New computer system to identify and track occupational, environmental health risks goes online in 2004

WASHINGTON, October 2, 2003 (DeploymentLINK) - The Department of Defense's focus on force health protection has become more intense with the increased operational tempo. Protecting the health of those who go into harm's way is a top priority. Whenever sickness or injury does occur, it is important to have the information to understand why. DoD is working to develop electronic systems that will collect and store data that may be necessary to explain illnesses that later may arise in personnel.

The first segment of DOEHRS is ready to go.
	DOEHRS-Hearing Conservation, in use worldwide, captures data on hearing loss and occupational noise exposures. Capabilities include:
	Noise exposure surveillance Hearing loss and injury referrals Auditory readiness documentation Medical outcomes documentation
	DOEHRS-Industrial Hygiene will provide individual longitudinal exposure records. Capabilities will include
	Industrial hygiene, environmental health and safety exposure Executive decision support Enrollment into medical surveillance programs
	Captures data on occupational exposures and transfers it to the Composite Health Care System II, the Military Electronic Medical Record
	Provides information needed to conduct exposure-based occupational medicine and industrial hygiene.
	Serves as the occupational and environmental health component of the Theater Medical Information Program

One way force health protection will be enhanced in the future is through the Defense Occupational and Environmental Health Readiness System, or DOEHRS. Jeff McClaflin, an industrial hygienist at the National Naval Medical Center in Bethesda, Md., has been part of a Tri-Service plus-team - which includes members of the Army, Navy, Air Force and other agencies - working on the design of the system since 1998.

"The Gulf War illness question was the driver for our whole software development program," McClaflin said. "DOEHRS is designed to be able to answer questions like that."
DOEHRS will provide individual longitudinal exposure records - occupational and environmental exposure histories for all DoD personnel - both military and civilian.

When fully operational, DOEHRS will be the Defense Department's multi-service occupational exposure database information system for all three military departments. DOEHRS will provide military leaders with a Web-based computer program. The program will support the data collection, storage and analysis needed to provide operational commanders risk-based information for tactical decision-making as well as providing occupational medicine professionals the kind of medical surveillance related exposure data that can reduce future health risks to the military and civilian force.

As an occupational exposure database, DOEHRS will hold information on potentially harmful exposures primarily documented in paper files today. One example McClaflin points to is overexposure to noise.

"There's no way to look at the impact for hearing loss to all DoD affected personnel, or even across all of the Navy," McClaflin said. "If we're looking at noise exposure to sailors on the flight deck of an aircraft carrier, it's hard to pull that information together now."

Although DOEHRS will collect data on occupational exposures, its use won't be limited to industrial hygienists and bio-environmental engineers. This information will be of use to occupational health physicians, technicians, audiologists and nurses who want to track the effects of various exposures. It will become the way for them to see the big picture.

"In the Navy we have groups of professionals, industrial hygiene officers, preventive medicine officers and preventive medicine technicians, that do a lot of work with deployed troops," McClaflin said. "In the Air Force, there are the bio-environmental engineers and their technicians who do a lot of the data collection. The Army has environmental science officers, preventive medicine officers and technicians that support the troops. Public health professionals will also be users."

McClaflin said that part of the challenge in dealing with Gulf War illnesses was trying to answer the health questions with limited exposure data. After DOEHRS is fully fielded, he said, any similar situation would be easier to investigate.

"If we have folks sitting in a base camp, and we find out there's an environmental exposure associated with that location, then that information can be captured," McClaflin said.

When the individuals present are associated with that environmental data that will create an occupational exposure database record that experts can examine later if that group develops any health issues. The services will provide the technical resources for that kind of analysis.

"We have the Navy Environmental Health Center," McClaflin said, "similar to the Army's Center for Health Promotion and Preventive Medicine in Aberdeen and the Air Force's Institute for Operational Health located at Brooks Air Force Base. They each have a group that would do the epidemiological analysis, looking at all of the collected data."

When in place, DOEHRS will tie a lot of valuable information together. It will have an interface with the Composite Health Care System II, the military electronic medical record, and interface with the DoD Hazardous Substance Management System of the Environmental Information Technology Management Program.

McClaflin expects basic work on the DOEHRS program to be completed in the spring of 2004, allowing the system to begin deployment to sustaining base units, such as garrison locations, as early as June 2004. The majority of DOEHRS capabilities will be added into the Theater Medical Information Program, which is an integrated suite of medical information systems that provide automated information management support in deployed environments. TMIP is the medical component of both the Global Command and Control System and the Global Combat Support System. Currently, TMIP's Medical Surveillance System is designed to monitor medical treatment data to detect disease outbreaks and injury trends among deployed service members. DOEHRS will add exposure data to that mix of information. As a component of Theater Medical Information Program, DOEHRS will support risk identification for environmental and occupational hazards among deployed civilian and military personnel.

"Where we document specific exposures to DoD personnel, we can assist commanders in making informed tactical decisions. And, we can provide specific medical surveillance and personal protection recommendations," McClaflin said. "That information can be transmitted to the operational commanders as well as health care providers so that they know what's going on in the workplace, whether it's a deployment type workplace or the industrial workplace where we're making parts for the aircraft carrier or plane."

McClaflin sees DOEHRS flexibility as a major asset. Aside from its applications to overseas deployments and industrial applications, the system could hold information that could be used to measure national readiness for homeland security.

"How many people at every installation are trained in HAZMAT response? How many have been issued respiratory protection? How many have appropriate chemical protective clothing? Just to be able to answer questions like that now, with a simple Web-based query would be great." McClaflin said.

Even the actual data entry for the DOEHRS system will be cutting edge. Industrial hygienists, doctors, nurses and other health care professionals will compile the longitudinal data in the course of doing their regular jobs using the latest technology.

"We are transitioning from a pad of paper and note-taking in the field to a tablet PC with all the data collection forms on the tablet," McClaflin said. "This means that while the person is collecting data at a base camp or industrial site, their critical reference databases will be there. They will be able to capture all the necessary information. There will be no need to recreate their notes or any information they have collected. They will just input to their tablet, then plug it into a docking station in their office and upload to the web based system. And once it is completely operational, the value of the DOEHRS system will steadily increase as more and more data is entered into the system. This will be a long-term, ongoing project.

"Just getting all the initial data collected for all of our initial work sites throughout DoD might take three to five years," McClaflin said.

However, once enough health, location and exposure data are loaded into the DOEHRS system, it could make military service safer and reduce fears of illnesses from unknown causes.