Military

     STATEMENT OF

 VICE ADMIRAL RICHARD A. NELSON, MEDICAL CORPS

 SURGEON GENERAL 

UNITED STATES NAVY

 JULY 18, 2001

   FY02 Posture Statement   

 Chairman McHugh and distinguished members, thank you for the opportunity to review Navy Medicine’s accomplishments in 2000 and plans for the future.

This has been a challenging and rewarding year for the Navy Medical Department.   We have successfully responded to many challenges placed before us. We continue to face a period of unprecedented change for medicine. Our health system must remain flexible as we incorporate new technologies and advances in medical practice, struggle to maintain our facilities, optimize our health care delivery, embrace new health benefits, enhance patient safety, and increase our ability to provide care to beneficiaries over age 65 in the coming months. Navy Medicine has been working tirelessly to maintain our superior health services in order to keep our service members healthy and fit and ready to deploy while providing a high quality health benefit to all our beneficiaries.  As you know, healthcare is an especially important benefit to service members, retirees and family members. It is an important recruitment and retention tool.  For active duty members and their families it’s one of the key quality of life factors affecting both morale and retention.  Additionally, the benefits afforded to retirees are viewed by all as an indicator of the extent to which we honor our commitments.  The expanded health care benefits in last year’s National Defense Authorization Act were most welcomed by all our beneficiaries and will help restore the faith of our retirees in Military Health Care.   However, we must also ensure the provisions are delivered and that sufficient resources are available now and in the future to avoid making a commitment we can’t afford to keep. 

Global Force Health Protection

The year 2000 has seen Navy Medical Department personnel assigned to Navy and Marine Corps forces world wide, many of whom are deployed with our underway ships or in forward areas.  This year, thousands of Navy medical personnel supported joint service, Marine Corps, and Navy operations and training exercises.

Our medical personnel have provided humanitarian relief to many countries around the globe.  During periods of social unrest, Navy medical personnel provided environmental and preventive medical assistance in Guatemala, Columbia, Peru and Micronesia.  In support of our national strategy to assist governments pursuing democracy and independence, our medical personnel assisted in the Ukraine, East Timor, Indonesia, Samoa, and Mozambique, coordinating humanitarian relief, epidemiology, preventive medicine, dentistry, and ophthalmology support.  Despite the challenges of working in austere environments, these deployments have provided a valuable opportunity to hone our medical skills and test our readiness while providing relief to people in need. 

During the tragic events of military and commercial airline crashes, Navy medicine quickly mobilized Special Psychiatric Rapid Intervention Teams (SPRINT) to assist servicemen, families and civilians through their grieving process.  A SPRINT team deployed to assist the 318 uninjured crewmembers of USS COLE after the terrorist attack in Yemen.   In addition, a task-organized Fleet Surgical Team deployed to augment the medical capability in theater in support of the forces still operating in the high threat environment.

As we move into this new millennium, our Navy and Marine Corps men and women are called upon to respond to a greater variety of challenges worldwide. This means the readiness of our personnel is now more important than ever.  Military readiness is directly impacted by Navy Medicine’s ability to provide health protection and critical care to our Navy and Marine Corps forces, which are the front line protectors of our democracy. That’s what military medicine is all about – keeping our forces fit to fight.

I am also pleased to report that we recently implemented a new Reserve Utilization Plan (RUP) that will optimize our use of reservists during peacetime and contingencies. The Medical RUP is Navy Medicine’s plan for achieving full integration of Medical Reserves into the Navy Medical Department.  Prior to the Total Force Policy, the Medical Reserves were considered a “Force in Reserve,” to be called upon during national emergency.

Taking Care of the Fleet

Under our theme of “Force Health Protection,” we will place special emphasis on keeping Sailors and Marines healthy and fit and ensuring our deployable platforms are ready to deliver effective casualty care - Manage Health Not Just Illness.   The Force Commander Health Promotion Unit Award (which we call the Green "H") is used to measure one aspect of Fleet medical readiness. It enhances the health, fitness and mental well being of our Sailors through their involvement and participation in unit health promotion initiatives. This award is a tangible, visible measure of the operational force's progress toward prevention and population health, since those commanding officers who earn the Green "H" are authorized to paint it on their ship’s superstructure.

This year, more than 130 ships or units have earned the right to paint the Green "H" on their bridge wings, reflecting decreases in alcohol related events and tobacco use rates, as well as increased physical readiness test scores.

Readiness

Navy Medicine tracks and evaluates overall medical readiness using the readiness of the platforms as well as the readiness of individual personnel assigned to those platforms.  The platforms include the two one thousand bed hospital ships, 6 Active duty and 4 Reserve 500 Bed Fleet hospitals, as well as medical units supporting  Casualty Receiving and Treatment Ships (CRTS),  units assigned to augment Marine Corps, and overseas hospitals. One of our measures of readiness is whether we have personnel with the appropriate specialty assigned to the proper billets; that is, do we have surgeons assigned to surgeon billets and Operating Room Nurses assigned to Operating Room Nurse billets, etc.

 The readiness of a platform also involves issues relating to equipment, supplies and unit training.  Currently these are tracked separately. Navy Medicine is developing a metric to measure the readiness of platforms using the Status of Resources and Training System (SORTS) concept tailored specifically to measure specific medical capabilities such as surgical care or humanitarian services.  Navy Medicine also monitors the deployment readiness of individual personnel within the Navy Medical Department.  Personnel are required to be administratively ready and must meet individual training requirements such as shipboard fire fighting, fleet hospital orientation, etc.  The compliance of individual personnel is tracked through a database called Standard Personnel Management System (SPMS) and reported to Headquarters.

 Our People

People are critical to accomplishing Navy Medicine's mission and one of the major goals from Navy Medicine’s strategic plan is to enhance job satisfaction.  We believe that retention is as important if not more so than recruiting, and in an effort to help retain our best people, there has been a lot of progress. Under our strategic plan’s “People” theme, we will focus on retaining and attracting talented and motivated personnel and move to ensure our training is aligned with the Navy’s mission and optimization of health.  Their professional needs must be satisfied for Navy Medicine to be aligned and competitive.  Their work environment must be challenging and supportive, providing clear objectives and valuing the contributions of all.

All Navy Medicine personnel serving with the Marine Corps face unique personal and professional challenges. Not only must they master the art and science of a demanding style of warfare, but they must also learn the skills of an entirely separate branch of the armed services. Whether assigned to a Marine Division, a Force Service Support Group, or a Marine Air Wing, Navy medical personnel must know how Marines fight, the weapons they use, and the techniques used to employ them effectively against harsh resistance.  To excel in this endeavor is an accomplishment that should be recognized on a level with other Navy warfare communities.

Navy leadership approved a new program allowing Hospital Corpsmen and Dental Technicians, as well as other ratings assigned to the Fleet Marine Force, to qualify for a Fleet Marine Force warfare pin.  This designation and associated warfare pin is an outward recognition of the important role our corpsmen and dental techs play in this unique duty.  It will be a positive motivator for current and future HMs and DTs supporting the Marines in the field.

Finally, as we work to meet the challenges of providing quality health care, while simultaneously improving access to care and implementing optimization, we have not forgotten the foundation of our health care – our providers. We appreciate and value our providers’ irreplaceable role in achieving our vision of "superior readiness through excellence in health services."

Within each of our medical facilities there has been an overall initiative to reward clinical excellence and productivity and to ensure that those who are contributing the most are receiving the recognition they deserve.  Additionally, selection board precepts now emphasize clinical performance in the definition of those best and fully qualified for promotion.

 Medical Corps

This past year, the three Surgeons General asked a Flag Officer Review Board to review special pays and propose changes to improve critical provider retention and satisfaction.  I also asked the Center for Naval Analysis to complete a study on provider satisfaction to assess the extent to which changes in special pay would promote retention. The goal is to make the pays more flexible, raise the caps, and remove some of the restrictive aspects of the contracts with the intent of demonstrating early in an officer's career that they are valued. If we don’t value our providers, we cannot expect them to continue to provide outstanding medical service.  We track retention by the use of loss rates compared to beginning full strength numbers.  The annual loss rates for the Medical Corps, as a whole has held steady at 10-11percent and the primary care communities are healthy.   However, I am concerned about our retention rates for enlisted and officer medical specialties.   Loss rates within surgical specialties are high and we have dramatically low retention rates.  Specialties such as General Surgery have a loss rate over 22 percent and Orthopedic Surgery has a loss rate over 27 percent.    Other equally important wartime critical specialties are also undermanned, including anesthesia (93%) and neurosurgery (57%).  We predict a large exodus of radiologists in the next two years as many reach the end of their service obligations.  Distribution problems are significant because we have not been able to keep pace with attrition in some specialties.  There exist significant pay gaps between our surgical specialists, and their civilian counterparts (frequently in excess of $100 thousand per year).  Reductions in the Health Professions Scholarship Program (HPSP) several years ago, coupled with reductions in Graduate Medical Education training pipelines, have contributed to significant shortages of providers.  We have several military treatment facilities where we are unable to assign a military radiologist, and therefore must substitute with high cost contract support.

 Dental Corps

After three years of increasing annual loss rates, the dental corps annual loss rate for FY99 was down to 8.3 percent.  While still too early for conclusive analysis, this improvement may have resulted from increased special pay for military dentists and resolving manning shortages through enhanced accession programs.  Continuation of such initiatives is essential to ongoing efforts to access and retain qualified officers.

 Nurse Corps

Although, overall FY’-2000 data revealed generally higher retention levels than in prior years, the nationwide nursing shortage has adversely impacted our Nurse Corps.  In direct competition with the private sector for a diminishing pool of appropriately prepared registered nurses,  Navy faces shortages in the nurse anesthesia, maternal-child, psychiatric and operating room specialties, that must be addressed if we are to effectively meet both operational and peacetime healthcare delivery missions.  Currently, only nurse anesthetists are authorized to receive incentive special pay.  That program has been a successful retention tool thus far, but the civilian-military pay gap in that field continues to grow.  In order to more accurately gauge compensation gaps for both generalist and advanced practice nurses, the Nurse Corps is also included in the Center for Naval Analyses study on Health Professions Retention Accession Incentives.  Results of the study will provide a tool for future strategies. Further retention bonuses may be needed to retain all types of nurses as competition increases for the dwindling supply.

 Medical Service Corps

Medical Service Corps as a whole, enjoys a relatively stable annual loss rate of nine percent, however loss rates vary significantly between specialties.  Many of our health professionals incur high educational debts prior to commissioning and the amount of debt load increases with succeeding accessions.   In addition, a substantial pay gap  between military and civilian licensed professionals has resulted in decreasing retention.  There is some variation over time of those specialties that are most difficult to recruit and retain, although some are consistently on our critical list.  Currently, optometrists, pharmacists, psychologists and environmental health officers present the greatest challenges.

 Enlisted Members

Navy Medicine’s enlisted member retention statistics compared to Navy Line communities are fairly similar.  However, problems arise in specialized areas such as pharmacy, radiology, and search and rescue fields.   In the Dental community, shortfalls are beginning to appear both in recruitment and retention.  An enlistment bonus for HMs and DTs is needed to help us more effectively compete in today's tight employment market.  Increasing the selective reenlistment bonus (SRB) cap and authorizing SRB payments for advanced technical Navy Enlisted Classifications (NECs) would help improve retention in the ratings, particularly where there is a substantial pay delta with  civilian counterparts.

Uniformed Services University of the Health Sciences

          As the Executive Agent of the Uniformed Services University of the Health Sciences (USUHS) I would like to comment on the achievements of the University and its contributions.  I am proud to inform you that the Secretary of Defense recently awarded USUHS the Joint Meritorious Unit Award for exceptionally meritorious service from July 1, 1990 to July 1, 2000.  The University has graduated 3000 military physicians with a better overall understanding of the military, a retention rate almost twice as long as scholarship physicians and 42 percent of the graduates serving in operational or leadership positions.  The University also provided over $85 million in clinical services to the military services and has trained over 200,000 defense personnel with an annual cost avoidance of over $40 million.  The Casualty Care Research Center of the University has trained over 4,000 emergency health providers.  I would also like to point out that USUHS’ unique military training offers an enormous intrinsic value to our hospitals and operational billets that cannot be measured.    

Make TRICARE Work

We continue to make significant progress in improving TRICARE and enjoy the full support of the senior line leadership.  The Chief and Vice Chief of Naval Operations (CNO, VCNO) have already shown a great degree of interest and appreciation for Navy Medicine and are providing continued support in making TRICARE work.   The Defense Medical Oversight Committee (DMOC) continues to be an active and influential body when it comes to Defense Health Program (DHP) funding requirements in the context of other service decisions and management and reengineering initiatives.  Line and medical leadership is looking for ways to improve the delivery of the health care benefit. 

As stated earlier, the passage of the FY2001 National Defense Authorization Act (NDAA) brings expanded health care benefits to our beneficiaries.  Although the new law includes initiatives such as TRICARE Prime Remote for families, elimination of co-pays for active duty family members, and a catastrophic cap reduction,  its greatest impact will be enhancing the healthcare benefit for our senior retirees and their families.  In looking at our strategic plan’s “Health Benefit” theme, we will concentrate on informing our customers, with the goal that all our beneficiaries will be knowledgeable about and confident in their health benefits. This objective will be even more critical as we implement the legislative changes that improve the health benefit.  We will also focus on improving access, so beneficiaries will have timely access to services, assistance and information. And we will do all we can to simplify the delivery of the health benefit

This legislation is a milestone in military health care not seen since the initiation of the CHAMPUS program more than thirty years ago. We are working with DoD (Health Affairs), the TRICARE Management Activity and the other services to put these changes into effect.

Embrace Best Business and Clinical Practices - Optimization

There is no more important effort in military medicine today than implementing the MHS Optimization Plan to provide the most comprehensive health services to our Sailors, Marines and other beneficiaries. Optimization is based upon the pillar of readiness as our central mission and primary focus.

For several years now, we have attempted to shift our mindset from treating illnesses to managing the health of our patients. Fewer man-hours will be lost due to treatment of injury or illness because we manage the health of our service men and women, which keeps them fit and ready for duty.  With this in mind, TRICARE Management Activity and the three services created an aggressive plan to support development of a high performance comprehensive and integrated health services delivery system. We took lessons learned from the best practices of both military and civilian health plans. The outcome was the MHS Optimization Plan. Full implementation of this plan will result in a higher quality, more cost effective health service delivery system.

The MHS Optimization Plan is based on three tenets.  First, we must make effective use of readiness-required personnel and equipment to support the peacetime health care delivery mission.  Second, we must equitably align our resources to provide as much health service delivery as possible in the most cost-effective manner – within our MTFs.  And third, we must use the best, evidence-based clinical practices and a population health approach to ensure consistently superior quality of services.

Although many commands report numerous efforts to optimize or improve their facility, I am concerned that frequently these efforts are not tied to specific goals or objectives. This is where performance measurement comes in. Performance measurement provides focus and direction, ensures strategic alignment and serves as a progress report.

A part of the Optimization Plan is identifying a specific Primary Care Manager for each beneficiary.  Assigning PCMs by name will improve access and continuity of care.  Each PCM will manage the health of their patient and coordinate their care.  When necessary, PCMs will refer patients to a specialist. Each PCM is a member of a health care team.  This team will provide support when the PCM takes leave, has training or is deployed.  The team concept further enhances continuity and customer satisfaction.  The end result is a healthier population, which is a primary goal of the Optimization effort.

 In the Navy, we are making available comparative performance data on all facilities - so MTF commanders can see where they stand and learn from each others’ successes.  Ultimately, it allows us to raise the bar for the whole organization.  As we continue in our journey of applying performance measurement, we will begin to identify targets for our system and for each MTF.  Holding MTF COs accountable for meeting those targets will be the next step in this evolution.

When Navy Medicine first decided that using metrics would help us drive organizational change, we asked the Center for Naval Analysis to help us.  Once the leadership of Navy Medicine had come to agreement on our Mission, Vision, Goals and Strategies, we partnered with CNA to develop a fairly complex system of composite metrics that we can look at to see if we are going in the right direction.  We are completing our second year with these metrics and have found that many of the measures have data that only changes once a year. This may be fine to measure how well we are doing in moving towards some of our strategic goals, but they are not adequate by themselves to manage the complexity of the Navy Medical department.  This year we’ve added two other “levels” of metrics.  One is a group of Annual Plan measures.  After reviewing our strategic plan in light of the current environment, understanding the strengths, weaknesses, opportunities, and threats to our organization, we identified several priorities for the year.  We then identified measures to track progress on these items - and this data has to be measurable at least quarterly.  Finally, we have just identified 20-25 measures for our “Dashboard of Leading Indicators” that our leadership will be looking at on a monthly basis.  Once we look at the historical data for these dashboard indicators, we will be setting not only targets for where we want to be but also action triggers in case we are going the wrong direction in some area. We will agree on a level below which, we will no longer just watch and see if it improves, but we will take action to change the processes.  So you can see it is an ongoing journey or evolution - and I believe each of the services is involved in a similar evolution.  We in the Navy have web based our Optimization Report Card and the satisfaction survey data is provided to MTF commanders in a more user friendly display on a quarterly basis.

Dental

 Let me provide one more example of effective use of performance measures that is taking place within our Navy Dental organization. In June 1998, senior dental leaders, including Commanding Officers, implemented 12 system metrics to be collected uniformly across all levels of Navy Dentistry.  The system-wide application and utilization of this initiative has lead to improved alignment while documenting higher performance.  During the past seven quarters, improvements in the data collection process enabled valid and useful data based decision-making.  This metric-based management has produced significant outcomes:

--Dentist Productivity increased by 12%.

--Operational Dental Readiness increased from 90 to 96%.

            --Dental Health Index increased from 22 to 34%.

A composite metric “dashboard” was developed as a tool to allow overall performance evaluation while considering all metrics simultaneously.  This tool is used quarterly to monitor the performance and effectiveness of each Command (and even down to the branch level at 170 branches, and 13 Naval Hospitals and 59 ships). All dental units achieve a composite score ranking. It is significant to note that today’s lowest scoring dental unit has a higher composite performance score than that of the top performer 12 months ago.   Guided by metrics, Navy Dentistry moved military dental billets and eliminated substantial contract costs.  These dollars are then available as working capital to meet requirements within the dental system to further increase production and efficiency.

Optimization Resourcing Levels

Although the President's Budget provided an increase in funding for the Military Health System, analysis of the direct care system, consisting of our Military Treatment Facilities and clinics, indicates that military facilities are not optimally resourced to deliver efficient health care.  The internal allocation between funding the civilian contracts and funding direct care creates an austere fiscal environment, and puts the direct care system at risk.  For example, a Family Physician working with two clinical support staff may be able to effectively care for a panel of only 750 adults.  If provided with the industry standard of 3.5 support personnel, that same provider can assume responsibility for 1500-2000 adults.  The Optimization Plan requires that the cost of the additional support staff be recouped via the higher throughput.  In addition to increasing our marketshare, return on investment is generated as the actual cost of care is lower when that care is performed at marginal cost in the direct care system. 

To begin this process, we must make an initial investment in staff.  Clinical support staff to clinical provider ratio is presently 1.81.  The MHS Optimization target is 3.50.    Additional staff in the following categories is also necessary:  Case Managers to coordinate care for the top 1 percent of medically complex cases, freeing clinical providers to do more direct patient care. Utilization Managers are needed to analyze trends in ambulatory care usage by diagnostic and patient category, and develop plans for population health interventions. Medical Record Coders to perform accurate and detailed coding to account for workload and performance, thus ensuring marketshare is accounted for in comparison with contractor performed work.  And Pharmacy technicians are needed to support increased prescription volume with workload recapture.  I am aware that investments of this nature carry the inherent risk that return must be earned quickly enough to pay for the salary tails that will be created.  However, I am firmly committed to changing the business practices and culture of Navy Medicine to recapture workload currently being done in the private sector.

It is important to note that the rapidly escalating costs of the Managed Care Support Contracts places the Direct Care system at risk.  As these costs increase, there is constant pressure to find relief by reducing the Direct Care Program funding in our Military Treatment Facilities to pay for the Managed Care Contracts.  The Direct Care System cannot continue to be the source for the Department’s relief from these unplanned and unexpected increased costs without serious degradation of the most cost effective portion of our Military Health System.   As a result of this internal pressure, I have restricted the resourcing of the Direct Care Program of Navy Medicine to a survival basis over the past two years.  This action has left us in a position of detracting from our facility maintenance, equipment replacement, and continuing medical education programs to ensure that we use our limited resources for the delivery of the healthcare benefit.  The President's budget is intended to help address these shortfalls.  If we continue to underfund our facilities maintenance, this will eventually come back to haunt us in more costly repair requirements, higher Military Construction Program requirements, and higher equipment replacement requirements.

            Of concern is also the replacement cycle for our MTFs and maintenance of real property.  We now face an average facility replacement cycle of over 100 years, compared to data indicating the private sector is less than 25 years.  This does not mean that the private sector plans to replace their facilities every 25 years, but implies that a major renovation will be required every 25 years to remain competitive.  If we do not spend more on maintenance requirements, a significant degradation of our infrastructure will result.      

Quality of Care

We are all concerned over the quality of care our military beneficiaries receive.  As we move to ensure greater access, we must balance this with quality of care. Navy Medicine's goal is to increase the number of support staff to more efficiently and effectively assist our providers.  These steps will minimize the time providers currently spend performing administrative duties; enabling the provider to spend more quality time with their patients while increasing their overall productivity.

Assigning patients to a personal Primary Care Manager, who will be familiar with his/her patients, thus decreasing the time required for the physician to review the patient's history, will further improve continuity of care and customer satisfaction.  The MHS Optimization Plan will play a key role in allowing enrollee assignment to a PCM by name. 

            Deployment of the Computerized Patient Record (CPR) will also increase quality and access.  The CPR has been fully funded for worldwide implementation by the end of fiscal year 2002.  When deployed, the CPR will provide a comprehensive life-long medical record of illnesses, hazardous exposures, injuries suffered, and the care and immunizations received by our beneficiaries.  The CPR will also provide clinical decision support and gives military health care providers instant access to the health care history of each patient.

Navy Medicine has critically examined opportunities for improving patient safety.  The following initiatives have been undertaken to improve quality of care: 

·        A systems approach to improvement using a root cause analysis tool has been implemented at all of our facilities.  This tool is used to analyze all adverse events and certain close calls and requires the involvement of a multidisciplinary analysis team.  Information regarding common themes is reported back to our facilities for appropriate preventive action.

  ·        Participation in the Institute for Healthcare Improvement (IHI) Breakthrough Series to identify opportunities to implement best practices in four hospital high hazard areas: the Operating Room, Obstetrics, the Intensive Care Unit, and the Emergency Department.

·        Establishment of a Birth Product Line to address the delivery of our largest patient service and implement refined clinical practices across Navy Medicine.  This will include a focus on reducing variation in access to anesthesia and pain control, and a standardized approach to perinatal education.  

·        Promoting the use of Evidence Based Medicine with active involvement in the DoD/VA Clinical Practice Guidelines (CPG) development working groups.  Navy Medicine is sponsoring an evidence based CPG addressing urinary tract infections.

·        Implementation of Composite Health Care System II (CHCS II) of computerized patient records to improve documentation of care provided including the follow up of laboratory and radiology exams, and pharmacy orders.

·        Deployment of the Pharmacy Data Transaction System (PDTS) to prevent prescription and allergy errors in a highly mobile population.

Medical Research

Navy Medicine also has a proud history of incredible medical research successes from our CONUS and OCONUS laboratories.  Our research achievements have been published in professional journals, received patents and have been sought out by industry as partnering opportunities. 

The quality and dedication of the Navy’s biomedical R&D community was exemplified this year as three researchers were selected to receive prestigious awards for their work. CDR Daniel Carucci, MC, USN received the Joints Chiefs of Staff Award for Excellence in Military Medicine for his work as an operational flight surgeon caring for Marines and Sailors and as a cutting-edge molecular biologist working on advanced malaria genomics research.  His current efforts in malaria research are providing new and exciting avenues for malaria research and will accelerate the development of novel malaria vaccines and drugs.

 As other examples of scientific achievement, the former Secretary of the Navy, Richard Danzig, personally recognized two senior Navy researchers and awarded them Legion of Merit Medals.  CAPT David Harlan, USPHS (until recently US Navy), was lauded for his research into new strategies for the treatment of combat injuries.  While a Navy researcher, he developed a new therapy to “educate” the immune system to accept a transplanted organ -- even mismatched organs.   This field of research has demonstrated that new immune therapies can be applied to “programming stem cells” and growing bone marrow stem cells in the laboratory.  The therapies under development have obvious multiple use potential for combat casualties and for cancer and genetic disease.

CAPT Stephen Hoffman, MC, USNR, was recognized by former Secretary Danzig for his pioneering work in malaria vaccine development and malaria genomics.  He published the first report that DNA vaccines were safe, well tolerated, and elicited an immune response in normal, healthy people.  His work could lead to the development of other DNA-based vaccines to battle a host of infectious diseases such as dengue, tuberculosis, and biological warfare threats.

The Navy’s OCONUS research laboratories are studying diseases at the very forefront of where our troops could be deployed during future contingencies.  These laboratories are staffed with researchers who are developing new diagnostic tests, evaluating prevention and treatment strategies, and monitoring disease threats.  One of the many successes from our three overseas labs is the use of new technology, which includes a hospital-based computerized data management, analysis and reporting software system.  This technology is in use at our laboratory in Jakarta, Indonesia.  This system will identify infectious disease outbreak occurrences over an archipelago consisting of some 17,000 islands inhabited by 230 million people. 

Our researchers have designed a prototype computer system and lightweight flight vest that translates digital information from an aircraft’s orientation instruments into vibrations so a pilot’s sense of touch becomes a continuous spatial orientation cue. This research is especially important since future generation aircraft will have performance parameters that severely challenge human spatial orientation.

Other achievements during this last year include development of hand-held assays to identify biological warfare agents, documentation of the immunogenicity of the first oral campylobacter vaccine and determination of the Norwalk-virus as a major infectious disease threat.  Our researchers designed probability-based decompression dive tables for Navy divers, studied the acute effects of exposure to jet fuel vapors and designed a software package that estimates medical supply requirements based on patient flow and level of care. 

Conclusion

Navy Medicine has covered a lot of ground over the last year and we face the future with great enthusiasm and hope.  The new legislative initiatives, along with the MHS’s Optimization plans join to make our Navy Medical Department a progressive organization.  I thank you for making the military health care benefit the envy of other medical plans.  You have provided our service members, retirees and family members a health benefit that they can be proud of.   The new entitlements are not inexpensive and solutions to pay for them must be found.  The MHS can no longer be under-resourced for the design of the benefit.  We must also have predictable and stable funding levels, which would make planning more effective.  Optimization and reengineering efforts can only be successfully implemented if our commanding officers know what resources they have to work with.

We appreciate the close attention that Congress affords to improving the quality of military medical care and our ability to resource healthcare requirements.