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.

The National Center for Telehealth & Technology (T2) aims to leverage cutting-edge technologies to support psychological health and traumatic brain injury initiatives within the Military Health System’s Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. Through innovative products and programs, T2 enhances the well-being and resilience of service members and their families.

With a substantial portfolio of military community-facing behavioral health technologies and initiatives –  and recognizing the unique hurdles behavioral health mobile apps presented for government agencies – T2’s mission was to establish an innovative full-service usability lab. The lab’s development, along with all community-facing behavioral and psychological health technology originating from it, required a meticulous design that seamlessly integrated user experience and emerging technologies into current and prospective technological initiatives throughout the DoD.

TIAG was contracted to develop and support T2’s usability lab. TIAG spearheaded, implemented, and oversaw T2’s usability lab program by blending tailored, human-centric design methodologies with a fusion of user research and design excellence. Our objective was to furnish T2 with intuitive, pertinent, and captivating behavioral health technology initiatives, products, and programs, dedicated to aiding those in service. Key capabilities included:

• Assembling a multi-disciplinary UX team to ensure comprehensive coverage in planning, implementing, and managing T2’s usability lab program. This included acquiring, maintaining, and managing lab accessories, hardware, and software, ensuring optimal functionality and efficiency.
• Collaborating with key stakeholders across T2 and the DoD, service members, and military community supporters in the design and development process through interviews, stakeholder workshops, scoping meetings, and user research. 
• Managing, implementing, and updating recruitment strategies for usability testing with behavioral health and health care providers, veterans, and military families, including children aged 5 to 17. 
• Developing an education and training program for T2 personnel and leadership on user experience best practices, human-centered design processes, and methodologies.

T2 saw remarkable engagement: 

• Over 200 service requests from subject matter experts and external DoD entities influenced numerous applications and drove hundreds of concept and product validations, expert evaluations, and design initiatives. 
• Nearly 2,000 soldiers, behavioral health and healthcare providers, veterans, and military families participated in senior-level user research and formal usability testing activities.
• Feedback from more than 50 formalized satisfaction surveys underscored the UX team’s exceptional performance. The team consistently met or exceeded the expectations of T2 personnel and stakeholders who utilized the lab’s services.
• Since its launch, TIAG has crafted over 22 intuitive and user-friendly applications focused on bolstering overall health and resilience while safeguarding the data of our country’s defenders for T2. These applications are reshaping the landscape of care for PTSD and TBI-related issues among our nation’s warriors and their families. 
• The legacy of this innovation and our corporate behavioral health and usability expertise can be seen through our work with the Army Resilience Directorate and our unique mResillience product offering.

The collective mission of the Defense Health Agency (DHA), and the Naval Information Warfare Center Atlantic’s (NIWC) Defense Health IT Division is to modernize and enhance the Military Health System (MHS) Information Platform (MIP) and work together to enhance the overall health and well-being of service members and their families by creating a more robust, resilient, and innovative health information system.

NIWC and its industry partners faced significant hurdles in ramp-up time for developers, particularly during the initial creation of an application within the MHS MIP environment. The excessive lag time between application creation and subsequent development presented a critical issue that NIWC needed to address. NIWC aimed to automate and standardize application development to accelerate project timelines and improve access to patient-centric data. The goal was to enable developers to quickly and efficiently create applications from the ground up, ensuring they were set up for success when starting development within the MIP.

TIAG leveraged its proven DevSecOps approach to revolutionize application development by creating the Software Development Kit (SDK). The SDK streamlined and standardized the tech stack, solutions, and methodologies for real-time data connectivity and continuous improvement across all aspects of NIWC’s application development to ensure efficient delivery of high-quality, patient-centric applications while prioritizing security, continuous integration, and deployment by developing. Many initiatives and tools were leveraged throughout the SDK’s development lifecycle including:

• Culture of transparency and collaboration. Our approach to DevSecOps infuses human-centered design throughout every development lifecycle phase. We started by breaking down silos between development, security, and operations teams and assembling a diverse, multi-layered team to develop a proof of concept for enterprise packaging and container-ready patient-level data endpoints in the development environment (AVHE LABS). This collaborative approach ensured that all stakeholders were aligned in their goals, promoting continuous information sharing and expertise across the teams.
• Continuous integration and deployment pipeline. The team leveraged the latest tech stack, including .Net Core, to modernize and standardize the MIP environment. This enabled the acquisition of multi-platform applications that can be integrated into the MIP, streamlining continuous integration and deployment processes. It also accelerated release cycles – new features, updates, and security patches were quickly implemented with strong security postures, and NIWC could be sure deployments were reliable across all environments.
• Automated version control. The SDK’s automated setup featured standardized and platform-agnostic technology stacks, reusable application packages, and pipelines. This approach facilitated faster project completion without compromising quality, rapid code validation, management, and integration, and enhanced change management tracking. The SDK leverages nPm and NuGet package pipelines to standardize the use of JavaScript, creating a reusable solution with an internal artifact repository as a trusted source of truth. 
• Fully integrated and automated security checks, vulnerability scanning, penetration testing, and regulatory compliance processes were included in the development lifecycle to ensure security was embedded at every phase, allowing for faster identification and mitigation of potential security risks.
• Robust monitoring and feedback. The team developed a series of downloadable and reusable VUE.js-based user-interface components for developers to use in new or existing MIP applications and sites. The pre-styled components were easily customizable and designed to fast-track the development of aesthetically pleasing interfaces. This approach improved coordination and development across teams and provided robust, real-time insights and monitoring capabilities to improve adjustments, security, and overall user experience continuously.
• Comprehensive resources. We worked diligently to provide NIWC and external developers with comprehensive resources, including a library of materials on dashboard registration stocked with getting-started tutorials, dashboard templates, workbooks, and more organized by application. This wealth of information enabled NIWC to quickly customize application tools, supporting automated checks, scans, and compliance processes.

By encouraging and supporting frequent code check-ins, version control, sensible test automation, continuous low-risk releases, and feedback, TIAG achieved substantial gains in security issue detection through threat modeling, code reviews, and red teaming.

“WOW, I am really impressed. I am just amazed at what the team has been able to accomplish in this Fiscal Year.” Lt Col Easter, Major Constantine, DHA

TIAG’s implementation of the SDK transformed the development and deployment of applications within the MIP environment, resulting in key wins for NIWC:

• Reduced Lag Time: TIAG addressed NIWC’s mission-critical issue of excessive lag time between application creation and development, expediting the development process and accelerating project timelines.
• Standardized Tech Stack: The SDK provided an automated setup with a standardized, platform-agnostic technology stack, including reusable application packages and pipelines. This enabled MIP application development and allowed for substantial reductions in the labor hours typically spent on foundational development efforts.
• Enhanced Scalability and Compliance: TIAG ensured scalability and compliance with the MIP Style Guide and 508 standards, paving the way for improved efficacy, cost savings, and successful case studies.
• Automated and Streamlined Development: The SDK standardizes the use of JavaScript by employing nPm and NuGet package pipelines from an internal artifact repository, creating an all-in-one reusable solution. This provided access to patient-centric microservice architecture of endpoints using standard JSON messaging.
• Expanded Reach and Capabilities: TIAG’s approach enabled multi-platform integration, allowing non-Windows teams to access the platform and creating an additional revenue stream for the DHA. This enhanced reach and capabilities pave the way for continued success.
• Developer Empowerment and Innovation: The SDK included a comprehensive library of resources such as tutorials, dashboard templates, and workbooks, empowering developers with tools to customize and streamline applications according to user needs.
• Progressive Web App Support: The SDK contained API modules for creating applications that conform to DHA mobile app standards, such as Progressive Web Apps (PWAs). This flexibility enables the development of native Android or iOS apps using frameworks like Cordova.
• Modernized and Agile Development: TIAG’s solution enabled developers to work more efficiently and creatively, resulting in a groundbreaking approach that supports further innovation in the industry.

The SDK provided NIWC with the tools and resources needed to transform the MIP development process. The approach not only facilitated faster timelines and improved efficiency but also set the stage for sustained success and growth across the DHA’s MIP environment.

While military service members often use supplements to augment an exercise and fitness regimen, if the user is unaware of their specific ingredients, they can actually inhibit performance rather than improve it or, in some instances, result in failed drug tests. As part of the Consortium for Health and Military Performance (CHAMP), Operation Supplement Safety (OPSS) strives to provide the best evidence-based information about dietary supplements to military service members, their families, healthcare providers, and leaders to achieve human performance optimization.

CHAMP leadership and staff required an accessible web application to help service members make informed decisions on the benefits and risks of supplement usage, and they were disappointed in the existing OPSS.org web design effort. Existing site challenges included problematic navigation schemes, confusing screen hierarchy, insufficient accessibility, and an unappealing responsive web mobile experience. Plus, many of the most popular OPSS.org features and resources were not easily discoverable from the home page – a crucial design limitation.

TIAG was tasked to produce an innovative, human-centered design to alleviate existing challenges and optimize soldiers’ experience with the website. Armed with stakeholders’ in-house user research, we reviewed site analytics data to get an in-depth understanding of usage trends and user behaviors (such as page views, usage rates, and drop-out rates) and conducted a baseline assessment. From there, we created personas based on research gathered on soldiers who engage in supplement use and then a goals-driven design roadmap. We were then able to design the information architecture scheme and wireframes for both web and mobile to provide visual context for stakeholders’ review. After soliciting insights and guidance from stakeholder and subject matter experts, we were able to construct high-level web and mobile prototypes. User interface color schemes, icon assets and style guides were created that upheld accessibility standards for visual design and sight impairments. Through collaborating with user experience specialists and developers, we were able to ensure the redesign effort met accessibility and design standards for the site.

As a result of these efforts, we created a compliant, visually appealing, and soldier-friendly OPSS.org mobile responsive website offering streamlined information and resource access for supplement safety. Post-redesign, stakeholders reported a 50% to 100+% increase in usage for some of the site’s more popular pages and features.

JOMIS develops, deploys, and maintains operational medicine information systems to deliver comprehensive health services to deployed forces across a range of military operations.

JOMIS required software sustainment of fielded Theater Medical Information Program Joint (TMIP-J) components and modernization support for components slated for the new Electronic Health Record (EHR), MHS GENESIS.

TIAG sustained three of the clinical components of the TMIP-J suite: the Armed Forces Health Longitudinal Technology Application – Theater, the Theater Medical Information Program Composite Health Care System Cache, and the Mobile Computing Capability. In addition, we modernized the Mobile Computing Capability application to interface with MHS GENESIS.

Through a progressive methodology of software development, we were able to create solutions that improved mission reliability and performance for the TMIP-J clinical components and guaranteed the availability of critical medical data to care providers and decision-makers for U.S. military deployed forces. We were also able to modernize the mobile component to interface with MHS GENESIS.