Theater Medical Information Program Maritime TMIP-M Overview and Status Update 24 June 2008

1. Theater Medical Information Program �Maritime (TMIP-M)Overview and Status Update24 June 2008 Claudia Kiefer, TMIP-M Program Manager

2. 2 Introduction Theater Medical Information Program � Joint (TMIP-J) 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 forces�who 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) �The use of these approved applications will ensure the theater healthcare data collected on Service members will be stored in the clinical data repository (CDR) and enable sharing with other governmental agencies, such as the Department of Veterans Affairs�� �The use of these approved applications will ensure the theater healthcare data collected on Service members will be stored in the clinical data repository (CDR) and enable sharing with other governmental agencies, such as the Department of Veterans Affairs��

3. 3 TMIP-J Operational View OV-1 This is the TMIP-J operational view or OV-1. It represent the ultimate vision for interoperability across the continuum from garrison to theater and back.This is the TMIP-J operational view or OV-1. It represent the ultimate vision for interoperability across the continuum from garrison to theater and back.

4. 4 TMIP-J Software Applications Suite The TMIP-J Applications Suite includes all of these applications, which support the 4 mission pillars: Electronic Health Record, Command & Control, Medical Logistics and Patient Movement. Telehealth - Lleverages advanced digital and telecommunications technology for improved provider efficiency and productivity by our local and remote clinical personnel. TRAVAX � TRAVAX is a handheld tool that allows users to locate hospitals or clinics that can provide needed emergency services by country location or GPS Coordinates. EIC � Electronic Information Carrier � Enables viewing of last encounter (From ALHTA�T to SAMS or SAMS to SAMS) MAT/JMAT � Joint Medical Analysis Tool - JMAT is the Joint Staff approved medical planning tool used to estimate a medical unit�s sustainability and requirements. PMITS � Patient Movement Item Tracking System - PMITS tracks the location of high-dollar medical equipment that travels with patients and ensures that replacement equipment is returned to theater. Medical Environmental Disease Intelligence and Countermeasures (MEDIC) is a Government Off-the-Shelf (GOTS) application. It is an automated medical reference tooldesigned to provide information on worldwide disease and environmental health risks. The TMIP-J Applications Suite includes all of these applications, which support the 4 mission pillars: Electronic Health Record, Command & Control, Medical Logistics and Patient Movement. Telehealth - Lleverages advanced digital and telecommunications technology for improved provider efficiency and productivity by our local and remote clinical personnel. TRAVAX � TRAVAX is a handheld tool that allows users to locate hospitals or clinics that can provide needed emergency services by country location or GPS Coordinates. EIC � Electronic Information Carrier � Enables viewing of last encounter (From ALHTA�T to SAMS or SAMS to SAMS) MAT/JMAT � Joint Medical Analysis Tool - JMAT is the Joint Staff approved medical planning tool used to estimate a medical unit�s sustainability and requirements. PMITS � Patient Movement Item Tracking System - PMITS tracks the location of high-dollar medical equipment that travels with patients and ensures that replacement equipment is returned to theater. Medical Environmental Disease Intelligence and Countermeasures (MEDIC) is a Government Off-the-Shelf (GOTS) application. It is an automated medical reference tooldesigned to provide information on worldwide disease and environmental health risks.

5. 5 Joint Military Needs

6. 6 Defense Health Information ManagementSystem (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

7. 7 Defense Health InformationManagement System (DHIMS) Vision & Mission Vision Provide a world class health information management system to supportthe 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

8. 8 Current TMIP Capabilities (Block 1) Currently TMIP Block 1 applications include: AHLTA Mobile is the hand-held and used to be called BMIST. TC2 is the tech refresh for CHCS-NT, AHLTA Theater for Outpatient treatments; JMEWS for Command and Control on the SIPRnet side, and TMDS for access to Patient encounters on the NIPRnet side. AHLTA-Mobile is the point-of-injury application used by first responders. This application replaces pounds of paper and books formerly carried by medics in the field. Using AHLTA Mobile, a first responder can document care given at the point-of-injury and make it accessible to the facilities in the continuum of care. AHLTA-Theater operates on a single laptop computer enabling medical personnel in theater to document or update medical treatment rendered to Service members for inclusion into their electronic medical record and make it accessible to the facilities in the continuum of care. Data collected with both AHLTA Theater and AHLTA Mobile can be aggregated, sorted and compiled to provide valuable insight for medical surveillance. JMeWS & TMDS are the classified and unclassified databases used for decision making and Command and Control. Defense Medical Logistics Standard Support (DMLSS) Customer Assistance Module (DCAM) Tool for replenishing medical supplies Patient Movement Items Tracking System (PMITS) Tracks medical equipment that travels with evacuated patients Joint Patient Tracking Application (JPTA) Tracks deployed patients� location U.S. Transportation Command Regulating and Command & Control Evacuation System (TRAC2ES) Monitors and tracks patients leaving theater via Air Force aero-evacuation (interface) Currently TMIP Block 1 applications include: AHLTA Mobile is the hand-held and used to be called BMIST. TC2 is the tech refresh for CHCS-NT, AHLTA Theater for Outpatient treatments; JMEWS for Command and Control on the SIPRnet side, and TMDS for access to Patient encounters on the NIPRnet side. AHLTA-Mobile is the point-of-injury application used by first responders. This application replaces pounds of paper and books formerly carried by medics in the field. Using AHLTA Mobile, a first responder can document care given at the point-of-injury and make it accessible to the facilities in the continuum of care. AHLTA-Theater operates on a single laptop computer enabling medical personnel in theater to document or update medical treatment rendered to Service members for inclusion into their electronic medical record and make it accessible to the facilities in the continuum of care. Data collected with both AHLTA Theater and AHLTA Mobile can be aggregated, sorted and compiled to provide valuable insight for medical surveillance. JMeWS & TMDS are the classified and unclassified databases used for decision making and Command and Control. Defense Medical Logistics Standard Support (DMLSS) Customer Assistance Module (DCAM) Tool for replenishing medical supplies Patient Movement Items Tracking System (PMITS) Tracks medical equipment that travels with evacuated patients Joint Patient Tracking Application (JPTA) Tracks deployed patients� location U.S. Transportation Command Regulating and Command & Control Evacuation System (TRAC2ES) Monitors and tracks patients leaving theater via Air Force aero-evacuation (interface)

9. 9 Current Logistics Capabilities in Theater

10. 10 Block 2 Release FY07 (Formerly B2R1)

11. 11 Block 2 Release FY07 Highlights

12. 12 Theater Medical Data Integration (TMDI): Today

13. 13 TMDS-BHIE ViewLab Data Sharing

14. 14 TMDS-BHIERadiology Data Sharing

15. 15 TMDS-BHIEMedication Data Sharing

16. 16 TMDS-BHIEInpatient Data Sharing

17. 17 TMDS-AHLTA ViewCDR Records

18. 18 TMDS-VISTA CPRS BHIETheater Clinical Data Sharing

19. 19 TMDS-TRAC2ES InterfacePatient Movement Data

20. 20 TMIP Outpatient DATA

21. 21 Access to TMDS (NIPRnet) https://fhp.osd.mil/registration.jsp

22. 22 Access to JMEWS (SIPRnet) https://www.mc4.army.mil/mc4newsletter/2007_7/ask.asp

23. 23 Access to AHLTA Warrior https://warrior-sa.lrmc.amedd.army.mil

24. 24 Block 2 Release FY08 The TMIP-J FY08 release will include AHLTA-T convergence, DMLSS Oracle Tech Refresh, DCAM upgrade, JMEWS upgrade and an interface that enables SAMS users to conduct Paitent Encounters in AHLTA-T w/o duplicating patient demographic data. The TMIP-J FY08 release will include AHLTA-T convergence, DMLSS Oracle Tech Refresh, DCAM upgrade, JMEWS upgrade and an interface that enables SAMS users to conduct Paitent Encounters in AHLTA-T w/o duplicating patient demographic data.

25. 25 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) AHLTA-T convergence will include capabilities for: Post Deployment Health Reassessments, immunizations, AIM forms, BI/DNBI, and specialized Patient Encounters, such as PRP.AHLTA-T convergence will include capabilities for: Post Deployment Health Reassessments, immunizations, AIM forms, BI/DNBI, and specialized Patient Encounters, such as PRP.

26. 26 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

27. 27 TC2 Graphical User Interface Enhancement

28. 28 TMDS: Mid Term (FY10)

29. 29 Transforming business processes and driving organization-wide benefits

30. 30 Our objective is to get the right medical and operational information to Combatant and Joint Task force Commanders when they need it. This approach supports transformation efforts by leveraging existing capabilities like the Joint Medical Work Station (JMeWS) with commercial and other DoD systems using a Service Oriented Architecture, mapping tools (or Geographic Information Systems), and Decision Support Tools DoD movement to a Services Oriented Architecture enables sharing of information across applications in ways that were unachievable previously. By utilizing this architecture we will be able to link Medical, *Geospatial, Intelligence, *Logistics and *Personnel data to provide you with actionable knowledge to support decision making. In a moment I�ll walk you through a quick scenario to illustrate this point.Our objective is to get the right medical and operational information to Combatant and Joint Task force Commanders when they need it. This approach supports transformation efforts by leveraging existing capabilities like the Joint Medical Work Station (JMeWS) with commercial and other DoD systems using a Service Oriented Architecture, mapping tools (or Geographic Information Systems), and Decision Support Tools DoD movement to a Services Oriented Architecture enables sharing of information across applications in ways that were unachievable previously. By utilizing this architecture we will be able to link Medical, *Geospatial, Intelligence, *Logistics and *Personnel data to provide you with actionable knowledge to support decision making. In a moment I�ll walk you through a quick scenario to illustrate this point.

31. 31 TMIP-M Program The TMIP-M program (my office) serves as the Naval capabilities advocate to the TMIP-J program. We document Naval capability requirements and route them through the TMI-J requirements management process. We also coordinate with the Navy Infrastructure program (Integrated Ships Network System (ISNS)/ Consolidated Afloat Networks & Enterprise Services (CANES)), which is responsible for delivering the afloat hardware and communications infrastructure to support the TMIP-J application. We provide support for Developmental Test and Operational Test, and provide Training and help desk, and onsite support for the TMIP software.The TMIP-M program (my office) serves as the Naval capabilities advocate to the TMIP-J program. We document Naval capability requirements and route them through the TMI-J requirements management process. We also coordinate with the Navy Infrastructure program (Integrated Ships Network System (ISNS)/ Consolidated Afloat Networks & Enterprise Services (CANES)), which is responsible for delivering the afloat hardware and communications infrastructure to support the TMIP-J application. We provide support for Developmental Test and Operational Test, and provide Training and help desk, and onsite support for the TMIP software.

32. 32 Parallel Efforts in Transition

33. 33 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

34. 34 Recent Milestones; Upcoming Targets

35. 35 TMIP Deployment Planning Planned FY09-FY11 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 I.E. hardware in place, only MTFs with Radiology Depts, Server/clients in place meeting min hardware specs. I.E. hardware in place, only MTFs with Radiology Depts, Server/clients in place meeting min hardware specs.

36. 36 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

37. 37 Questions?