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CHIPS Articles: Information Dominance for Navy Medicine Decision Makers

Information Dominance for Navy Medicine Decision Makers
Space and Naval Warfare Systems Center Atlantic delivers innovative capabilities in an NMKMS architecture
By Holly Quick - April-June 2010
Sponsored by the Office of the Chief of Naval Operations, Medical Resources, Plans and Policy Division (OPNAV N931), the Navy Medicine Knowledge Management System (NMKMS) began as a research and development project to: address high-value capability gaps in current Joint Electronic Health Record capabilities; assess the value of data warehousing techniques for data storage and retrieval; and design an open architecture that could be leveraged by multiple sources with ease of integration.

The goal of NMKMS is to collect the highest quality of casualty care data in an operational setting with the minimum amount of disruption to the healthcare providers. Rather than simply exchanging data files, Navy Medicine requires interoperable applications that not only share data, but also leverage computing and storage resources.

What is NMKMS?
NMKMS is a data warehouse capability for the collection, standardization, storage and servicing of operational medical data of interest and value to Navy Medicine.

Data Collection
NMKMS accepts multiple data sources, including Armed Forces Health Longitudinal Technology Application – Theater (AHLTA-T) encounters; Shipboard Non-tactical Automated Data Processing (SNAP) Automated Medical System (SAMS) 8 and 9 environmental, logistical and medical encounters; and Theater Medical Information Program (TMIP) Composite Health Care System (CHCS) Cache (TC2) medical encounters. The encounters are transferred through either the TMIP Framework or SAMS Communicator in an encrypted manner to a centralized NMKMS data collection and storage instance (see Figure 1).

Data Standardization
At point of entry into NMKMS, the data is parsed and each individual data element is compared to the business rules governing that data element. These business rules allow NMKMS to reduce the "apples," "oranges" and "peaches" to "apples" so the reporting is performed using the standardized data. This apples-to-apples approach accounts for differences in data such as numeric code, capital letters and lowercase letters, and converts data to a standard format that can be used for query and reporting purposes.

Data Storage
Once the data has passed all validation tests and has been transformed according to the business rules, it is then stored in a data warehouse for optimal analysis and reporting.

"In the future, the NMKMS data warehouse is envisioned to serve as the collection point and data broker for all authoritative sources of Navy and Marine Corps operational medical data. NMKMS will then serve up properly normalized data marts that support critical applications and services to Navy Medicine decision makers, including the Navy Surgeon General and combatant command (COCOM) surgeons," said Claudia Kiefer, Space and Naval Warfare Systems Center (SPAWARSYSCEN) Atlantic project manager for NMKMS.

Data Servicing
NMKMS uses customized data marts that are specific to the reporting need. This prevents users from directly accessing the data warehouse, and helps to protect personally identifiable information. Additionally, these data marts allow for distributed networking of the enterprise components, abstract reporting from data storage, and allow the data model within NMKMS to evolve without breaking third party visualization tools.

Solving Business Problems and Creating Business Opportunities
SPAWARSYSCEN Atlantic employs agile software development and Lean Six Sigma methodologies within the overarching Department of Defense (DoD) Software Development Life Cycle (SDLC), using short iterations to break down larger goals. SPAWARSYSCEN Atlantic practices open and transparent communication with its partners and customers and believes in providing training and support in the adoption and implementation of best practices for agile software development and Lean Six Sigma methodologies.

Most recently, SPAWARSYSCEN Atlantic has been involved in extending the current NMKMS architecture to include new capabilities, such as the Naval Operational Requirements for Medical Manpower (NORMMan), Operational Workload Reporting (OWR) and Epidemic Outbreak Surveillance (EOS). Additionally, SPAWARSYSCEN Atlantic is pursuing new opportunities to extend NMKMS capabilities in support of a Joint Medical Distance Support and Evacuation (JMDSE) demonstration, and in the integration of Navy Medicine Online (NMO) and NMKMS.

Naval Operational Requirements for Medical Manpower
NORMMan is a medical manpower modeling and simulation capability that resides within the NMKMS architecture. The goal of the NORMMan application is to provide a scenario-driven, predictive model for Navy medical manpower requirements, based on occupational specialty.

NORMMan outputs are used as inputs in the overarching processing of medical staff planning. NORMMan receives data from the Total Force Manpower Management System (TFMMS), performs complex computations and produces manpower predictions.

TFMMS tracks more than 50,000 Navy medical billets distributed across approximately 300 medical occupational specialties. Essential to the NORMMan application is the algorithm that modifies and clusters these billets into occupational specialties and generates report data. While many billets cluster to obvious specialties, there are also special situations that must be accounted for, such as Navy policy, location-specific situations, education-based constraints and personnel availability issues.

The NORMMan application utilizes Drools, a business rule engine, which facilitates the clustering of algorithms and produces the NORMMan models.

The predictions supplied by NORMMan will be used by various organizations within the Navy to support formulation of the Future Years Defense Program (FYDP) for the Program Objective Memorandum/Program Review (POM/PR). These predictions are also used to support other medical manpower requirements organizations within the Navy to support formulation of the Future Years Defense Program (FYDP) for the Program Objective Memorandum/Program Review (POM/PR). These predictions are also used to support other medical manpower requirements analyses such as the Medical Readiness Review and Quadrennial Defense Review.

Operational Workload Reporting
The OWR capability that leverages the NMKMS data warehouse architecture provides Navy Medicine with information on the Navy and Marine Corps medical workload in operational theaters worldwide. To alleviate the cumbersome task of manually collecting, cleansing and collating monthly data from the multiple medical data sources, SPAWARSYSCEN Atlantic developed a Web-based OWR capability that displays medical workload data of Navy and Marine Corps deployed medical units.

Data from the Joint Medical Workstation (JMeWS) and the Theater Medical Data Store (TMDS) are uploaded into the application where data are dynamically analyzed to provide the user with a series of views of workload information by unit, unit type and COCOM over time.

OWR is currently servicing the Navy Surgeon General’s requirement for monthly reports on worldwide operational medical workload.

Epidemic Outbreak Surveillance
The EOS advanced concept technology demonstration (ACTD) was initiated to deliver a validated, integrated, operational biodefense system that accelerates command decisions and improves joint force sustainment.

The Epidemic Outbreak Surveillance ACTD’s system-of-systems approach enhances both biodefense operations and operational medicine through the integration of technology and data components that are needed to provide individual patient care on the front end while serving a higher public health/operational need, in real-time, on the back-end.

At the request of U.S. Joint Forces Command (USJFCOM), SPAWARSYSCEN Atlantic extended the NMKMS architecture and services to provide a data fusion capability for the EOS ACTD that would transform integrated data from existing medical health information systems into decision quality information.

An EOS-NMKMS test event was conducted to demonstrate an outbreak detection capability that met the EOS program goals using the NMKMS infrastructure.

The EOS-NMKMS test event was conducted to simulate a scenario involving influenza outbreaks on the USS Shoup (DDG 86) and USS Peleliu (LHA 5) over a three-day period. The demonstration utilized simulated patient encounter records that were created using AHLTA-T.

The records were imported into the load directory of NMKMS, simulating TMIP’s expeditionary framework. The demonstration record set contained data that would cause alerts to be activated on both ships. The records also contained data that would trigger the software to notify the local medical department that a reportable event had occurred.

The success of the EOS-NMKMS test event highlighted the value of a capability that provides for the near real-time environmental surveillance, detection and reporting of disease outbreak.

Joint Medical Distance Support and Evacuation
NMKMS is currently being evaluated for use as a platform to support the Joint Medical Distance Support and Evacuation (JMDSE) joint capability technology demonstration (JCTD). JMDSE will provide a virtual triage and remote patient monitoring and care capability.

The role of NMKMS in this demonstration would be to collect and integrate medical encounter data generated by forward deployed medical first responders, and deliver custom patient information displays to remote healthcare providers.

Integration of NMO and NMKMS
Navy Medicine Online currently serves as data broker for Navy Medicine, by collecting individual readiness information from legacy Navy Medicine data systems, such as SAMS, Dental Common Access System (DENCAS) and Navy Medical Board Online Tracking System (MEDBOLTS), and transmitting select information to the Medical Readiness Reporting System (MRRS) to support DoD Individual Medical Readiness (IMR) reporting, Defense Health Information Management System (DHIMS), Force Health Protection and other Navy systems.

Additionally, NMO hosts critical applications for specific Navy Medicine communities of interest. Originally built in the 1990s, NMO uses obsolete technology, and a stove-piped architecture that is costly to maintain.

SPAWARSYSCEN Atlantic is currently embarked in the planning phase to merge NMO and NMKMS capabilities into a common extensible data warehouse architecture that will service the current and future information needs of Navy Medicine.

The outcome of this merged NMO/NMKMS capability will support a reduction of computing and storage hardware, and provide a scalable, extensible solution that will meet the performance requirements of existing and future projects (see Figure 2).

The merger of NMO/NMKMS capabilities is aligned with Navy Medicine’s strategic goals and is expected to generate the following desired outcomes:
• Provide an enterprise-wide operational Navy Medicine data repository;
• Reduce duplication in Navy Medicine systems;
• Support current and future Navy and Military Health System (MHS) stakeholders;
• Provide data marts for specific stakeholders;
• Support receipt of additional medical data elements that are not currently captured via existing interfaces;
• Leverage existing Navy Medicine technology for data normalization, data warehousing and data marts; • Support customized reporting;
• Support future applications;
• Provide data curation, resulting in improved data quality; and
• Eliminate stove-piped systems and reduce hardware footprints.

In merging the NMO/NMKMS capabilities, SPAWARSYSCEN Atlantic will enable enhanced information sharing and knowledge management across Navy Medicine, and deliver an extensible data warehouse architecture that provides improved management of Navy Medicine information technology investments, and reduces duplication in Navy Medicine systems.

For more information about SPAWAR, go to To learn more about Navy Medicine, go to

Benefits of NMKMS
The capabilities of NMKMS offer great benefits to the field of Navy Medicine. These benefits include:
• Lower operating costs;
• Greater security over PII within the data through decreased exposure;
• Higher quality data from more disparate data sources;
• Greater accessibility to standardized data;
• Reduced application and development costs; and
• Near real-time reporting capabilities.

Holly Quick is a contributor to CHIPS and an operations research analyst with Space and Naval Warfare Systems Center Atlantic.

Figure 1. NMKMS supports aligned, centralized and operational Navy and Marine Corps data.
Figure 1. NMKMS supports aligned, centralized and operational Navy and Marine Corps data.

Figure 2. Merged NMO/NMKMS capability architecture.
Figure 2. Merged NMO/NMKMS capability architecture.
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