Dedicated to the Military Medical & VA Community
Combat Casualty Care Special Section
Information Technology Organizer Roger W. Baker Assistant Secretary for Information and Technology Department of Veterans Affairs
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August 2011 Volume 15, Issue 5
Leadership Insight Rear Adm. Thomas McGinnis Chief Pharmacy Officer TRICARE Management Activity PRSRT STD U.S. POSTAGE PAID Merrifield, VA PERMIT # 620
Mobile Laboratory Testing O DoD/VA Small Business Vendors WRAIR Drug Development O VA T4 Contracts
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Military Medical/CBRN Technology
August 2011 Volume 15 • Issue 5
Cover / Q&A
Features Faster, Better Care
8
Military services and their private supporters often make dramatic progress in preventing injuries by providing the immediate care that can save lives and limbs and in treating long-term consequences. By Henry Canaday
Mobile Laboratory Testing Mobile labs work in a wide range of environments and conduct operations from collecting forensic evidence, identifying weapons of mass destruction and conducting chemical warfare agent analysis. By Ray Sullivan
13 VA Revamps Supply Acquisition Department of Veterans Affairs staff discuss how T4 Contracts benefit the acquisition process and how it will affect the VA for years to come.
21 Roger W. Baker Assistant Secretary of Information Technology Department of Veterans Affairs
Leadership Insight
Rear Admiral Thomas McGinnis (USPHS) Chief Pharmacy Officer, TRICARE Management Activity
25 Industry Supports VA Initiatives Industry leaders give feedback on how Transformation TwentyOne Total Technology (T4) is changing the way Veterans Affairs is acquiring products and services.
24
Departments 2 Editor’s Perspective
27
3 MHS Health IM/IT Report Department of Defense/Veterans Affairs Small Business Vendors
29
Small businesses do their best to land a government contract that can vastly grow their business. Not only is there a lengthy procurement process, there is also an issue with security clearance, a catch-22. It’s difficult to land a contract without security clearance, and they can’t get clearance without a contract. By Joan Michel
Drug Discovery at Walter Reed Army Institute of Research
32
WRAIR scientists are engaged in developing antiparasitic drugs to help treat cutaneous leishmaniasis, a skin infection that afflicts approximately 12 million people worldwide in 98 countries on five continents, with as many as 2 million estimated new cases emerging each year.
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4 Program Notes 6 People 18 Vital Signs 35 Calendar, Directory
Industry Interview
36 Peter Cempellin President/CEO CAE Healthcare
Military Medical/CBRN Technology Volume 15, Issue 5
August 2011
Dedicated to the Military Medical & VA Community Editorial Editor Brian O’Shea briano@kmimediagroup.com Medical Training and Simulation Editor Judith Reiss judithr@kmimediagroup.com Managing Editor Harrison Donnelly harrisond@kmimediagroup.com Online Editorial Manager Laura Davis laurad@kmimediagroup.com Copy Editor John Marth johnm@kmimediagroup.com Correspondents Henry Canaday • Joan Michel
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Roger W. Baker, CIO of Veterans Affairs (VA), recently approved the use of iPhones and iPads for certain staff members at the VA. He explained the decision was made due to the popular demand of VA employees. Before taking my position at Military Medical/CBRN Technology magazine I was the editor of a health care compliance regulation publication that focused on having compliant security measures for maintaining protected health information (PHI). Any time a provider introduces a new technology, proper security steps must be taken. In May 2006, a VA information technology specialist’s house was burglarized and a laptop and an external hard drive were stolen. Brian O’Shea The hard drive contained approximately 26 million health records of Editor veterans. The Office of Inspector General (OIG) investigated the breach to look at whether the employee should have had the access to that PHI, whether that employee should have taken the PHI out of the VA automated system (to their residence) and if it was properly safeguarded. Many VA staff currently use laptops and BlackBerrys, so taking PHI away from the VA automated system is already occurring and policies and security procedures are in place. In the cover Q&A with Baker in this issue, he explains that department management will determine which employees are able to use iPhones and iPads, and I cannot stress enough the importance of taking that decision seriously. If an employee has no need to access PHI or bring it out of the VA automated system then there is no reason for them to have these kinds of tools. The majority of OIG breaches tend not to be from hackers breaking into a system electronically and stealing data, they tend to be more of human error. Leaving a laptop on a bus or losing a smartphone are common ways to have thousands of health records unsecured. If more than 500 individuals’ health records are breached, the provider must notify those individuals and prominent media outlets. In the past year I could only find three instances of reported data breaches at VA providers, all of which were categorized as improper disposal of equipment containing PHI. This brings up another point: If some employees are going to be retiring their devices, the data on those devices needs to be properly erased. If you have any questions for me regarding Military Medical/CBRN Technology feel to contact me at any time.
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Computer/Electronic Accommodations Program
By Air Force Col. Portia Prioleau Acting Chief Information Officer Military Health System One of the programs under the Military Health System Office of the Chief Information Officer is a unique organization known as the Department of Defense Computer/Electronic Accommodations Program, which we refer to as CAP. On June 8, I was reminded again of the impact CAP has on the lives of servicemembers and federal employees when it was recognized with the 2011 Tele-Vision Award for Innovative Application of Technology to Support Telework. CAP provides assistive technologies for employees of the DoD and other federal agency partners, including returning wounded servicemembers, and seeks to increase employment opportunities for those with disabilities. The Tele-Vision Awards are presented annually by the Telework Exchange, a publicprivate partnership dedicated to increasing the impact and benefits of telework within the federal community and to recognizing excellence in government telework programs and their accomplishments. CAP works by evaluating the needs of employees with disabilities, including those who telework as a form of reasonable accommodation, and purchasing the assistive technology necessary for them to effectively complete their job duties. CAP offers comprehensive accommodation solutions to DoD and 68 federal partner agencies by providing employees with needs assessments, assistive technology, training and technical integration support, to ensure that accommodation recipients can effectively use the assistive technology provided. Since its inception in 1990, CAP has filled over 103,000 requests for accommodations and www.MMT-kmi.com
has provided over 2,300 accommodations for employees who telework as a form of reasonable accommodation since establishing its Telework Initiative. CAP’s institutional knowledge base, formed over the course of two decades, mitigates the likelihood of providing ill-suited accommodations and helps agencies avoid unnecessary overhead costs. CAP plays a critical role in promoting telework as a form of reasonable accommodation throughout the federal government. As a member of the U.S. Office of Personnel Management’s Fast Track Action Committee on Telejobs, CAP helped draft guidance on accommodating teleworkers with disabilities. Working with teaming partners such as the Telework Exchange has also integrated CAP’s diversity and retention strategy into the mainstream telework discussion. By providing the assistive technology and equipment required for individuals to telework as a form of reasonable accommodation, CAP ensures that agencies have the necessary tools at their disposal to retain employees with disabilities and comply with various federal regulations. Target groups for telework as a form of reasonable accommodation include recipients of workers’ compensation payments, employees susceptible to disability retirement, employees with disabilities who may be more productive by teleworking, and employees with disabilities who are physically unable to access the workplace. In fiscal year 2010, telework accommodations increased by 54 percent over the previous year, thanks in large part to an aggressive outreach campaign that included working with teaming partners such as the Telework Exchange. One example of how CAP can benefit an agency, which was highlighted in the recent award presentation, is their work with the Department of Energy’s Bonneville Power Administration (BPA), which integrated CAP into its reasonable accommodation program. BPA saw a 67 percent increase in CAP accommodations and an average cost savings of $1,500 per teleworker. CAP works closely with information technology staff throughout the federal government to ensure that accommodations, including computers and software, are compatible and approved for use on the agencies’ networks and facilities, including at alternate work locations.
America’s Military Health System is a unique partnership of medical educators, medical researchers, health care providers and their support personnel worldwide. This DoD enterprise consists of the Office of the Assistant Secretary of Defense for Health Affairs; the medical departments of the Army, Navy, Marine Corps, Air Force, Coast Guard and Joint Chiefs of Staff; the combatant command surgeons; and TRICARE providers (including private sector health care providers, hospitals and pharmacies). Visit www.health.mil to learn more about the Military Health System or the CIO’s efforts.
These aspects of CAP’s overall model, combined with our ability to evaluate employee requirements on-site or remotely through an interactive needs assessment approach, have helped ensure that more than 90 percent of customers rated CAP services as “excellent” or “above average.” In addition to acting as a retention tool for those who become disabled during employment, CAP services have also helped federal agencies comply with the requirements of President Obama’s Executive Order No. 13173, increasing federal employment of individuals with disabilities and the Rehabilitation Act. O Air Force Colonel Portia Prioleau is the acting chief information officer for the Military Health System. Please direct any questions to MHS Health IT Communications at 703-681-8836. MMT 15.5 | 3
Compiled by KMI Media Group staff
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Air Force Purchases $9.3 Million Worth of Monitor/Defibrillators Philips received a $9.3 million order from the U.S. Air Force, through the Defense Logistics Agency (DLA) Troop Support, for HeartStart MRx monitor/defibrillators. In the past year, Philips has received more than $20 million in orders from the DLA Corporate Exigency Contract including most recently a $5.4 million order from the Air Force in January 2011 for HeartStart MRx monitor/ defibrillators. Philips has been working closely with DLA Troop Support to enhance the U.S. Air Force’s medical support capabilities. The DLA is the Department of Defense’s largest logistics combat support agency, providing worldwide assistance in both peacetime and wartime to military services, as well as several civilian agencies and foreign countries. DLA Troop Support provides food, clothing and textiles, construction supplies and equipment, and medicine and medical equipment for servicemembers worldwide. Philips’ opportunities with the U.S. military are now expanding into the pre-hospital market, which covers point-of-injury at the battlefield through global medical transport. The U.S. military continues to look to Philips, a leader in defibrillators, patient monitors and imaging systems, to support all capabilities of care levels in the military. The HeartStart MRx monitor/defibrillator provides several advantages to support emergency care providers. The HeartStart MRx meets military airworthy standards for rotary and fixed wing aircrafts. It is a portable, rugged, advanced monitor/defibrillator compatible with Philips IntelliVue monitoring systems within military hospitals. In addition, the 12-lead transmission capability allows emergency care providers to send advanced notification to hospitals or receiving facilities. The early transmission helps hospitals and receiving facilities quickly mobilize appropriate staff and resources to treat the patient upon arrival. Lori Shamroth; lori.shamroth@philips.com
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First Mobile MRI Systems to be Sent to Afghanistan Theater Naval Medical Logistics Command (NMLC) announced the award of a contract for two mobile Magnetic Resonance Imaging (MRI) systems to Philips Healthcare June 7, to aid in the diagnosis and treatment of traumatic brain injury of wounded warriors in Afghanistan. The Navy has been working closely with the Army and Air Force to field an unprecedented MRI capability for deployed forces as part of the overall comprehensive approach to diagnosing and treating concussive injuries. The procurement of the MRI systems has been a joint initiative between NMLC’s technical and operational partners including: Bureau of Medicine and Surgery, U.S. Army Medical Material Agency, Chief of Mobility Command, the Veterans Administration, and the Army’s Rapid Equipping Force. While there is no clinical requirement for MRI systems in battlefield trauma care, they will be informative and may lead to cutting-edge discoveries in the diagnosis, treatment and enhanced follow-up care for wounded personnel with traumatic brain injuries (TBI). “The acquisition of an MRI system for use in a combat theater is something new and provides some interesting challenges but it’s amazing to see those challenges being overcome so quickly,” said James B. Poindexter, commanding officer of NMLC. “This is a complex and unprecedented acquisition issue and our team is working hard to field this equipment as soon as possible while ensuring it will do the job we intend it to do, taking care of our men and women in uniform close to the battlefield.” According to Poindexter, the MRI systems destined for Afghanistan are unlike anything commercially available. The units need to be self-contained, requiring that they be designed from the ground up to account for the many unique and
challenging working environments that will be encountered in combat theater such as vast temperature differences, fine blowing sand and power issues. They must also meet size and weight requirements to be capable of being airlifted into theater. “We are taking prudent measures to ensure successful deployment of this important equipment by late summer,” said Poindexter. “We continue to aggressively address every element involved including engineering, logistical and technical issues.” The contract to build the MRI systems was awarded to Philips after a competitive, best value acquisition process. “We are honored to help improve access to care by bringing advanced medical technologies to Afghanistan as part of our longstanding efforts to support soldiers and veterans,” said Joe Robinson, senior vice president, government and enterprise solutions, Philips Healthcare. NMLC is the center of logistics expertise for Navy Medicine, designing, executing and administering individualized state-of-the-art solutions to meet customer’s medical material and healthcare needs. Headquartered at Fort Detrick, Md., NMLC supports the U.S. Navy with acquisition and logistics systems training, healthcare services strategies, operational forces support, medical equipment and logistics solutions, acquisition management, deployable platforms and eye wear fabrication. NMLC has responsibility as technical manager of the Navy’s Direct Healthcare Services Contracting Program and has formal agreements with the U.S. Marine Corps and U.S. Coast Guard to provide medical logistics and materiel management information and medical mobilization planning assistance. Brian Healey; brian.healey@philips.com
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When time isn’t on your side, Microstream Capnography is. ®
In battlefield medicine, making quick care decisions requires information that is immediate and accurate. Microstream® Capnography from Oridion delivers both. Microstream provides a complete picture of a patient’s adequacy of ventilation, even in rapidly changing conditions. So you’ll know for certain if and how well your patient is breathing. In fact, monitors from the leading medical equipment providers to the military, including Physio-Control, Philips, Zoll,Welch Allyn, Impact Instrumentation, Athena GTX, and RDT, are available with Microstream Capnography. Capnography has long been the standard for monitoring intubated patients in the operating room. Learn why capnography is the new standard for non-intubated ventilation monitoring at www.oridion.com.
160 Gould Street, Suite 205, Needham MA 02494, USA • Toll Free: (888) ORIDION (674-3466) • Tel: (781) 453-0500 • Fax: (781) 453-2722 Hamarpe 7, Jerusalem 97774 Israel • Tel: +972 2 589-9111 • Fax: +972 2 586-6680 © 2011 Oridion Medical 1987 Ltd. All rights reserved.
Compiled by KMI Media Group staff
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VA Funds Solar Energy Projects at Five Hospitals The Department of Veterans Affairs (VA) has awarded $56.7 million in contracts to build solar photovoltaic (PV) systems in support of ongoing energy efficiency and renewable energy initiatives. “With these investments in clean energy and other renewable energy projects, we are marching forward with the president’s initiative to expand innovation in the federal government and create new jobs,” said VA Secretary Eric K. Shinseki. “The benefits of using solar power are profound, from reducing greenhouse gas
emissions to improving the quality of the air we breathe. This initiative is good for veterans and good for our environment.” By summer 2012, VA will install the solar PV systems at five VA medical centers in sunny locations, from Texas to California. VA selected the sites based on feasibility studies that determined the most ideal locations to invest in on-site renewable energy projects. Solar PV installations are slated for Oklahoma City; Temple, Texas; Amarillo, Texas; Loma Linda, Calif.; and West Los Angeles.
VA’s goal is to increase renewable energy consumption to 15 percent of annual electricity usage by 2013. The installation of these five solar PV systems will help VA meet that goal. Renewable energy projects such as solar PV and wind turbines provide free energy to power VA facilities and provide a variety of benefits. VA has also awarded 35 additional solar PV systems at medical centers and national cemeteries across the nation. VA has invested over $300 million in renewable energy projects since 2009.
People
Col. David Bobb
Colonel David Bobb assumed command of the 59th Clinical Support Group on June 30 during a ceremony at Wilford Hall Medical Center, Lackland Air Force Base, Texas. Bobb received a Bachelor of Science in pharmacy from Ohio Northern University in 1977. He received a Master of Arts in military studies in air warfare from the American Military University in 2002 and a
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Master of Military Operational Art and Science from Air Command and Staff College in residence in 2003. He is also an attorney who received a law degree from Franklin Pierce Law Center in 1983. 5AM Solutions recently announced that Brigadier General Michael J. Kussman, M.D. (U.S. Army, Ret.) has joined their board of advisors. Recently retired after completing 37 years of distinguished government service in May 2009, Dr. Kussman’s last position was under secretary for Health for the
Veterans Health Administration. In this role, he led the nation’s largest integrated health care system, the VHA, which provides health care to more than 5.7 million veterans and 7.7 million enrollees. With nearly four decades of military medical expertise, Dr. Kussman will fill the critical role of chief advisor to 5AM’s Health IT practice. Rear Admiral Thomas McGinnis, chief of the TRICARE Pharmaceutical Operations Directorate, recently received a lifetime achievement award from the United
States Public Health Service (USPHS) Commissioned Officers Association. He was awarded the George F. Archambault USPHS Career Achievement award, which recognizes a senior level pharmacist for outstanding career achievements and contributions to the pharmacy profession during their USPHS career. McGinnis earned his pharmacy degree from Rutgers University in 1977 and joined the Food and Drug Administration (FDA) the following year as a drug information specialist in the division of overthe-counter drug evaluation. In 1983,
he became chief of drug information services branch and in 1985 was appointed acting division director of drug information resources, where he was responsible for publishing FDA’s Orange Book and other drug information publications. In 1990, he helped establish the new Office of Generic Drugs and served as special assistant to the office director until joining the Office of Health Affairs, Office of the Commissioner in 1991. He became deputy associate commissioner for health affairs in 1997 and in 1999 moved to the Office of Policy and Planning.
Secretary of Defense Leon E. Panetta announced August 2 that the president has nominated Navy Rear Admiral Matthew L. Nathan, senior health care executive, for appointment to the rank of vice admiral and for assignment as chief of the Bureau of Medicine and Surgery and surgeon general, Washington, D.C. Nathan is currently serving as commander, Navy Medicine Capital Area/ commander, National Naval Medical Center, Bethesda, Md.
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Propaq M: The New Standard in En Route Care Monitoring ®
Like the Propaq 206 you already trust, the new ZOLL® Propaq® M Vital Signs Monitor has all the capabilities needed to meet the unique military en route care needs of tactical MEDEVAC and critical care transport missions—plus advanced features like an NVG-friendly mode. The lightweight Propaq M is not only four pounds lighter than other monitors, it provides more than twice the monitoring time. You’ll get 7½ hours of run time on one hot-swappable battery while monitoring ECG, Sp02, NIBP, EtCO2, three invasive pressures, and two temperature channels. With the new XML open architecture, data can be easily transferred to an EMR. And backward compatibility with existing Propaq and ZOLL accessories makes patient transfers seamless. Come see the Propaq M at ZOLL’s ATACCC booth, visit www.zoll.com/propaqm, or call 1-800-804-4356.
Propaq® MD
Propaq® M
AED Pro® & Propaq® LT
©2011 ZOLL Medical Corporation. All rights reserved. AED Pro and ZOLL are trademarks or registered trademarks of ZOLL Medical Corporation in the United States and/or other countries. Propaq is a trademark of Welch Allyn.
By Henry Canaday MMT Correspondent Wars are bad for health but sometimes good for health care. Especially for traumatic wounds, the military services and their private supporters often make dramatic progress in preventing injuries by providing the immediate care that can save lives and limbs and in treating long-term consequences.
Wound Treatment The majority of wounds received by Marines in Afghanistan are penetrations of lower extremities, including the pelvis area and genitalia, explained Kevin Joyner, program analyst for research and development for the family of field medical equipment at Marine Corps System Command. The Marines’ highest medical priority is stabilization of the casualty immediately after trauma. “We want to save life, limb and eyesight at the first two levels,” Joyner emphasized. Marine Corps Systems Command (MCSC) acquires medical equipment according to the requirements of Marine Corps Combat Development & Integration and works with the Marine Corps Warfighting 8 | MMT 15.5
Laboratory (MCWL) in seeking new solutions. The Marines have standardized the Combat Application Tourniquet, two of which are put in each Marine’s field kit. MCSC has initiated a new tourniquet study to ensure the most effective equipment is going into the field. It is also looking at equipment for monitoring vital signs. “Ultrasound equipment has crossed my desk but we have not initiated anything on that,” Joyner said. MCWL is working on the mobile trauma bay (MTB), a modular, medical asset capable of being transported on and off road in austere conditions and allowing shock trauma platoons (STPs) to provide emergency trauma care through task-organized tactical trauma teams with force protection and environmental control. The MTB is an armored container on a logistics vehicle system replacement consisting of state-ofthe-art medical equipment and carrying one doctor, a nurse and three corpsmen. It is designed to support five patients, including three critically-injured and two less injured. Private firms are pushing field medicine forward. Combat Medical Systems has a team of former medics and medical
researchers and talks constantly with combat medics at nearby Fort Bragg to simplify tactical medicine, explained President Corey Russ. “We want to enable medics to do their jobs better, faster and with fewer errors.” The company developed QuikClot combat gauze, which enables soldiers or medics to stop the bleeding that accounts for a large portion of battlefield deaths. CMS has started production of its wireless vital signs monitor (WVSM) designed as a replacement for the PulseOximeter. The WVSM measures blood pressure, pulse rate and pulse oximetry and does a three-lead electrocardiogram. The aim is to give field medics the most information on wounded soldiers as soon as possible. WVSM data can be read for one soldier or transmitted to a laptop or other monitor where up to 99 soldiers can be monitored for vital signs. The device stays with the patient and stores up to 4.5 hours of vital-sign data for each casualty, so higher-echelon personnel can judge trends that might save a life. Young soldiers in good condition often compensate for blood losses that may be pushing them toward shock, so medics and military doctors need objective data. www.MMT-kmi.com
Another new CMS product is the simplified automatic ventilator (SAVe), designed as a substitute for or complement to the bag valve mask (BVM) used in the field to help soldiers breathe. Manual BVM use requires skill and care, while SAVe automates and controls ventilation assistance. SAVe has been deployed in small volumes in the field. Russ is excited about another device under development, the CRoC, a clamp that can be affixed to stanch pelvic bleeding. Wounds below body armor but above a point that can be stanched by a tourniquet are a mortal danger. CRoC controls blood moving through the two pelvic arteries. KCI’s vacuum-assisted closure (VAC) uses negative-pressure wound therapy to improve and speed up the healing of wounds. Aaron McClain, senior director of government sales operations, said VAC removes infectious materials, draws wound edges together and promotes granulation at the cellular level faster than traditional therapy, which consisted of wet-to-moist gauze
dressing. The speed of healing increases up to 66 percent with VAC. Conventional bandaging requires changing wound dressings three to four times a day, to ensure dressings still absorb fluids. With VAC applying constant negative pressure 24/7, dressings only need changing once every two days, a relief to recovering patients and to caregivers. VAC has been deployed in theater by the Defense Department since 2004. McClain said it can be pushed out as far as combat surgical hospitals, and VAC units are on all fixed wing Air Mobility Command aircraft. H&H Associates makes combat dressings, bandages and other devices for medics and corpsmen, according to Vice President of Operations Chuck Bolin. “We do abdominal dressings, compressed bandages, chest insert tubes, stuff that does not have an on and off switch,” Bolin summarized. “We make the full gamut. Most of it is carried in bags.” H&H emergency products are designed to save lives from the most
common preventable deaths in the field: excessive bleeding, tension pneumothorax, and obstructed airways. H&H’s Bolin Chest Seal is a sterile occlusive chest wound dressing for treating open pneumothorax and preventing tension pneumothorax that result from penetrating chest trauma. A patented failure proof, triple-valve design allows air and blood to escape while preventing the re-entry of either, thereby eliminating any unwanted gas or liquid exchange at the trauma site. The BCS’s 6-inch diameter covers practically any size chest trauma site. H&H makes a series of kits, like its Emergency Cricothyrotomy Kit with the tools for doing surgery to gain prompt access to a compromised and inaccessible airway. Its sterile Penetrating Chest Injury Kit provides proven emergency care for general, sucking and exit chest wounds. And H&H’s Situational Instrument Tray (SIT) Kit is a sterile, single-use kit for performing many surgical procedures immediately.
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MMT 15.5 | 9
Treatment and Prevention of Blast Injuries
Rauch also researches better TBI treatment. So far clinical trials of 27 drugs have failed to yield a safe and effective one for TBI. There are currently 70 projects looking The Defense and Veterans Brain Injury at drugs, including one derived from fatty Center (DVBIC) is congressionally funded to acids. One of the most promising drugs for work with 17 defense facilities, four Veterans protecting brain cells from cascading TBI Administration polytrauma centers and two damage is NNZ-2566. private sites to help deal with traumatic Private firms work to prevent TBI and brain injury (TBI). Michael Wilmore, direcother injuries from blast waves. Since 2005 tor of clinical affairs, said DVBIC has greatly Team Wendy has been the sole provider expanded during 10 years of war in Iraq and of padding for the interior of Army and Afghanistan. The center employs only 230 Marine Corps helmets. The firm makes pads people, but they provide crucial assistance to of polyurethane, Zorbium, engineered for caregivers at its facilities and to families and impact protection. A NISH unit cuts them caregivers of wounded soldiers. and the pads are installed in Kevlar helmets DVBIC provides educational coordinaby several firms. Product Development tors for caregivers and families and develops Manager Ron Szalkowski said this padding materials for their instruction. There is a is the most protective on the market. regional care coordinator at each facility. Blast injuries to the head come from Although most TBI care is provided by reguthree sources. First is the shock wave from lar medical staff, DVBIC deploys clinicians, the blast. Second is debris or fragmentatherapists, researchers and others as needed. tion of the blast device, against which The center is conducting a study of treatment the helmet shell is the chief protection. outcomes that will be used to spread best Team Wendy pads are primarily designed practices throughout TBI care. And DVBIC to minimize the damage done by the third maintains an email consulting service that impact, wind that suddenly knocks soldiers provides guidance, within four hours, to or vehicles around, accelerating brains sudmedical staff in theater on relief or treatment denly and possibly causing mild TBI. of possible TBI victims. Current pads are evaluated at an impact There has been a great increase in TBI velocity of 10 feet per second. The military cases, due to both continued war and the would like improved protection against ability to recognize TBI. DVBIC is increas14-feet-per-second impacts. Several studies, ingly looking at treating TBI when combined including one done under a Small Business with other conditions, such as psychological Innovation Research grant and another by problems, sleep difficulties and drug addicLawrence Livermore Laboratories, indicate tion. “The military is now on the cutting that may be impossible with available mateedge of treating TBI and this will eventually rials, except by thickening change civilian treatment as the pads, which requires well,” Wilmore said. increasing helmet size and The highest priority in TBI thus poses other issues. research is diagnosing mild More protection against TBI, explained Dr. Terry Rauch the blast shock wave could of Force Health Protection require face shields. and Readiness in the Office Team Wendy has develof the Secretary of Defense. oped foam padding for floors “These are the vast majority, and seating of ground com77 percent, of cases,” Rauch bat vehicles and offers these said. “TBI with polytrauma is a Dr. Terry Rauch to the military and seat significant issue.” manufacturers. The aim is Rauch is working with to minimize the damage of under-vehicle the Joint Trauma Analysis and Prevention blasts that can crush soldiers’ spines or of Injury in Combat Program (JTAPIC) to tibia. Product Development Engineer Joe develop helmet sensors that record impact Pease said these injuries are more comwaves. His office has funded more than 60 mon as armor has improved but nonstudies to define and identify mild TBI by penetrating blasts still cause severe injuries. means such as electrical activity of the brain, Team Wendy seat pads are tuned to the eye tracking, imaging and proteins released shock-absorbing dynamics of vehicle seats, from damaged brain cells. 10 | MMT 15.5
reducing blast impulse by more than 50 percent. Its floor pads are 1.5 inches thick, waterproof, covered with tread to prevent slipping, and reduce force to the tibia by nearly 75 percent. BAE Systems has been a leading provider of body armor for 13 years. Its ECLiPSE line of body armor offers complete modularity and customization through the Modular Vest Program. Gregory Kraak, director of warfighter equipment, said helmet protection has reached a very high level now and will be hard to improve. BAE is exploring alternatives for an enhanced combat helmet sought by the military. “They want more protection, but lighter,” Kraak noted. “That is hard to do. You need a new material solution.” BAE is working on helmet sensors to detect head acceleration and wave pressures indicating mild TBI. Kraak hopes to have these sensors fielded later this year. The services would also like to protect arms and legs, but this is hard to do without losing mobility. Improvised explosive devices were the chief danger in Iraq, but Afghanistan is seeing more enemy snipers who shoot for unprotected areas of the body. Along with individual protection, BAE also produces vehicle seats that resist mine blasts and absorb blast energy. Michael McDermott, director of business development for occupant protection, said these dissipate energy and reduce compression loading on occupants. BAE seats are on both BAE and other firms’ mine resistant ambush protection (MRAP) vehicles. Seating systems can be floor-mounted, post-mounted or sidewall-mounted, and BAE is looking at roof-mounted systems. “There is a lot of interest in getting legs off the floor to reduce leg injuries or tibia loading,” McDermott said. BAE makes seats that have footrests to reduce possible lumbar compression and loading on spines. BAE is considering different restraint configurations, three-, four- or five-point systems, because speedy exit from a mineblasted vehicle is also important. “We have one restraint that can be released by one buckle,” McDermott noted. The future will see more focus on preventing lower leg injuries, including foot rests. BAE, as a vehicle manufacturer, is well-positioned to integrate protective seating in to design. www.MMT-kmi.com
Training for Combat Care Hardware means little unless combat medics, corpsmen and other medical staff deal promptly and effectively with badly wounded soldiers. Training the first to reach the wounded is the focus of Lieutenant Colonel Wilson Ariza, project manager for combined arms tactical trainers. “We train combat medics and soldiers to help their buddies,” Ariza explained. Training includes teamwork, leadership and communication, as well as diagnosis and treatment. In 2005 the surgeon general of the Army decided to train for first-level care with medical simulation training centers. MSTCs emphasize life-threatening wounds, like collapsed lungs, blocked airways and heavy bleeding. There are now 23 MSTCs, including ones in Kuwait, Afghanistan and Korea. Training typically lasts five days and is done with manikins and other devices, such as “moulage” kits, that replicate what medical staff will see in the field or in hospitals. “Manikins mimic patients; if you do it wrong, they will die,” Ariza explained. “We can simulate stress, including shooting and the smell of burning flesh. Training used to be see one, do one and then teach one. Now we train and test them on what they have learned.” Each MSTC trains about 4,500 students for a total of 120,000 per year. The goal is to have 40 of these facilities in place by 2017.
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Training keeps getting more realistic. “We have double amputees with human actors. If you try to speak to him he is screaming. And you must return fire.” Ariza is working with a Medical City that will open on 7,000 acres in Orlando in 2012. He is looking at virtual training and video games. Anything to make training more effective is essential because, as Ariza explained, “70 percent of the medics we train will treat traumatic injuries in field, on the way or in hospital.” Dr. Jeffrey Cain has seen combat medical training from a variety of perspectives. A West Point graduate, he served in special operations infantry in SimMan 3G. [Photo courtesy of Laerdal] the 1990s, then went to the device and acquire hands-on skills,” Cain medical school and returned to serve in the explained. He said CAE has developed two Rangers before retiring from active duty in new products that take simulation to a much 2008. He is now an emergency medicine more advanced level. physician, works with civilian emergency The first is VIMEDIX, which does simmedical technicians and consults with CAE ulation training for ultrasound imaging. Healthcare on their training simulators. Ultrasound provides extremely critical infor“Simulation technology ranges from mation about a variety of conditions affecting micro devices and gaming up through highwounded soldiers, for instance blood flows fidelity haptics that allow you to manipulate
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and pressures inside the head, in real time and without radiation. But interpreting ultrasound images requires a high level of skill. Now students can learn from highly realistic simulations of ultrasound images. The second big advance, due for first delivery in October, is Ceasar, a major step forward in training medics and evacuation teams dealing with tactical situations. Here the aim is to increase survival from those traumas—heavy bleeding, breathing difficulty and penetrating chest wounds—that can be fatal depending on how fast and correctly care is given. Medical personnel learn these skills first from classroom training, then from partial task trainers—for example, limbs that tourniquets can be placed onto—and finally from fuller simulation manikins. But Cain said current manikins have several weaknesses. First, they are not rugged enough to be used in the kind of field conditions that simulate the stresses and confusion of true combat. And second, their simulation of the patient’s reactions must be determined by instructors. Caesar, in contrast, will be rugged enough to handle the mud and dirt of realistic training. And Caesar will autonomously simulate the reactions of bleeding, screaming, mumbling, closing eyes, going unconscious, changing pulse rates and so forth that would occur on battlefields under different conditions and treatments. CAE, which is famous for its full-motion flight simulators for training pilots, has taken the same highly realistic approach to training medical staff with Caesar. “It is a game changer,” Cain emphasized. “Previously, these devices have been adapted from simulators used for different purposes in civilian medicine. This time we have developed it with a military customer for what the military needs.” Laerdal provides simulation devices for all the U.S. military services. It started out 50 years ago providing cardiopulmonary resuscitation (CPR) simulation training and its resuscitation simulation manikin is now the “gold standard” in this field, according to Business Development Manager Terry Frazier. Its simulation manikins are used to train at all levels of medicine, from first responders up through highly trained physicians. Laerdal’s SimMan series consists of fullsized, high-fidelity replicas of patients that have heart beats, blood pressures, dilating pupils and can talk. “If you give them an overdose of drugs, they will react to that,” 12 | MMT 15.5
Frazier explained. “They will also get better if treated correctly.” SimMan is now in its third generation with SimMan 3G widely deployed in military training facilities, alongside its predecessors, SimMan and SimMan 2G. “SimMan 3G has been out for about a year and a half and is at every major military medical facility in the country,” Frazier said. “The first generation of SimMan was supposed to have a lifespan of five years, but they are still working after 10 years.” The latest version, SimMan Essential, is essentially the same as SimMan 3G. The SimMan line is also deployed in Okinawa, Guam, by the Army in Iraq and Afghanistan and at many MSTCs. Laerdal’s latest innovation is Sim Center. It is a facility from which training personnel can download hundreds of very specific scenarios, which can then be plugged into SimMan, and physiological effects, such as pulse rates, blood pressure and even broken bones will be replicated. X-rays that mimic the injury can also be downloaded. Sim Center is being unofficially tested by two military training units now. Frazier acknowledges it poses some security issues for the military since it involves downloads of software, just like iTunes. Strategic Operations was founded by retired Hollywood producer Stu Segall. Executive Vice President Kit Lavell said its experience with hyper-realistic special effects for combat films gives Strategic expertise in extremely realistic simulation of battle conditions for training medics and soldiers. Strategic’s Human Worn Partial Task Surgical Simulator, or Cut Suit, fits over a real human actor and simulates wounds, bleeding and torn internal organs. “It can do a sucking chest wound,” Lavell noted. The Cut Suit aims to train soldiers and medics as realistically as possible for airway clearance and control of bleeding crucial to survival in the first hour after a potentially lethal wound. SIMmersion makes audio-video systems for training soldiers, doctors and other caregivers in dealing with patients recovering from a variety of physically and psychologically damaging events. President Dale Olsen said these systems are extremely realistic. “We give them scripts they can choose from and depending on what they choose the character in the video will react in different ways. These sessions can last from five minutes to more than one hour.” Simulations can involves dealing with the psychological effects of blasts, with doing job
interviews during recovery or with alcohol or other addictions acquired during recovery. One simulation helps a soldier counsel his fellow soldiers on where to go for psychological health issues. “Psychological issues are probably the longest lasting problems faced by soldiers,” Olsen noted. SIMmersion has worked for the Navy, for the Veterans’ Administration, for the National Institute of Health and for the Army on suicide prevention. “The Department of Defense is our biggest customer,” Olsen added. Most of Mymic’s projects have been funded by the Small Business Innovation Research (SBIR) program. Phil Jones, vice president for human solutions, said Mymic works with game-based and virtual environments. “We are not medical experts. We do simulations of operating conditions and environments based on the functions they need to be trained in.” Mymic has trained medical response teams of reservists who may suddenly have to shed civilian jobs to respond to medical emergencies. “We are not training on medical skills but on teamwork.” The company is now working on a Complex Incident Response Training System (CIRTS) for combat medics and corpsmen. “We are training them on the decisions they will have to make, not the medical procedures. They enter the CIRTS matrix at a point that depends on how experienced they are and then do multiple missions over time.” The simulation engine is the military’s virtual battlespace, but Mymic intends to make CIRTS engine-agnostic eventually. CIRTS simulates the whole “muddy boots” medic experience. “You enter, go through processing, get assigned to a unit, go to a FOB and then to a combat outpost and stay there for the duration,” Jones explained. “Situations can be very simple, not life-threatening, or they can go all the way up to hair-on-fire situations, very complex in urban environments with multiple IEDs, an ambush, many casualties and life-threatening polytraumas.” Mymic is also looking at doing simulations for dealing with TBI and post-traumatic stress syndrome. It works closely with the medical experts at Eastern Virginia Medical School and Old Dominion University. O
For more information, contact MMT Editor Brian O’Shea at briano@kmimediagroup.com or search our online archives for related stories at www.MMT-kmi.com.
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Mobile labs work in a wide range of environments and conduct operations from collecting forensic evidence, identifying weapons of mass destruction and conducting chemical warfare agent analysis. Since the 9/11 and Amerithrax attacks, the Department of Defense reorganized and expanded its chemical, biological, radiological, nuclear and high explosive (CBRNE) defense capabilities. Part of the expansion was the 2004 establishment of the 20th Support Command. Commanded by Brigadier General Leslie C. Smith, the 20th has now grown to more than 6,000 military and civilian employees committed to combating weapons of mass destruction (WMD). The command provides expeditionary CBRNE forces to support joint force commanders and homeland defense authorities with field interdiction and analytical capabilities to assist commanders in making decisions to support consequence management, weapons of mass destruction interdiction/eliminations operations, and force health protection. Consequence management includes actions taken to reduce the effects of a WMD attack or an event in our homeland, in an allied homeland or on a battlefield. If requested by state and local authorities, 20th Support Command forces are prepared to support civil authorities in response to a WMD event in the homeland. When directed, the command will likewise support allies and partners. The command’s CBRNE field analytics core capability rapidly processes samples, enabling commanders to make timely decisions regarding evacuation, shelter-in-place, required personal protective equipment, medical prophylaxes, therapeutics and decontaminations for our soldiers, sailors, airmen and Marines fighting on the battlefields. 20th Support Command units include the CBRNE Analytical and Remediation Activity (CARA), 48th Chemical Brigade, three Explosive Ordnance Groups, and a Consequence Management unit. Its headquarters element is the core element of the Joint Task Force for Elimination of WMD with the requisite command and control capabilities to plan, direct, coordinate and control operations in the accomplishment of WMD elimination missions.
CARA Mobile Expeditionary Laboratory The 20th Support Command unit equipped to receive and analyze CBRNE materials including precursors, degradation www.MMT-kmi.com
By Ray Sullivan
products, toxic industrial chemicals/materials, biological warfare agents, homemade/improvised explosives, and also military grade explosives is the CBRNE Analytical & Remediation Activity Mobile Expeditionary Laboratory. The laboratory deploys civilian scientists to perform high-throughput chemical, explosives and biological sample analysis to support Department of Defense combatant commanders, military installations, and to also provide support and assistance to U.S. civil authorities if requested. The laboratory is equipped with two mobile packages: a Light Mobile Expeditionary Laboratory (LMEL) and a Heavy Mobile Expeditionary Laboratory (HMEL). They deploy to support consequence management and WMD elimination efforts worldwide. After mission notification and requirements determination, the CARA Mobile Laboratory can respond with either a Light Laboratory or Heavy Laboratory infrastructure with a tailored instrument and analyst package to meet specific mission requirements to identify and characterize chemical warfare agents, explosives and biological warfare agents in support of weapons of mass destruction elimination and remediation efforts. The laboratories can be employed in the full spectrum of military environments from an operating base in which host country military and law enforcement agencies have control to a forward operating base in a hostile environment in which the U.S. is conducting offensive combat operations.
Laboratory Infrastructure The HMEL consists of a 5-ton tactical vehicle, a 20-foot expandable laboratory shelter (AAR Mobility Systems), two attachable deployable rapid assembly shelter (DRASH) tents, 10 Quadcon dry freight shipping containers for equipment and consumable transport and storage (7.33 m3 capacity each), two refrigerated, insulated ISU-96 containers (AAR Mobility Systems) for consumable and sample transport and storage (7.33 m3 capacity each), and three improved environmental control units (IECU) for heating or air conditioning. The heavy laboratory shelter is equipped with a MMT  15.5 | 13
germfree glove box, chemical fume hood, and biological safety cabinet, an AirFiltronix PCR workstation, a Sanyo biological freezer and refrigerator, a Thermo Scientific chemical refrigerator, a Yamato autoclave, a Thermo Scientific incubator, Eppendorf centrifuges and Sartorius balances. The LMEL consists of a 2.5-ton tactical vehicle with a mounted laboratory shelter, a trailer mounted 30 kilowatt power unit, an HMMWV carrying a lightweight storage shelter, and a tent-like Modular Command Post System erected to connect between the tactical vehicle/laboratory shelter and the HMMWV. The light laboratory shelter is equipped with a glove box and a DNA-free PCR workstation.
Instrumentation Both the laboratories can be custom configured depending on mission requirements with an optimal instrumentation package. The laboratory relies on industry to supply it with mature analytical technologies. Most of the laboratory’s instruments are proven, commercial off-the-shelf technologies. The following equipment is available to the laboratory’s scientists to detect and quantify chemical, biological and explosive agents and components. LC/MS/MS: A Thermo Fisher Accela dual pump liquid chromatograph with an auto-sampler and a photodiode array detector (190-800 nm) in tandem with an LTQ XL linear ion trap mass spectrometer. The instrument is used for analysis of explosives residues such as nitroaromatic, nitroamine and nitrate ester compounds and for fungal, bacterial and viral identification by proteomic analysis. GC/MS: An Agilent model 7890 gas chromatograph with an Agilent model 5975C mass selective detector for identification of a wide variety of volatile organic compounds, including chemical warfare agents, toxic industrial chemicals (TICs) and toxic industrial materials (TIMs). FTIR: A Thermo Nicolet 380 Fourier Transform Infrared Spectrometer for fast identification of a wide variety of organic and polymeric materials. Ramanan InPhotonics: InPhotote Raman Spectrometer for rapid identification of narrow range of organic compounds of interest. XRF: A Rigaku Primini Wavelength Dispersive X-ray Fluorescence Spectrometer for metals analysis. XRD: A Rigaku MiniFlex II X-ray Diffraction Spectrometer for crystalline materials. CE: An Agilent 7100 Capillary Electrophoresis system for identification of charged chemical agents, biomolecules and low molecular weight drugs and other ions. qPCR: An Idaho Technologies Joint Biological Agent Identification and Diagnostic System (JBAIDS) for quantitative (real-time) polymerase chain reaction identification of select biological agents. ECL: A Bioveris M1M electrochemical luminescence biological analyzer for immunological identification of select biological agents Microscope: A Nikon model 50i phase contrast microscope for basic morphological identification of microbes. ELISA: A Molecular Devices SpectraMax M5 Multi-Detection Microplate Reader for detecting bacteria, viruses and toxins by enzyme-linked immunosorbent assay (ELISA). The ELISA plates are produced by the Biological Defense Research Directorate at Navy Medical Research Center. 14 | MMT 15.5
The laboratory infrastructure was built to accommodate the instrumentation. Power requirements are 60 kilowatts, a significant constraint in an austere field environment. Laboratory weight and cube requirements were designed with transportation in mind. Both the heavy and light laboratories are specifically designed for transport on US Air Force C-17 or larger aircraft or by sea on almost any military or commercial cargo vessel.
Mobile Laboratory Operations The laboratory works synergistically with elements of the 48th Chemical Brigade or other deployed CBRNE response teams who identify and destroy WMDs. The teams are equipped to interdict potential CBRNE capabilities, make preliminary CBRNE agent identifications and collect CBRNE samples for further analysis by the deployed CARA Mobile Expeditionary Laboratory. Since the laboratory is deployed in relatively close proximity to deployed CBRNE interdiction forces, precious time is saved getting results into the hands of decision-makers. Laboratory scientists receive samples from the field operators and use the appropriate techniques to identify or confirm the identity of chemical, explosive and biological agents. The laboratory can also quantify agent concentrations if required. The laboratory employs strict sample chain of custody and storage procedures, if shipment is required to national laboratories for more in depth analysis and/or sample attribution. There are significant challenges associated with performing forensics analysis in the field and not in a brick and mortar facility. Although the laboratory equipment is protectively packaged for shipment by long sea voyage or rough terrain, it is not a perfect design and things break in transit. Most of the operating environments are austere with extreme weather conditions, severe dust, oppressive humidity, frequent power outages, challenging waste disposal and primitive living conditions. The scientists perform set-up and tear-down of the laboratory themselves; it is physically challenging and requires a cadre of physically fit scientists. The duty hours are demanding; they typically require the scientists to work 16 hour days, seven days a week. Exposure to chemical and biological agents is always possible and working in hot and clumsy chemical protective gear with full-face chemical protective masks is sometimes required. The dusty environments are a constant challenge. The laboratory must be kept clean enough to avoid sample contamination and ensure sample integrity; the dust may contain low concentrations of target, but nonetheless indigenous organisms, and/or the dust may hold low levels of explosive residues present from past conflicts but immaterial to the existing investigation. Dust also plays havoc with all aspects of the precision instrumentation: filters and tubing clog, circuit boards overheat, moving parts foul. Humid conditions also require increased maintenance vigilance. The supply chain for lab consumables is very long with resupply opportunities few and far between. The laboratory must arrive with everything it needs to operate.
Future Capabilities CARA’s mobile expeditionary laboratory is an innovatively designed system providing core capabilities addressing significant threats to our nation. However, it was a rapidly fielded system and the pace of technology will soon render it obsolete. The Department www.MMT-kmi.com
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Q&A with U.S. Army Criminal Investigation Laboratory Staff By Lt. Col. Rodger Glenn, Operations Officer, Expeditionary Forensic Division, U.S. Army Criminal Investigation Laboratory
Q: How is your command involved with mobile laboratory testing on a military battlefield? A: The Expeditionary Forensic Division of the U.S. Army Criminal Investigation Laboratory mans, trains and equips expeditionary forensic laboratories that establish operations in support of the full range of military operations in any global theater of operation. Specifically, we create linkage between events and materials collected in the operating environment with the biometric data associated with threat individuals. Our efforts are aimed at establishing the link between the two in support of targeting, operations and prosecution by local national and coalition partners. Q: When testing a battlefield scene, how does your command go about doing a chemical weapons agent analysis? A: Our organization does not analyze chemical weapons. We do, however, conduct chemical analysis on other materials captured in the battlespace. Q: What are the main challenges for your command when conducting forensics on the battlefield? A: Much of the design of equipment and processes assume support for law enforcement and optimal facilities. The conduct of forensic operations in austere environments requires the ability to rapidly establish operations to include IT and communications links and conduct processing in mobile laboratories or lower standard physical construction. The industry as a whole is moving toward better accommodating this new mission by making equipment more rugged and more mobile, facilities more rugged and mobile, and redefining quality assurance standards and best practices appropriate to support military operations in all theatres of operations vice criminal prosecutions in U.S. courts, both military and civilian.
existing forensic disciplines as well as the development and introduction of new modalities that will outpace our adversaries ability to adopt their techniques. Additionally, we are optimizing the enterprise to deliver the highest possible quality rapidly at the lowest possible cost basis. Much of this latter effort is associated with the proliferation of remote examination techniques and increasing the IT infrastructure to enable processing power to reside in rear echelons versus the forward edge of the operational space. Q: Does your command have to make tradeoffs between size, weight, power, accuracy, etc., in terms of battlefield forensics? A: Yes. Generally speaking, the more complex an instrument the more difficult it is to field in environments such as Iraq and Afghanistan. Also, the recruiting and retention of highly qualified experts remains challenging. Both combine to motivate our move toward reducing our forward footprint in an architecture that allows for sophisticated processing in the rear echelons without sacrificing speed or quality. The return-on-investment can be increased significantly by leveraging remote computing technology and innovative approaches to the problem set. Q: How do you see mobile laboratory testing changing over the next five years? A: Mobile laboratories will become more focused on processing materials and be integrated into a sophisticated IT/communications infrastructure that will enable a major improvement in operational efficiency.
Q: How is your command working with industry to help minimize those challenges? A: We are exercising all possible public/private sector ventures and the liberal exchange of ideas to facilitate necessary changes in science for
Q: Is there anything else you would like to say that I have not asked? A: We believe that military operations and the forensic support provided to them will fundamentally enhance the capability set associated with forensic science and lead to the advancement in techniques, technology and processing that will serve not only the military customer set, but also law enforcement agencies, intelligence agencies and homeland defense enterprise. The needs of our customer set will push the science to greater levels. Lastly, there will likely be consolidation within forensic science to consider and accommodate more esoteric forms of analysis such as electrical engineering as well as nuclear, biological, radioactive and chemical applications so that otherwise disparate processes can be consolidating in order to achieve optimal results and economies of scale. O
of Defense is currently developing replacement systems for the laboratory. The Joint Program Executive Office for Chemical and Biological Defense (JPEO-CBD) is charged with coordinating research, development, acquisition, fielding and life cycle support of chemical and biological defense equipment. JPEO-CBD through its subordinate organization Joint Product Manager–Consequence Management (JpM-CM) collaborates with academia and industry to ensure the best technology is available to the armed forces protecting the country. Turning scientific innovation into integrated material solutions is challenging business. Immature technology requires
costly and time-consuming systems development. A balance must be struck to avoid quick obsolescence (and irrelevancy) but also avoiding immature technology. Technology procured from industry must be demonstrated in a relevant, preferably operational, environment to be considered mature. The leading edge of technology is desired, not the bleeding edge. The Common Analytical Laboratory System (CALS) program will improve upon the currently fielded analytical laboratory technology to enhance detection and identification of CBRNE agents. The CALS program is currently in the technology development
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phase, wherein the appropriate set of technologies to be integrated into the CALS will be determined. Many of the technologies already in use by CARA will continue to be used or perhaps upgraded. New technologies under consideration are as follows: PCR Microfluidics allows rapid DNA amplification due to the smaller thermal capacity and larger heat transfer rate between the PCR sample and temperature- controlled components. Multiplex Electrochemical Luminescence—multiple target antigens or antibodies can be identified simultaneously in a sample. xMAP—a multiplex, ELISA-like technique that relies on the combination of microbeads, flow cytometry, digital signal processing and traditional chemistry to identify and quantify target antigens, antibodies or nucleic acids in samples. Differential Mobility Spectrometry identifies and detects chemical compounds based upon a chemical species’ ion mobility in a rapidly varying set of electric fields. In 2008, the bipartisan congressional Commission on the Prevention of WMD Proliferation and Terrorism published World at Risk, which outlined the nation’s activities, initiatives and programs to prevent weapons of mass destruction proliferation and terrorism. The commission was particularly concerned about the rapid advance in biotechnology and the challenge it presented in the effort to prevent equipment, technology and the knowhow needed to weaponize biological agents out of the hands of criminals, terrorists and belligerent countries. Especially troubling would be if terrorists genetically modified well-known pathogens to prevent antibiotics and vaccines from working or turn to new technologies to create chimeric organisms such as an Influenza/ Marburg combination that spreads like the flu, but kills like Ebola. Three years later on June 24, 2011, the congress seems impatient with the nation’s progress in implementing the recommendations of the Weapons of Mass Destruction Commission and introduced new legislation to help guard against a WMD attack against the United States. Rep. Bill Pascrell (D-NJ) stated: “For years, we have had the benefit of the WMD Commission’s findings and recommendations, but we still have not acted upon them. Nearly a decade after the terrorist attacks on 9/11, we have not addressed the greatest catastrophic risk threatening the American people and that is unacceptable. This bipartisan legislation will help provide a truly comprehensive approach to securing the nation against weapons of mass destruction by looking at all angles—prevention and deterrence; preparedness; detection; attribution; response and recovery. It’s the time to act decisively to counter this great threat to the American people.” Clearly, the nation’s CBRNE defense capabilities will only improve and expand in the years to come. O
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www.RAZOREX.info Ray Sullivan is a microbiologist with the CBRNE Analytical & Remediation Activity Mobile Expeditionary Laboratory, a unit of the U.S. Army 20th Support Command. Formerly, he was an assistant research professor at Rutgers University and is a retired captain in the U.S. Navy Reserve.
For more information, contact MMT Editor Brian O’Shea at briano@kmimediagroup.com or search our online archives for related stories at www.MMT-kmi.com.
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Salt Lake City, UT, 84108, USA | 1-800-735-6544 | www.idahotech.com
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Compiled by KMI Media Group staff
Food and Drug Administration Clears In Vitro Diagnostic The U.S. Food and Drug Administration cleared the first nucleic acid amplification in vitro diagnostic (IVD) test that detects Coxiella burnetii, the bacteria that causes Q fever. The test developed by Idaho Technology Inc. (ITI) will be used to test military personnel suspected of contracting the disease and run on the Joint Biological Agent Identification and Diagnostics System ( JBAIDS), utilized across all branches of the military for diagnostic testing. Use of the test is limited to designated Department of Defense laboratories equipped with the JBAIDS. Q fever is an emerging infectious disease among U.S. soldiers serving in Iraq and other countries around the globe. The disease is usually transmitted to humans after contact with infected animals or exposure to contaminated environments. The bacteria is extremely hardy and resistant to heat, drying and many common disinfectants which can enable it to survive for very long periods in the environment. Early detection and identification of the bacteria will enable faster treatment and recovery. Philip Maggi, philip_maggi@idahotech.com
Unmanned Aerial Nuclear/Biological/ Chemical Sensing Technology Unmanned aerial nuclear/biological/chemical sensing technology is the U.S. Army’s attempt, in the wake of the Japan earthquake disaster, to review the developmental efforts for a chemical and biological (chem/bio) payload for small unmanned aircraft systems and to allow the personnel, including the new MANSCEN Requirements Determination Directorate chief, to participate in a small unmanned aircraft flight demonstration on Redstone Arsenal. Included in the demonstration were the Raven, the Puma and the Wasp small unmanned aircraft systems.
Next-Generation Medical 3-D Simulations Within the Defense and Military Sector
Heartwood Inc. and Innovation in Learning— the developers of the CliniSpace medical simulation platform—announced they will team up to offer browser-based and mobile immersive 3-D virtual medical training environments targeting the training needs of the DoD medical sector. CliniSpace is an award-winning serious gaming platform for the development of a wide range of immersive virtual medical training applications running on the Unity development platform. The Unity Web player has been certified by the U.S. Army and Air Force. Logging into these virtual environments, learners encounter realistic scenarios and problems. They practice alone and in 18 | MMT 15.5
teams, learning to make decisions, to communicate effectively, and to recover safely from errors. “We had been waiting for the right opportunity to broaden our virtual training offerings to encompass the DoD medical sector and were impressed with the robust features built into the CliniSpace platform.” said Neil Wadhawan, co-founder, vice president of sales & marketing for Heartwood. “In terms of effectiveness, ease of use, customization and scalability, they were hitting all the right marks. Furthermore, Heartwood’s experts use the same tools and languages used to develop CliniSpace and we are now offering extended custom development to make the CliniSpace solution specific to our customer’s requirements and not force-fitting any one feature.” Virtual environments with authentic 3-D medical spaces provide an engaging yet cost-effective and scalable alternative to the use of physical simulators. Unlike reorganizing a physical space into a new medical environment, virtual medical environments and virtual patients are available at the touch of a button. With the addition of servers, or through cloud computing, larger class sizes can be accommodated, with anytime, anywhere access to these learning environments. Neil Wadhawan; neil@hwd3d.com www.MMT-kmi.com
Next-Generation Device Offers Enhanced Performance for MissionCritical Professionals Panasonic Solutions Company, provider of collaboration, information-sharing and decisionsupport solutions for government and commercial enterprises, announced the Toughbook H2, a fullyrugged, ergonomic Windows tablet PC. The device’s handheld design offers the right mix of mobility, performance and connectivity for field service workers, first responders, clinicians and other mission-critical professionals. This next-generation tablet includes an enhanced processor, increased RAM and hard drive capacity, I/O ports and a screen that delivers exceptional viewability in all lighting conditions through the use of Panasonic’s TransflectivePlus technology. The Toughbook H2 is powered by an Intel Core i5-2557M vPro processor (1.7GHz with Turbo Boost up to 2.7GHz) for faster speeds and enhanced device management. The device also comes standard with 4GB RAM, expandable to 8GB, and a 320GB 7200rpm hard drive, with an optional 128GB solid state drive available. The Toughbook H2 offers exceptional ergonomics, including a molded hand strap, which allows workers to comfortably stand or carry the device for an entire shift. As a fully-rugged device, the Toughbook H2 is IP65 certified and MIL-STD-810G tested—with a six-foot drop rating. The Toughbook H2 does not require a fan, reducing the risk of potential contamination by pathogenic microorganisms. The H2 is also fully enclosed, with sealed buttons, tight seams and no exposed ports for easy cleaning. Optional screw hole covers are available. The Panasonic-designed Cleaning Reminder Tool software is available for the Toughbook H2; the software can be programmed to remind users to wipe down at defined intervals and automatically records cleanings. Barcode medication administration vitals capture along with electronic medical records capture and review are all available through a secure and intuitive platform on the Toughbook H2. The design of the Toughbook H2 helps to maximize workflow and ease clinical loads for doctors and nurses, allowing them to access patient records at the point of care and document a patient’s condition in real time. The workflow advantages offered by the H2 can help health care organizations maximize efficiency, a critical issue as the industry faces an aging population, increased demand for health care services and a shortage of nurses. www.MMT-kmi.com
New Patient Transfer System Available Next Health now offers the AgileLife Independent Living System, an automated, no lift patient transfer and mobility system. The AgileLife patient transfer system helps people who are bedridden move in and out of bed easily, safely and quickly. This innovative patient transfer system transports the patient down the bed and into a wheelchair docked at the foot of the bed. For caregivers, AgileLife automates patient transfer to and from a hospital bed and wheelchair or commode chair, without any patient lifting. In both the home and institutional setting, the AgileLife patient transfer system virtually eliminates risk of patient falls and can reduce the
development of bed sores (decubitus ulcers) through increased patient mobility. The AgileLife patient transfer system is the only true “no lift” device that can reduce nursing injury due to musculoskeletal strain. Disabled individuals regain their dignity and independence. Family burden is reduced without resorting to nursing home care or exorbitant in-home hourly expense. Caregivers can save time and avoid career-threatening injuries. Insurers save money as a result of improved patient and caregiver outcomes. Few technologies hold so much promise to so many throughout the health care system. Chris Rottner; crottner@fitlinxx.com
Mild Traumatic Brain Injury Pocket Guide Mobile Application Now Available The Department of Defense announced it has released a new mobile application for health care professionals, the Mild Traumatic Brain Injury Pocket Guide. This application, developed by the National Center for Telehealth and Technology (T2), gives providers a comprehensive, quick reference that includes clinical practice guidelines for assessing and treating servicemembers and veterans who have sustained a mild traumatic brain injury, commonly referred to as a concussion. “This new tool is about providing clinicians with quick and convenient access to clinical guidelines for concussion care. It not only allows the clinician to provide evidenced-based care but maximizes time spent with the patient,” said Katherine Helmick, deputy director for traumatic brain injury. The mobile application is free and available for download on Android smartphones at https://market.android.com/details?id=org.t2health.mtbi. Hard copies of the pocket guide can be ordered by contacting the Defense and Veterans Brain Injury Center at info@dvbic.org or 1-800-870-9244.
MMT 15.5 | 19
Information Technology Organizer
Q& A
Maintaining IT Operations at the VA
Roger W. Baker Assistant Secretary for Information and Technology Department of Veterans Affairs
Roger W. Baker was nominated by President Obama to serve as the assistant secretary for Information and Technology for the Department of Veterans Affairs and subsequently confirmed by the Senate on May 18, 2009. As assistant secretary, Baker serves as the chief information officer (CIO) for the Department, directly managing an organization of over 7,500 information technology (IT) professionals and a budget of over $3.3 billion. Prior to his appointment, Baker was most recently president and chief executive officer of Dataline LLC, a mid-sized IT services and integration company based in Norfolk, Va. Prior to joining Dataline, Baker was CIO at General Dynamics Information Technology, and executive vice president and general manager of the Telecommunications and Information Assurance business group for CACI International. From 1998 to 2001, Baker was the CIO at the U.S. Department of Commerce, where he led efforts to convert old systems and processes to e-commerce, improve technology management, reduce costs, and create the Federal CIO position. Prior to his federal service, Baker had a successful career in high technology, helping to grow and sell three software/Internet companies. He served as the chief operating officer of BlueGill Technologies, a market leader in Internet Bill Presentment; as vice president of Engineering and Operations at VISA International, where he was responsible for the creation and operation of the VISA Interactive Banking System; and as vice president of Consulting and Services for Verdix Corporation. Baker has a Bachelor of Science degree in computer science and a Master in Business Administration, both from the University of Michigan. Q: What do you consider the major priorities in your position as Assistant Secretary for information and technology for the Department of Veterans Affairs? A: Since I started in 2009, we have had five areas of focus in VA IT: customer service, information security, operational metrics, disciplined systems development process, and strong financial management. www.MMT-kmi.com
These focus areas reflect both the standards for an IT organization [e.g., customer service] as well as key problem areas for VA [e.g., the systems development process]. Each one of these focus areas is key to supporting VA’s administrations [health, benefits, and cemeteries] in their efforts to provide better services to our nation’s veterans. Q: What are the major challenges in making those priorities happen? A: VA IT is largely structured like a private sector service organization, with senior staff focused on our main service areas. This also maps directly to the five focus areas discussed above. We benefit tremendously from the fact that all IT budget and staff at VA have been consolidated into a single organization. While we try to operate much like a private sector organization, we are still governed by the laws of the federal system. In particular, we have challenges related to the acquisition and personnel systems that significantly restrict our flexibility in those areas. Making change happen, and striving to meet a goal of being as good or better than private sector IT organizations, is made much more difficult in the federal system due to constraints around acquisition and personnel. MMT  15.5 | 21
Q: What new initiatives are on the horizon for your office at VA? A: Currently, our largest effort is to establish a new joint integrated electronic health records [iEHR] system with the Department of Defense. This is a huge project involving hundreds—and soon thousands—of people in both organizations. This project is being driven by an agreement between the two secretaries [VA and DoD], and is focused on providing better tools to our clinicians so they can provide better care to our servicemembers and veterans. We have also recently moved VA’s home-grown EHR system, VistA, to an open source model of development, which is a new approach for a federal system. We hope to get substantial private sector engagement to move our EHR technology forward through that model. And I’d be remiss if I didn’t mention a paperless benefits processing system we are developing right now to help our benefits organization address the backlog and handle the large volume of claims they receive each year. We are using a relatively new development approach, known as Agile development, for this system, and are on track for a May 2012 delivery. Q: How does your office stay current and utilize technology to care for our nation’s veterans? A: As I mentioned above, we try to run the VA IT organization like a private sector IT services company. We are constantly looking
for better approaches to serving the needs of our customers. In many cases, that means trying to find ways to do things just a bit better every day. In other cases, that means trying to identify new technologies or approaches that could provide substantial improvement. For example, we recognize doctors who provide care for veterans would like many more mobile IT tools. Q: How has technology changed the way VA provides the best possible care for our veterans? A: It has, absolutely. VA is the most “wired” of all medical systems in the United States. Everything we do in patient care is electronic, and has been for about 15 years. With that comes constant pressure from our clinicians to provide even better tools. For example, we are releasing a new pharmacy package right now to all of our hospitals—152 of them!—that has enhanced orderchecking technology to ensure we are detecting any possible interaction between multiple prescribed drugs. Technology at VA has clearly helped enhance our quality of care. Q: How does your office partner with industry to advance your initiatives? A: We have about 8,000 IT employees in VA IT. I know many of them talk regularly with our industry partners, which is an essential part of our ability to keep current on technology trends. We encourage our IT staff to participate in IT professional associations to build their understanding and associations with the private sector. As an example, we participated in an event a few months ago where we spent the morning briefing about 600 private sector folks on the secretary’s major initiatives and the upcoming IT requirements for those initiatives. I know the feedback from industry on that event was very positive, and I’m sure it has helped us get better solutions. Q: How important is maintaining that partnership with industry in furthering VA’s goals? A: About two-thirds of our annual budget is spent with the private sector. Q: What are some of the major accomplishments your office has seen in the past year or so? A: Wow, do you have that much column space available? In the past two years we have: •
•
•
• 22 | MMT 15.5
Generated over $700 million in savings by eliminating over 100 IT projects and instilling strong financial disciplines in the VA IT organization. Improved our IT development success rate from about 30 percent to 79 percent by introducing and enforcing a new development methodology that requires delivery of capabilities to customers at least every six months. Introduced a customer satisfaction survey that scores us on our performance at every VA facility, and lets us compare ourselves with other IT organizations worldwide. Achieved real-time monitoring of every desktop, laptop www.MMT-kmi.com
•
and server on our network. That’s about 380,000 units. So we know where our security vulnerabilities are, and can track their remediation as it happens. Created a detailed, prioritized operating plan for the organization that we use to make decisions about exactly where we will spend our money and what benefit we expect to get from the expenditure. We track about 1,500 expenditure lines now, and regularly review each one to ensure we are spending our money in ways that best benefit veterans.
Q: How do you balance care with cost? A: It turns out that great health care is also less costly. By focusing on detecting potential issues and addressing them early, VA has been able to reduce our cost of care. For example, one of the secretary’s major initiatives is to increase our telehealth capabilities. This means we are monitoring patients more closely in their homes, our patients have to travel less, and they can be more easily seen by a doctor. As a result, developing problems are frequently addressed before an admission is necessary, which certainly increases quality of care and also decreases the cost of care. Q: What was the main reason for allowing VA staff to use iPhones and iPads? A: Clinician demand! As part of our customer service focus, I tell our customers that my goal is to stop being the “CI-NO” and start being the “Chief Yes Officer.” That means recognizing the tools our clinicians most want to use and figuring out how to balance our security concerns with their need for the latest tools. Q: How will VA ensure proper security controls are in place on iPhones and iPads to secure protected patient information? A: In this case, we did an extensive analysis and identified potential risks. We then determined how to mitigate those risks sufficiently
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VA staff making use of electronic health records. [Photo courtesy of the Department of Veterans Affairs.]
to allow me to make a decision to allow those devices to access our network. So, before we allow the device to connect, we will detect what software it is running, and stop the connection if unauthorized software is detected. If a package is storing information on the device, we will have ensured it is encrypted and strong passwords are required. Primarily, we have implemented systems that will allow the devices to only view, not download, most applications information, so that our most sensitive information is never resident on the device. Q: Who within the VA would be receiving these iPads and will the iPad be replacing the corporate laptops? A: Decisions on what equipment is required by which employees are made in conjunction with the employee’s management. Mobile devices tend to be focused on high-demand positions such as clinicians. Yes, in most cases we expect that the user will have either a mobile device or a laptop, not both. O
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Leadership Insight Q: How does TRICARE’s mail-order pharmacy and network retail pharmacy programs improve effectiveness and efficiency of DoD’s pharmacy benefit? A: DoD’s 9.6 million beneficiaries are located throughout the country and across the globe. The retail and home delivery programs expand accessibility to the pharmacy benefit, which otherwise would be limited to those within driving distance of a military treatment facility [MTF]. Over the years, Base Realignment and Closure actions have significantly reduced the number of bases with military pharmacies. As a result, fewer and fewer beneficiaries have access to military treatment facilities for pharmacy services and must utilize the commercial sector of the DoD pharmacy benefit through an extensive retail network and the home delivery program. Q: What are some of the challenges TRICARE faces by having a worldwide pharmacy program? A: Since the pharmacy program is structured around four points of service—military pharmacies, retail network pharmacies, retail non-network pharmacies and home delivery—worldwide access is possible. In foreign countries, home delivery is not possible in many areas due to national customs laws on importation of prescription drugs, but home delivery is possible for military members and their family members who are assigned overseas on official orders and have an APO [Army Post Office] or FPO [Fleet Post Office] address. Retirees working at bases may also be able to use the APO/FPO delivery system. Beneficiaries working at U.S. embassies can also get delivery through the diplomatic pouch. In cases where home delivery is not possible and military pharmacies are not geographically accessible, DoD beneficiaries still have the retail non-network option available to them. DoD does ship to all five U.S. territories and many of these territories have network pharmacies. Check the website at www.tricare. mil/pharmacy for current network pharmacy locations. Q: What goals does the TRICARE’s pharmacy program have for this year? A: TRICARE Pharmaceutical Operations Directorate continues to align its mission to the Quadruple Aim. Specific projects include continued emphasis on support for pre-deploying and deployed troops with medication management, decreasing per capita costs of the pharmacy benefit, and increasing the use of the lowest-cost points of service, which are the MTFs and home delivery. In addition, we continue to encourage cost-effective use of medication, invest in maximizing use of technology, such as electronic prescribing to all points of service, and disseminate information about value of medications through increased adherence to prescribed therapy by our beneficiaries, while maintaining the robustness of the pharmacy benefit. Q: How does TRICARE manage beneficiaries who are deployed overseas and then return from duty so they can maintain a continuous effective drug therapy? A: Deployed troops receive care from their associated deployment medical units, leaving for theater with a six-month supply of 24 | MMT 15.5
medications. In addition, deployed active duty members receive refills of their maintenance medications through the same home delivery pharmacy other beneficiaries use. When they return to their home units, their care is assumed by their local military treatment facility pharmacy, retail or home delivery pharmacy. Q: What is the future in having retail pharmacies, chains and independents, serve DoD personnel?
Rear Admiral Thomas McGinnis (USPHS), Chief Pharmacy Officer, TRICARE Management Activity
A: Currently there are 60,400 retail pharmacies in the TRICARE pharmacy network. They remain a critical component of the DoD pharmacy benefit. Over the past few years, more prescriptions were filled by retail pharmacies than any other venue. In addition, a recent Federal Register notice published that TRICARE is expanding accessibility of other recommended vaccines that are routinely provided in retail pharmacy setting to TRICARE beneficiaries, further validating the integral nature of retail pharmacies in the TRICARE pharmacy benefit. Q: What are some of the challenges TRICARE faces serving military beneficiaries? A: Like other large health plans, rising costs is always a concern. TRICARE serves over 9.6 million beneficiaries and one of the major challenges is to ensure that every dollar spent is the best value possible for healthy outcomes in our beneficiary population. Nearly three out of four Americans do not take their medications as directed, a problem known as medication non-adherence. The least effective and most expensive pill TRICARE provides is the one a beneficiary never takes. According to the National Consumer League, one in three Americans never fills their prescriptions, and a third of hospital admissions are linked to poor adherence. This is especially true for people with chronic health conditions that can worsen quickly without proper medication use. We are using social media technology such as Twitter and Facebook to inform our beneficiaries about the importance of following the labeled directions for prescription medications, which is one of the easiest ways to help protect and improve overall wellness. Q: How does TRICARE’s pharmacy program mitigate those challenges? A: We are attempting to mitigate these challenges through diligent efforts to ensure cost-effective therapy while maintaining the highest quality care possible. We are encouraging our beneficiaries to use home delivery and MTFs. We are educating them on the most cost-effective choices concerning their pharmacy benefit. O www.MMT-kmi.com
VA Revamps
Supply Acquisition
The future of how the VA procures its supplies and
services will change for the better in the years to come through the T ransformation T wenty -O ne T otal Technology (T4) Program As the Department of Veterans Affairs (VA) transforms itself into a world-class, 21st century organization that is peoplecentric, results-driven and forward-looking, it remains fully committed to the ideals of being a more transparent, participatory and collaborative agency. Further supporting these principles, VA believes exceptional leadership and good governance are essential to serving those who have served our country. It is for these reasons the Secretary of Veterans Affairs, the Honorable Eric K. Shinseki, designated Peter Levin, VA’s chief technology officer, as the senior accountable official for open government, along with calling upon other senior leaders who have equally stepped up to play important roles in this ever-so-important transformation effort. VA is in the process of some very profound cultural changes, changes which reflect an openness and transparency that has the agency already yielding results. One very notable outcome can be witnessed in the information and technology (IT) arena. Specifically, through the innovative approaches of some very talented technical and acquisition leaders, the Transformation Twenty-One Total Technology (T4) Program will substantially change how VA will procure IT supplies and services for years to come. In testimony before the House Veterans Affairs Committee, Secretary Shinseki said one of VA’s main goals is to provide timely access to benefits and high-quality care
www.MMT-kmi.com
By Karen Casiero and Jack Kulaga, Department of Veterans Affairs Contract Specialists
to veterans over their lifetimes. To improve VA’s execution of IT projects, and to further advance top-priority programs for veterans, Secretary Shinseki first announced in fiscal year 2010 the innovative T4 contracting strategy. While at the center of the T4 approach is transparency and leveraging IT talents of both industry and government, a key aspect of T4 is also to focus on giving veteran-owned small businesses more opportunities to support VA. Speaking at the annual National Veterans Small Business Conference in July 2010, Secretary Shinseki summarized this by stating, “T4 is a win-win-win strategy. Veteran-owned businesses win by getting more contracting opportunities; VA wins by getting the contractor support it needs more quickly, with less risk, reduced costs and in a more manageable form, and all veterans win by getting better services and support from a transformed VA.” The services and products to be provided under T4 will cover all phases of an IT systems life cycle, and include program planning and management, systems and software engineering, cybersecurity, and operations and maintenance—essentially, a total solutions approach. Many existing VA programs will be positively impacted through T4’s broad range of IT and telecommunication services. Perhaps most significantly, T4 contracts allow the most efficient use of technology to assist in meeting demanding VA objectives, represented by the secretary’s 16 Major Initiatives. The Major Initiatives require integrated information technology systems capable of transforming VA to meet its responsibilities to veterans and their families over the coming decade. T4 will be a critical enabler to support the implementation of these forwardleaning initiatives. For instance, through contractor-provided solutions, VA can fully engage in a backlog of benefit claims, or sustain a system that allows veterans to access comprehensive online information anytime and anywhere. Prior to the award of T4, an inordinate amount of upfront effort was initially required to be done by VA. VA conducted extensive market research through the use of industry days, one-on-one sessions, draft request for proposals (RFPs), presolicitation conferences, and responding to thousands of questions submitted by industry. Collectively, these efforts allowed VA to identify the most effective acquisition strategy to best meet the information technology needs of veterans. At the Industry Day alone, over 700 attendees representing some of the best IT prime and subcontractors in the country provided invaluable input and insight into the IT marketplace from which the T4 program would be dependent. MMT 15.5 | 25
As a result of these efforts, and only upon careful review and analysis of the entire collection of market research data, VA determined a five-year indefinite delivery/indefinite quantity (IDIQ) multiple-award contract (MAC) would be the contractual vehicles to be used in T4. Along those same lines, VA also determined that in order to most efficiently implement the T4 concept while also most effectively meeting the agency’s IT needs, a total of 15 contracts would include the best contractors within a streamlined, competitive environment. Recognizing the importance of veteran-owned small businesses, it was also determined of the 15 contracts, four awards would be reserved for service-disabled veteran-owned small businesses (SDVOSBs) and three for veteranowned small businesses (VOSBs), which constitutes 47 percent of the total awards. A best-value tradeoff selection approach was used to evaluate the proposals. Consistent with existing regulations and procedures, T4 evaluation criteria included technical, past performance, small business participation commitment, veterans involvement and price. The proposing of aggressive small business subcontracting goals was part of the T4 evaluation. At a minimum, offerors are required to meet a total small business subcontracting goal of 35 percent, which further requires the following minimum individual goals: SDVOSB—10 percent; VOSB—12 percent; small disadvantaged business—5 percent; woman-owned—5 percent; and HUBzone—3 percent. These subcontracting goals are an essential factor to the success of the T4 program, because as task orders are awarded off the T4 IDIQ contracts, future task order competitions will consider past performance, which includes how well subcontracting goals are met. Prime contractors may not receive a T4 task order award if they fail to meet their proposed subcontracting goals. On June 30, 2011, 14 contractors were awarded contracts, and on July 18, 2011, the 15th and final contract was awarded under the T4 program. Each T4 contract is a five-year IDIQ MAC, representing a total overall program estimated ceiling of $12 billion. Of these 15 awards, seven awards were reserved to SDVOSBs and VOSBs, as originally planned. Unsuccessful competitors will be notified and each will be given the opportunity to receive a debriefing about their respective proposals and learn how they might improve their future submissions. The T4 program will no doubt be a major tool in VA’s acquisition toolbox, as the overall benefits of T4 are many. As stated earlier, the T4 program aligns with the acquisition reform strategic planning initiative as it provides a contract vehicle allowing the Office of Information Technology (OIT) to benefit from a program that can rapidly respond to requirement needs and avoid service gaps. Also toward the top of the benefits list is having a single focal point for managing multiple contracts. It also gives VA access to the best industry capabilities without the long acquisition lead time that typically hinders the government’s “requirements to contract award” processing timeline. This streamlined approach will provide savings to the government, as well as to the taxpayer. By making the procurement of critically needed services easier and more rapid, T4 will minimize the potential for gaps in services which can occur using more conventional acquisition processes. Not to be overlooked, T4 will help the VA meet its ambitious veteran-owned small-business goals. Perhaps the greatest benefit of all is how the T4 will touch the lives of veterans. 26 | MMT 15.5
Future task orders awarded off of the T4 contracts will undoubtedly support vital Major Initiatives, such as Veterans Relationship Management (VRM) and the Veterans Benefits Management System (VBMS). The VRM initiative will significantly improve veterans’ access to health care and benefits information. This initiative will transform veterans’ interactions with VA by using innovative 21st century information technologies. Veterans will have a better experience when they contact VA for assistance, and the employees of VA will be able to quickly convey accurate, up-to-date information through call centers and Internet. VBMS is a multi-year project to transition from paper-intensive claims processing to a paperless environment through deployment of technology solutions and migration to electronic claims processing. Claims processing steps will be automated and existing applications will be modernized, resulting in a standardized, tracked and efficient claims processing solution. Through T4’s positive impact on these two important programs, veterans receive improved service and VA can better serve the families of veterans as well. Once in full swing, the T4 program will actually function under a rather simple concept, within a dual organizational structure. At the heart of the program, T4 aligns proven acquisition practices with the information technology requirements of VA. Championing VA’s IT needs is VA’s OIT. OIT is the steward of all VA IT assets and resources, and is responsible for ensuring the efficient and effective operation of VA’s IT Management System to meet mission requirements of the secretary, undersecretaries, assistant secretaries, and other key officials. On the contracting side, T4 efforts are conducted by VA’s Technology Acquisition Center (TAC). Aligned under the Office of Acquisition, Logistics, and Construction (OALC), the TAC is specifically dedicated to providing IT acquisition and program management expertise and support for life cycle management of enterprisewide solutions for OIT. The TAC represents a cadre of experienced acquisition personnel extremely adept at understanding and successfully navigating the diverse and sometimes trying world of government contracting. These two VA organizations—OIT and TAC—share a common T4 goal, a goal which is best summarized by Secretary Shinseki, who stated T4 “will help VA transform into a 21st century organization and enable us to deliver the high-quality health care, benefits, and services veterans have earned.” VA anticipates reaping many rewards as it moves forward in the initial months of T4. Yet as VA looks even further into the future, it is imperative it embrace the idea of excellence through innovation, and share in a commitment with industry to recognize and implement best practices. Over the next five years, T4 will demonstrate a renewed commitment to veterans by improving the way VA delivers products and services now—and for decades to come. It will provide greater insight to industry of VA’s total information technology needs resulting in better information technology solutions for veterans. The T4 charter continues to be as it has been from the very beginning; that is, to never lose sight of this nation’s veterans, for it is veterans who are the real beneficiaries of the T4 program, and only they can be the true measurers of success. O
For more information, contact MMT Editor Brian O’Shea at briano@kmimediagroup.com or search our online archives for related stories at www.MMT-kmi.com.
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Industry Supports
VA Initiatives T4 contract awardees discuss how their company supports V eterans A ffairs initiatives . Industry leaders were asked the following question: As a T4 contract awardee, what capabilities will your company provide to benefit the Department of Veterans Affairs IT initiatives?
7 Delta Inc. Mike Sawyers Chief Executive Officer
7 Delta Inc., founded in 2005, is a verified service-disabled veteran-owned small business and a leading provider of innovative technology solutions to defense and federal civilian agencies. Core services include information technology program management, software application development and systems integration, operations management, requirements management, security architecture, and system and performance testing. Customer satisfaction has been the key to building successful, long-term relationships with our customers. In 2010, 7 Delta was awarded the 2010 GovStar Star Performer Award. 7 Delta provides a full range of IT services across the full program life cycle, using best practices and standards from the IT industry. 7 Delta’s T4 team is dedicated to being a catalyst for innovation at the VA, with a team that includes 36 small businesses and 12 large businesses who bring thought leadership in IT and health care, and offer innovative ideas, tools, and methodologies to enhance VA’s support for veterans. Our team brings experience in both clinical health care and IT to the federal government, particularly the VA, DoD Military Health System, and the Department of Health and Human Services. 7 Delta has enjoyed a successful history of support to the VA in areas such as health care benefits enrollment, veterans’ personal health records, health care fee claims and revenue management, web portal development, program management, IT operations management, www.MMT-kmi.com
virtualization and cloud computing, information technology support services and help desk services. 7 Delta’s distinctive solutions respond to the challenges VA faces to continually improve performance while reducing operating costs. 7 Delta supports the VA now and in the past, in noteworthy programs such as the My HealtheVet web portal, the Veterans Relationship Management program, VistA 5010 enhancements, VA’s health care benefits enrollment, VA’s program to enhance the veteran experience and access to health care, and VistA core development. Booz Allen Hamilton Susan Penfield Senior Vice President
Booz Allen has the opportunity to provide support for T4 in six broad technical areas: program management, strategy and planning; systems/software engineering; enterprise network; cybersecurity; operations and maintenance; and IT facilities. For over 20 years, Booz Allen has served as a trusted partner to the Department of Veterans Affairs, both at headquarters and at many of the VA’s medical centers and regional offices across the country. Through that experience, we have developed a deep knowledge and appreciation of the mission of the VA, as well as the unique requirements and in-depth knowledge of the VA security and technology environment. Because of our unique understanding of the VA’s business requirements, Booz Allen sets itself apart from typical systems integrators. Booz Allen’s strong track record of coupling our VA, health, benefits and business expertise with our expert IT programmatics, architecture, MMT 15.5 | 27
software/systems engineering, cyber technologies and innovations helps it bridge the gap between the VA business and IT community. We bring a successful track record of incubating and delivering innovations in IT for our clients. VA faces a number of challenges, and our goal is to bring mature solutions to address these key challenges— integrated electronic health record, benefits transformation, the evolution towards patient-centric care, mobile computing and transforming the VA’s infrastructure. Our holistic approach is the intelligent way to tackle the multi-dimensional challenges of health and benefits reform. We anticipate we will successfully support the VA in its transformation and modernization efforts by delivering bundled services—technology, strategy, change management and analytics—along with our deep industry expertise.
solutions developed by SMS are focused on improving interoperability, maximizing efficiencies, eliminating risks and reducing costs. Our initial T4 task order is in development support of the Veterans Service Network (VETSNET) program. VETSNET is a custom suite of inter-related applications designed to deliver critical business systems for compensation and pension claims processing, from claim establishment through the payment and accounting of benefits. This program is a highly visible solution, and serves as one of VBA’s primary benefits delivery systems, providing critical services and distributing over $4 billion in benefits a month.
Systems Made Simple Inc. Al Nardslico Chairman and President
Technatomy Corporation, a service-disabled veteran-owned small business (SDVOSB) and certified 8(a) small disadvantaged business, is proud to be a T4 prime contractor holder. We provide full software life cycle and program management support to a wide variety of customers, including the Department of the Treasury, the Internal Revenue Service, the Defense Logistics Agency and the Department of Veterans Affairs. We have supported the VA on a range of contracts since 2005, including currently serving as a prime on the Enhancing the Veteran’s Experience and Access to Healthcare vehicle. We meet customer expectations through our corporate Quality Management System, built on ISO 9001:2008 registration and a corporate CMMI Maturity Level 3 appraisal. Technatomy plans to support all 11 key PWS areas with internal and team resources. We developed a high-quality team for the T4 contract that includes eight large and 13 small businesses to provide the VA with a veteran-owned small business/SDVOSB led team that could meet the full range of VA’s long-term technology needs. We provide access to more veteran-owned/SDVOSB and other small businesses and leverage large businesses with knowledge and understanding of VA’s systems and operations. Our team’s composition allows us to respond quickly to information technology task order requirements using the right management tools, processes, procedures and people. Our team has proven experience in implementing information technology solutions in a health care environment through our work at the VA, MHS, and commercial health care organizations, presenting a low risk to the VA. O
Systems Made Simple Inc. (SMS), a service-disabled veteran-owned small business, is a proven IT services provider and systems integrator with more than six years of experience at the Department of Veterans Affairs (VA). SMS is presently the prime contractor providing Virtual Lifetime Electronic Record Program Management Office (VLER PMO) support, program/project management services and systems architectural design services. Also, SMS is integrating a COTS solution to deliver the VA’s enterprise time and attendance system with over 300,000 users anticipated. Additionally, SMS is presently providing support for over 46 other projects within the Department of Veterans Affairs. SMS was recently awarded one of the VA’s T4 contracts, allowing us to continue our long-term partnership. SMS, a critical partner to the VA, has extensive experience designing, developing, implementing and operating IT solutions in the health care field. Our core competencies include program management, software engineering, and system/software support services. Through our work, we have improved many of the legacy health care systems used by Veterans Affairs to manage, schedule and provide care to our nation’s veterans. Notable programs include HealtheVet Program Management, Clinical Health Data Repository, Bidirectional Health Information Exchange, Nationwide Health Information Network, and Veterans Authorization and Policies. The leading-edge health care
28 | MMT 15.5
Technatomy Corporation Nadeem Butler President and CEO
www.MMT-kmi.com
Despite the lengthy procurement process, there is also an issue with security clearances when doing business with the D o D and VA, resulting in a catch -22. By Joan Michel MMT Correspondent One of the surest ways for a small business to expand quickly is to land a contract with a federal government agency. Most small businesses desire the stability and long-term growth potential that government contracting can offer, but to get those contracts, small businesses have to navigate a challenging federal procurement process. And although government agencies have put programs in place to make it easier for small businesses to navigate federal agencies, many small businesses still find themselves caught in “catch-22” circumstances as they try to adapt their organizations for government contracting. “I think the ultimate catch-22 has to do with security clearances. You need a www.MMT-kmi.com
facility security clearance to get a contract but you can’t get that clearance without a contract,” said Rod Hudson, president of QuickSilver Analytics, a service-disabled veteran-owned small business that develops chemical and biological defense products for warfighters, HAZMAT teams and first responders. “Nobody [government officials] wants to be the first to use a new small business,” said Dr. Cedric Jeannot, president of I Think Security, a data protection company based in Ontario, Canada. “No one is going to get fired for hiring IBM, for instance. This is a chicken and the egg problem.” “There is higher risk associated with utilization of small businesses,” said Tom Leney, executive director, Small and Veteran
Business Programs for the Department of Veterans Affairs (VA). “They may not have the past performance qualifications that larger businesses do. If I go to a large contractor with lots of corporate experience, I see that as a low-risk option. If they make a mistake, the responsibility for failure lies with the company. If I pick a small business that no one has heard of, I am accountable for this decision.” Small business is perceived to be the most important economic growth engine in the United States. According to the Small Business Administration, small firms represent 99.7 percent of all employer firms, employ half of all private sector employees, pay 44 percent of total U.S. private payroll, generated 65 percent of net new jobs over MMT 15.5 | 29
the past 17 years, were 97.5 percent of all identified exporters and produced 31 percent of export value in FY 2008, and produced 13 times more patents per employee than large firms. The U.S. government is the world’s largest buyer of goods and services, with purchases of over $435 billion per year. Of that, 23 percent of all procurements are required to go to small businesses. Both government agencies and small business advocacy organizations are working to make it easier for small businesses to navigate the federal procurement environment because of the size of the federal budget and the strength of the small business community. One of the biggest challenges small businesses face in working with the VA and other government agencies is access, said Leney. Knowing who to talk to in a very large organization and then getting access to that person is difficult for all businesses, but especially small businesses. To address this challenge, VA has developed programs to increase face-to-face interaction between vendors and procurement officials. VA is hosting monthly vendors’ days on how to do business with VA, hosting vendor expositions where VA brings in a small number of vendors in a particular market sector to talk with the appropriate government officials, and attending over 100 outreach events per year, attended by vendors in market sectors that service VA. Leney said that this year he is hosting a national veterans conference in New Orleans that will bring over 200 procurement decision-makers together with more than 4,000 veteran-owned small businesses. This approach will allow his staff to reach a larger set of small businesses at once, he said. “Navigating the many layers of people and departments is a challenge,” said Jeannot. “Each government agency has its own technology department with its own vetting process. A small business needs a lot of resources and time to learn about each of these agencies and to get to the right person. And then once you do, the procurement process is very long. You must have much money in the bank so you can be around long enough to get a contract. “I am convinced that the government is missing out on solutions. From my perspective, I see many technologies and concepts that the government could use that would give them a significant advantage, 30 | MMT 15.5
but companies find that putting it in front of them will require so much effort, they don’t do it. It is easier for us, for instance, to expand to other commercial sectors,” Jeannot said. Michael J. Luby, co-founder and CEO of Ellumen, a Virginia-based health IT provider, agrees. “It’s challenging to compete with the mid- and large-sized companies in this space because potential customers might not recognize that for a specific project or task the small business may offer a better value and probably has similar ‘bandwidth.’ Large companies in our industry don’t have a lot of excess talent sitting on the bench and might offer little depth advantages, particularly in specialized areas like clinical systems integration. “Access to the right contract vehicles and ‘feet on the street’ to access the right people and information is also challenging,” Luby said. Ellumen developed the operational health information exchange (called the Bidirectional Health Information Exchange, BHIE) for DoD and VA. The company has worked with DoD and VA to develop enterprise-level solutions that enable secure data access and sharing in real-time. Ellumen was recently featured on the Washington Technology “Fast 50” list of growing IT companies in 2010. “Whether a mature business or a micro business, we are looking at how to reduce the barriers for both,” said Andre Gudger, director of the Department of Defense’s Office of Small Business Programs. “How we can make things easier? Most small companies are afraid of DoD—it is an organization that is hard to understand with acronyms and layers.” Gudger said his office recently crafted a new policy that directs all contracting officers across the services to use market research as they plan acquisitions. “We want them to look at where small businesses can participate where they aren’t participating, and what they can do that they aren’t currently doing.” DoD views small business, said Gudger, as key to increasing the competition of the defense sector’s industrial base, and for the small business sector’s flexibility, innovation and responsiveness—characteristics that are more difficult for large corporations to exhibit. Gudger’s office recently piloted an analysis tool with the Navy that can be used by all services to identify opportunities for increased small business participation. This analytical model, called the Maximum
Practicable (MaxPrac) Opportunity Process Model, helps identify maximum practicable small business opportunities and allows DoD to evaluate procurements based on the maximum benefit and improvement in small business achievements. Using NAICS codes, the tool serves as a leading indicator for procurement officials to identify where opportunities exist for small business. Also, Gudger’s office has commissioned a study by Rand to look at barriers to “new entrance” to the Department of Defense. “We are going to take some actionable items to lower that barrier” said Gudger. “We are serious about it.” DoD sponsors a mentor-protégé program that provides funds for large companies to mentor microbusinesses on issues like accounting systems, security clearances, proposals, and other issues of small business specific to government contracting. A participant in the mentorprotégé program, Randy Rippin, president of Maryland-based RTR Technologies, suggests that small businesses looking to break into the federal marketplace should take advantage of all programs geared toward helping small businesses win federal procurements. That strategy worked for Rippin, whose business has grown to 38 employees from three, with a lot of help from others, he said. RTR Technologies develops operations research models and analyses for workload allocation, technology, budget, business performance management, and decision support. The company started working with the federal government in 2003 as a subcontract to ManTech in support of NAVAIR. “Take advantage of all the programs out there. There’s lots of help out there. Everyone understands that small business is the engine. That’s why they make that help available,” Rippin said. “There are a lot of good primes out there who really support you. If you are a small disadvantaged business, set up a mentor-protégé relationship; they get paid and you get help establishing your marketing, business development, contractual and security clearance systems.” Rippin also said that a good deal of assistance came to him from his local economic development office in Maryland. “The local small business incubator program was very important to us. Here we were, three technical guys who needed help with the non-technical aspects of the business. Through the incubator, we had www.MMT-kmi.com
access to experts in law that taught us about intellectual property, an expert in the Federal Acquisition Regulation (FAR), who helped us set up an accounting system, we got training for employees through grant programs, and we also got early dollars to develop marketing and sales strategies,” Rippin said. In addition to providing local programs to help small businesses grow, the Small Business Administration (SBA) monitors federal agencies’ compliance with small business regulations and goals. Each year, the SBA evaluates the agency’s performance against its goals and issues it a letter grade and scorecard. In 2010, federal agencies awarded $97.95 billion in contracts to small businesses. This represents 22.7 percent of eligible contracting dollars and a small increase over the previous year’s rate of 21.9 percent. Its annual goal is 23 percent. “I certainly believe that small businesses have a lot to add,” said Leney. “They provide innovation, and we get
the very best they have on every project. Failure has a bigger impact on small businesses so small businesses pay a lot of attention and that is a good thing for VA.”
Additional resources for small businesses
The Defense Logistics Agency, on behalf of the Secretary of Defense, administers the DoD Procurement Technical Assistance Program (PTAP). PTA centers are a local resource available at no or nominal cost that can provide assistance to business firms in marketing products and services to the federal, state and local governments: www.dla.mil/db/procurem.htm Department of Defense Office of Small Business Programs: www.acq.osd.mil/osbp/ index.shtml The Department of Defense Regional Councils for Small Business Education and Advocacy are a nationwide network of small business specialists organized to promote the National Small Business Programs of
the United States: www.acq.osd.mil/osbp/ sb/initiatives/councils/index.shtml The Department of Defense SBIR and STTR programs fund a billion dollars each year in early-stage R&D projects at small technology companies—projects that serve a DoD need and have commercial applications: www.acq.osd.mil/osbp/sbir/ Defense Federal Acquisition Regulation Supplement and Procedures, Guidance, and Information: www.acq.osd.mil/dpap/ dars/dfarspgi/current/index.html Mentor-Protégé Program: Since 1991, the Department of Defense Mentor-Protégé Program has offered substantial assistance to small disadvantaged businesses. Helping them to expand the overall base of their marketplace participation has produced more jobs and increased national income: www.acq.osd.mil/osbp/mentor_protege/ O
For more information, contact MMT Editor Brian O’Shea at briano@kmimediagroup.com or search our online archives for related stories at www.MMT-kmi.com.
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MMT 15.5 | 31
Drug Discovery
at Walter Reed Army Institute of Research WRAIR scientists are engaged in developing antiparasitic drugs to help treat C utaneous leishmaniasis . By Lt. Col. Mark Hickman, Capt. J.R. Managbanag and Col. Max Grogl reservoirs such as rodents and dogs. There are no vaccines or Cutaneous leishmaniasis is a skin infection that afflicts chemoprophylactic drugs to prevent leishmaniasis, and there approximately 12 million people worldwide in 98 countries on are no drugs approved by the FDA for treatment. five continents, with as many as 2 million estiCutaneous leishmaniasis has afflicted an mated new cases emerging each year. Most cases unknown number of U.S. military members staof leishmaniasis are caused by the transmission tioned in Iraq and Afghanistan. Exact numbers of parasites from the bite of infected sand flies. are not available for a variety of reasons: the Human infection is caused by 21 of 30 Leishmadisease was not parasitologically confirmed, clininia species that infect mammals. It is mostly an cally suspicious cases are usually not reported, endemic disease with epidemic outbreaks occurmost cases are noted from passive case detection ring in both sedentary and mobile populations versus an active process, soldiers won’t come (military personnel, refugees, travelers). Cutaforward as they don’t want to leave their unit, neous leishmania transmission concentrates in and elite units such as the special forces treat so-called “hot spots” in the field that are imposLt Col. Mark Hickman themselves and their infection data is difficult sible to predict, with infection rates of up to 100 to capture. At the Walter Reed Army Institute percent in humans. Cutaneous leishmaniasis of Research (WRAIR) Leishmaniasis Diagnostic is probably the “most neglected of neglected Laboratory, more than 2,832 U.S. members of the diseases” due to the fact that it does not result in armed forces have been diagnosed with cutaneous death; however, the true socioeconomic impact leishmaniasis from April 2003 to April 2011. Of of cutaneous leishmaniasis cannot be quantithe OIF/OEF cases, about 850 were evacuated to fied. Severe disfigurement, disability, and social/ CONUS at a cost of $35,000 and 60-90 lost duty psychological stigma often results from cutanedays per servicemember infected. The treatment ous leishmaniasis infections. In addition, there time specified from the MEDCOM Guidance for is a potential for latent infections primarily from the Management of Cutaneous Leishmaniasis Leishmania infantum, a visceral disease that (November 2010) is 10-20 days for each event could appear later in life as an opportunistic Col. Max Grogl plus follow-up. The impact on individual and unit infection in immunocompromised individuals. morale is hard to quantify but not insignificant. Cutaneous leishmaniasis prevention is limited Soldiers with large ulcerative lesions caused by a parasite have to personal protective measures such as insect repellent, bed a demoralizing effect on other troops who fear the infection nets, portable tent air conditioners, and control of disease
32 | MMT 15.5
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they may acquire. U.S. forces must be able to protect themselves, allied/coalition forces, DoD civilians and DoD contractors against infectious disease threats during deployments, sustainment operations and redeployments, especially to tropical and subtropical regions of the world where leishmaniasis is endemic. The U.S. military will no doubt be involved in leishmania endemic areas in the USCENTCOM, USAFRICOM and USSOUTHCOM areas of responsibility for the foreseeable future. The Walter Reed Army Institute of Research (WRAIR) is a DoD-administered biomedical research organization that is tasked with delivering lifesaving products that sustain the combat effectiveness of soldiers. The Experimental Therapeutics Division of WRAIR has been engaged in antiparasitic drug discovery and development research since 1965. WRAIR scientists are engaged in developing antiparasitic drugs for malaria prophylaxis and also for treatment of cutaneous leishmaniasis. WRAIR and our associated research partners have the only complete bench to bedside drug discovery and development program for cutaneous leishmaniasis. This therapeutic area is generally not interesting to a pharmaceutical company as developing drugs for neglected diseases is not profitable. This DoD research effort is necessary to provide the impetus to develop a drug to the point where a pharmaceutical company can take over the final FDA approval process and production of a drug. The Leishmaniasis program, which is part of the Military Infectious Disease Program (MIDRP), is vertically integrated with full-spectrum capabilities that include basic science, drug discovery and development, pre-clinical optimization, and clinical trials expertise for early Phase 1 testing of drugs for safety up to Phase 4 studies conducted after a drug is first put on market. The program particularly excels at “translational research” to discover and move a new product from the technology base to a level where a commercial partner will take the product on to licensure and marketing to the U.S. military and civilians. Some recent successful products developed by the program include: a Cepheid SmartCycler PCR assay which has recently received FDA 510(k) approval, a disposable point-of-care dipstick test for infection (transitioned to InBios International Inc.), a skin antigen test to
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detect delayed-type hypersensitivity to Leishmania, (transitioned to Allermed Laboratories Inc.) and WR279,396, a new topical formulation for the treatment of uncomplicated cutaneous leishmaniasis, (manufactured under contract by Teva Pharmaceutical Industries Ltd.) which is currently in a large scale, multicenter Phase 3 clinical trial in Tunisia. As the spectrum of cutaneous disease caused by Leishmania parasites is extremely broad and diverse, clinicians need a full array of therapeutic options. Today, the largest gap in the treatment of cutaneous leishmaniasis is the lack of an oral drug for complicated cutaneous leishmaniasis that is safe, effective against all forms of cutaneous leishmaniasis, has superior cosmetic results, is available at low-cost and is adaptable for use in rural areas. Anti-parasitic drug discovery and development at WRAIR is an essential element in providing FDA-licensed drugs for soldiers who are infected with tropical diseases not present in the U.S. Cutaneous leishmaniasis is a neglected disease which merits drug discovery and development where pharmaceutical companies are likely not willing on their own to pursue. O Lt. Col. Mark Hickman, Chief, In Vitro Screening, Experimental Therapeutics Division, Walter Reed Army Institute of Research, Capt. J.R. Managbanag, Chief, Leishmania Diagnostic Research, Experimental Therapeutics Division, Walter Reed Army Institute of Research, Col. Max Grogl, Division Director, Experimental Therapeutics Division, Walter Reed Army Institute of Research This report was supported by the United States Army Medical Research and Materiel Command. The opinions or assertions contained herein are the private views of the author and are not to be construed as official, or as reflecting true views of the Department of the Army or the Department of Defense. For more information, contact MMT Editor Brian O’Shea at briano@kmimediagroup.com or search our online archives for related stories at www.MMT-kmi.com.
MMT 15.5 | 33
NEXTISSUE Dedicated to the Military Medical & VA Community
October 2011 Vol. 15, Issue 6
Cover and In-Depth Interview with:
Brig. Gen. Joseph Caravalho Commander Northern Regional Medical Command
Command Profile
An overview, history and look ahead at the DLA Troop Support’s Medical Supply Chain from Director Col. Earle Smith II.
Special Section Annual Shelters Capabilities Review
CBRN SPECIAL SECTION Cover Q&A: Col. Vance Visser, Commander of Army CBRN School CBRN Features: • Radiation Response • Chem/Bio Unmanned and Manned Vehicle Detection Systems
A side-by-side comparison (chart) of shelters developed by various industry leaders based upon the requirements at the Natick Soldier Lab.
Features
VA Yellow Ribbon Program
An overview detailing the Veterans Affairs Yellow Ribbon Program by Keith M. Wilson, director of education service at the Department of Veterans Affairs.
Force Health Protection
An overview of specific programs geared toward soldier fitness working with the office of Force Health Protection and Readiness.
Aeromedical Evacuation
An in-depth look at the challenges faced by evacuating warfighters via airborne vehicles with feedback provided by the Air Mobility Command.
Renewable Energy and Water Management
The Department of Veterans Affairs’ Energy and Water Management Program focuses on a variety of aspects that help VA facilities become more energy efficient and sustainable.
Insertion Order Deadline: September 13, 2011 • Ad Materials Deadline: September 20, 2011
Advertisers Index Agilent Technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C4 www.agilent.com/chem/5975t_informationkit Cera Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 www.ceraproductsinc.com Combat Medical Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 www.combatmedicalsystems.com HDT Global . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 www.hdtglobal.com Idaho Technology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 www.razorex.info Joint Forces Pharmacy Seminar. . . . . . . . . . . . . . . . . . . . . . . . . . 31 www.jfpsinfo.org Laerdal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 www.laerdal.com LiteCure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C2 www.litecure.com Nova Southeastern University. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 www.medicine.nova.edu/msbi Oridion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 www.oridion.com Pelican-Hardigg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C3 www.pelican.com/mmt Philips Healthcare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 www.philips.com/government RDT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 www.rdtltd.com Skedco. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 www.skedco.com Zoll Medical Corporation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 www.zoll.com/propaqm
For more than 50 years, healthcare providers and educators have trusted Laerdal to offer products, services and solutions that help improve patient outcomes and survivability. By supporting the advancement of resuscitation science, improving medical education and strengthening the chain of survival in communities worldwide, we help you save more lives.
www.laerdal.com Calendar August 15-18, 2011 ATACCC Fort Lauderdale, Fla. www.ataccc.org August 15-18, 2011 National Veteran Small Business Conference and Expo New Orleans, La. www.nationalveteransconference.com
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Š2011 Laerdal Medical. All rights reserved. #11-11030
The advertisers index is provided as a service to our readers. KMI cannot be held responsible for discrepancies due to last-minute changes or alterations.
MM T CALEND A R & DI REC TO RY
9/16/10 9:36 AM
MMT  15.5 | 35
Industry Interview
Military Medical/CBRN Technology
Peter Cempellin President/CEO CAE Healthcare
Q: Can you give me a brief profile of CAE Healthcare? A: We are very much an international company, and the CEO and board of directors thought we had a lot of core expertise in simulation that we could apply to other fields such as medicine. In the context of health care and how health care training is delivered to surgeons, nurses and allied health professionals, it is still largely based on the old style apprenticeship model and some of the things that they’re doing in terms of surgery and trauma treatment are high risk procedures that can be done incorrectly. It isn’t often the case that they have the opportunity to practice some of these procedures that may contain complications, etc., so simulation had a very significant impact on improving training quality and training proficiency of health care professionals to create difficult and sometimes infrequently encountered complications that enable health care workers to learn how to overcome some of the dangerous situations in providing care to patients. It seemed like the track record we had established with aviation was sort of a natural extension into health care. Q: How do your company’s health care simulation products specifically benefit the military? A: Some of these solutions may be used by military medical institutions or veterans administration hospitals. In the case of military for trauma treatment for a battlefield situation, you need to give instruction to those first responders. This is where Caesar really helps; in fact, it was specifically designed for this application. It enables training around the procedures that normally need to be applied to a person injured on the battlefield in the first few minutes, which can be lifesaving if done properly. It is designed to support several training scenarios. 36 | MMT 15.5
off the side of a truck. You name it; the other simulators aren’t capable of this. Basically you can’t train outdoors. All the training today I think has to be done indoors, where Caesar has the ability to provide training in the field. Q: What are some of the challenges in engaging in business with the military?
Q: How do you determine the needs of the military and then translate that into a product? A: We work largely with an organization called 68 Whiskey, which is a military first aid training organization, so they helped us to find some of the requirements for this. We also assembled a physicians advisory board of about 14 emergency medicine physicians, who not only helped us find the original requirements but we worked with them consistently throughout the entire design process and development cycle to provide feedback and support of the necessary features and functionality for the product. Q: How do your health care simulation products that are geared toward the military stand out in the marketplace? A: In the case of Caesar, it has the added capabilities I just commented on, but the other nice feature about this product is it is unique in its durability. It’s specifically designed to be able to take the beating that the military training environment requires. Simulators of this kind produced by our competition generally cannot be used in real battlefield training scenarios. Caesar was specifically designed in the way that it is waterresistant; it can operate in extremes of temperature and an outdoor environment such as a jungle or desert. It can be dragged around in the dirt or thrown
A: I think the biggest challenge, and this is true for many products, is the procurement cycle and the time it takes in order to secure ongoing sales with the government. I think they recognize clearly the capabilities of the product and they’re very interested, but we have to go through all that procurement process, which can be very time-consuming. Q: Can you give us some examples of goals that CAE Healthcare has for this year? A: This year we’re going to be growing substantially compared to last year. We’re looking at 100 percent growth in revenue. In the case of military sales we feel there’s great potential for Caesar and I wouldn’t be surprised if we were able sell upwards of 50 units before our fiscal year concludes in March. We’re focused not only on the U.S. military market, but also foreign nations, and have already secured Caesar in countries such as Singapore, Malaysia and parts of Western Europe. I think what’s unique about CAE Healthcare is we have a very large engineering team and the resources to do innovative designs, so we come to this space as a new player, but not new in the sense of our understanding of how to design products and incorporate simulation into training. We have created high-end products for the market that we feel is really needed thus far, and the market’s response has been very positive. We’ve generated a lot of excitement around Caesar and we think it’s a winner and going to be a success. O www.MMT-kmi.com
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Sometimes the most important life, health, and safety decisions have to be made in the field. That’s why you need the Agilent 5975T LTM GC/MSD – the industry’s first transportable GC/MS system that delivers lab-quality analysis Perform lab-quality analysis in the field Now you can make important decisions in the field with confidence. The Agilent 5975T Low Thermal Mass (LTM) GC/MSD delivers the same reliability and performance as our high-end Agilent 5975C Series GC/MSD – at less than two-thirds the size. • Fast analysis and results. Uses advanced heating and cooling technology. • Safer transport. Anti-vibration base and solid mechanical structure meets highest standard for ruggedness. • Lower equipment costs. Equally suitable for in-lab and mobile analysis. Download your FREE 5975T information kit or request a quote at www.agilent.com/chem/5975T_InformationKit
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