Enabling Health Optimization Through data Mobility

From Combat & Casualty Care, Fall 2018 Issue

By COL Michael W. Greenly, PM, Joint Operational Medicine Information Systems, PEO DHMS

The Joint Operational Medicine Information Systems (JOMIS) Program Management Office, under the Program Executive Office for Defense Healthcare Management Systems (PEO DHMS), manages the deployment and sustainment of current and future operational medicine information systems to deployed forces across the range of military operations. Currently, JOMIS is planning for the integration and deployment of the MHS GENESIS electronic health record (EHR) to the theater community. JOMIS is equally focused on sustaining and modernizing the Theater Medical Information Program-Joint (TMIP-J) suite of software applications currently in use at over 900 worldwide locations, including forward resuscitative sites, ships and submarines, and aircraft. JOMIS also acquires and integrates new requirements for patient movement, medical situational awareness, medical command and control, and medical logistics.

Theater blood and operational medicine mobile computing are primary focal areas for near-term delivery of new capabilities. In 2019, we will release a new version of the Mobile Computing Capability (MCC) which includes several new capabilities, such as the ability to send patient encounters from one MCC device to another using the military tactical network. This allows a first responder to send a patient encounter documented at the point of injury to a forward care and/or transport team so caregivers at the next stage can properly treat the patient. MCC allows users to rapidly document patient care on Defense Information Systems Agency-approved commercially available mobile devices. Tactical Combat Casualty Care (TCCC) card and sick call inputs are primary use situations. MCC is compatible with TMIP-J systems and with MHS GENESIS.
JOMIS is working with vendors to incorporate new and emerging mobile technologies to expand MCC and other operational medicine mobile applications at and beyond point of injury (Role 1) use. Since mobile use throughout society will increase, we’re giving users additional mobile capabilities. JOMIS also plans to deliver a mobile theater blood capability in the near term. Eventually, the MCC platform will host this capability.

Advancing Electronic Health Records

The Department of Veterans Affairs (DVA) acquisition of MHS GENESIS will lead to new levels of interoperability and data sharing with the DVA and DoD on the same system.

The Joint Legacy Viewer already allows clinicians to view patient records across EHRs and nearly 60 health information exchange partners outside the DoD/DVA. Electronic documentation is essential to interoperability. Electronically capturing patient records ensures our active duty service men and women and veterans receive the best care possible and all of the benefits they deserve. Electronic documentation of health records is often a bigger challenge in theater environments than in garrison facilities, so we increased our train-the-trainer efforts at all levels in the last 12 months to expand use of our TMIP-J systems.

Specifically, training efforts focus on our Medical Situational Awareness in the Theater (MSAT) tool and the Theater Medical Data Store (TMDS), training current users at combatant command posts and implementing new courses at the schoolhouse level. MSAT combines data from multiple sources to provide a common operating picture and decision support for combatant command surgeons and staff. TMDS is the Theater Medical Data Repository – the central hub – that allows clinicians and caregivers the ability to view inpatient and outpatient records. Deployed forces need to understand how to leverage these systems to document encounters and place search-able data into the EHR.

In the last 12 months, we trained MSAT and TMDS to over 430 users at 15 command locations across U.S. Southern Command, U.S. Pacific Command, U.S. European Command, and U.S. Africa Command. The training provided commanders the same military medical capabilities – such as management of blood supplies and commander visibility into unit disease and non-battle injury reporting – that U.S. Central Command successfully used in the Middle East over the last decade. Usage on our MSAT training tier increased 700 percent. This training will continue across the combatant commands.

We also collaborate with schoolhouse partners on a number of training courses and curriculums to increase user awareness and proficiency of our software before deployment. We recently worked with the Medical Education and Training Campus in San Antonio and Defense Medical Readiness Training Institute to integrate MSAT/TMDS training and practical scenario-based medical readiness exercises into their regular courses. We expect this to be completed in January. Other training courses and curriculums are in various stages of development, including a new MSAT/TMDS course set on Joint Knowledge Online and TMDS/MSAT computer-based trainings. All of these will steer users toward using the EHR and TMIP-J and away from the paper forms still used in many places today.

A Focus on Mobile Communications

Advancements in operational medicine mobile computing and other new technologies will increasingly drive military medicine and healthcare documentation. Soldiers currently deployed grew up using their mobile devices for all types of applications, and most are more comfortable using mobile phones than any other devices. With their portability and constantly improving connectivity, mobile devices are the ideal device for the Servicemember.

Hands-free technology, voice-to-text dictation, multiple patient monitoring, training applications, and the ability to securely connect to any available network are some of the key mobile capabilities that JOMIS is working to provide our deployed Servicemembers. Providing our medics easy-to-use mobile solutions to capture and document all theater treatment encounters remains our primary goal. Looking further into the future, we plan to use emerging technology to provide our field medics with live video feeds that provide instruction for performing surgeries and other medical techniques.

Meeting Challenges Ahead

Ensuring theater medical providers document their medical encounters electronically instead of on paper is our greatest current challenge and remains our top priority. Paper is a problem, not a solution. Paper records require management and unfortunately do not always make it into the patient’s health record. Even paper records scanned into TMDS do not always produce computable data, providing only snapshots that are difficult to map, sometimes unreadable, and require more people to manage. We need less paper managers. EHRs provide doctors and caregivers necessary information for optimal patient treatment, and allow active duty personnel and veterans to receive the benefits they deserve.

Ensuring providers not only can treat patients, but understand how to accurately document care, is essential as we move healthcare beyond paper records and optimize electronic documentation.

This is a challenge, particularly in a theater/battlefield setting where treating injured or sick Servicemembers is – and should be – the number one priority. Hence, up-to-date user training and new schoolhouse courses are essential. We commit to making users proficient with our software as early as possible so electronic documentation becomes the easiest way to document patient data. Advancements on the mobile platform, particularly with hands-free technology, will also help in this regard. We will continue to prioritize user readiness and just-in-time training and collaborate with the functional healthcare community to field advanced software to improve electronic healthcare documentation for our Servicemembers. JOMIS is committed to educating the services, commanders, and leaders on the importance of documenting encounters into the EHR.