|Developing a Joint Medical Asset Repository|
by Captain Mary P. Govekar and Gerard F. LoSardo
The U.S. Army Medical Materiel Agency is developing a "one-stop shop" for medical logistics information to meet the medical logistics total asset visibility needs for all military services.
As most military logisticians know, logistics support during Operations Desert Shield and Desert Storm was a constant nightmare. The supply pipeline was clogged with thousands of shipping containers whose contents were unknown and with redundant requisitions, all of which caused a large logistics footprint. The medical logistics system suffered similar problems. The inability to "see" the flow of medical assets throughout the distribution pipeline created container backlogs and duplicate requisitions. Chaos resulted because logisticians were forced to operate blindly in the absence of the most fundamental asset visibility. This shortcoming led to a widespread loss of confidence in the medical logistics community's ability to get the right mix of supplies and equipment to healthcare providers in a combat zone.
The U.S. Army Medical Materiel Agency (USAMMA) at Fort Detrick, Maryland, is addressing this problem on behalf of the joint medical logistics community. Through its Medical Logistics Total Asset Visibility (MEDLOGTAV) Office, USAMMA began developing the Joint Medical Asset Repository (JMAR) in 1997. JMAR is a data warehouse that will function as the single authoritative source of medical logistics data for the Joint Total Asset Visibility (JTAV) Program. When JMAR development is completed in 2004, commanders at all levels from all military services will have access to the medical logistics data necessary for logistics planning and execution. JMAR will enable medical logisticians from all services to develop and execute logistics support in line with the supported commander in chief's priorities and that is based on joint logistics data that combine assets with needs.
Why JMAR Is Needed
Besides the obvious benefits of establishing total asset visibility, some unique traits and business practices of medical supplies drive the urgency for creating JMAR. First, all of the services rely almost exclusively on medical prime vendors and the manufacturing base for both pre-deployment surge support and sustainment in the theater, except for several hundred military-unique items. Visibility of all medical assets in military and commercial storage facilities and distribution pipelines is key to the success of the joint medical community's deployment planning and sustainment support.
Second, it is likely that medical logistics in future operations will use the Single Integrated Medical Logistics Manager concept, in which one service is responsible for all medical logistics support in a theater. JMAR will provide the tools needed to ensure that medical materiel is managed, allocated, and distributed jointly rather than in a stovepipe fashion within each military service.
How JMAR Works
JMAR does not create new data. Instead, it accesses data in existing service and wholesale medical logistics automation systems. JMAR is designed to act as a "one-stop shop," where all medical logistics information is combined so that logisticians and planners can see what is available, what is incoming, and what is currently in the logistics pipeline.
The scope of JMAR's capabilities will remain consistent with the capabilities required for medical asset visibility stated in JTAV's Functional Requirements Document. JMAR ultimately will provide visibility of all medical assets at the tactical (retail), operational (intermediate), and strategic (wholesale) levels. It will show all assets in storage, in process, in transit, and in theater and will include visibility of blood, blood products, and medical-unique equipment repair parts.
How JMAR Is Being Developed
USAMMA devised a three-phase strategy for developing JMAR. A proof of concept was developed and implemented in phase 1, which was completed in September 1998. The proof of concept integrated six medical materiel data sources and two catalog data sources into the JMAR data warehouse. For the test, JMAR developers selected a small number of medical logistics automated management information systems that represented all services and all operational levels. Data were accessed with a system of canned queries that provided basic visibility of equipment items, war reserve materiel, and selected component items. The queries also allowed users to sort data by a variety of data fields, such as owning service, organization, location, and condition code.
Phase 1 also provided visibility of a small amount of commercially stored assets owned and managed jointly by USAMMA and Defense Supply Center Philadelphia, Pennsylvania. This represented an initial, though extremely limited, step toward using JMAR to show readiness-significant assets at the wholesale level.
JMAR is currently available to medical logisticians on the Internet at http://jmar.detrick.army.mil. After registering and obtaining a password from USAMMA, users will be able to see asset profiles of various service-owned, pre-positioned medical war reserve materiel at both stateside and theater storage sites. Queries and displays are both user friendly and functional. Completing phase 1 established JMAR as the first web-based source of medical asset visibility available to all Department of Defense (DOD) planners and warfighters. However, it represents only an embryonic capability that is based on a small number of participating data sources.
JMAR Development Phases
Phase Fiscal Year
1. JMAR Proof of Concept 1998
2. Active Component Integration 1999-2001
3. Reserve/Wholesale Integration 2002-2004
Phase 2 will provide a much more robust capability than phase 1. First, JMAR will bring in considerably more data by expanding the number of data sources that "feed" the JMAR data warehouse. Second, query capabilities will be expanded and refined. Scheduled for completion by the end of fiscal year 2001, the objective of phase 2 is to capture and integrate all relevant logistics data on all service-owned active component medical materiel and secondary items into JMAR. Additional visibility will include
One of phase 2's more ambitious objectives is to build a powerful capability for comprehensively viewing and analyzing biomedical maintenance. The JMAR goal goes beyond merely providing the maintenance status of equipment assets and all known sources of applicable repair parts and support kits. JMAR also will allow planners to extract and manipulate management data so they can look into systemic maintenance problems or conduct trend analyses. These data may target a specific item of equipment and include such elements as maintenance history, average equipment downtime, average annual maintenance cost, and average annual man-hours used.
Phase 3 of JMAR's development is scheduled for completion by January 2004. The goal is to integrate data from reserve component medical units and the wholesale sector into the system. It will interface with emerging medical logistics automated information systems as they are fielded, such as those being developed by the Defense Medical Logistics Standard Support Office. The Readiness Management Application, which is being developed at Defense Supply Center Philadelphia, will be the primary system used to capture wholesale medical asset data.
What JMAR Will Do for the Logistician
JMAR's true value will be realized only when all of this information can be integrated and presented to the logistician in a useful fashion. Therefore, one of USAMMA's key objectives is to embed a certain level of decision support capability in JMAR by fusing asset visibility, requirements data, and materiel sources. For example, JMAR eventually will provide the logistician of a deploying hospital unit with the fill percentage of pre-positioned combat support hospital medical materiel sets that are scheduled to be handed off to his unit upon arrival at the theater reception and staging area. The logistician could compare unit-owned assets to JMAR-identified shortages and include this information in his deployment plan. The logistician then could coordinate with USAMMA, which, as the Army's service item control center for medical materiel, would use JMAR to identify alternative wholesale sources to satisfy known shortages. The unit then could acquire assets rapidly and have them shipped to the theater and included with the pre-positioned materiel.
Another challenge for JMAR's developers is to provide visibility of wholesale-level and commercially available medical materiel. In the last 5 years, Defense Supply Center Philadelphia, acting as the DOD wholesale-level medical materiel provider, has partnered with the armed services to develop acquisition tools that will enable the rapid and economical procurement of medical materiel to support contingencies. These initiatives usually involve innovative contractual agreements with the commercial sector.
One result of this partnership is the stock rotation contract. A stock rotation contract allows for Government-owned medical materiel with short potency periods (such as narcotics or laboratory reagents) to be rotated through a commercial vendor's peacetime sales volume to minimize losses due to potency expiration. Another pay-off is the implementation of vendor-managed inventory, in which a commercial vendor guarantees the availability of select medical materiel for military use during a contingency. The challenge is for JMAR to capture and integrate this information from commercial and industrial bases, fuse it with materiel data obtained from military sources, and provide it in a form useful to medical materiel managers, planners, and commanders. For example, a deploying medical unit should be able to obtain an asset and shortage profile for pre-positioned medical equipment sets designated for that unit. The deploying unit commander then could fuse those data with a profile of assets from vendor-managed inventory or current stock rotation contracts to determine potential commercial sources that would meet shortages.
The potential sources will grow in number if and when JMAR is able to obtain true commercial asset visibility of medical prime vendor inventories. Such visibility not only will identify numerous commercial sources for medical requirements, but also will help determine which products to standardize based on usage trends in the commercial market. At its present stage of development, JMAR does not possess a decision support capability. USAMMA's goal is to acquire such a capability during phase 3.
A key issue regarding JMAR's design is ease of user access. Users currently are able to access JMAR through the World Wide Web. The user friendliness afforded by using the web as a gateway fulfills the JMAR vision of access to any user, at any time, on any machine.
Development of medical logistics total asset visibility not only is a key milestone toward the objective of joint management of medical assets; it also is critical to managing medical materiel effectively under the new business practices that the medical community is implementing. To be effective in this environment, MEDLOGTAV must include visibility of both DOD-owned and commercial assets and show items that are unique to the medical logistics discipline, such as blood and medical-unique repair parts. MEDLOGTAV also must offer the data in a flexible and friendly mode that is useful to medical logisticians and planners at all levels. Once completed in 2004, JMAR will deliver this vision. ALOG
Captain Mary P. (Pat) Govekar is the Deputy Program Manager for the Medical Logistics Total Asset Visibility Program at the U.S. Army Medical Materiel Agency. She is a graduate of the Combined Logistics Officer Advanced Course and the Medical Logistics Management Internship Program.
Gerard F. LoSardo is a medical logistics theater functional analyst with Information Systems Support, Inc., and is currently working at the Defense Medical Logistics Standard Support Program Office. He has a B.A. degree from Rutgers University in New Jersey and an M.B.A. degree from Hood College in Maryland.