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.