readiness

 

readiness

Cognitive Readiness: The Future for Success?

Tuesday, December 19th, 2017 - 9:58
Most of us would likely agree that organizations today benefit from the digitization, sharing, and integration of data. But data without the application of analytics just leaves us with big unusable data. We all know this because we experience it regularly. But, what if we could apply traditional analytics and artificial intelligence (AI) to create new insights for improved decision-making? Well, that would be great, but where should we focus this new technology? I would propose in the area of readiness.

Leading the Defense Health Agency: Interview with Lt. Gen. (Dr.) Douglas Robb, director, Defense Health Agency

Friday, August 15th, 2014 - 12:07
Friday, August 15, 2014 - 09:42
Across the country healthcare systems are focused on ways to reduce variation in care, improve patient safety and more effectively use health information technology to improve clinical decision-making and outcomes. The Military Health System isn’t immune to such changes. In fact, within the military, there are additional imperatives for designing an integrated health system which includes more joint operations as a way to meet its aims of readiness, improving the health and care of people it serves, and doing this while managing costs.

Using Crowdsourcing In Government

Friday, April 11th, 2014 - 12:46
Posted by: 
This trend has been inspired by similar efforts in the commercial world to design innovative consumer products or solve complex scientific problems, ranging from custom-designing T-shirts to mapping genetic DNA strands. The Obama administration, as well as many state and local governments, have adapted these crowdsourcing techniques with some success.

Using Crowdsourcing In Government

Tuesday, August 13th, 2013 - 10:37
Author(s): 
The growing interest in “engaging the crowd” to identify or develop innovative solutions to public problems has been inspired by similar efforts in the commercial world.  There, crowdsourcing has been successfully used to design innovative consumer products or solve complex scientific problems, ranging from custom-designed T-shirts to mapping genetic DNA strands. 

Ellen P. Embrey interview

Friday, July 24th, 2009 - 20:00
Phrase: 
"Force Health Protection addresses three areas - improve existing health, proactively addressing threats, and finally, assuring that we have the capacity to take care of injuries and illness acutely."
Radio show date: 
Sat, 07/25/2009
Guest: 
Intro text: 
In this interview, Embrey discusses the: Mission and scope of the Office of Force Protection and Readiness; DoD's Force Health Protection and Readiness assessment process; Improving the medical readiness of the total force; The Deployment Health and Family...
In this interview, Embrey discusses the: Mission and scope of the Office of Force Protection and Readiness; DoD's Force Health Protection and Readiness assessment process; Improving the medical readiness of the total force; The Deployment Health and Family Readiness Library; Upgrades to the military electronic health record; and Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE).

Tommy Morris interview

Friday, June 5th, 2009 - 20:00
Radio show date: 
Sat, 06/06/2009
Guest: 

A Conversation with S. Ward Casscells, M.D.: Assistant Secretary of Defense for Health Affairs U.S. Department of Defense

Tuesday, April 7th, 2009 - 9:55
Posted by: 
The provision of health services is a critical and significantmission within each branch of the U.S. military as well as

Ellen P. Embrey interview

Friday, November 17th, 2006 - 20:00
Phrase: 
"Force Health Protection addresses three areas - improve existing health, proactively addressing threats, and finally, assuring that we have the capacity to take care of injuries and illness acutely."
Radio show date: 
Sat, 11/18/2006
Guest: 
Intro text: 
In this interview, Embrey discusses the: Mission and scope of the Office of Force Protection and Readiness; DoD's Force Health Protection and Readiness assessment process; Improving the medical readiness of the total force; The Deployment Health and Family...
In this interview, Embrey discusses the: Mission and scope of the Office of Force Protection and Readiness; DoD's Force Health Protection and Readiness assessment process; Improving the medical readiness of the total force; The Deployment Health and Family Readiness Library; Upgrades to the military electronic health record; and Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE).
Complete transcript: 

Originally Broadcast Saturday, November 18, 2006

Arlington, Virginia

Mr. Morales: Good morning and welcome to The Business of Government Hour. I'm Albert Morales, your host, and managing partner of The IBM Center for The Business of Government. We created this center in 1998, to encourage discussion and research into new approaches to improving government effectiveness. You can find out more about the center by visiting us on the web at www.businessofgovernment.org.

The Business of Government Radio Hour features a conversation about management with a government executive who is changing the way government does business. Our special guest this morning is Ellen Embrey, deputy assistant secretary of Defense for Force Health Protection and Readiness, and director of Deployment Health Support at the U.S. Department of Defense.

Good morning, Ellen.

Ms. Embrey: Good morning.

Mr. Morales: And joining us in our conversation, also from IBM, is Russ Sanford, Director in IBM's DOD practice. Good morning, Russ.

Mr. Sanford: Good morning.

Mr. Morales: Ellen, to provide a proper context around this subject of military medicine, could you give us a general sense of the history and mission of the Department of Defense's health affairs?

Ms. Embrey: Yes, I'll try. The Department of Defense's health affairs programs evolved primarily since 1949 when the Office of the Department of Defense was established. Health Affairs has a specific assistant secretary advocate for the health programs within the department to establish not only the programs for protecting the force, but also to advise the secretary of defense as they move forward.

Primarily, the office provides policy, program guidance, and sets standards for the execution of heath and the delivery of health by the services. And that has continued to evolve and become more effective and efficient through time.

Mr. Morales: Can you give us some specifics around the mission and the scope of the Office of Force Protection and Readiness of which you lead?

Ms. Embrey: It might be easier to talk about what I don't do because the assistant secretary's office deals with the delivery of healthcare to the entire Department of Defense service members and their beneficiaries, including retirees. I don't do that. We also establish clinical polices and how the health providers in the system, what standards they have to clinically adhere to and the standards of pharmaceuticals and things like that that are used in the system. I don't do that either.

Ms. Embrey: But what I do do is about everything else. I engage in trying to understand how we maintain a healthy fighting force, and we look at it from a prevention point of view, from a protection point of view, and from a point of care on the battle space and making sure that we have the medical assets available in that battle space to deliver the care to help them survive and get back to definitive care in the states.

So, it's everything that isn't the day-to-day peacetime healthcare delivery. It covers longitudinally what we do in peacetime and wartime, but it's specifically focused on the deploying force.

Mr. Sanford: Ellen, you've given us a good idea of this mission and the scope of your directorate. Can you talk to us a little bit and give us an idea of how your directorate is organized, the size of the budget, how many employees you have working for you to support the program?

Ms. Embrey: I'm double-hatted, as you mentioned at the beginning. I have a very small staff. Eight -- in fact -- including myself and my secretary, who advises the assistant secretary on policy matters. We exercise oversight of the execution of those policies with that staff.

My other "hat" is the director of Deployment Health Support. I manage about 12 individuals, government employees, and then the rest of the staff that I work with is contracted support, and that's about 70 to 80, sometimes more, depending upon surge requirements.

The budget is about $20 million, and it also increases with global war on terrorism -- supplemental our work because we focus on deployment health and the programs and policies in place to make -- execute that during time of war.

We are significantly expanded right now because we are engaging in deployment health issues with ongoing war on terrorism. So, we do get a fair amount of additional funding to deal with the ongoing deployment of our forces.

Mr. Morales: That's a very high contractor to government employee ratio.

Ms. Embrey: Yes, it is. It's quite challenging. In fact, I've been in the process of trying to justify, and in fact, and I think I'm going to be successful into converting some of our contractor resources to full-time equivalence in the force.

Again, because we managed deployment health issues and we weren't deploying for a period of time, you didn't need a large staff to evaluate what you might do. Well, now for several years, we are doing, and the work requires a significant amount of workload, and we are going to try to make accommodations. We believe the global war on terrorism is not going away, and so we have to organize for success in that arena.

Mr. Sanford: Can you talk to us a little bit now about some of the specific responsibilities that you have as the deputy assistant secretary of Defense for the office of Force Health Protection and Readiness, and the deployment health Support directorate?

Ms. Embrey: I think the most important thing that I have is to make sure that I understand the operating reality out there. I have to work very closely with the surgeon general in each of the services with the combatant commanders who are our primary customers. They are the ones that look to the services and the department for making sure we deliver them the capability they need to execute their jobs. Understanding what that is, keeping current with the changing requirements, and then assuring that we're a step ahead of the program guidance to ensure effective, joint, seamless operations with a medical force that's also delivering peacetime care is a challenge.

I spend most of my time understanding what the challenges are and challenging my staff to work with the proper customer base to make sure that we are posturing ourself for success. I think the major focus that I've been looking at here recently is to try to understand more effective ways to do business, to streamline, to leverage other activities, and to bring together the three services into a more coherent end-to-end process.

And so, that's really what I do. My staff really does all the hard work.

Mr. Morales: They'll be glad to hear that. Ellen, you've -- I believe you started your career in public service back in the mid '70s. Can you describe your career path progressing through the ranks and to your current role, please?

Ms. Embrey: I don't have a traditional career path. I mean, actually, I started as the GS-2 clerk typist. I was a summer hire for the Civil Service Commission. I was in college at the time, and I was a psychology major, and I thought a government job typing would just get me good money.

So, anyway, to make a long story short, I learned about an opportunity to compete for an intern program in the government, and I applied for it and was accepted. And I worked in the civil service commission and supported the taskforce, which led to the Civil Service Reform Act in 1978. That gave me some interesting opportunities with the establishment of OPM and the Merit Systems Protection Board.

I learned quite a bit about things; and as part of my follow-on assignments in that organization, I did audits of different headquarters, agencies in the Washington, D.C. area to find out how personnel policies actually supported the agencies in doing their primary missions. I learned a lot about what not to do, and that informed me for my future.

When President Reagan was elected, he sought to reduce the size of the federal government, and the then head of OPM determined that OPM would set the example, and I was a very, very young GS-13 at the time and in the rift process. I landed in the Department of Defense.

I was hired by the Defense Contract Audit Agency to be a program analyst, even though I was a personnel-ist. So, what I did there was do basically efficiency reviews that followed on those types of audits that I did in OPM. And worked there for a period of time, and then was called up to work for the assistant secretary in Reserve Affairs to help them handle some legislative initiatives that were imposed on that office involving computer systems.

That was back in the early '80s when everybody was on mainframe, remote computers, and the audit agency was trying to move to LANs and WANs. And I knew about that because my college days, I had to take a foreign language and I took computers instead. And so, I had a knowledge of computers that I -- that they wanted to leverage.

So, it was kind of interesting there, and so they leveraged that and moved me to OSD to provide assistance. I was a non-techno-speak person that could explain computer issues in English to the assistant secretary, and so that's why I was hired. I didn't have much background in that either, so I'm a atypical career person.

I think the lesson here is, and it is repeated over and over again throughout my career is, if you're open-minded, you're analytical, you're able to solve complex problems, you can do just about anything if you're given enough time to learn what the problem is and work with the experts who can assist you. And I think that has been demonstrated in all of my career path, and, you know, from personnel to contract auditing, to information systems to legislative and budget affairs, and I've done all those things.

I stayed in the Reserve Affairs community for a long time trying to understand how we could better leverage the reserve community and the department. And went through a lot of different other issues, but before I left Reserve Affairs, I was engaged in trying to understand, as a matter of policy, how the department's reserve components might assist in attacks in the government. And when that issue became quite important during the -- I guess the Clinton Administration with Secretary Cohen, you know, pulled out the bag of sugar and said if this was anthrax, what would you do? You know -- that kind of thing.

I worked issues from the Reserve component's perspective. Again, not with a background in biochemical warfare or anything like that, but just to evaluate how we might better prepare the nation to respond to that.

In the context of working those issues, I spent a great deal of time working with the Justice Department and with other parts of the U.S. government on how we organize in this country to respond to weapons of mass destruction threats, and -- and to mitigate them when they do occur, and to recover from them.

I learned as part of that process, that there's always a health response required in small, medium, and large events of those types. And I spent a lot of time with HHS and the department's medical resources to try to understand how we should prepare ourselves for that, and I started to engaged with the medical community that way.

I ended up being asked to act as the assistant secretary for Reserve Affairs in the transition time between the Clinton Administration and the most recent Bush administration. I was asked to help them define how this would happen. When the new -- new political appointee teams came in, they asked me if I would be wiling to go over and fill a slot over in Health Affairs that focused on health issues. So, I said okay.

So, you know: what does that tell you? I don't know. It tells you be flexible, have some core competencies, be willing to listen to experts, and play well with others. You know, you can go and do just about anything and be successful at it.

Mr. Morales: Well, Ellen, it certainly tells me that you have a wide range of skills and an incredible style of management approach which has made you successful over the years.

How critical is Force Health Protection to military operations? We will ask Deputy Assistant Secretary of Defense for Force Health Protection and Readiness, and Director of Deployment Health Support, Ellen Embrey, 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 Ellen Embrey, deputy assistant secretary of Defense for Force Health Protection and Readiness, and Director of Deployment Health Support at the U.S. Department of Defense. Also joining us in our conversation is Russ Sanford, director in IBM's DOD practice.

Ellen, could you define in more detail Force Health Protection? What are some of the broad areas that make up Force Health Protection?

Ms. Embrey: Well, Force Health Protection is really -- it's both a concept, it's a comprehensive way of looking about how you -- how we, as a -- as an organization and as a force look at how we take care of ourselves. Force Health Protection really addresses three areas, how we improve existing health, how we proactively address how threats for protecting folks, and finally, to assure that we have the capacity to take care of injuries and illness acutely, as well as in the long run.

Mr. Morales: When the average person thinks about medical readiness and assessment, they tend to think about pre-deployment, but the DOD has recently tatted the roll out of the post-deployment health reassessment, or something referred to as PDHRA.

What exactly is this, and why is it an important tool for Force Health Protection and Readiness assessment?

Ms. Embrey: Well, before I answer that direct question, I think I need to give you some context about how the Force Health Protection Program looks at health and health assessment in -- along the continuum. We strive to recruit healthy people to begin with, and then we have a program to assure that their health is sustained over time. And we do that through periodic health assessments, we do that through various occupational skill requirements where for different specialties, we need different things. We have immunization schedules; we have a wide variety of things that bring people to the medical system to make sure that their health is maintained.

When we have the deployable force looking at them in terms of how are they ready to go, we make sure that during wartime that there is a fairly rigorous process to continuously screen individuals for their prepared -- medical preparedness, both physical and mental, before they go while they're there to sustain their ability to perform their function in a war-fighting situation, and then when they return.

Formal programs to assess this really were instituted as a lesson learned from the first Gulf war, that we didn't have good baseline health information on the veterans that went to war in the first Gulf war. So, duty policy and programs were set up to have a pre-deployment assessment process where we captured baseline health information and laboratory information.

We have expanded upon that for Theater surveillance to monitor exactly what kinds of health issues come up during deployment, and we have now more preventive and medicine capabilities in-Theater to deal with documentation of the health experiences in Theater, including injuries, combat, but most of our health issues associated with diseases and non-battle injuries. And so, we have to have a capacity to deal with those things and document it in their health records. So, we spent a large amount of time expanding that capacity.

And then, when people return from deployment, it's important for us to assess and understand and screen how they believe their deployment experience -- what concerns they might have about their deployment experience on their long-term health. And so, we have a immediate upon redeployment process for asking folks about that and having doctors, you know, sort of check them out on the way out the door back to their home station. Or, if they're a reservist, back to civilian life until they're reactivated later.

What we learned in the last few years through research is that folks who have been in a combat experience come back, and they are frequently very anxious to get home, and they are likely to say I'm fine, just fine, let me go home. So that initial assessment process, immediately upon redeployment may not really get the true indicator of their concerns and things that are going on with them mentally and physically.

So, with some research outcomes that had been done in the 2003/2004 timeframe, what we had learned is around the three to six month timeframe, individuals were starting to manifest issues. And we decided that it was important for the department in the military health system to establish a safety net, if you will, or a screening process that would allow us to identify and gives its service members an opportunity to identify concerns and problems before they became chronic so that there was a much better chance of us treating those issues, and, you know, obviating a long-term chronic problem, whether it's physical or mental.

So, we instituted that post-deployment reassessment process. We announced it early 2005; we had pilot projects in the fall of 2005, and we really have just really gotten, you know, sort of going on it early in 2006. So, we've -- we've about eight months of expanding experience in this area. It's very important to us.

Mr. Sanford: Ellen, could you tell us a little bit about the military health system, and specially -- more specifically about the treatment facilities and the health centers that are served by your directorate? Who do they serve, the population base, and what kind of services do they provide?

Ms. Embrey: Well, there's over 238 military treatment facilities serving the forces around the globe, and we have very large centers of excellence in Washington, D.C. and Bethesda, San Diego, Portsmouth, Seattle, San Antonio, and then we have other smaller clinics and ambulatory centers. Have military bases all over -- all over the globe.

We also have mobile medical capabilities that are in our theaters of operation, and they provide care on an ongoing basis in Iraq, Afghanistan, and in the AORs of the other combatant commanders, Korea and South American, the Caribbean, and so forth. So, these military treatment facilities exist to provide ongoing care to individuals for whatever reason. But an important part of that portfolio is the Force Health Protection Program being executed and along with day-to-day healthcare deliveries, so it's a, you know, a two-for, if you will, in those locations.

Mr. Sanford: The global war or terror represents the largest ongoing mobilization of reserved deployments since World War II. Many rules and procedures that have worked well for smaller mobilizations of shorter durations may no longer be suitable for larger and prolonged mobilizations.

Since your office ensures that the medical lessons are learned from previous conflict and are integrated in the new policy, could you elaborate on initiatives, such as DOD Instruction 6490.03, that your directorate has undertaken to improve the medical readiness of the total force?

Ms. Embrey: Sure. For the listeners, DOD Instruction 6490.03 actually is our deployment health instruction. It replaces a prior instruction that was focused on how we do surveillance of health in deployed environments, and it expands it to the full spectrum of deployment health issues that we are trying to assure that we not only surveil, but document and then follow-up over the life a serviceperson's career. The key features of that instruction are to document the linkage between occupational and environmental monitoring and the locations of individuals in a combat environment. Especially if there's combat exposures or occupational exposures that might have an impact on an individual. The only way we would know is if we would document acute symptoms at the time of that exposure and then identify that cohort for follow-up throughout their lifetime.

We also update the policies and standards for how we are going to prepare for and screen for health requirements for deployments, and that is in this instruction, as well. And we also define the prevention and protection requirements for the services to execute, as they prepare for deployments, and in deployments, and it applies not only to the military, but to our DOD civilians and contractors that deploy.

Mr. Sanford: I understand there's something called the Deployment Health and Family Readiness Library. Could you tell us a little more about it? What does it contain? How is it structured to assist the service members with the delivery of health service?

Ms. Embrey: This library is a virtual library; it's available on a -- of a Web site, and it's really a clearinghouse of the very best of what we have to say, that each of the services and our office has published on a wide variety of topics that relate to deployment health and deployment health concerns. It's written with different customers' viewpoints in mind.

We have a section that deals with a child's understanding of these kinds of issues, one for families, mothers, fathers, grandparents, and that, as well as commanders and service members themselves if they want to get into some more detailed information. It is an award-winning site, and it really does provide fact sheets, guides, and other products from emotional health to infectious diseases, to environmental hazards, as well as what we have in a way of capability to deal with those things. And I'm very proud that we've been able to pull this together because it's been extraordinarily helpful, and we have a very high rate of utilization based on the number of hits that we have, and so on.

Mr. Morales: That's excellent. Ellen, I only have a minute, but you described earlier that the Force Health Protection represents a "continuum" of care, ranging, you know, all the way back from enlistment through retirement. As such, the portability of service members' health information is very critical.

Could you elaborate on the upgrades to the military electronic health record, and what are the core benefits, and does it link to the VA's computer patient record application?

Ms. Embrey: The Department of Defense, along with VA, is participating in a national initiative to create a good electronic health record, and DOD, because it has a program now to -- that will assure that we capture electronic health records for all of our forces and beneficiary, the ALTA Program is a newly-established program that is about to be completely fielded everywhere, and it will capture electronic health records for all of our forces, assumed it is fully deployed.

It is not the standard that we're all working towards, however, we believe us, in partnership with the VA and other industry partners, that we'll be able to deliver, you know, a very positive way to capture and mind that information for good health outcomes and research, and as well as to better manage our forces because we are so widespread. So, it's a very positive thing, it's very important to us. It's not exactly linked with VA, but it's very close, and we're working towards that.

Mr. Morales: Great. What are some of the innovative ways to protect the health of deployed forces? We will ask Deputy Assistant Secretary of Defense for Force Health Protection and Readiness, and Director of Deployment Health Support, Ellen Embrey, 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 Ellen Embrey, deputy assistant secretary of Defense for Force Health Protection and Readiness. Also joining us in our conversation is Russ Sanford, director in IBM's DOD practice.

Ellen, regarding DOD Health Affair's focus in support of medical research, can you tell us a little bit about something called the Millennium Cohorts Study?

Ms. Embrey: Yes, it's a longitudinal health study that we instituted back in 2001. The idea is to identify cohorts of deploying service members and to capture their long-term health over time. And so, every year, we capture new cohorts to add to that study, and it's the largest prospective study that the department has undertaken to try to understand the actual long-term health effects of deployment.

Periodically, we send out a survey to the individuals in the study to identify their health issues as they evolve over time - well, we hope to have about 140,000 (enrolled).

So, it's a -- it's a major undertaking, and we hope it will yield a lot of important outcomes that we can use to help us do a better job of preventing those long-term effects. Most of the work and most of the benefit of this study will not happen until far in the future, although, we are levering certain of the cohorts to look at different kinds of things.

Like we had enrolled some folks just before 2001, 9/11, and we enrolled -- we queried those individuals to talk about the impacts of that experience on -- on their mental health and other issues. So, yes, we've had some shorter term outcomes, but it's a longitudinal study.

Mr. Morales: Ellen, we've spent a fair amount of time talking about some of the health and medical concerns as it relates to the theaters of combat. But what role does your office play in tracking, and monitoring, and preparing for other threats, such as a possible avian flu?

Could you elaborate on the national strategy and what unique set of DOD assets could be used to support some national response to something like this?

Ms. Embrey: Yes. The department has a fairly large global footprint, and the Force Health Protection Program is set up to monitor infectious diseases in areas where we have military activity. So, we have laboratory surveillance capacity to understand infectious diseases in -- in the areas around the globe, and we are now leveraging that to help support our awareness, detection, and understanding of the strains of avian influenza that are out there. And collaborating with CDC and the WHO to make sure that we are very carefully monitoring the potential for a pandemic. And it may not be the one that we're looking at, it may some -- be some different one.

We have been actively engaged in supporting the president and the development of his strategy and his implementation plan. We -- we've had several representatives working with the White House on that, and we have engaged significantly with the other federal agencies to integrate what we have been tasked to do in the plan with the other work.

There's 116 tasks that the department has been asked to address as part of the overall plan, and 32 of them -- the Department of Defense has the U.S. government lead. There are a number of them; most of them are -- fall into the Health Affairs category, so, you know, we are actively engaged in these issues.

The kinds of things that we would provide, supplies for the protection and the viral medications pre-pandemic vaccines and antibiotics, personal protective equipment, that's for our own force, but then, in addition to that, we would support HHS and the Department of Homeland Security, and the Department of Agriculture in whatever they require of us, and primarily of trained manpower.

Mr. Sanford: The National Bio-surveillance Integration System, or, as it's known, NBIS, represents a critical federal multi-agency collaborative effort. Could you describe the work DOD is doing in bio-surveillance and elaborate a little bit on a program called ESSENCE, the Electronic Surveillance System for the Early Notification of Community-based Epidemics?

What does it do? How does ESSENCE -- or how has ESSENCE evolved since its original development?

Ms. Embrey: Yeah. ESSENCE is a syndromic surveillance system that encompasses the entire system. It involves some 8 million beneficiaries and the symptoms that go along with that; it's captured at over 400 facilities globally. It provides a way in which to interpret on a near real-time basis outpatient health events and selective pharmacy data to help us understand, gee, what might be going on in advance of any technical area. We're refining that system now to include laboratory x-ray and other chief complaint data so that we have a better understanding of what's going on out there before the actual diagnosis, the case definition comes out.

But ESSENCE is an important pillar in a whole series of activities that the department is engaged in. We have requirements to -- and we've built into our capacity for surveillance within the services and across the department for reportable events for looking at and providing samples, viral samples, laboratory samples, to help inform how we build the season flu strains on an annual basis; we collect those in different geographic locations around the world for CDC. We do mortality surveillance, we engage in a medical intelligence, looking at foreign health trends, and we use that to help address our Force Health Protection objectives.

We have a program called Project Guardian which works with ESSENCE to try to understand potential threats for exposure to chemical and biological agents that might be untowardly placed in our installations. I think this all sums to the fact that we have quite a bit of capacity, and a major initiative in the department right now is to tie these together into a coherent program that uses the same standards, ties them together within a network of communication and data streams that allows us, for the first time, to have enterprise-wide surveillance data where we can talk about what's going on in the department from a health perspective trend-wise with data that uses the same standards.

Right now, we don't have that capacity; we have it in stovepipes for different types of activities and within each service. So, we are creating an armed forces health surveillance center that will bring those things together, and we anticipate that the announcement of that established program or center will be coming out very soon. We expect it to be fully operational by the end of FY08, and initially operational this fiscal year, FY07. So, it's a big -- big initiative, and we're very excited about it.

Mr. Sanford: We've heard you mention that you work with different federal agencies, or your director works at different federal agencies. I would assume that tying all the separate public health networks that comprise the DOD health environment is a critical task of part of what you're working in.

Could you tell us a little bit more about the role of the armed forces health surveillance center, and when is it they're expected to reach its initial operating capacity?

Ms. Embrey: The center is going to tie all this stuff together. Tie all of those activities and streamline and enable us to have an enterprise-wide. Right now, if you were to ask us how many blue-eyed, left-handed individuals contracted the flu last year, we would be able to tell you that. We would have to go to each of the services and use their capabilities. So, this is a way in which we will bring together the network and the capacity, and that was a pretty bad example, but it's supposed to be bad so that you can, you know, get the idea that we will come up with standards for how we're going to collect, and then use and report on the health trends in the department.

The center will be available 24 hours a day. It will provide epidemial(?) expertise to the services when we have an outbreak to go out and do the proper investigation. It will create a career path for the development and enhancement of epidemiologists in the system, and it will allow us to do and give us the data we need to do a lot better job evaluating health trends and -- and research.

So, for us, it's -- as I said, it's very, very important. We expect it to stand up fully by FY08, and initially, this fiscal year, probably by January.

Mr. Morales: We only have a minute, but can you tell us about the joint patient tracking application and how it was modified to support Hurricane Katrina disaster relief efforts?

Ms. Embrey: Yes. The department has had an ongoing requirement since OIF and OEF came about. Our doctrine has changed where we stabilize in-theater and actually move quickly out of theatre into definitive care, either in war areas or back in the States. And with this change in strategy, we are bringing recently-injured individuals who are stable, transporting them back to a more sophisticated care elsewhere.

Well, with that becomes a mandate to have better tracking. The status of that patient and the demands of that patient so that when they land on the tarmac, the -- the patient reception is ready to go. And so, that put a demand in the system for us to track the status of these individuals and to bring in the information that was necessary to manage between points of evacuation.

The JPTA is the solution that we brought up to meet that requirement. We had a system to say a patient was on a plane, but we didn't have a system that said what that patient needed and -- and what kind of meds they were on, and that kind of thing. So, the JPTA was developed to support that requirement.

We adopted it for Katrina disaster relief efforts. It was not used exhaustively in that environment, but we have been in negotiation with the VA and with HHS to expand its use now for future mass disasters, such as Katrina.

Mr. Morales: What does the future hold for DOD's Office of Force Health Protection and Readiness? We will ask Deputy Assistant Secretary of Defense for Force Health Protection and Readiness, and Director of Deployment Health Support, Ellen Embrey, 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, Al Morales, and this morning's conversation is with Ellen Embrey, deputy assistant secretary of Defense for Force Health Protection and Readiness. Also joining us in our conversation is Russ Sanford, director in IBM's DOD practice.

Ellen, the evolution from acute care to preventive care has represented a historic shift in the delivery of healthcare. What other shifts do you anticipate in military medical care within say the next five to ten years, and how do you envision your directorate's role shifting to adapt to that accordingly?

Ms. Embrey: That's a really good question. It's hard to predict the future. I think their research is making tremendous strides in a wide variety of areas, and one of our focus areas for the future is on human performance optimization.

Force Health Protection, to this point, really addresses how do we sustain a healthy force, and we're defining that in the context of absence of disease, and assuring that people are fit.

The military community is seeking ways to ensure that our forces are not only fit, but they're hyper fit, that they are capable of sustaining in austere environments for extended periods of time. And so, the research and the focus for the future is to understand resiliency, both physical and mental, and I believe that's where we're going to see the biggest focus and change for the future.

Because we are going to be able to be getting our arms around a health surveillance and we'll have the largest centrally standardized health surveillance capacity in the world, I think we will learn quite a bit from that surveillance capacity and that will inform us in ways that we might not be able to imagine right now.

I also see that there is going to be a closer alignment of how we evaluate what the medical community needs to be prepared to do in a combat environment. As we change our tactics in combat environments, we have to be able to change our tactics for providing care in those environments. And I think we're seeing a trend towards a smaller, more dispersed combat force, and therefore, we are going to be placing more and more responsibility on individuals to understand what to do to situations that they are confronted with. And so, the idea of a large combat medical unit is just not in our future.

We'll be probably looking at creative ways to bring together modules of capability in a -- in a net-centric environment, and to manage the theater as much as we managed trauma systems in the U.S. that have the capacity and move it around as appropriate and build in skills at the individual level with really good tools and technologies. That's where I see us.

Mr. Morales: Great. Ellen, you've a couple of times talked about some of the research that your office is doing. Regarding the area of the application of technology, does your office direct much of its own research and development either of software systems or of equipment items? If so, are there are particular focus areas?

Ms. Embrey: Yeah. My office plays a very important role in partnership with other organizations. There is a CIO, if you will, in Health Affairs who looks at the broader information technologies and how we capture that in a more effective way.

But my office is looking at how to leverage information technologies primarily, as well as medical technologies that will improve our ability to understand threat, to respond to it medically, and to assure that we are doing the best we can to preserve and protect life. And having that responsibility puts a very interesting demand on my staff to understand what the war-fighter needs, and then challenge the status quo to develop that.

And, as you know, in any major acquisition system, there is rigor, there is defining the requirements, and so forth. Well, my job is to understand what's new about those requirements that have been set in stone through the acquisition process and to evaluate how that new requirement racks and stacks against the ongoing program and to do spiral developments that can plug and play into the program as we move forward, both for medical material, as well as information systems.

Mr. Sanford: As an organization known as the "Force Protector," your directorate plays a really critical role in the health, security, and safety of the country service members. To that end, what steps are being taken to attract and maintain a high-quality, technical workforce?

Ms. Embrey: I think if you are doing important, relevant work, people learn about it, and good people want to come and play. If you're not doing it, it's hard to do. So, I think, for me, the fact that we have a very vibrant, very relevant, and very exciting opportunity to make a difference, I think our office has experienced quite, you know, the best and the brightest; we are attracting people all the time, they beg to come to our office, and I think that's a wonderful thing.

So, for me, recruiting qualified people is not a problem. From within the force and from outside the department. However, that's just for now. You know, we have to do more than that, and I think we're actively engaged in looking at a human capital strategy for the long run, especially in the medical field.

Again, the idea of this resiliency, how to build resiliency, both physically and mentally, is an ar3ea where there's not a lot of expertise, and if that's where we're headed, we've got to build that capacity, we've got to incentivize the community to train those kinds of skills, and then, you know, have a good program for recruiting and retaining the --

Mr. Sanford: Ellen, along those same lines, you told a wonderful story about how you got your career started in government. What advice would you give to a person who is considering a career in public service?

Ms. Embrey: If you want to do public service, you aren't going to be motivated by money. The salaries in the federal government leave a lot to be desired. But they have their own rewards, and that is that you have an opportunity to really, really make a difference, and in the Department of Defense specifically, you have a well-supported structure of planning, recruiting, they have a very rigorous training program to build the skills that are necessary, and strong support for the senior and mid executives, as well as the individual workers themselves.

So, that with the changing authorities in the personnel systems, especially in the Department of Defense, it's a very attractive place to work as an individual. There's job security, there is full accountability, and there's good support. So, I would say if you're motivated to do public good and to make a difference in people's lives on a day-to-day basis, and -- and to be a good steward for the taxpayer's interest, public service is a way to go. It's very rewarding. It does have its frustrations, I won't lie to anybody, but overall, I've had many opportunities to leave the federal government and the Department of Defense, and I would not change it. I've been in the government for 30 -- more than 30 years now, and I absolutely love it and I would highly recommend it to anyone.

Mr. Morales: We are reaching the end of our hour. I want to thank you for fitting us into your busy schedule today. But, more importantly, Russ and I would like to thank you for your dedicated service to our country and to the war-fighter.

Ms. Embrey: Well, thank you. For anyone that's interested in learning more about what we do in our organization, I'd like to refer you to our Web site. It's www.ha.osds.mil/ -- and that's a back slash, fhpr.

Mr. Morales: Great, thank you. This has been The Business of Government Hour featuring a conversation with Ellen Embrey deputy assistant secretary of Defense for Force Health Protection and Readiness, and Director of Deployment Health Support at the U.S. Department of Defense.

Be sure to visit us on the web at businessofgovernment.org. There you can learn more about our programs, and get a transcript of today's conversation.

Once again, that's businessofgovernment.org.

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 can't 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 Al Morales. Thank you for listening.

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