▫ Reachback to the CDR for Patient History • Clinical Encounter • Allergies • Laboratory • Radiology • Pharmacy ▫ Single Sign On (SSO) with TMDS • Eliminates multiple passwords • Reduces multiple login screens to one 11

Theater Medical Data Integration (TMDI): Today 12

TMDS-BHIE View Lab Data Sharing TMDS View AHLTA - BHIE Data Viewer 13

TMDS-BHIE Radiology Data Sharing TMDS View AHLTA - BHIE Data Viewer 14

TMDS-BHIE Medication Data Sharing TMDS View AHLTA - BHIE Data Viewer 15

TMDS-BHIE Inpatient Data Sharing TMDS View AHLTA - BHIE Data Viewer 16

TMDS-AHLTA View CDR Records TMDS View AHLTA CDR view 17

TMDS-VISTA CPRS BHIE Theater Clinical Data Sharing TMDS View VISTA CPRS BHIE 18

TMDS-TRAC 2 ES Interface Patient Movement Data TMDS View TRAC 2 ES PMR 19

TMIP Outpatient DATA Outpatient Statistics (1 Jan 05 – 30 Apr 08) 1, 748, 051 Total Encounters 20

Access to TMDS (NIPRnet) » https: //fhp. osd. mil/registration. jsp Theater Medical Data Store (TMDS) provides web-based access to service member information collected at theater based medical treatment facilities (MTFs) using AHLTATheater, Shipboard Automated Medical System (SAMS), Global Expeditionary Medical System (GEMS), and Caché TC 2. Individuals seeking access to this data must request a TMDS user account by filling out this registration form. Account requests must be reviewed and validated before user accounts are created. User accounts are usually validated and activated within 48 hours of the request. Questions about this web site should be directed to tmds. help@deploymenthealth. osd. mil. Register for a TMDS account. 21

Access to JMEWS (SIPRnet) » https: //www. mc 4. army. mil/mc 4 newsletter/2007_7/ ask. asp To acquire a JMe. WS account from a SIPR computer, go to the URL: https: //JMe. WS. fhp. smil. Click on the “Need Access” link. Fill in the requested information and select “Register. ” After you complete and submit the registration process, you will receive an e-mail stating that you are now a registered user of JMe. WS. You can also contact the JMe. WS Help Desk via e-mail (jmews. help@deploymenthealth. osd. mil) or call 703 578 -8553. 22

Access to AHLTA Warrior » https: //warrior-sa. lrmc. amedd. army. mil AHLTA Warrior is currently available only in theater. It features a Virtual private network (VPN) access to a CITRIX server allowing read-only access into the central data repository (CDR), which stores Service members’ permanent medical records. • Provides deployed medical professionals with access to past medical histories, from which they base current and future treatment plans for injured Service members • Prevents redundant tests and treatments on the battlefield • Assures Service members do not have to remember and recite their complete medical history to medical staff when being treated in the combat zone • Request an AHLTA Warrior account by completing the request form at https: //www. mc 4. army. mil/help/AHLTA_Warrior. asp, and emailing it Mr. Daniel Armstrong, Daniel. Armstrong 2@amedd. army. mil 23

Block 2 Release FY 08 Products Brought Forward From Block 2 Release FY 07 Ø AHLTA-Mobile Ø TMIP Composite Health Care System Caché (TC 2) Ø Patient Movement Items Tracking System (PMITS) Ø Expeditionary Framework (EF) Ø Defense Occupational & Environmental Health Readiness System - Industrial Health (DOEHRSIH) Web Ø AHLTA Reachback Ø JPTA merge with TMDS Ø TMDS to BHIE-T Ø TRAC 2 ES Interface with TMDS New Development Ø AHLTA-Theater Convergence Ø Defense Medical Logistics Standard Support (DMLSS) Oracle Technical Refresh (OTR) Ø DMLSS, Customer Assistance Module (DCAM) Upgrade Ø TRAC 2 ES Mobile - Non-Integrated with Expeditionary Framework Ø Shipboard Non-tactical Automated Data Processing Program (SNAP) Automated Medical System (SAMS) – Interface Demographics Ø Public Key Infrastructure (PKI) and Internet Protocol version 6 (IPv 6) – Address requirements applicable to Theater Ø Joint Medical Work Station (JMe. WS) Upgrade Ø Business Objects Upgrade Environment: Windows XP Professional/Server 2003 Oracle 10 g Sustain Block 1 and Block 2 Release FY 07 including COTS Licenses and Upgrades 24

AHLTA-Theater Convergence » Same look and feel as AHLTA in garrison » Dental » Spectacle Request Transmission System (SRTS) » Post-Deployment Health Reassessment (PDHRA) » Individual medical readiness: immunizations, profiles » Alternate Input Method (AIM) forms » Battle/Non-battle categorization (e. g. , BI/DNBI) » Off-line demographic verification » Able to transfer encounters via removable media » GEMS and SAMS Patient Encounter Module (PEM) functionality ▫ Duties Not Including Flying (DNIF) ▫ Undersea Medicine ▫ Personnel Reliability Program (PRP) 25

Near Term Initiatives: FY 08 Release » TC 2 ▫ Improve usability with a user friendly Graphical User Interface ▫ Remote access for outlying Theater medical facilities • Allows providers to leverage clinical capabilities from off-site locations ▫ Improved interoperability between Theater hospital systems • Laboratory • Radiology • Consultations » Automatically access data for a single patient across multiple applications » Extend Single Sign On across the TMIP Suite of software » Technical analysis to determine best solution to support Theater business practice for Psychological Health and Traumatic Brain Injury 26

TC 2 Graphical User Interface Enhancement 27

TMDS: Mid Term (FY 10) 28

Long-Term Strategy: Service Oriented Architecture Transforming business processes and driving organization-wide benefits Enterprise Visibility Make it simple to manage medical information Collaboration Keep providers in sync Individual Impact Discovery Increase accuracy, self-sufficiency and Make the right information available to the right people effectiveness Mobile Solutions Applications with workflow interoperability Fundamentals Make it secure, user friendly and reliable 29

Future Capability: Medical Situational Awareness in Theater (MSAT) Provide commanders and their staffs actionable knowledge and enhanced medical situational awareness for critical decision making Medical Situational Awareness Support Decision by Making • Joint Medical Information Systems • Global Combat Support System • Net-Centric Enterprise Services • Services Oriented Architecture • Mapping Tools • Decision Support / Business Intelligence Leveraging existing success to Empower commanders and emerging capabilities with Actionable Knowledge 30

TMIP-M Program Maritime Version of the Joint Acquisition Program responsible for: » Naval Capabilities Advocate to the TMIP-J program » Formal documentation and routing of Naval Capability requirements through the TMIP-J Requirements Management process » Coordination with Navy Communications and Hardware Infrastructure Programs of Record (ISNS) » DT/OT Support » Deployment of TMIP-J software applications » Training » Sustainment Support 31

Parallel Efforts in Transition Notionally, all Navy capabilities may be transitioned to TMIP-J applications by Q 2 FY 12 32

Current TMIP-M Concept of Employment » Primarily designed for Navy Operational Commands in the Fleet Environment ü Large Deck • SAMS 9. 0 • AHLTA T for Patient Encounters • JMEWS II • MICROMEDEX ü Medium/Small Deck • SAMS 9. 0 • AHLTA T for Patient Encounters • MICROMEDEX ü Expeditionary Medicine • SAMS 9. 0 Medical Materials and Environmental Health Modules • AHLTA T Patient Encounters • AHLTA Mobile (BMIST J) • MICROMEDEX ü MTF • SAMS 9. 0 Health Services and Radiation Health Modules 33

Recent Milestones; Upcoming Targets » Successful OT onboard USS RONALD REAGAN (Feb 08) » First Do. D-wide permanent implementation of TMIP Block 2 (Apr 08) » Participating in Trident Warrior ’ 08 (Jun 08) ▫ USS BONHOMME RICHARD (LHD 6) ▫ USS MILIUS (DDG 69) » Planning TMIP implementation at EMF Djibouti, Africa Q 4 FY 08 » Planning NECC implementations Q 1 FY 09 » Planning Block 2 migrations for EMF Kuwait sites in FY 09 34

TMIP Deployment Planning » Planned FY 09 -FY 11 deployment schedule » Hardware assumed to be installed and available for TMIP software implementation » DT/OT events planned upon Navy’s receipt of each TMIP release » External software release approvals for Navy installs require 6 -8 months, and are mandated for every release » (DIACAP/ATO, NMCI testing, SHIPMAIN, etc. ) » All sites (except aircraft squadrons) will have to be revisited to turn-off SAMS 9 capability once all Navy Capabilities are transitioned to TMIP 35

Summary » TMIP-M PMO is working to deliver Navy Medical capabilities to the Fleet • Focused on the Fleet Customer • Providing formal requirements management process for operational Navy Medicine • Creating communication forums for Navy Medicine stakeholders • Infusing Project Management Discipline 36

Questions? Claudia J. Kiefer TMIP-M Program Manager Space and Naval Warfare Systems Center Norfolk (757) 443 -0698 (757) 831 -2683 claudia. kiefer@navy. mil 37