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 (TMIPJ) is the DoD-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 forceswho are deployed. Title 10; Section 1074f (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 TeleHealth TRAVAX


Health Record Patient Movement 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 militarys 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 First Responder Application

Electronic Field Medical Card TMIP CHCS Cach (TC2) Version Technical Refresh of CHCS-NT Inpatient Treatment Documentation Pharmacy, Laboratory, Radiology Support AHLTA-Theater Version 301.3 Outpatient Treatment Documentation Joint Medical Work Station (JMeWS) Version Command and Control Medical Surveillance Classified/SIPR

Theater Medical Data Store (TMDS) Version Individual Theater Medical Encounters BHIE-T Interface Unclassified/NIPR 8 Current Logistics Capabilities in Theater DMLSS Customer Assistance Module (DCAM) Version 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 Operates in austere communication environments Capability to feed data to Joint Medical Asset Repository (JMAR) Patient Movement Item Tracking System (PMITS) PlexusD Version

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 FY07 (Formerly B2R1) Originally Development Planned: Added to Block 1: Other Products:

AHLTA-Mobile 2.0* TMIP Composite Health Care System Cach (TC2) TMDS with JPTA functionality DMLSS Customer Assistance Module (DCAM) TRANSCOM Regulating and Command & Control Evacuation System (TRAC2ES) Interface Patient Movement Items Tracking System (PMITS) Shipboard Non-tactical Automated Data Processing Program (SNAP) Automated Medical System (SAMS) 9.02.00 AHLTA-Theater 301.9*

JMeWS* Business Objects (Ad Hoc Reporting) 6.5.1 * Newer Version Than Planned Environment: Windows XP Professional/Server 2003 Oracle 10g Sustain Block 1 until the Services migrate to Block 2 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 FY07 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 BHIE-T GCSS AHLTA Mobile and AHLTA

Theater outpatient encounters sent to the CDR VA JMeWS Theater clinical data in TMDS accessible by VA and MHS GEMS SAMS JPTA CDR

TMDS TMDS AHLTATheater All theater outpatient and inpatient clinical data viewable (December 2008) Patient tracking & in-transit visibility data AHLTA Mobile JPTA Web Entry TMIP CHCS Cach (TC2) Outpatient and Inpatient clinical notes and PLX data sent to the

TMDS JTTR Trauma Data (planned) TRAC2ES 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-TRAC2ES Interface Patient Movement Data TMDS View TRAC2ES PMR 19

TMIP Outpatient DATA Outpatient Statistics (1 Jan 05 30 Apr 08) 1,748,051 Total Encounters 20 Access to TMDS (NIPRnet) The 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 Cach TC2. 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 [email protected] Register for a TMDS account. 21

Access to JMEWS (SIPRnet) k.asp To acquire a JMeWS account from a SIPR computer, go to the URL: 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 JMeWS. You can also contact the JMeWS Help Desk via e-mail ( [email protected]) or call 703 578-8553. 22 Access to AHLTA Warrior 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,and e-mailing it Mr. Daniel Armstrong, [email protected] 23 Block 2 Release FY08 Products Brought Forward From Block 2 Release FY07 AHLTA-Mobile TMIP Composite Health Care System

Cach (TC2) Patient Movement Items Tracking System (PMITS) Expeditionary Framework (EF) Defense Occupational & Environmental Health Readiness System - Industrial Health (DOEHRSIH) Web AHLTA Reachback JPTA merge with TMDS TMDS to BHIE-T TRAC2ES Interface with TMDS New Development AHLTA-Theater Convergence Defense Medical Logistics Standard Support (DMLSS) Oracle Technical Refresh (OTR) DMLSS, Customer Assistance Module (DCAM) Upgrade TRAC2ES Mobile - Non-Integrated with Expeditionary Framework Shipboard Non-tactical Automated Data

Processing Program (SNAP) Automated Medical System (SAMS) Interface Demographics Public Key Infrastructure (PKI) and Internet Protocol version 6 (IPv6) Address requirements applicable to Theater Joint Medical Work Station (JMeWS) Upgrade Business Objects Upgrade Environment: Windows XP Professional/Server 2003 Oracle 10g Sustain Block 1 and Block 2 Release FY07 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: FY08 Release TC2 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 TC2 Graphical User Interface Enhancement 27 TMDS: Mid Term (FY10) BHIE-T

Theater clinical data in TMDS accessible by VA and MHS Medical Dashboard VA (Decision Support Tools) GCSS MSAT

MEDLOG Blood Pt. Visibility Clinical Surveillance Medical Dashboard GEMS AHLTA Mobile and AHLTATheater outpatient encounters sent to the CDR (Decision Support Tools) SAMS JPTA

MEDLOG Blood Pt. Visibility Clinical Surveillance TMDS TMDS CDR AHLTATheater Outpatient and Inpatient

clinical notes sent to the TMDS All theater outpatient and inpatient clinical data viewable Patient tracking & in-transit visibility data TMIP CHCS Cach (TC2) JTTR JPTA Web Entry Trauma Data TRAC2ES

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 andMake the right information effectiveness available to the right people

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 Empower commanders to 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 SAMS 09.02.00 (PEM Convergence) TMIP FY08 Release Pulls demographic data fm AHLTA

Interface SAMS9 demographics; Delivery to Navy projected Jan 09 SAMS 09.03.00 (TR Fixes/ HS Retirement) Severity 3 and selected Severity 4/5 TRs TMIP FY09 Release Implement Health Services in AHLTA-T; Delivery to Navy projected Jan 10 TMIP FY10 Release SAMS 09.03.01 (TR Fixes) Maintenance release Implement other Navy Capabilities (TBD) Delivery to Navy projected Jan 11 TMIP FY11 Release SAMS 09.03.02 (TR Fixes) Maintenance release

Implement other Navy Capabilities (TBD) Delivery to Navy projected Jan 12 Notionally, all Navy capabilities may be transitioned to TMIP-J applications by Q2FY12 32 Current TMIP-M Concept of Employment Primarily designed for Navy Operational Commands in the Fleet Environment Large Deck SAMS 9.0 AHLTA T for Patient Encounters JMEWS II MICROMEDEX Medium/Small Deck SAMS 9.0 AHLTA T for Patient Encounters MICROMEDEX

Expeditionary Medicine SAMS 9.0 Medical Materials and Environmental Health Modules AHLTA T Patient Encounters AHLTA Mobile (BMIST J) MICROMEDEX MTF SAMS 9.0 Health Services and Radiation Health Modules 33 Recent Milestones; Upcoming Targets Successful OT onboard USS RONALD REAGAN (Feb 08) First DoD-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 Q4FY08 Planning NECC implementations Q1FY09 Planning Block 2 migrations for EMF Kuwait sites in FY09

34 TMIP Deployment Planning Planned FY09-FY11 deployment schedule Hardware assumed to be installed and available for TMIP software implementation DT/OT events planned upon Navys 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 [email protected] 37

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