Originally Broadcast July 26, 2008

Arlington, VA

Announcer: Welcome to The Business of Government Hour, a conversation about management with a government executive who is changing the way government does business. The Business of Government Hour is produced by The IBM Center for The Business of Government, which was created in 1998 to encourage discussion and research into new approaches to improving government effectiveness. You can find out more about this center by visiting us on the web at businessofgovernment.org. And now The Business of Government Hour.

Mr. Morales: Good morning. I'm Albert Morales, your host and managing partner of The IBM Center for The Business of Government.

The provision of health services is a critical and significant mission within each branch of the U.S. military. Since its inception in the summer of 1949, the Air Force Medical Service has sought to provide its airmen and their families with first-rate healthcare and benefits anywhere and at any time. In support of deployed forces, the Air Force Medical Services also plays an essential role in a most effective joint casualty care and management system in military history, a system that has saved thousands of lives that otherwise would have been lost in the battlefield.

With us this morning to discuss the mission of the U.S. Air Force Medical Services is our very special guest, Lieutenant General James Roudebush, Surgeon General, U.S. Air Force.

Good morning, General.

LTG Roudebush: Good morning.

Mr. Morales: Also joining us in our conversation is Tom Romeo, IBM's general government industry leader. Good morning Tom.

Mr. Romeo: Good morning, Al.

Mr. Morales: General, many of our listeners will be familiar with the U.S. Air Force, but they may not be as familiar with the Air Force Medical Services. Could you share some history and a perspective with us? When was the Air Force Medical Services created? And can you describe for us its mission today, and how it supports the overall mission of the DOD?

LTG Roudebush: Well, thanks for the opportunity to be with you this morning. It really

is a pleasure to be able to share the story of the Air Force Medical Service. As you are probably aware, the Air Force itself was established in 1947, when it was recognized that having an independent entity that provided the capabilities of an Air Force were recognized and the United States Air Force was established. About a year and a half after that it was further recognized that to support this doctrinal capability of this United States Air Force, the medical support of that capability was indeed unique and required the dedicated capabilities of a medical service that supported that force in all the ways that it performed its mission.

So in July of 1949, the Air Force Medical Service was established. The principal activities within that very early Air Force Medical Service, no surprise, followed the doctrinal applications of the Air Force. Aerospace medicine was both an established and evolving specialty and capability that addressed the unique attributes of operating in the aerial environment and all the implications of that sort of mission.

In addition to that, the expeditionary nature of the Air Force and its ability to basically reach virtually any area on the globe within hours to a day at the most required the medical support that complimented that global reach capability. And the medical service needed to be supportive of that capability.

And lastly air medical evacuation had certainly proven its value during World War II. But as we began to operate in the far-reaching areas of the globe, it was recognized that the ability to bring our soldiers, sailors, airmen, and marines home safely, if in fact their health condition required it, was in fact a unique attribute of the United States Air Force, and the medical service clearly needed to be prepared and able to support that mission.

So as we established the Air Force Medical Service there were some unique attributes in support of the Air Force as well as supporting the day-to-day requirements of the active-duty force, and their families, and retirees as well. So that's the genesis of the Air Force Medical Service.

Mr. Morales: That's great. So as this organization has evolved over the past 60-some odd years. Can you give us a sense of the scale of this organization, a little bit about how it's organized, size of its budget, and how your forces are deployed across the world?

LTG Roudebush: Certainly. Today's Air Force Medical Service is made up of a little over 43,000 individuals, and that is active duty and civilian members of the Air Force Medical Service. But importantly, we also have 9,000 Air Force Reserve medical members as well as 6,000 Air National Guard. We execute as a total force that brings the capabilities of the active regular component together with the reserve and the guard in a way that leverages the capability of all the components. So we really are a total force. So you can see that we're well over 50,000 members basically reaching worldwide, supporting 75 bases and installations around the world, and supporting our forces, both at home and deployed wherever we find the mission.

Mr. Romeo: General, now that you've provided us with a sense of the larger organization, could you talk a little bit about your specific responsibilities and duties as the U.S. Air Force Surgeon General?

LTG Roudebush: Certainly. My job as the Air Force Surgeon General is to assure that each one of those medics -- and I use the word "medic" rather broadly. Physicians, nurses, technicians, officer, enlisted, we're all Air Force medics. My job is to make sure that every Air Force medic can do their job, that they have the training, they have the resources, they have all of those capabilities that they need to do the job wherever they find it.

Mr. Romeo: And in fulfilling your responsibilities, what are the top three challenges that you face, and how have you addressed those challenges?

LTG Roudebush: Well, it goes back to the top three challenges or priorities for our Air Force. Number one is winning the fight today. We are engaged in a global war on terror, and it's a fight that we must win. Certainly our focus, our effort, is in providing all the capabilities for our Air Force and for our joint forces to be able to win that fight, to prosecute that fight successfully.

The second challenge is to take care of our people. And certainly as medics our responsibility, in fact our privilege, is to take care of our airmen as well as our soldiers, sailors, marines, coastguardsmen who all go in harm's way. But that also means my responsibility is certainly there in taking care of our medics, to assure that they are well cared for, that they are trained, that they are prepared to do the job that they are asked to do.

So first priority, win the war fight. Second priority, equally on that footing, is to take care of our people. And thirdly is to be ready for tomorrow, to prepare for the challenges tomorrow which may well be rather different than the challenges we're facing today. To do that we obviously have to have the right equipment, the right structure, but most importantly we have to have the right people. And that involves recruiting the very best, training them, preparing them, and then retaining them to assure that we continue to be able to meet the mission wherever we find it.

Mr. Morales: Now, General, I understand that you began your medical training back in the early to mid-'70s at the University of Nebraska. Could you tell us a little bit about your career path? What brought you to serve as both a physician and an officer within the U.S. Air Force?

LTG Roudebush: Well, as I grew up in Western Nebraska, my heroes were my mom, my dad, and the family physician that took care of us. That was a huge force in my life in terms of thinking about what my goals and priorities would be. So as I grew up, I knew I wanted to be a physician. And I was able to stepwise move through the educational requirements and ultimately to be educated at the University of Nebraska, School of Medicine, which gave me a marvelous education.

While I was there, the opportunity to join the military presented itself in the health profession scholarship program. At that time it was a very new program, but it offered the opportunity to join the military, to serve, but also to have financial assistance and support in getting my education. So it really allowed me to further my education, but also to fulfill what I viewed as a privilege to serve.

So I joined the Air Force as a health profession scholarship student, was able to do my family practice residency at Wright-Patterson Medical Center in the Air Force, and moved on to Cheyenne, Wyoming as my first assignment at F.E. Warren, rather anticipating that once my obligated service was completed that I would go back to Western Nebraska and go back into private practice, but as I got to know more about the Air Force mission and the military mission, I was literally captured by it. I've truly enjoyed every day in uniform since.

Mr. Morales: That's a wonderful story. So as you reflect back on your training and your career over the years, both as a physician and as an officer in the Air Force, how have these experiences perhaps shaped your current leadership role and your current management style?

LTG Roudebush: Well, the opportunities I had, beginning with that family practice residency, which was extraordinarily effective training, followed by my first assignment at F.E. Warren which allowed me to really employ my training, but also understand how it fit into the broader military mission, the mission of the Air Force, gave me a sense of what I was looking for in terms of challenges. And subsequent assignments, both at the wing level in Europe, allowed me to expand my horizons to become more operationally engaged with the flying mission. Gave me the underpinnings, I think, to really understand the Air Force medical mission.

Then I was given the opportunity to be the central command surgeon, a unified command surgeon at a very challenging time in the early '90s, and that really gave me exposure and experience in joint operations and joint medical operations. Following that experience I had the chance to serve at both the major command and the air staff level. So my experience, I believe, has prepared me very well for the challenges that we face today, and given me a real sense of what the issues are both from the service and from the joint perspectives. And also a sense of how really to leverage our medical capabilities, Air Force, Army, Navy, in support of the broader war fight.

Mr. Morales: That's fantastic. What about the success of the Air Force's aeromedical evacuation capability? We will ask Lieutenant General James Roudebush, Surgeon General of the US Air Force, to share with us when the conversation about management continues on The Business of Government Hour.

(Intermission)

Mr. Morales: Welcome back to The Business of Government Hour. I'm your host, Albert Morales, and this morning's conversation is with Lieutenant General James Roudebush, Surgeon General of the US Air Force. Also joining us in our conversation, from IBM, is Tom Romeo.

General, I understand that the Air Force Medical Service is structured differently than the medical services of, say, the Army and the Navy. Could you tell us more about this structural difference, and what your view is on the best balance strategy to fit your operations?

LTG Roudebush: The Air Force Medical Service doctrinally supports airspace and cyberspace missions. The Army supports the ground maneuver. The Navy supports the forces at sea, both sub and surface, as well as the littoral forces, the marines. And each one of those is doctrinally different and requires a different approach to supporting that doctrinal capability. For we in the Air Force, in executing the airspace and cyberspace mission, we use every one of our wings and our bases as an operational platform.

For example, we deliver strategic deterrence from F.E. Warren in Cheyenne, Wyoming standing missile alert. We deliver space operations from Peterson Air Force Base, managing the satellite constellations and our capabilities in the space domain. And we deliver global mobility from Charleston, from Travis, from a variety of places. So each one of our bases and our wings are literally an operational platform. And our medical support of that operational platform is woven into that wing structure, working for that wing commander, that line commander.

So for us, doctrinally, Air Force medics work for the mission commander, the line of the Air Force. The Army and the Navy are structured somewhat differently in terms of the medics also working for the wing commander, but tending to work through other medics to do that. Works very well for them. Doctrinally, it's very coherent, very sound. Our approach works very well for us. So it's not a matter of good or not good. It's a matter different for very important doctrinal reasons.

Mr. Morales: So with this perspective, could you tell us a bit more about your unique capabilities, the Air Force's unique capabilities, in areas such as Expeditionary Medical Support, or EMEDS, and the aeromedical evacuation? Specifically, how has this capability changed over the past six or seven years, and how successful has it been in areas like Iraq or Afghanistan?

LTG Roudebush: I think to really understand that we need to go back even further and go back to the Cold War. The fact was we were attempting to contain those forces, communism and others, that could potentially threaten our national interest. When the Wall came down in Germany we moved from a strategy of containment to a strategy of engagement, wherein we looked to more globally engage with friends and allies around the world, and to be able to respond globally to any particular area of concern and do it in a real-time way, which obviously is the capability that the Air Force brings.

So as we transitioned our medical forces during the Cold War, we had very heavy, very far-forward-positioned contingency hospitals, turnkey operations that were designed to operate in-place to take care of casualties and then only transition back to the United States if the condition required it, or time permitted. When the Wall came down and we went to strategy of engagement, we became a much more expeditionary Air Force, globally engaged.

We in the Air Force Medical Service made that transition as well. We moved from relatively heavy, fixed capabilities to very light, lean, modular, very capable modules that we could employ, put in place. We could stack them, use them separately, provide whatever capability that was required, sort of right care, right time, in the right place. That allowed us to engage globally, but when we think about putting these light, lean, modular assets forward we also need to have that lifeline home that allows us to stabilize a casualty or someone who is ill far forward, but then bring them back to definitive care very quickly and very safely. And our air evacuation system gives us that capability.

So what we have today with our expeditionary medical capabilities is our ability to put light, lean, modular assets far forward where they are required and then bring anyone who is ill or injured home safely, real time, to definitive care. In terms of economy, it is very effective, it's cost effective, it preserves forces, and it allows us to respond to virtually any contingency, anywhere in the world.

Mr. Morales: Can you give us a real-life example of how this would work?

LTG Roudebush: Well, if you think about our war on terror and our activities in Iraq and Afghanistan, our soldiers, sailors, airmen, and marines far forward are in fact experiencing significant injuries as a result of the weapons that are being used, improvised explosives, for example. With our theater hospital forward in Ballad in Iraq and our theatre hospital forward in Bagram, these Air Force theater hospitals serve as the hub for a joint theatre trauma system which is made up of Air Force, Army, and Navy capabilities, all leveraged together to support their doctrinal missions, but come together to form a joint theater trauma system.

When a soldier, or a marine, or an airman is injured their life is literally saved by far better first aid capability forward, better equipment, hemostatic bandages, one-handed tourniquets, better training for the Navy corpsmen, the Army medics or Air Force PJs who are providing that first aid, and the ability to get those injured individuals to that damage control surgery. For example, at Ballad, once that patient is stabilized then the patient is packaged for air evac, literally, put into the air evac system with a critical care team, transported to Landstuhl, and then re-transported on to the States when appropriate, or if it's appropriate to transport directly from Ballad back to Washington or San Antonio, via our aerial refueling capability.

So this scalable, modular, lean capability allows us move casualties from point of injury back to definitive care on average within three days, which is by any regards remarkable. Even as recently as the Gulf War it was averaging probably 12 to 14 days to get someone injured home. So I think you can see the effect of that kind of system

Mr. Morales: It's a phenomenal statistic, absolutely phenomenal.

Mr. Romeo: General, it is very impressive. And you talked a little bit about some of the challenges and solutions you've put in place with getting airmen back to the point of care that is best for them, as quickly as possible. Are there lessons that you've learned in the recent past that allow you to move forward in a way that better suits the airmen?

LTG Roudebush: I think the lessons that we have learned, we have learned certainly as Air Force medics, but I think also as joint medics with our Army and Navy counterparts. For example, this joint theater trauma system that's present in Iraq has a joint theater trauma registry which basically records all injuries, all aspects of injuries, so that we are able to not only provide the care, but we're also able to examine the care to see where improvements could or should made to do the research that will help take us forward in terms of providing that cutting-edge battlefield care, and also to transition that knowledge to our private sector and academic counterparts, so that as we do learn how better to mange the kind of trauma that we're seeing, that knowledge and those capabilities are transited into both academia and research for the utilization of all physicians wherever they may be encountering trauma.

So it's one of those aspects of war which allows us to use that knowledge to further medicine in all regards. We would much rather not be engaged in that, if we didn't need to be. But given that we are, we certainly want to be sure that not only do we improve the care that we provide all our servicemen, but that we share that knowledge with all our medical counterparts.

Mr. Romeo: Great. Thank you, General. I'd like to switch to information technology discussion for a moment. The AFMS was recognized as the winner of the 2007 Microsoft Health Utilization Group's Innovation Award for Performance Reporting. Would you tell us more about the AFMS' investment in innovative informatics? And give us a sense of how your portfolio of informatics tools insures delivery of high quality care.

LTG Roudebush: Well, informatics and the systems that all our information ride on really is, if you will, the life blood of medicine, because the information is absolutely key. Patient information, research data, the ability to move information from point to point, is all critical to providing really high quality care. We have really leveraged the capabilities of some incredibly bright and dedicated Air Force medics that have taken this on as a challenge to both improve the quality of the data that we have, but also the utilization and transmission of that data, and the transition of that data into information, useable information.

The award that Microsoft presented was earned by people who are taking a very critical look at the care that we provide every day, all aspects of that care, the timeliness, the quality, all elements of that care, and then parsing that information, reassembling it in ways that allow us to assess the quality, and also to improve in those areas where we are able to move forward on that information. So we are very proud of that. But at the very basic level, the ability to capture information and move information in an electronic healthcare record for example, or in an electronic database that allows us to access and mine that data to assure that we are able to improve quality or do research as required, is very important to all military medics.

In our work with the electronic healthcare record and being able to transition that information, for example, to the VA so that when a soldier, sailor, airman, or marine may become ill or injured in Iraq, and is cared for in Iraq, the information surrounding that episode of care now is able to be captured and transited to each point of care along the way, whether it's Landstuhl, Bethesda, Walter Reed, or a VA so that we can assure that all the information necessary for that episode of care is available.

Now I will tell you that electronic healthcare records and the transmission of data is by no means perfect or where we want it to be. But it is evolving, we are making significant improvements, and we are absolutely committed to assuring that both the information for the episode of care, but also the transportability of that information to other providers that will need to know that as they continue to care for that individual is also available. That is a point of great interest and key concern for all of us within military medicine and VA medicine, I would add.

Mr. Morales: Now, General, we've talked quite a bit about Iraq and Afghanistan, but in fact your Air Force medics are engaged globally with allies supporting a variety of humanitarian missions and responding to a variety of disasters around the world. Could you elaborate on some of the involvements that your organization has in some of these global efforts?

LTG Roudebush: Yes, thank you. Our Air Force medics are very deeply engaged with medical activities around the world. It's important as we work with our friends and allies around the world that we work with them in the medical realm as well, sharing information, working on training medics from emerging nations that we would much rather be our friend and ally. As time goes on, using medicine as that first step forward to build relationships is something that we feel has great value, and Air Force medics are out there doing that.

In addition, around the world we also support a variety of activities, Operation Deep Freeze in the Antarctic, for example. The Air Force and the Air Force medics facilitate the work that's being done in getting personnel and capabilities back and forth in support of that activity. When there is a shuttle launched, or a Soyuz recovered there are Air Force medics along the tracks to assist, if required. When we have the opportunity to work with nations around the world in order to learn and better understand their medical systems, and also to understand medical issues of interest to us all. For example, pandemic influenza, or malaria, or other infectious diseases that continue to emerge or reemerge around the world.

Our folks are out there working with those nations to better understand, to learn, and to leverage all our capabilities to the betterment of all concerned, and working with our Army and Navy counterparts who also do a good bit of that work around the world in a way that I think serves our national interest, but also serves very well our friends and allies.

Mr. Morales: Fantastic. What are some of the innovative treatments for traumatic brain injury? We will ask Lieutenant General James Roudebush, Surgeon General of the U.S. Air Force to share with us, when the conversation about management continues on The Business of Government Hour.

(Intermission)

Mr. Morales: Welcome back to The Business of Government Hour. I'm your host, Albert Morales, and this morning's conversation is with Lieutenant General James Roudebush, Surgeon General of the US Air Force. Also joining us in our conversation, from IBM, is Tom Romeo.

General, traumatic brain injury or TBI may be what some have considered the signature injury of Iraq and the Afghanistan wars. Could you describe what really constitutes TBI? And second, could you tell us about the research being pursued in TBI prevention, assessment, and treatment? And finally, how prevalent is this in the Air Force?

LTG Roudebush: The issue of traumatic brain injury certainly is an injury and a condition that is rightfully occupying a great deal of attention and focus, ss it's referred to as the signature injury. I think the way that my counterpart, General Eric B. Schoomaker of the Army, Surgeon General, described it, the IED is the signature weapon which has a variety of injuries associated with it, which could be blast, could be penetrating injury, could be the concussive force which can result in traumatic brain injury.

So I think as we put traumatic brain injury into the constellation of injuries that can occur as a result of the really devastating weapons that we're seeing, it does help us think about the individual as a whole person and think through the implications for caring for that individual. Now, traumatic brain injury in and of itself is something that in some regards we have certainly been aware of over time immemorial. We have referred to that as a concussion which could be as a result of a blow to a head, which could occur in football, could occur in a fall. But in this regard it is rather more traumatically induced by a very heavy blast, which has both sound, has overpressure, has the concussive force that results in this injury.

Not every traumatic brain injury is of the worst possible nature. We certainly do see that. But there is a whole spectrum that goes from very, very mild to very, very severe. And one of the challenges of dealing with traumatic brain injury is fleshing out our knowledge of the entire spectrum of TBI, both in our ability to detect it, to characterize it, and then appropriately treat it.

So as we look at the whole spectrum of TBI, we know that we have research that needs to be done. We know that we have treatment modalities that need to be addressed and improved. And we know that we have a long period of treatment, generally, that's going to be required, because the treatment of traumatic brain injury does require taking care of that individual over a significant period of time, working through the evolution of the injury and hopefully the recovery of that individual from the injury itself.

So traumatic brain injury is something about which we have significant knowledge, but there are also significant areas that we need more research, that we need more understanding of both the pathophysiology as well as the treatment of this. But it does occupy a very central focus within our activities. Congress has been very forthcoming, providing resources to us, to examine both traumatic brain injury as well as Post Traumatic Stress Disorder. So we do have the resources, we have the opportunity, and we clearly have the need to better understand and to be better able to take care of this particular injury.

Mr. Morales: General, I've always been impressed with some of the long, very long distance missions that the Air Force flies. You know, I take a five-hour trip from the east coast to the west coast, and I'm just completely wiped out. How do you avoid and mitigate the effects of some of these long-duration missions or poor sleep due to combat operations?

LTG Roudebush: Well, the impact of time and distance has long been an issue for the Air Force. When we are able to put forces or to take resources and assets literally around the globe you are going to be crossing multiple time zones, and you are going to be inducing what is known as circadian asynchrony or jet lag as you move across those time zones. There are a variety of ways to deal with those. Importantly, there are strategies in terms of how you prepare yourself, your sleep cycles, your work cycles, that allow you to in great part to mitigate the impact of jet lag.

There are also strategies that involve exercise, and what you eat, the kinds of food you consume. Coffee is not a panacea. In fact coffee may be one of the largest culprits in trying to deal with jet lag -- as is alcohol. As travelers, not military travelers, but as travelers know, too much to eat, too much to drink, whether it's caffeine, alcohol, or whatever it maybe, simply makes things worse. Now, in the military sense of course alcohol has no place in those strategies. But the fact is that what you eat, when you eat it, how you exercise, when you exercise, how you work your sleep and rest cycles, are really the most effective strategies.

There are pharmaceutical approaches to this which are available, and those are used in very judicious and very structured ways. And almost always only as a final resort if in fact that's operationally required and if it is appropriately administered it can be a useful adjunct. But the real strength of the strategy is in managing all those other aspects of both your sleep, work, exercise, and eating habits, and you can do that. And frankly, just as travelers around the world, there is a great body of literature that speaks to that, that I would recommend to anyone who is looking at multiple time-zone crossings. It can make life a lot easier.

Mr. Romeo: General, psychological health means much more than just the delivery of traditional mental healthcare. Given operational tempo, and the stress it places on service members, what has the AFMS done in the area of mental health, and specifically would you elaborate on the programs in place to diagnose, prevent, and treat the service members in need?

LTG Roudebush: Certainly. Psychological health is an important aspect of overall health. The first thing that we do is work to both establish and sustain a healthy, fit force, and that has to do with all parameters of health. Cardiovascular health, fitness, psychological health, and emotional wellbeing in terms of assuring individuals that their healthcare needs will be met as well as their family's, because that does give you a sense of reassurance and wellbeing. So as we take care of our airmen and their families, we look towards the establishment of that healthy, fit force, and healthy, resilient families, which really provides the best basis for ongoing psychological health.

Now, as our airmen, as well as soldiers, sailors, and marines, go in harm's way we do several things. Before we deploy an airman we assure that their health is as it should be, both physical and psychological. And if there are issues in either regard we address those, and if the individual should not deploy, they don't. But the fact is we examine, first, to assure that all aspects of health are present. When deployed we continue to surveil, and to support, and to assess, and intervene if required. If someone is having either physical or emotional health issues, we have the assets forward to assist in addressing those.

And then as the individuals redeploy, we re-examine their health with the Post-Deployment Health Assessment, which is principally a survey, but it's also an opportunity to meet with a healthcare provider and assess any issues that might be attendant. And then understanding that psychological issues can evolve after return home at about that six-month point out we do a Post-Deployment Health Reassessment. One, to reexamine the health and well-being of the individual, but also to provide another opportunity to work with a healthcare provider, if in fact that's the appropriate thing to do. So we work to provide that continuum of health.

Now, in addition to that, just in day-to-day activities, we have mental health providers basically embedded in our family health units to provide the full spectrum of care for both our active duty and their family members. We found that putting behavioral health experts in with our family medicine teams really leverages the capabilities of both, and allows us to approach issues in a way that is both conducive to quick recognition and resolution as well as reducing any perceived stigma of emotional or behavioral circumstances that folks might not want to talk about otherwise.

Mr. Romeo: Great. You mentioned that, you know, an important aspect of psychological health of the airman is insuring that his family is safe and secure. What programs are available to families to support them while their loved ones are deployed?

LTG Roudebush: Well, for our deployed folks in our active duty forces there are significant and very effective family support activities at the wing level and the unit level right down to the squadron to support those families, and to support the commander in supporting both the families and the troops that are deployed. Those are coordinated in a variety of ways at the wing level, through the family support center, which really provides, I think, good support as well as a safety net, if you will, if there are issues that need to be addressed.

For our Reserve and Guard forces that continues to be a bit of challenge, because, you know, those families may not be near a military installation. So our Guard and Reserve leadership are working and continue to work to assure that those families too are well cared for, and if they need support that they are able to provide it.

Now, in addition, there is also a capability called OneSource, which is a network or a system of support functions that are accessible through the OneSource avenue that really brings a variety of support capabilities to bear, if in fact the OneSource portal is engaged. So that is another aspect of support for the folks that remain home while their loved one are deployed.

Mr. Romeo: Could you elaborate on the research initiatives you are pursuing to advance the delivery of care, training, and disease surveillance for your airmen? And to what extent do these research initiatives such as the partnership between the University of Pittsburg Medical Center and the use of virtual medical trainer improve the health of your airmen, and enable the Air Force to proactively meet their needs?

LTG Roudebush: Our partnership with the University of Pittsburg Medical Center has been a very productive partnership. They have worked with us, and we have been able to leverage each other's expertise in approaching a variety of issues. You mentioned the virtual medical trainer, which allows us to further the training, and the fidelity of the training for our medics in caring for a variety of illnesses or operating in a variety of operational circumstances without necessarily having to put people into those circumstances.

The virtual or simulation capabilities as they increase in fidelity are truly remarkable resources, or a very cost-effective way to train and prepare our medics to do a variety of missions. We're also working with UPMC in diabetic research, looking at how we can improve the care of diabetics and the training and the knowledge base for anyone who has that diagnosis to help them better care for their own diabetes in a way that prolongs life and improves the quality of life as it goes. So our research in that regard has been very productive.

Other avenues of research for us have been in the area, again, of the informatics, how we support these activities, utilizing or mining data to better understand illness pathophysiology and the treatment of that illness. So the research in those regards has been very beneficial. In addition, and I mentioned very briefly previously, the research that is ongoing in traumatic brain injury and PTSD, which is really tri-service and VA research, focused at the Center of Excellence which has been established here in Washington at the new Walter Reed National Military Medical Center, gives all the services an opportunity to leverage really aggressive research, both in the military, but also in all aspects of academia to bring to bear some very important capabilities on these very demanding issues that are before us.

Mr. Morales: Now, General, I understand that the use of telehealth and telemedicine is another important area of focus for your organization. We only have about another minute left, but could you elaborate on some of your efforts in expanding the presence in the use of telehealth and what clinical situations present the most promise?

LTG Roudebush: Telehealth is an opportunity really to leverage technology. I'll give you in just the brief time we have a very good example of that, and that has to do with teleradiology. We are working to establish a network wherein virtually any radiologist within our Air Force Medical Service can read any film regardless of where it might be, simply by moving the images on a network between the point where the image was taken to the point where the radiologist is available to read that, and then immediately transmitting that reading back to the originating site for utilization by the healthcare providers there. That network exists in large part today. Within the coming months to a year or so we should be able to fully leverage that capability across the entire AFMS and literally worldwide.

Mr. Morales: That's great. Thank you. What does the future hold for the Air Force Medical Service? We will ask Lieutenant General James Roudebush, Surgeon General of the U.S. Air Force, to share with us, when the conversation about management continues on The Business of Government Hour.

(Intermission)

Mr. Morales: Welcome back to our final segment of The Business of Government Hour. I'm your host, Albert Morales, and this morning's conversation is with Lieutenant General James Roudebush, Surgeon General of the U.S. Air Force. Also joining us in our conversation, from IBM, is Tom Romeo.

General, I would imagine that an essential part of taking care of your medics is to make sure that they have the right balance in their lives between their professional duties and their family duties. Could you elaborate on your efforts to create a better balance for your medics through staffing, finding the right mix of military, civilian, or contractors and by focusing on recruiting and retention efforts to maintain the proper mix?

LTG Roudebush: Al, you are absolutely right. The real strength of our Air Force Medical Service is first, last and always people. For each one of our medics they are well-trained, they are well-motivated, they are well-prepared. But you are very correct in characterizing the balance that's necessary. Our mission can be all-consuming, and it can occupy 24 hours of every day. But it's absolutely essential for each of our Air Force medics to have the opportunity to have balance in their lives, to be able to engage in that mission, but also to have time for family, for professional growth, for personal and spiritual growth, and to be able to balance.

The mission, for example, can become all-consuming for a period of time. Then you have to rebalance and find that additional time for family, for growth, to get that individual back into the circumstances that best assure a long, continued, satisfying service. So as we look at the right mix of medical forces; physicians, nurses, administrators, scientists in all our enlisted personnel, we do look for that proper and balanced mix that allows us to support the mission, because my view is that we are going to be in a very high OPS tempo for years to come.

So to find that right force structure that allows you to aerobically, if you will, meet the mission, do it repetitively, and continue to do it in a both productive, challenging, and satisfying way really does cause you to get to the right force mix. What we are doing in terms of our recruiting and retention is focusing on having sufficient personnel to aerobically meet that mission and do it repetitively over time, and to have the correct balance among active duty as well as Reserve and Guard, and our civilian Air Force medics that are important parts of our team.

This allows us to get to that best balance, if you will, to meet today's mission, but to continue to prepare for tomorrow's, and when tomorrow arrives to execute that mission as well. So it really is a balance. Now, we also have to understand that the mission can change as we look five or ten years forward. We are anticipating what the world might look like and what might be required. And you also have to understand that we have an expanding mission today. The stability operations that we are currently engaged in, in helping Iraq, and Afghanistan, and other countries rebuild their infrastructure and get back on a solid footing is an emerging mission, and one that I think will be with us.

And there is also the expectation that we'll be able to respond to our nation's needs within our shores. Hurricanes Katrina and Rita certainly pointed out the need for our military to at times assist our civil capabilities in meeting the needs of the Americans within our shores. So we have a very challenging, and over time, I think, perhaps changing mission requirement that causes us to look at our force mix and to be sure that we can meet that, but always in a way that provides the balance.

Recruiting is always a challenge, to have the best and the brightest come forward, but we are blessed with folks that do just that, and they do come forward. And I will tell you, they continue to impress as they move forward. But it's also important to retain those individuals. And in order to do that, we need to continue to assure that they have full productive opportunities to exercise their skills, as well as proper compensation to assure that we are competitive with the private sector and others that would also dearly love to utilize these individuals. So, right force mix, right incentives, and most importantly all put together to meet our nation's needs.

Mr. Romeo: General, would you tell us more about your involvement with the Taskforce on the Future of Military Health Care and what are some of the core findings and recommendations associated with this effort?

LTG Roudebush: Well, the Taskforce on the Future of Military Health Care was chartered to provide a very close look at military medicine, what it is today, and how it should be structured and prepared to meet the challenges of tomorrow. The Taskforce had seven civilian as well as seven Department of Defense representatives. I was chosen to be one of the Department of Defense representatives. The individuals selected -- and I will characterize the other 13 -- these were very, very bright, engaged, and very committed individuals that took this task on as a focus, and a very important job to be done correctly.

As the Taskforce came together there were guiding principles. And I think the guiding principles really drove the outcome. The first principle was to maintain or improve the health readiness of our military forces and preserve the capability of military medical personal to provide operational healthcare anywhere worldwide. Secondly it was to maintain or improve the quality of care provided to all our beneficiaries, taking into account their health outcomes as well as access to the care that they need.

And the third was to result in improvement in the efficiency of the military healthcare by utilizing best healthcare practices in the private sector and internationally. So as we had these guiding principles among several others, it really did shape the recommendations. I could characterize the recommendations in several broad categories. One particular thrust of the recommendations was to ensure that the direct care system, the uniformed healthcare system was properly prepared and capitalized to do the mission that it needs to do. And in so doing was properly integrated with the private sector care, our managed care support contractors, who are very important allies in assuring that we were able to meet the entire spectrum of care that our beneficiaries need and deserve.

So that integration, I think, leverages the best aspects of both systems, but to assure that the direct care system was in fact able to meet the mission of the military healthcare system, and to continue to do that in the future.

Other key recommendations focused on the utilization of prevention as a focus in ensuring that we not only provide intervention when appropriate, but that we focus on prevention, which really leads to the most healthy and most optimal outcomes for all our beneficiaries. And then certainly to increase the efficiency of the military healthcare system, to make it more cost effective in providing the healthcare benefit and assuring the military medical support that it's designed to provide.

Other aspects of this had to do with the benefit aspects, both in terms of cost and co-pays. All of these recommendations are under consideration. Ultimately it will be the decision of our congressional, and our line, and our civilian leadership as to how all these recommendations are brought to bear. But I think the Taskforce did a very good job of both characterizing the opportunities to make our whole system better, and to comment very specifically on strategies that could improve both the health as well as the efficiency of our military healthcare system

Mr. Morales: Now, General, you've had a very successful vocation within medicine and in the service of our country. I'm curious, what advice might you give to someone who perhaps is out there thinking about a career either in medicine, or perhaps in the military, or perhaps both?

LTG Roudebush: I would very strongly encourage anyone who has as an interest in the medical career field, in whatever specialty, to consider the military as an opportunity. It's not for everyone. But its an opportunity to both exercise all your skills within your area of medical expertise, as well as serving our nation in a way that I think greatly contributes to the greatness of our country as we have all come to know it.

The military is my choice. I have certainly cherished the opportunity to do that. But it may not be for everyone, and that is okay. There are other opportunities to serve. And I would offer the Public Health Service, I would offer the Veterans Administration, just as two other opportunities to consider to serve both our nation's need as well as serving each other in a way that is truly satisfying, but truly is contributory towards improving our nation as a whole.

Mr. Morales: That's a wonderful perspective, and great advice, General. Thank you. I do want to thank you for fitting us into your busy schedule. But more importantly, Tom and I would like to thank you for your dedicated service to our country and our soldiers across the world.

LTG Roudebush: Well, Tom and Al, thank you so much for the opportunity to talk about the Air Force and the Air Force story. It is a privilege to serve, but it is also a pleasure to share that story. For any of our listeners who might desire a bit more information, particularly about Air Force medicine, I would direct you to our website, which is www.sg.af.mil. And if there are any questions or issues that you might that have that aren't covered within that website, my staff and my office would certainly be available to address any of those issues or concerns.

But again, thank you so much for this opportunity.

Mr. Morales: Great, thank you General.

This has been The Business of Government Hour, featuring a conversation with Lieutenant General James Roudebush, Surgeon General of the U.S. Air Force. My co-host has been Tom Romeo, IBM's general government industry leader.

As you enjoy the rest of your day, please take time to remember the men and women of our armed and civil services abroad who may not be able to hear this morning's show on how we're improving their government, but who deserve our unconditional respect and support.

For The Business of Government Hour, I'm Albert Morales. Thank you for listening.

Announcer: This has been The Business of Government Hour. Be sure to join us every Saturday at 9:00 a.m. And visit us on the web at businessofgovernment.org. There you can learn more about our programs, and get a transcript of today's conversation. Until next week, it's businessofgovernment.org.