Dr. Edward Martin Acting Assistant Secretary of Defense for Health Affairs Dr. Edward Martin serves as the Acting Assistant Secretary of Defense for Health Affairs and as the Principal Advisor to the Assistant Secretary of Defense (Health Affairs). In the latter position, held since December 1992, Dr. Martin has been responsible for providing day-to-day executive management and oversight for all DoD health policies, programs and activities within the Military Health System (MHS). This is his second term as ASD (HA), his previous term running from January 1993 until March 1994. His arrival at the Pentagon was the result of 15 years of experience in positions such as the Public Health Service and the Department of Health and Human Services. He was commissioned in the Public Health Service in May of 1975 and currently holds the rank of Rear Admiral. Though he will be retiring this year, he agreed to discuss his vision and his legacy in an interview with MMT's Eleni Kavros.

A. Digitization of Radiology: Medical Diagnostic Imaging Support (MDIS)-exploits teleradiology techniques in combination with a Picture Archive and Communications System (PACS) to increase the amount of information captured from radiographs.
Life Support for Trauma and Transport (LSTAT): A compact, transportable, individualized medical care unit, featuring a suite of integrated state-of-thc-art treatment and diagnostic technologies. The LSTAT provides a means of projecting sophisticated trauma care forward towards the site of injury. This will increase survivability rates by reducing the time to delivery of life-saving definitive care.
Advanced Surgical Suite for Trauma Care (ASSTC)/ Multipurpose Health Services Facility (MHSFP): Developed in order to bring an emergency surgeon supported by a necessary staff and facility as close as possible to the site of injuries for aggressive life saving and casualty stabilization. Can be moved in a V-22, slingloaded and/or trailer moved.
Medical Personal Information Carrier (PIC): Issued to each serviceman and woman, will contain vital information about their health status. In a deployed situation, for example, health care providers may access this information, render appropriate treatment and record it directly to the PIC.
Computerized Patient Record: A platform-independent medical record system that will ensure immediate continuity, distribution and accessibility of medical information from the forward battlefield to the rear-echelon support in United States-based medical centers. The information will be archived in multimedia databases and be available over a worldwide telecommunications system for real-time, interactive collaboration among physicians.
Personnel Status Monitor: A wearable biomedical device that combines processing functions with micro-electro-mechanical systems. Each soldier could wear a thin belt-like band that could measure such parameters as temperature, heart rate, breath-mg rate and mean arterial blood pressure. The command unit for this would be able to tell if the individual was dead or alive and give details of their physiological state.

Q. What are the top three automation priorities for the Military Health System? How long will it take to implement them?

A. My top three automation priorities for the Military Health System are a Computer-based Patient Record (CPR), a Preventive Health/Immunization Tracking system and a Personal Information Carrier (PIC).
Patient records in the Department of Defense (DoD) military health system are currently paper-based. The Department is developing a longitudinal, comprehensive, CPR that will document the health status of each eligible beneficiary and the healthcare received. Ultimately, the CPR will completely replace the current paper record and will offer new capabilities that will improve the quality of care rendered by healthcare providers and enable the rapid transfer of clinically relevant data between and among providers.
Efforts to build a healthy community, to deliver a healthy and fit force and to manage the health of a population will be facilitated by the Preventive healthcare System (PHCS). The PHCS will allow providers to deliver, track and report appropriate and timely delivery of clinical preventive services.
An interim version of immunization tracking is being deployed by the Services now to support the anthrax program. Data from the immunization-tracking module will provide the immunization elements of the CPR.
The Personal Information Carrier (PIC) leverages promising technology to overcome the challenge of imperfect medical record keeping and documentation, especially during deployments. The PIC is a small, rugged, tag-like device that will be the primary repository of medical force-protection data to include individual readi-ness data, deployable status, casualty prevention training, medical history, problem list and demographic information. The device will be carried by service members and updated by medical personnel whenever the service member is examined or treated.

Q. Because funding has been increasingly more difficult to acquire over recent years, specifically for the DoD, what do you think will happen to the military medical technology budget? How will that outcome affect technolog-ical advances such as telemedicine?

A. I expect the military medical tech-nology budget to remain fairly constant in future years. In January 1997, Health Affairs established a set of mission essential goals the Military Health System (MHS) must reach prior to the close of this century in order to accomplish the DoD health mission. Since then, the MHS lnformation Management (IM) community has assessed where the currently are in relation to these goals and specifically what remains to be done. Military Health System Information Management/Information Technology (IM/IT) oversight and management committees have approved the resulting MHS IM/IT Mission Essential Require-ments (MER) and related funding recommendations.

Q. The Corporate Executive Information System (CEIS) has been labeled as the foundation for your healthcare information man-agement strategy. what is the sta-tus of GElS and what role will it play in some of your latest projects?

A. The Corporate Executive Information System (GElS) is a joint Service and Health Affairs initiative. It is an enterprise system that will provide decision-makers at all levels of the MHS with a suite of decision support analytical tools and other capabilities, needed to support TRIGABE and Readiness. It is an investment in our ability to mect future business demands and it is essential for the success of Enrollment Based Capitation.
CEIS is providing decision-makers with analytical and trending capabilities using patient-level and aggregated data extracted and integrated from population, workload and costing source data collection Systems such as the Defense Enrollment Eligibility System (DEERS), Medical Expense and Performance Reporting System (MEPRS) and Composite healthcare System (CHCS).
Work to date has focused on the needs ofthe Medical Treatment Facilities and the TRICARE Regions. The next stage begins with the building and fielding of the Enterprise Data Warehouse (EDW), which will directly support all levels of the MHS.

The ASSTC/MHSFP will help bring an emergency facility with medical support staff as close as possible to the site of injuries.

Q. The Theater Medical Infor-mation Program is one of five key business areas in the military medical vision. How will TMTP fit into the overall MHS architecture?

A. TMIP is our key effort in bringing medical information systems and infrastructure to the deployed forces. TMIP is assisting in the development of our Defense Information Infrastructure (DII) Common Operating Environment architecture by building in the foundation of Windows NT. TMIP is responsible for integrating the other business areas into an interoperable system that ties the theater operational area of responsibility to the sustainment base. TMIP has the additional challenge of providing the architecture that works through the use of the Services' deployed architecture using the Global Combat Support System and Global Command and Control System.

Integral to the evacuation process, medical helicopters such as this will be used for emergency evacuation in conjunction with the latest medical technologies such as the LSTAT and the ASSTG.

Q. How do the AKAMAI and PACMEDNET (Pacific Medical Network) projects address the issues of the electronic patient record and deployable telemedicine? Where are the projects headed?

A. The Pacific Medical Network (PACMEDNET) and the AKAMAI Telemedicine Project are distinct though complimentary efforts. PACMEDNET focuses on creating information sharing between and among heterogeneous databases as well as identifying the location of the information unique to each patient. Through creation of an interface engine, PACM EDNET has successfully shared information between multiple Composite healthcare System sites and the Department of Veteran's Affairs Vista System (formerly Defense healthcare Program). Through creation of a Master Subject Index (MSI ), the project has provided electronic pointers to patient intormation through use of a Master Patient Locator. To insure appropriate protection of patient information the MSI also tracks provider access privileges to virtual data through the Master Provider Index.
The AKAMAI project enhances the healthcare delivery system and improves military readiness in the Pacific Basin Region by projecting the medical specialty expertise of Tripler Regional Medical Center and other regional hubs to remote sites though the use of medical technologies and telecommunications capabilities. This is accomplished by investigating clinically relevant applications of emerging telemedicine related products, technologies and services.
Further, the Project has a major effort to evaluate telemedicine's impact on the healthcare delivery system and military readiness. This includes clinical outcomes, organizational impact, human factors behavior, cost benefit analysis and patient and physician satisfaction.

Q. Many supporters of telemedicine are beginning to wonder if telemedicine should be controlled by one federal agency. Is ASD (HA) looking to be the agency to lead the nation's telemedicine efforts?

A. DoD wants to take the lead in Battlefield Telemedicine.

Q. The military medical com-munity has been hearing rumors that you plan to retire this spring. What enduring legacy will you leave to OSD (HA) and the MHS as a whole?

A. The Information Management/ Information Technology Program Evolution.
Working in concert with the Surgeons General, the Military Health System (MHS) Strategic Principles were developed to provide a universal foundation for creation of the Information Management/Information Technology (IM/IT) Program. A committee of senior executives representing the Secretary of Defense and the Military Departments was formed to provide a focused and unified information management policy for the execution of the program in support of the mission of Health Affairs and the MHS. This committee aligned the program with National Security Objectives, goals of the National Command Authority and directions of Congressional and industry leaders. The IM/IT Program was framed to meet the new challenges of supporting not only the critical Medical Readiness mission of the Department, but also the formidable task of providing day-to-day healthcare to the beneficiaries of the MHS in its evolving managed care environment. The program was designed to ensure that the right information was provided to the right people at the right time to improve and maintain health status across the entire continuum of healthcare operations.
The evolution of the IM/IT Program has witnessed many profound changes. The relationship of OSD and the Services has been restructured and the roles of the Army, Navy and Air Force Surgeons General enhanced and expanded. As a result, the MHS information management landscape has been permanently changed. The IM/IT Program can claim many successes resulting from its evolution. One of the more important ones is the radically reengineered business process of the Defense Medical Logistics Standard Support Program to adopt just-in-time inventory concepts, electronic commerce, universal product numbers and best price determination. Through implementation of the Prime Vendor Program, Health Affairs has become a leader in DoD and industry in the implementation of Electronic Commerce/Electronic Data Interchange. The strengths of the TM/IT Program foundation have been tested though the requirement to evaluate and implement cutting-edge technology in the MHS.

Force protection is at the top of the list for OSD (HA). Troops such as ones pictured here will soon be receiving immunizations against biological agents such as anthrax.