Reliable System Provides Ready, Resilient Soldiers

Army Medicine's core business has always been health readiness. To achieve our mission, we are national leaders in medicine, dentistry, medical research, education and training, and public health. Although persistent conflict presents great challenges to health readiness, Army Medicine continues to focus on four enduring priorities: combat casualty care; readiness and health of the force; a ready and deployable medical force; and the health of families and retirees, our partners in health.

We have made great strides leading the Army's cultural change toward a more ready and resilient soldier powered by the performance triad of sleep, activity and nutrition. In the coming year, Army Medicine will continue transforming from a health care system to a system for health, on the journey to becoming a high-reliability organization.

Unwavering Dedication to Enduring Missions

Warrior care. Significant investment in the Warrior Care and Transition Program produced an unprecedented 45 percent return-to-duty rate. As the wounded, ill and injured populations continue to decline, right-sizing the program footprint ensures we will meet population needs while sustaining high-quality care. When soldiers are unable to return to duty, Army Medicine is dedicated to a seamless transition by collaborating with the VA to standardize and reduce variance within the Disability Evaluation System. These improvements not only benefit our soldiers and their families but also maintain the overall health readiness of our total force, enabling the Army to fully support future engagements.

Behavioral health. The majority of our soldiers have been extremely resilient during the longest period of conflict in our nation's history. However, Army Medicine is keenly aware of the unique stressors facing soldiers and families today and continues to address these issues on several fronts. Each year, we invest more than $300 million in support-andsustain behavioral health initiatives to take care of our own, physically and emotionally. These include 11 standardized clinical programs within our medical treatment facilities; up to 65 embedded behavioral health teams that provide targeted care in close proximity to soldiers' unit areas; and the Behavioral Health Data Portal, which collects clinical outcome metrics at every outpatient visit. The Army's behavioral health system identifies issues early, delivers evidencebased treatment, and leverages resources across the Army community to decrease stigma, suicide risk and other adverse events.

Army Medicine implemented the Child and Family Behavioral Health System in response to the significant national shortage of child and adolescent behavioral health providers. Though this, Army Medicine collaborates with primary care teams, embeds behavioral health providers in on-post schools and leverages regional teleconsultations. Through 2017, we will increase to 381 behavioral health providers supporting 107 schools across 32 installations to deliver comprehensive support to Army families.

Traumatic brain injury. Building on innovations, partnerships and research to better identify, treat and track concussions in deployed and garrison settings, Army Medicine manages the largest portfolio of traumatic brain injury research in the world-an investment of more than $800 million since 2007.

Additionally, we are leveraging partnerships with the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, our sister services and the VA to translate research into guidelines, products and technologies. In addition, through collaborations with the NFL and the NCAA, Army Medicine is not only increasing awareness and scientific knowledge, but also changing the culture regarding brain injuries on the battlefield as well as at home. These collective efforts will ensure soldiers without injury can stay in the fight, while those who are diagnosed are effectively treated to preserve their future health.

Telehealth. Telehealth is the use of telecommunications and information technologies to connect people to health care across distance. In the Army, it can be traced back to the early '90s when the Army pioneered its first satellite-based Telehealth system, in Somalia.

Telehealth revolves around one core concept: connecting health globally to increase readiness, access, quality and patient safety. Telehealth helps Army Medicine distribute its medical capacity effectively across the world, leveraging clinical expertise when and where it is needed without having to physically move providers or patients.

Army Telehealth currently provides clinical services across the largest geographic area of any Telehealth system in the world-civilian or military-including 18 time zones in more than 30 countries and territories. From FY 2008 to 2014, Army Telehealth provided over 150,000 patient encounters and provider consultations in garrison and operational environments across 30 specialties.

In FY 2015, Army Telehealth will also include Connected, Consistent Patient Experience. This is an innovative, three-year expansion plan that creates a 360-degree care continuum around patients by using advanced telehealth modalities.

Sexual Harassment/Assault Response & Prevention (SHARP). As an integral participant in the Army's SHARP program, Army Medicine continues to be at the forefront of the management, regulatory guidance and oversight of care for all sexual assault victims. Regardless of evidence of physical injury, all patients who allege sexual assault receive comprehensive and compassionate treatment by highly trained and certified sexual assault medical forensic examiners within our military health system or by agreement at a local facility. Treatment is followed by a care plan based on the patients' input and needs, a plan that is developed by a designated multidisciplinary group of health care providers including sexual assault response coordinators and victim advocates.

From Health Care System to System for Health

Army Medicine has made great progress over the last three years in our transition from a health care system-one primarily focused on injuries and illness-to a system for health that promotes health, prevention and wellness as critical enablers of readiness. Army Medicine is a valuable partner in making our force "Army Strong."

Performance Triad (P3). The Army must be prepared to win in a complex world even as it draws down. Each day, however, over 43,000 soldiers-or more than 10 brigade combat teams-are nondeployable due to medical profiles. Annually, 10 million duty days are limited or lost due to injuries or illnesses, of which 80 percent are preventable. Further, 1 in 20 active-duty soldiers fails the Army physical fitness test.

To maintain a premier fighting force and influence the human dimension, the Army's P3 initiative provides training and tools to optimize human performance and enhance health readiness through sleep, physical activity and nutrition. P3 empowers leaders to support lasting cultural change through weekly instruction, competition and technology use. P3 also is reaching family members and Army civilians; they, too, require a combination of physical, emotional, cognitive and spiritual fitness to thrive.

A second P3 pilot program is underway in FY 2015 that will train up to 30,000 active-duty soldiers and their families across U.S. Army Forces Command and the U.S. Army Reserve and National Guard. In addition, Army Medicine initiated P3 pilots at the U.S. Army Medical Department Health Readiness Center of Excellence and the U.S. Army Maneuver Center of Excellence. Plans are taking shape for eventual Armywide implementation through P3 University. The Army continues to invest in P3 to achieve the collective vision set forth in the Army Warfighting Challenges, the Human Dimension, and the Ready and Resilient Campaign.

Medical readiness assessment tool. To enhance the ability of commanders to effect health readiness, Army Medicine developed an assessment tool that enables proactive identification and management of health readiness risk factors using "big data" already in place. It provides monthly and rapidly accessible metrics on Army units using a systematic format that does not require local data management. The chief goal of the tool is to provide early interventions to preserve unit readiness. Within the constraints of the Health Insurance Portability and Accountability Act and privacy rules, the assessment tool provides leaders and clinicians a powerful way to mitigate factors that threaten individual medical readiness. It's currently being rolled out to Army and Army Medicine leaders.

High-reliability organization. Army Medicine has been on a longstanding journey to become a high-reliability organization and serve as a national example for its culture of safety in health care. High-reliability organizations are committed to achieving zero preventable harm in an environment marked by risk factors and complexity. Success relies on leadership and robust process improvement initiatives. These contribute to enhanced efficiencies, more effective health care delivery and improved patient outcomes.

The 2014 Military Health System Review on access, quality and safety clearly validated that our transformation to a high-reliability organization is on the correct course. Even though Army Medicine provides high-quality care that is safe and timely compared to the best civilian health care facilities, we are not satisfied and will continue to strive to lead American health care. Over the next year, transparency will be increased regarding patient safety metrics so our patients and external stakeholders can measure our system against the best in the nation. The journey to become a high-reliability organization is continuous, and Army Medicine will relentlessly pursue zero preventable harm.

Our medical force has remained ready and deployable, leveraging lessons learned in theater to improve care in garrison, and using evidenced-based practice and cutting-edge research to improve care delivered far forward. The increasing instability across the globe demands that we ensure the health readiness of our soldiers, retirees, family members and Army civilians while sustaining our ready medical force.

Pfc. Ian Flores, foreground, a health care specialist with 18th Engineer Brigade, leads a litter team during a casualty evacuation exercise in Logar Province, Afghanistan.

Capt. Melissa Powers, right, a psychiatric/mental health nurse practitioner with the 328th Combat Support Hospital, reassures a soldier role-playing a mental health casualty during a predeployment exercise.

Dr. Gregory Johnson, concussion clinic medical director at Tripler Army Medical Center, Hawaii, checks Spc. Andrew Karamatic's eye movement during a neurological exam.

A radiologist reviews images transmitted from a smaller clinic that lacks an assigned radiologist.

Spc. Mary Ipiniu, 1st Cavalry Division, explores the functions of a Sexual Harassment/Assault Response & Prevention application at Fort Hood, Texas.

Maj. Gen. Dean G. Sienko, then-commander of U.S. Army Public Health Command, works out on a treadmill as an observer tracks his metabolic rate and cardio-respiratory fitness level.

By Lt. Gen. Patricia D. Horoho

Commanding General, U.S. Army Medical Command and The Surgeon General of the Army

Lt. Gen. Patricia D. Horoho is commanding general of U.S. Army Medical Command and the Surgeon General of the Army. Previously, she was the deputy surgeon general, Office of the Surgeon General. Before that, she served as the 23rd chief of the U.S. Army Nurse Corps and commander of Western Regional Medical Command, Fort Lewis, Wash.; Madigan Army Medical Center, Tacoma, Wash.; Walter Reed Health Care System, Washington, D.C.; and DeWitt Health Care Network, Fort Belvoir, Va. Horoho earned her bachelor's degree from the University of North Carolina at Chapel Hill and a master's degree from the University of Pittsburgh. She is a graduate of the U.S. Army Command and General StaffCollege and the Industrial College of the Armed Forces.