DOD administers system cure

Some medical logistics problems are too complex for military personnel to solve without
help from an intelligent algorithm.

That's why the Defense Department has spent more than $25 million on a medical
decision-support system to improve the efficiency of theater airlift and medical
evacuation. The development cost will reach $40 million by the end of 1997.

When the U.S. Transportation Command airlifted patients during the Gulf War, 60 percent
were sent to a different hospital than originally planned.

"The patients weren't at risk because we sent them to the wrong hospital, but we
had a larger administrative burden than we thought," said Air Force Lt. Col. Corey
Kirschner, the functional program manager for the new DOD system.

Beginning this month, the U.S. Transportation Command at Scott Air Force Base, Ill.,
will bring online a preliminary version of the USTRANSCOM Regulating and Command and
Control Evacuation System, or TRAC2ES (pronounced traces).

The decision-support system contains a sophisticated scheduling algorithm to help
military staff balance supply and demand for hospital beds and patient transport.

"The human brain doesn't do well with bulky mathematical problems," said
William C. Elm, director of advanced decision-support systems for Carnegie Group Inc. of
Pittsburgh, which designed the scheduling algorithm and user interface.

Officials said TRAC2ES is the first system of its kind to integrate hospital bed,
airlift and patient data with theater plans and schedules. It also will help medical staff
keep track of individual patients' status and location.

TRAC2ES will run initially on three connected Sun Microsystems Inc. Sparc 2000 servers
at USTRANSCOM headquarters and on similar server clusters in Germany and Japan. Medical
staff will use World Wide Web browsers to access the distributed global database.

Supporting the two-way data feeds is an object-oriented database built with object
tools from Versant Object Technology Corp. of Menlo Park, Calif.

The Versant database has just been approved for DOD's Common Operating Environment.

"Our engineers are really pushing the envelope on the capabilities of
Versant," Kirschner said, making demands on the company and becoming "one of its
biggest beta testers."

He said TRAC2CES will be maintained through a combination of local and global backup
functions. "We're looking at a disaster recovery plan for replicating the global
database, but we really haven't solved that yet," he said.

The scheduling algorithm, written in C++ and Java, acts as a capable assistant that can
forecast two to five days out and reschedule plans. For example, the algorithm calculates
how many landings a patient can tolerate and how much rest is needed between landing and

"All of those significant constraints are what the scheduling engine
juggles," the Carnegie Group's Elm said. The algorithm tries to solve the problem in
the aggregate while still respecting each component. The same algorithm can apply to a
broad range of command and control problems, he said.

The real-time graphical interface displays aggregate data alongside individual data
points representing planned and unplanned events. Urgent patients are presented as large
red squares.

The problem with drill-down interfaces that look simpler on the surface, Elm said, is
remembering what you are drilling for. Drilling down takes too many mouse clicks, he said.

The developers of TRAC2ES used cognitive systems engineering and artificial
intelligence methods and tools, plus government-developed and commercial software
including C++ libraries from Rogue Wave Software Inc. of Corvallis, Ore.

The Versant object database has powerful locking features for distributed applications,
Elm said. Versant's product was the most compatible with the Rumbaugh object modeling
technique and the computer-aided software engineering tool from ParaSoft Corp. of
Monrovia, Calif., that DOD used to build the C++ application code.

The decision-support system will reside on the Defense Information Systems Network
(DISN) and have two-way data interfaces to the Global Transportation Network. It's
supposed to be ready for DOD initial operational capability by next July, and useful life
should extend through 2005, Kirschner said.

USTRANSCOM plans to retire the mainframe-based Defense Medical Regulating Information
System and the PC-based Automated Patient Evacuation System by December 1998.

The command awarded a series of task orders for TRAC2ES to Science Applications
International Corp. of San Diego under the Defense Medical Information Management/
Systems Integration, Design, Development, Operations and Maintenance Services contract.

DOD Directive 5154.6 and DOD Instruction 6011 give the USTRANSCOM commander
responsibility for integrating medical regulating activities and patient evacuation,
Kirschner said.

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