The Defense Health Agency (DHA) is a joint, integrated agency with a global workforce of almost 130,000 civilians and military personnel committed to medical excellence, healthcare improvement, and ensuring Army, Navy, and Air Force military personnel are ready to perform combat operations and humanitarian missions at home and abroad in both peacetime and wartime. As part of its mission, the DHA manages the Military Health System (MHS), which provides health services to approximately 9.6 million uniformed service members, military retirees, and family members. The MHS is also responsible for modernizing and enhancing the MHS Information Platform (MIP) by creating a more robust, resilient, and innovative health information system. The Defense Healthcare Management System (DHMS) was chartered to transform healthcare delivery and advance data sharing through a modernized electronic health record for service members, veterans, and their families. The mission of the Enterprise Intelligence and Data Solutions (EIDS) program as part of DHMS is to support the strategic goals of the MHS and facilitate informed decision-making through the delivery of robust information services and data in a timely, relevant, and actionable manner. The Naval Information Warfare Center Atlantic (NIWC) is home to the DoD’s top scientists, engineers, and technicians in the information warfare battlespace. It is forward-based, forward-deployed, and globally positioned to drive innovation and warfighter information advantage. In partnership with NIWC, TIAG supports EIDS, leveraging cutting-edge technology and expertise to enhance data-driven solutions and streamline processes critical to mission success. Together, we ensure robust, secure, and innovative capabilities for the warfighter.

EIDS, a leader in centralized secondary data management and seamless data services for DHMS, faced a critical data analytics challenge. Their system for processing System Authorization Access Requests (SAARs) was experiencing extensive delays, taking over two months to complete each request. This inefficiency created a substantial backlog, preventing authorized users—including industry partners, DHA, NIWC, and military and government members—from accessing crucial technical assets via the MIP, MHS GENESIS. As a result, this bottleneck jeopardized all projects within the FY21 scope of work, threatening the mission’s success. Despite advanced capabilities, EIDS struggled to process and manage SAAR documents efficiently. The lack of an effective structure to shepherd these documents through the approval process was a significant data analytics problem, impacting the ability of employees and contractors to accomplish work supporting the mission.

To address the significant backlog and inefficiencies in processing System Authorization Access Requests (SAARs) for the DHMS, NIWC contracted TIAG to develop a comprehensive solution for EIDS. This partnership aimed to streamline the SAAR processing workflow, ensure timely access to necessary technical assets, and enhance overall project performance within the Military Health System’s Information Portal.

• Roadmap Creating + Backlog Clearance. TIAG began by providing personnel and technological support to DHA and NIWC, targeting the immediate clearance of the SAAR backlog. Team members were deployed to move SAAR efficiently requests through each milestone, ensuring the backlog was addressed promptly.
• eSAAR Application Development. TIAG collaborated closely with industry partners and stakeholders to identify the requirements for a minimum viable product (MVP) for a new eSAAR application. This phase involved conducting comprehensive requirement-gathering sessions to understand user needs and system specifications and ensuring the safe processing of requesters’ information throughout the system.
• Security and Performance Enhancements. Identified and mitigated security risks to ensure robust data protection and implemented stakeholder-approved and customer-preferred optimization tasks to enhance the system’s performance and usability. Building on the initial success of the MVP, TIAG introduced several critical features to the eSAAR application: digital signature functionality, SAAR dashboard, integrated Role-Based Access Control (RBAC) groups, and RBAC data mart.
• Ongoing Development and Optimization. After successfully implementing the MVP and introducing new functionalities, TIAG continued to refine and develop the eSAAR application, with continuous security and optimization efforts to maintain system integrity and performance and the latest development efforts to modify and enhance the SAAR processing workflow, aligning with evolving user needs and technological advancements.

The new eSAAR application developed by TIAG reduced the average time to complete new MIP requests by more than 75% and significantly enhanced the SAAR processing workflow. TIAG addressed the existing SAAR backlog, processed all pending requests, and implemented a new training program for Facility Security Officers and Government Supervisors, cutting review time by 50%. These efforts received consistent verbal praise and appreciation from stakeholders, highlighting the positive impact of TIAG’s solutions.

The Defense Health Agency (DHA) ensures the medical readiness of nearly 130,000 civilian and military personnel across the Army, Navy, and Air Force, enabling them to execute combat operations and humanitarian missions worldwide. Managing the Military Health System (MHS), the DHA delivers healthcare to 9.6 million service members, retirees, and families while advancing medical excellence and system modernization. As part of this effort, the Defense Healthcare Management System (DHMS) modernizes healthcare delivery and enhances data sharing through an advanced electronic health record system. Within DHMS, the Enterprise Intelligence and Data Solutions (EIDS) program strengthens decision-making across the MHS by providing timely, relevant, and actionable data. Naval Information Warfare Center Atlantic (NIWC) leads the Department of Defense’s information warfare capabilities, driving innovation and ensuring a warfighter information advantage. In partnership with NIWC, TIAG supports EIDS by integrating cutting-edge technology and expertise to optimize data-driven solutions and streamline mission-critical processes.

MTFs struggled with managing patient appointments and generating real-time reports, leading to scheduling inefficiencies that affected patient care and operational performance. They needed a system that provided real-time data, managed provider schedules, and optimized appointment bookings based on historical patient flow and patterns. Additionally, MTFs had to comply with the Interim Procedures Memorandum 18-001, which specifies standard appointing processes, procedures, hours of operation, productivity, performance measures, and appointment types for primary, specialty, and behavioral healthcare. Lacking real-time reporting capabilities, MTFs required a solution to continuously monitor provider schedules and ensure availability for patient bookings within the Composite Health Care System.

TIAG created the Direct Access Reporting Tool (DART), a web-based application designed to enhance access to care for the DHA and address the challenges MTFs face by integrating several access-related activities and serving as a robust reporting tool. This comprehensive approach leveraged the InterSystems CACHE interface to Military Health Systems globally. It used SQL Open queries and CACHE system connections to continuously monitor provider schedules and ensure appropriate slots are open for patient bookings. Critical features developed include:

• Virtual ATC analyst, a reporting tool for all MTFs, and an efficient, automated process to implement best practices. 
• Single Sign On (SSO) access through the Carepoint Application
• Real-time reporting and a harvested system to deliver real-time reporting capabilities and historical modeling to help facility staff create optimal provider schedules based on past patient flow and patterns.
• Centralized collection and continuous monitoring of patient scheduling, provider schedules, and appointment data for all MTFs to maintain optimal patient access and improved access in non-scheduling-related processes within the Direct Care System (DCS).
• User-friendly interface to facilitate easy access to real-time data and reporting tools.

DART revolutionized how the DHA manages Access to Care-related activities by integrating multiple operations into a streamlined, near real-time reporting system that empowers MTFs with actionable insights. By providing decision-makers with up-to-date data every 60 minutes, DART enhances the ability to assess and improve scheduling efficiency at the clinic level. Key benefits include:

• Minimizing delays in data reporting, allowing swift action based on the latest insights.
• Empowering decision-makers and analysts to manage operations more effectively, identify trends, and forecast future needs.
• Eliminating redundancy in data collection while improving accessibility for both internal and external stakeholders.
• Rapid deployment of user-friendly reporting tools to support evolving needs.
• Automating best practices for analysts, ensuring the DHA consistently operates at the highest efficiency level.

The Defense Health Agency (DHA) ensures the medical readiness of nearly 130,000 civilian and military personnel across the Army, Navy, and Air Force, equipping them to execute combat operations and humanitarian missions worldwide. Managing the Military Health System (MHS), DHA delivers healthcare to 9.6 million service members, retirees, and families while advancing medical excellence and system modernization. The DHA Hearing Center of Excellence (HCE) drives the prevention, diagnosis, treatment, and rehabilitation of hearing loss and auditory impairment, including conditions related to traumatic brain injury. Committed to optimizing operational performance and enhancing quality of life, HCE leads collaborative efforts in hearing and balance health initiatives. A top priority is tracking and analyzing patient data through the Joint Hearing Loss and Auditory System Injury Registry (JHASIR) to improve care and readiness. As part of its modernization efforts, the Defense Healthcare Management System (DHMS) advances healthcare delivery through a secure, interoperable electronic health record system for service members, veterans, and their families. Within DHMS, the Enterprise Intelligence and Data Solutions (EIDS) program strengthens decision-making across the MHS by delivering timely, relevant, and actionable data. Naval Information Warfare Center Atlantic (NIWC) leads the Department of Defense’s information warfare capabilities, driving innovation and ensuring a warfighter information advantage. In partnership with NIWC, TIAG supports EIDS by integrating cutting-edge technology and expertise to optimize data-driven solutions and streamline mission-critical processes.

JHASIR is the only auditory-vestibular injury registry for Service members and Veterans – providing queryable and longitudinal healthcare records that help clinicians and researchers improve medical readiness, raise awareness, and identify interventions to prevent and reduce the severity of auditory-vestibular injuries for more than 900,000 Service members and veterans. HCE discovered a gap in the JHASIR registry – nearly 800,000 patient clinical encounters lacked associated audiograms or audiometric tests. This indicated these records were not digitized, and technology didn’t yet exist to meet security requirements and transform raw files into queryable records. To bridge this gap, the Congressional Gap Audiograms program was mandated. HCE had a year to locate the records, create the technology to transform raw files into a queryable structured format, and then digitize the 800,000 records.

To tackle this challenge, HCE enlisted TIAG to develop the DVEIVR, with bidirectional data exchange, to identify and track the incidence and care of hearing loss and auditory injury and utilize registry data to encourage and facilitate the conduct of research, development of best practices, and clinical education. 

• TIAG analyzed 10,000 records, discovering 108 unique formats, nearly half handwritten and illegible. 
• Developed an abstraction interface and used AWS Textract to identify records from 2020/2021, enhancing stakeholder feedback and mitigating manual processing.
• Leveraged Tableau reports for monitoring accuracy to ingest and prepare 60,000 records and 11,817 AC/BC audiogram graphs and their associated frequencies for clinical use. 
• Utilized an Adobe triage and Talend ETL to streamline enterprise operations and workflows, prioritize records based on keywords, and implement an upgraded application with advanced abstraction procedures, enabling dynamic data capture and review. 
• Established bi-directional data pulls between DOD and VA medical information systems based on medical records. This interface securely compiles current and historical medical records and provides a unique standardized data resource.
• Created a comprehensive reporting library and dashboards that can display over 60,000 raw files to provide customized information and showcase diagnostic techniques, procedures, and various demographic data collected over time, such as injury prevalence rates.

Audiogram processing time decreased by 50%, and data accuracy hit an all-time high of 99.7%. Both DVEIVR and JHASIR contain data from 2001 to the present on inpatient and outpatient direct care provided at military hospitals and clinics, purchased care from non-military treatment facilities, the VA, pharmacies, laboratories, and radiology centers for active duty service members, the National Guard and Reserve, and Veterans. The registries bridge data gaps and provide customized information on diagnostic techniques, procedures, and demographic data – creating collaboration and synergies across the DoD and DHA that have made lasting impacts: 

• Project researchers pulled demographic data and occupational hearing health data to identify risk factors that may increase the likelihood of service members sustaining auditory injury from noise exposure as part of a multi-site field study with Walter Reed National Military Medical Center called CHASMPAS (Characterization of Acute or Short-term Acquired Military Population Auditory Shifts). The study is focused on characterizing short-term changes in hearing among military personnel exposed to blasts. So far, 170 service members have participated in the CHASMPAS study from multiple U.S. Army, U.S. Navy, and U.S. Marine Corps sites.
• Supported the development of multiple clinical practice guidelines to provide expertise across the clinical spectrum of eye care for a patient titled “Ocular Injuries and Vision-Threatening Conditions in Prolonged Field Care” and “Evaluation and Disposition of Temporary Visual Interference and Ocular Injury after Suspected Ocular Laser Exposure.” 
• Because of TIAG’s work digitizing the records, the VCE, in collaboration with the DOD and VA, including the Traumatic Brain Injury Center of Excellence, championed the production of clinical recommendation aids for the care of visual dysfunction after TBI, “Eye and Vision Care Following Blast Exposure and/or Possible Traumatic Brain Injury,” “Care of Visual Field Loss Associated with Traumatic Brain Injury,” and “Care of Oculomotor Dysfunctions Associated with TBI.”
• Used in the DOD/VA TRICARE hearing aid demonstration, which aims to replicate, to the fullest extent possible, the VA’s Community Care Network model for delivery of prescribed hearing aids and associated devices for veterans, active duty service members receiving care through the supplemental health care program in designated states, as well as to qualifying Prime active duty family members diagnosed with profound hearing loss. 
• Researchers from Brooke Army Medical Center used the system to publish a study in the American Journal of Otolaryngology examining the rates of sudden hearing loss by characterizing treatment options during the COVID-19 pandemic.

The Defense Health Agency (DHA) is a joint, integrated agency with a global workforce of almost 130,000 civilians and military personnel committed to medical excellence, healthcare improvement, and ensuring Army, Navy, and Air Force military personnel are ready to perform combat operations and humanitarian missions at home and abroad in both peacetime and wartime. As part of its mission, the DHA manages the Military Health System (MHS), which provides health services to approximately 9.6 million uniformed service members, military retirees, and family members. The MHS is also responsible for modernizing and enhancing the Military Health System (MHS) Information Platform (MIP) by creating a more robust, resilient, and innovative health information system. The Defense Healthcare Management System (DHMS) was chartered to transform healthcare delivery and advance data sharing through a modernized electronic health record for service members, veterans, and their families. The mission of the Enterprise Intelligence and Data Solutions (EIDS) program as part of DHMS is to support the strategic goals of the MHS and facilitate informed decision-making through the delivery of robust information services and data in a timely, relevant, and actionable manner. The Naval Information Warfare Center Atlantic (NIWC) is home to the DoD’s top scientists, engineers, and technicians in the information warfare battlespace. It is forward-based, forward-deployed, and globally positioned to drive innovation and warfighter information advantage.

EIDS faced a significant challenge in conducting comprehensive Operational Test & Evaluation (OT&E) and Independent Verification & Validation (IV&V) testing to ensure its software systems met stringent Department of Defense (DoD) standards. The primary goal was to validate and verify all requirements using advanced tools like Azure DevOps and Selenium, focusing on operational readiness and cybersecurity in compliance with the DoD Risk Management Framework (RMF). This robust IV&V process was essential due to the complexity of requirements validation and the need for rigorous cybersecurity evaluations. Additionally, EIDS needed to manage multiple projects under the Carepoint program, such as the DoD Trauma Registry (DODTR) and MHS Dashboards. These projects required consistent and reliable testing protocols to identify and manage defects, ensuring high-quality software performance and security. EIDS contracted NIWC to address this challenge due to its expertise in secure, data-driven technology solutions. NIWC, recognizing the need for a trusted partner with a proven track record in delivering high-quality testing and data solutions, partnered with TIAG to support the effort.

NIWC’s technical prowess in delivering cutting-edge information warfare solutions was critical in safeguarding and enhancing the Navy’s strategic communications and data integrity across various platforms. TIAG’s private sector expertise prioritized modernization to ensure hardware, software, and interfaces complied with industry standards. 

TIAG deployed highly skilled functional testers who validated and verified requirements using advanced tools like Azure DevOps and Selenium for functional script generation and automated testing. This approach was successfully applied to many projects under Carepoint, including the DoD Trauma Registry (DODTR) and Military Health System (MHS) Dashboards, ensuring that software was thoroughly tested and that defect management processes were meticulously followed. Our approach included: 

• Established test environments to address the challenges, conducted manual and automated testing, and tracked and managed defects meticulously. Certified Navy Qualified Validators (NQVs) performed IV&V Security Assessment testing at both the enterprise and system levels, assessing and documenting risks following DoD and Navy policies and guidance. This approach ensured that security standards were not only met but exceeded.
• Facilitated test event activities at the enterprise level using tools such as ACAS, SCAP, STIGs, STIG Viewer, eMASS, and VRAM. This allowed us to provide precise guidance on RMF activities to leadership, ISOs, and team members on other contracts. Additionally, TIAG offered Configuration Management (CM) support, including CM planning, baseline management, configuration audits, and comprehensive configuration management records and reports.
• Ensured compliance with DoD and DoN requirements for the security design and implementation of Federal IT systems and programs. This involved supporting system and software integration into FRCS or utility system IT enclaves. Our continuous monitoring and vulnerability management efforts included performing regular vulnerability scans, tracking POA&Ms, and emphasizing POA&M mitigation through system security patching. This was vital for ensuring systems complied with the latest guidelines and supporting IA or RMF controls testing and implementations as part of RMF and Continuous Monitoring policies.
• Expertise extended to automated testing and defect management. By utilizing Azure DevOps and Selenium for automated functional script generation and execution, we established robust defect management processes to track, prioritize, and resolve issues efficiently. This ensured high-quality software performance and security.
• Provided consistent IV&V support in supporting multiple projects within the Carepoint program, including the DoD Trauma Registry (DODTR) and Military Health System (MHS) Dashboards. This standardized approach facilitated smoother project execution, higher customer satisfaction, and thorough testing and validation of all software systems.

TIAG’s IV&V services enhanced software quality and reduced defect rates through rigorous testing, security compliance, and streamlined project execution. Automated testing and defect management ensured all software met operational and security requirements, minimizing errors. Cybersecurity IV&V processes enabled NIWC to achieve and sustain full DoD RMF compliance, strengthening system security. A standardized IV&V approach across Carepoint projects improved execution efficiency, reduced timelines, and increased customer satisfaction. Thorough validation and verification reinforced system reliability, ensuring software functioned as intended under all conditions.