Defense Health Agency

Individual Longitudinal Exposure Record(ILER)

Mr. Steven Jones, ODASD (Health Affairs)Mr. Robert Bell, DHA (Solutions Delivery Division)

Health Readiness Policy & Oversight

Disclosure

Presenter’s have no relevant financial or non-financial interests to disclose.

Disclosure will be made when a product is discussed for an unapproved use.

This continuing education activity is managed and accredited by AffinityCE in collaboration with AMSUS. AffinityCE and AMSUS staff as well as Planners and Reviewers, have no relevant financial or non-financial interests to disclose.

Commercial Support was not received for this activity

Objectives

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At the conclusion of this activity, participants will be able to:- Explain how the Solutions Delivery Directorate (SDD) worked with the Defense Health Community, Veterans Health Administration, and Veterans Benefits Administration to identify the data and key functionality required to improve the support provided to service members and veterans

- Identify the infrastructure and data sources used to support ILER

- Explain how ILER compiles, distills, and presents relevant exposure data for individuals and populations based on location, date, and time

- Outline the way ahead as Clinical Support Division (CSD) continues to expand the data used improve ILER ability to build cohorts based on exposures and health outcomes

- Direct participants how to access ILER

What is the Problem? A multitude of occupational and environmental exposures in deployed and garrison locations.

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Agent Orange

Nerve Agent

SolventsAnti-

Malarial

Dust & Sand

Fuels Pesticides Radiation

Depleted Uranium

VaccinesOil Well

FiresBurn Pits

What is the Solution?

∎ ILER links individuals to known exposure events and provides a (historic) record of service-related exposures

∎ ILER delivers the capability to: Improve the medical care for those who have exposure-related

health outcomes Research and support epidemiologic study of exposed cohorts to

determine whether deployment-related exposures are associated with post-deployment health outcomes

Create exposure cohorts based on location, date, time, and agents

Improve both medical surveillance and occupational and environmental health surveillance (OEHS) by detecting emerging (latent) health conditions on personnel returning from deployment

Assist Veteran disability evaluations and benefits determination

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ILER Conceptual View‘Search by Individual’ Capability

Medical

Encounter

Data

>10M

Records

Individual

Daily

Location Data

>13M

Records

Sampling Data/Reports

OEHSAs & POEMSs

OEH and CBRN Incident Reports

‘Search by Individual’ Query Logic Model: Garrison Locations

Deployment Location 2

Deployment Location 1

TIER 1: Confirmed / Probable

Exposures (10 Meters)

•Health Effects

•Biomonitoring

•Personal Monitoring

•Proximity Modeling

TIER 2: Possible Exposures

(50 Meters)

•Deployment Health Assessments

•OEH/CBRN incident reports

TIER 3: Supplementary Ambient

Monitoring Data (> 100 Meters

•OEHSAs & POEMSs in DOEHRS

•CBRN Sensors

Exposure

Data

>1.5M

Records

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EDIPI, Name, MOS

Geolocation, City, State

Dates

Encounter Record

Inpatient Data Record

Theater Medical Data

Filters Exposure Reports

Filters the Individual’s Medical

Encounters with Health Effects

Associated with Exposures

Supporting Data by Release

Pilot (FY14-19) Defense Occupation and

Environmental Health Readiness System - Industrial Hygiene (DOEHRS-IH)

Military Exposure Surveillance Library (MESL)

Defense Medical Surveillance System (DMSS)

- Pre-Deployment Health Assessments

- Post-Deployment Health Assessments

Defense Manpower Data Center (DMDC)*

- Limited to ‘Reid Memo’ data elements

- Deployment Start / Stop

- Location Coordinates

Medical Data Repository (MDR)

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Limited Deployment (FY19-20)

Expand Pilot Data Feeds

Defense Manpower Data Center (DMDC)*

- Location (Garrison and Theater) -Contingency Tracking System (CTS)

- Incorporate all Individual Location Data Elements of the DoDI 6490.3, Deployment Health:

- Military Occupational Specialty

- Unit Identification Code (Assigned)

- Unit Identification Code (Attached)

- Operation Name

- Marine Corp Data

Full Deployment (FY20-24) DOEHRS-Hearing Conservation (HC)

Electronic Deployment Health Assessment (EDHA)

Defense Medical Information Exchange (DMIX)

Joint Legacy Viewer (JLV)

Electronic Health Record Data (MHS GENESIS)

Federal Interagency Traumatic Brain Injury Research Informatics System (FITBIR)

Health Artifact and Image Management System (HAIMS)

VA Clinical Data Repositories (VA-CDR)

VA Health Data Repository (HDR)

VA Airborne Hazards and Open Burn Pit Registry (AHOBPR)

ILER Limited Deployment Delivery Roadmap

JIF ApprovalRequirement Development

Phase II:ILER v1.0

Phase I:ILER Pilot

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Start Finish

JAN 2013 MAR 2013

Key Activities

• JIF Project Approved• Funding to DHA• Funding to VA

Start Finish

JUN 2013 OCT 2014

Key Activities

• Completed CONOPS• Completed Business

Use Cases• Completed

Functional Requirements

• DHA Readiness and Force Support Portfolio Management Board (RFSPMB) approval

• DHA Medical Operations Group (MOG) approved

Start Finish

OCT 2018 SEP 2019

Key Activities

• Enhanced ‘Search by Individual’ Incorporated Medical Exposure

Indicator (ICD 9 and 10) Mapped all available surveys and

sample available in DOEHRS• Enhanced ‘Search by Location’

Improved Location Reporting and added Mapping functionality

• Ingested >20M deployment records form DMDC

• Produced >1.1M Individual Exposure Summary Reports

• Developed Epidemiology / Research Roadmap for Post Limited Deployment

• User Approval Rating 4.43/5

Start Finish

JUL 2016 SEP 2018

Key Activities

• Awarded ILER Development Contract • Validate Available DOEHRS Interface

Options • Defined DOEHRS Enterprise Services

(DES) Architecture• Integrated ESB DOEHRS Enterprise

Services (DES)• Migrated MESL to the DOEHRS-IH• Mined High Priority Data Sources• Initial Configuration and Pilot

Development• Developed Key Functionality

‘Search by Individual’ ‘Search by Location’

ILER Demonstration

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ILER Training & Contact Information

∎ Training is available now through the Joint Knowledge Online: http://jko.jten.mil Course Number: DHA-US1086 https://vimeo.com/352699862/2e68a1e203

∎ ILER Account Requests: https://iler.csd.disa.mil/iler/

For more information, contact:∎ ILER Sponsor: Steve Jones

(703) 681-7335 steven.p.jones10.civ@mail.mil

∎ ILER Program Manager: Devon Matthew 703-882-3939 devon.m.matthew.civ@mail.mil

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Questions and Answers

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Back-up Slides

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Phase 3 (FY22-):Researching Data Source

Phase 2 (FY20-21):Identify Exposure & Covariate Information

Epidemiology and Research Delivery RoadmapExpanding ‘Search by Location’ Capability

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ILER

ILER

ILER

Phase 1 (FY19):Define Population(s)

Build Cohorts• Ability to see and export Population(s) of Interest and or study

population• Display exposed group(s) and comparison or reference

population(s)

Search by Exposure/Covariates:• Monitoring data (SO2 and H2S); • Unit location • Demographic data• Search by Exposures

Search by Health Outcome Information• Diagnosis data (inpatient & outpatient

ICD9, ICD10)• Pharmacy data• Medical procedure data• Lab data• Ability to Cohorts / Exposed Groups to

Referenced Populations• Search by Conditions / Health

Outcomes

Phase 0 (Pilot): Define QuestionILER

Exposure/Disease Surveillance:• Ability to see Incident reports (i.e. odors characteristic of sulfur)

Sulfur dioxide (SO2), Hydrogen sulfide (H2S), etc.) by location• Ability to see and export potentially exposed population

ILER User ‘Search by Individual’

Screen Capture / Navigation

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Search by Individual PageFirst screen after login and disclaimer

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Data Sources:•DMDC*

Search by Individual Results Page Returned after selecting “Search”

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Data Sources:•DMDC*

Individual Exposure SummaryList of Exposure Events Associated with an Individual (i.e. POEMS, Incident, Registry, etc.)

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Data Sources:•DMDC*•DOEHRS-IH

Individual Exposure Summarywith Exposure Summary Detail (mouse over)

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Data Sources:•DMDC*•DOEHRS-IH

Exposure Event Details PageDrill down of the Exposure Source with Exposure Types (i.e. Airborne, Environmental, etc.)

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Data Sources:•DMDC*•DOEHRS-IH

Exposure Type Details PageDrill of the Exposure Type with Exposure Specific Information

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Data Sources:•DMDC*•DOEHRS-IH

How to Obtain CE/CME Credit

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