Verification and Improvement of the Medical Readiness and Reporting System (MRRS)

1. Verification and Improvement of the Medical Readiness and Reporting System (MRRS) LCDR Wayne F. Homan Faculty Advisor: Dr. Jamie Pomeranz Preceptor: Dr. IllyDominitz 11 April2014

2. Financial Disclosure • Wayne Homan has no affiliation or financial interest/relationships with any corporate organizations that may be mentioned in this presentation

3. Commercial Support Acknowledgment/Disclosure • Commercial support was not used for this presentation Wayne Homan has acknowledged and verbally disclosed to the participants that commercial support was not used for this presentation • Unlabeled/investigational products and/or services will not be mentioned in this presentation

4. Caveats • I speak in acronyms quite a bit. If I do this too much please remember to ask me in the Q&A • Any opinions I might express are mine alone and do not necessarily represent those of the United States Government, Department of Defense, or the Department of the Navy

5. Competencies • CPHC=Core Public Health Competency • PHPC=Public Health Practice Competency • CPHC 1: Monitoring health status to identify and solve community health problems • CPHC 5: Developing policies and plans that support individual and community health efforts • CPHC 6: Using laws and regulations that protect health and ensure safety • PHPC 5: Demonstrate the principles of problem solving and crisis management • PHPC 11: Identify, retrieve, summarize, manage and communicate public health information • PHPC 13: Monitor and evaluate programs for their effectiveness and quality

6. Objectives • Background • Methods • Results • Discussion • Implications

7. Background-Organization • Marine Infantry Division Organization • Battalion (~1000) • Regiment (~5 Bns) • Division (~22000) • Equivalent • Surgery Dept • Directorate of Surgical Services • Hospital

8. Background-Nomenclature • Marine Division/Battalion Organization • G1/S1 Administration • G2/S2 Intelligence • G3/S3 Operations • G4/S4 Logistics • G5 Strategy and Plans • G6/S6 Communications

9. Background-Nomenclature • Marine Division/Battalion Organization • G1/S1 Administration • G2/S2 Intelligence • G3/S3 Operations • G4/S4 Logistics • G5 Strategy and Plans • G6/S6 Communications

10. Background-Military Public Health • Military members from the five services have basic public health requirements * • There are a battery of immunizations, training, and health parameters that are common to all members -Examples: tetanus, diphtheria, hearing conservation, tuberculosis status * CPHC 6: Using laws and regulations that protect health and ensure safety

11. Background-Marine Public Health • Some occupations have unique public health requirements * • Examples: ionizing radiation workers, food handlers, special warfare * CPHC 6: Using laws and regulations that protect health and ensure safety

12. Background-Marine Public Health • Finally, some members have unique public health requirements based on their location/deployments * • Each area of deployment usually has one or more special requirements • Examples: deployers to CENTCOM-anthrax, deployers to PACOM-JEV * CPHC 6: Using laws and regulations that protect health and ensure safety

13. Background-Marine Public Health • Tracking all of these requirements is arduous and manpower intensive • In the early 2000’s the military contracted to create a database system that would track the medical status of everyone automatically • The electronic system developed and rolled out in 2006 was the Medical Readiness and Reporting System (MRRS) * * CPHC 1: Monitoring health status to identify and solve community health problems

14. Background-Questions Arise • Is MRRS actually giving us a clear picture on the readiness of the Division? • Much anecdotal information that MRRS could not be trusted • This led to Battalions reworking the data by hand each week • Very manpower intensive • If true, what can be done to fix the problem? • Bottom line: are the numbers we tell the General every week correct or not?

15. Description of Methods • A Lean Six Sigma (LSS) project was initiated by the Division Surgeon under the direction of Wayne Homan * • Most likely to last for years with multiple sub-projects • Eight core participants (four officers, three enlisted, one civilian) • Tasked with validating and improving MRRS to more accurately provide information to the commanders ** • Progress reported biweekly to MGen Nicholson *** * PHPC 13: Monitor and evaluate programs for their effectiveness and quality ** PHPC 5: Demonstrate the principles of problem solving and crisis management *** PHPC 11: Identify, retrieve, summarize, manage and communicate public health information

16. Description of Methods • Step #1 Stake holder determination Individual Battalion Surgeons (22) Individual Battalion Commanders (22) Division Surgeon Division Commander Marine Corps?

17. Description of Methods • Step #2 Apply LSS methodology (DMAIC) • Define • Measure • Analyze • Improve • Control

18. Description of Methods-Define • Define

19. Description of Methods-Define • Define

20. Description of Methods-Define • Medical Readiness and Reporting System (MRRS) • Definitive database for medical readiness • Reports from G4/S4; medical unit where Marine is physically located is usually responsible for maintaining • Marine Corps Total Force System (MCTFS) • Definitive database for personnel assignment • Reports from G1/S1; base is responsible for maintaining • Marine Online (MOL) • Definitive database for daily accountability • Reports obtained from Bn 1stSgts; G1/S1 responsible for maintaining

21. Description of Methods-Measure • Measure • The most important MRRS input (initially): MCTFS • Over several successive weeks data was collected from MRRS, MCTFs, and MOL • Each database was then compare to the others for errors using Access • Personnel were matched by first name, last name, and unit

22. Description of Methods-Measure/Analyze • Measure • MCTFS vs. MRRS consistently showed an error rate of ~20% • After several weeks the validity of MCTFS started to look suspicious • Therefore names in MCTFS and MOL were added together then compared to MRRS • This should provide us with the best possible readiness number • Each database is further complicated by Marines/Sailors that are deployed, on temporary assignment, deceased, in the brig, etc.

23. Results-Analyze

24. Results-Analyze

25. Discussion • As part of the initial meetings an error rate of 95% was deemed acceptable • Analysis shows that MRRS has a significant error rate • The error rate is at best ~17% and is most likely ~20% • One additional finding as we progressed was that the Corpsmen maintaining the MRRS database need to be trained. No two Corpsmen manipulate the database in the same way -> leads to errors * * CPHC 5: Developing policies and plans that support individual and community health efforts

26. Implication • MRRS shows significant error rates when compared to actual Marines/Sailors in the units • MRRS is one of the data points used by commanders to determine which units respond to military emergencies • Could lead a commander to deploy the wrong unit • Wastes money by making Marines/Sailors receive unnecessary care • Further study has been initiated to determine which database is introducing the most error (microanalysis) • Database to be fixed first

27. Implication • Significant errors may exist in other databases that are considered “definitive” by the Marine Corps • Possible Headquarters Marine Corps interest • Big bucks? • Are there lessons to be learned as the United States struggles to shift to a preventive healthcare model?

28. Questions ?