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Doctors Engage Trauma as Battlefield Enemy

Health professionals go to war against injuries and use data-driven command and control as their weapon.

Joint all-domain command and control, or JADC2, includes combatants’ health.

“If a service member is shot on the battlefield and they’re losing blood, someone has to provide very urgent care for that trauma. How does the next higher echelon of care know if the patient had a blood transfusion during patient movement or medical evacuation?” asked Holly Joers, program executive officer for Defense Healthcare Management Systems.

In the past, that patient depended on people delivering these reports accurately on paper or verbally. Both methods are inadequate in complicated field scenarios where practitioners or physical records can become unavailable in seconds, and answering questions accurately could mean the difference between life and death.

Much is involved in moving a service member from combat to a medical facility, and many professionals are engaged in treating that person. The decision-making chain may be long and requires precise steps.

“From the point that someone gets injured, when they’re in a polluted environment ... all the way from patient movement, from when they get back to maybe a forward operating base, where they have to be seen or maybe evacuated, to a higher level of care,” Joers laid out.

The health status of forces operating in contact with the enemy helps commanders understand how combat is unfolding, but there’s also a second part that will be a key component as the service member recovers.

“If you’re a clinician or a health care provider, it’s all about getting the necessary data to drive health care treatment decisions,” said Justin Hodges, integrated product team lead, cybersecurity service provider, Naval Information Warfare Center–Atlantic.

Part of decision-making on a battlefield includes choosing the best treatment option for a service member in need. And military thinking also fits this pattern for a field health practitioner.

For Hodges, health is another battlespace, and it shares attributes with, for example, kinetic contests among forces. The difference is that in the field of health, a physician’s enemy is trauma.

“The more you are in control and driving the chain of events occurring within whatever battlespace domain that the contest is occurring, you will be successful if the adversary can observe, orient, decide and act faster than they can,” Hodges explained. “So what JADC2 really is about is not just the communications piece, but it’s the observation, orientation, decision and then acting in enabling joint force commanders—not just the actual combatant commander—the four stars themselves. It’s anyone who’s operating in the team.”

In Hodges’ view, health integration is another part of the fight against an adversary. In this case, health care providers have to obtain the information they need, understand it, select a course of action and implement it as fast as possible. And like in any combat situation, to increase the chances of survival of an injured service member, health professionals need to have appropriate access to knowledge and resources.

“First and foremost, we need to make sure that we are not thinking about medical and health capabilities in a silo, rather, they are part of the overall integrated picture for operations,” Joers explained.

Integration into the larger Department of Defense data mesh also serves a purpose in peacetime for the warfighter and their families.

Integrating all operations with a network-centric system in contested environments means that disrupting health data, despite its humanitarian use, is part of an adversary’s arsenal. Furthermore, this information can be targeted to cause serious problems on the battlefield and complicate logistics. For these reasons, health data is another critical component of JADC2.

And this network demands a resiliency standard that becomes vital under critical conditions.

“Within the regular communication, electromagnetic spectrum, if someone can disrupt the flow of information to the battlefield commanders, they can inhibit decision-making ability,” Hodges explained.

The COVID-19 vaccine this soldier receives in a military facility will be part of her digital medical record and visible to providers around the world through a single service. Credit: Jacob Lund/Shutterstock
The COVID-19 vaccine this soldier receives in a military facility will be part of her digital medical record and visible to providers around the world through a single service. Credit: Jacob Lund/Shutterstock

Therefore, health data needs to be treated with the same care as other tactical or strategic information.

“We have to be able to operate in a standalone, disconnected environment because you may or may not be able to have bandwidth for network connectivity, and so then, we are thinking about ways to transmit data captured while operating in a standalone, disconnected environment,” Joers said.

As devices gather data, the information will ultimately be relayed to treatment centers. And this flow must be protected and compliant with other military information.

“We need to make sure that we are protecting operational medicine data, so we have what we call the Operational Medicine Data Service, which is a backbone or highway to ultimately connect operational medicine data back into MHS GENESIS for the long haul,” Joers said. (See sidebar.)

While on a battlefield, digitized medical records help doctors decide which treatments to administer, it also creates a record that will accompany the service member throughout the recovery cycle. “[It shows] what has happened to a service member as they are deployed and is able to bring that back as part of their continuum of care for their long-term health,” Joers said.

One of the pillars of this effort is readiness. “Providing health care, both preventative and reactive health care to the warfighter and to their beneficiaries, so that those warfighters are willing and able, medically speaking, to go defend the nation at a moment’s notice,” Hodges said.

An effective health fighting force doubles as a readiness element in peacetime and is a part of the war machinery that will allow warfighters to concentrate on their immediate job: defeating an adversary.

Military Health System: MHS GENESIS

The Military Health System’s new electronic health record system, MHS GENESIS, replaces the Department of Defense’s (DoD’s) current systems and consolidates clinical workflows for patients and providers.

The initiative to make records available in forward operations also serves the rear and military families under DoD care.
“MHS GENESIS is 81% deployed throughout the Military Health System,” said Holly Joers, program executive officer for the Defense Healthcare Management Systems.

As a global provider of health care for service members and their families, covering the continental United States, or CONUS, is only a part of the mission.

“We have one major wave of deployments to finish out the CONUS, so the continental United States this June, and then we will be moving to overseas and deploying in the Europe and Pacific areas this fall,” Joers said.
Global deployment will only be the beginning. This system will receive data from millions of patients, eventually including veterans, and this will create other opportunities.

“MHS GENESIS and MHS Information Platform gives us copious amounts of data that we have not been able to necessarily leverage previously,” Joers said. “Now we are unleashing the power of that data.”

Up to this point, there are about 3.5 petabytes of data, according to Joers, and more to come once all providers and patients continue their contributions. Data digestion will demand artificial intelligence models to optimize processes.

The final version is expected to include decision support and predictive analytics, according to Joers. A practitioner will be able to prescribe medicines and even check local stocks on a base in Korea or an outpost in the Persian Gulf.