Military Health system Informatics—Current Issues and Answers
Thomas Helfer, Ph.D.
Currently the Military Audiology leadership is taking up the issues of integrating Audiology and Hearing Conservation services functional process improvements and information management into the Military Health System’s (MHS) new Composite Healthcare System II (CHCS II) and the new Executive Information/Decision Support (EI/DS) system. At the same time they are tasked with maintaining migration systems data quality for CHCS 1, Ambulatory Data System (ADS), and Medical Expense and Performance Reporting System (MEPRS).
For automation systems Audiology services integration there are three main states of clinical data acquisition and information management. These states/dimensions are linked and have to be coordinated and accounted for simultaneously: objective audiometric data, clinical communications documentation of care (clinical notes in Subjective, Objective, Assessment, and Plan-SOAP-format), and healthcare administration and accounting data from ADS, CHCS 1, and the MEPRS data sets.
The coordination of these different data and information sets is best accomplished thru requirements definition that can be directly traced to published clinical practice guidelines, clinical statements, clinical algorithms, and published papers, both as technical reports and in the refereed literature. This means that the data and information management practices will be governed by business rules of clinical practice that are commonly understood to have a scientific evidence base.
The working relationship between data and information management practices and business rules is described. A suggested documentation audit trail for requirements definition is also demonstrated. The goal is to assure that optimal value for Audiology and Hearing Conservation data/information sets is maintained for outcomes analysis including healthcare quality improvement statistical process controls and cost effectiveness controls.
Hearing Conservation Training—Making It Quick, Fun, and Memorable
CPT John Merkley
There are several ways of providing hearing conservation training, i.e. home-made or commercial video presentations, pamphlets, group lecture, etc. For this presentation I will poll several audiologists throughout the military for their methods of providing this training, discuss the results and provide input on which methods are most effective. I will also poll noise-exposed soldiers to find out which method of training they prefer and which method is most memorable. I will then incorporate the results from both polls and discuss the most effective method for providing hearing conservation training.
Hearing Loss in Military Recruits: An Evaluation of Existed Prior to Service (EPTS) Separations for 1998-2000
LT Kim Kehoe
Introduction: All military applicants are screened for hearing loss with audiometric testing prior to accession. Despite this objective test, over 80 recruits are discharged from the military a year for hearing loss conditions that existed prior to service (EPTS).
Methods: A retrospective case series of active duty recruits from all services with an EPTS discharge due to hearing loss from 1998-2000 was performed. Of the 262 cases that qualified for inclusion, 240 medical records were available for review. Data was gathered about standard demographic variables, audiometric patterns, location of the medical entrance physical station (MEPS), and basic training (BCT) site.
Results: It was found that recruits in this study were more likely to be older, male, white, less educated, and have lower aptitude test scores than the general recruit accession population. The majority of the cases were classified as noise-induced hearing loss (59.6%). Audiometric testing performed at the MEPS stations was not automated or consistent from station to station. In addition, only 4 of the 9 BCT sites were doing universal audiometric testing as a part of recruit in processing. The BCT sites that were doing universal screening had higher numbers of EPTS discharges for hearing loss than th those t at were not.
Conclusions: This study presents evidence that audiometric testing varies between MEPS and BCT sites. The result is that recruits with preexisting hearing loss are accessed onto active duty for basic training and then discharged. This is a loss in both human and fiscal resources and limits military readiness. Premature attrition due to hearing loss can be prevented by making audiometric testing at MEPS standardized and automated, and by performing universal audiometric testing at all BCT sites.
Tri-Service Hearing Conservation Exportable Course
Don Ciliax, Ph.D.
The requirement to train hearing conservationists is not likely to end anytime soon. However, due to the uncertainty of adequate travel funds and for many other reasons, there is an increasing need to employ new techniques in order to train in a tri-service environment. This presentation gives an overview of a new compact disk (CD) developed at USACHPPM that is available for distribution to government audiologists who serve as course directors or instructors in the training of hearing conservationists. The CD contains the essential information needed to put on a tri-service workshop, including topical study guides, instructor Powerpoint presentations, appropriate supplemental handouts, as well as the administrative materials necessary to satisfy CAOHC requirements. The contents of the CD will be highlighted, including how to traverse its multiple hyperlinks. The CD represents a compilation of materials contributed by numerous personnel from all three services over the years.
Training With Industry (TWI) Report
MAJ Mark Little
This presentation will provide general information on each services’ specific procedures for applying for their TWI program and the possible benefits of being selected. An overview of my TWI experiences will be given to include: National Health and Nutrition Examination (NHANES) hearing data collection; Combined Effects of Lead and Noise on Hearing study; Non-Linear Attenuation Device study; Speech Understanding in High Level Noise with the “Ear Talk†Device; and a study on Speech Understanding in Noise Under Earmuffs With and Without the use of Hearing aids.
International Classification of Functioning, Disability, and Health (ICF) as Potential Metrics for Fitness for Duty Retention in Military Service
Thomas Helfer, Ph.D.
On May 22, 2001 the World health Assembly officially approved the International Classification of Functioning, Disability and Health and its abbreviation (ICF). This official approval happened after the World Health Organization (WHO) had been coordinating revision efforts on the earlier International Classification of Impairments, Disabilities, and Handicaps (ICIDH) for 9 years.
The National Center for Health Statistics (NCHS) houses the WHO Collaborating Center for the Family of International Classifications for North America. This center has coordinated US revision activities to ICF since 1993.
The ICF compliments WHO’s International Classification of Diseases-10th Revision (ICD). The ICD contains information on diagnostic classifications and health conditions. The ICD does not however cover functional status. That is the purpose of ICF. The language of the ICF focuses on function rather than condition or disease.
The ICF is structured around
- Body functions and structure
- Activities and participation (related to tasks and actions of an individual as well as involvement in a life situation)
- Information on severity and environmental factors.
The Military Health services each have their own functional health status regulations defining standards of fitness for duty and retention in military service. Each service’s standards of fitness are particular to each service. No services standard is expressed according to an international classification of function like the ICF. The author presents the advantages of each service changing over to express its fitness/retention standards IAW the ICF in order to communicate fitness standards more effectively when working across service boundaries.
A Method For Maintenance of the DPOAE Probe, or How to Change an Industry
Mr. Frank Froman, M.S.
Most users of the Otodynamics DPOAE probe find that the probe covering tends to crack and peel, exposing the plastic filler and the electrical components inside. The company suggests that the probe assembly should be replaced; however, the cost is prohibitive. This is a suggested method to maintain the probe without having to resort to frequent replacement.