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THEATER MEDICAL INFORMATION PROGRAM-JOINT (TMIP-J (1)

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									                                    SAIC D/SIDDOMS Doc. D3-TMIP-5017A
                                                            20 Sep 2008




THEATER MEDICAL INFORMATION PROGRAM-JOINT
                  (TMIP-J)
             SYSTEM OVERVIEW
                VERSION 1.1


                   Submitted in Response to:

        D/SIDDOMS III Contract No. W74V8H-04-D-0036
                       Delivery Order 0016
      Theater Medical Information Program – Joint (TMIP-J)
                    Integration Development
                       Deliverable Item 28


                             For:

     Defense Health Information Management System (DHIMS)
                  Lt Col Michael Holmes, USAF
                   5109 Leesburg Pike, Suite 100
                      Falls Church, VA 22041
                      (703) 998-6900, ext. 1103

                              By:

          Science Applications International Corporation
                  Health Solutions Business Unit
     5203 Leesburg Pike, Suite 1300, Falls Church, VA 22041
  Beth Le Duc, TMIP-J Program Manager, Phone: (703) 824-5808
Amy Ward, TMIP-J Deputy Program Manager, Phone: (703) 664-4834
                                                   SAIC D/SIDDOMS Doc. D3-TMIP-5017A
                                                                           20 Sep 2008


                             REVISION HISTORY
    Date       Document #    Version             Description                Author
15 Aug 2008   D3-TMIP-5017    1.0      Initial delivery with B2 FY07     SAIC
                                       SP1                               Training
20 Sep 2008   D3-TMIP-5017A 1.1        Updated per test comments         SAIC
                                                                         Training
                                                                                       SAIC D/SIDDOMS Doc. D3-TMIP-5017A
                                                                                                               20 Sep 2008




                                                  TABLE OF CONTENTS
Section                                                                                                                            Page
1.0    TMIP-J SYSTEM OVERVIEW.......................................................................................1
    1.1 TMIP-J Information System .............................................................................................1
    1.2 Acquisition Strategy..........................................................................................................3
    1.3 TMIP-J Block 1.................................................................................................................3
    1.4 TMIP-J Block 2.................................................................................................................4
    1.5 Block 2 FISCAL YEAR 07 (B2 FY07)............................................................................6
    1.6 Post-Deployment Software Support .................................................................................7
    1.7 Document Overview .........................................................................................................8
2.0    SOURCE DOCUMENTS..................................................................................................9
3.0    SYSTEM SUMMARY.....................................................................................................14
    3.1 Software Applications.....................................................................................................15
        3.1.1 Levels of Care ..................................................................................................... 15
        3.1.2 Functional Components....................................................................................... 16
        3.1.3 Software Component Integration ........................................................................ 18
    3.2 Software Component Descriptions .................................................................................21
        3.2.1 Foundation Components...................................................................................... 22
        3.2.2 Healthcare Delivery Components ....................................................................... 24
        3.2.3 Medical Logistics Components ........................................................................... 36
        3.2.4 Patient Movement Components .......................................................................... 40
        3.2.5 Command and Control (C2) Components........................................................... 41
    3.3 Modes of Operation ........................................................................................................44
    3.4 Security and Privacy .......................................................................................................44
    3.5 Assistance and Problem Reporting .................................................................................45
        3.5.1 Help Desk Support .............................................................................................. 45
        3.5.2 Triage................................................................................................................... 46
        3.5.3 Contacting the Help Desk.................................................................................... 46
4.0    TMIP-J B2 FY07 SP1 WORKSTATION ......................................................................48
    4.1 TMIP-J B2 FY07 SP1 Workstation Installation and Configuration...............................48
    4.2 TMIP-J B2 FY07 SP1 Workstation Components...........................................................49
    4.3 Access to Software..........................................................................................................51
        4.3.1 Equipment Familiarization .................................................................................. 51
        4.3.2 Access Control .................................................................................................... 51
    4.4 Initiating a TMIP-J Session ............................................................................................52
    4.5 Stopping and Suspending Work......................................................................................52
5.0    PROCESSING REFERENCE GUIDE..........................................................................55
    5.1 Capabilities .....................................................................................................................55
    5.2 Conventions ....................................................................................................................55




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      Processing Procedures ....................................................................................................55
     5.3
      Related Processing ..........................................................................................................55
     5.4
      Data Backup....................................................................................................................55
     5.5
      Recovery from Errors, Malfunctions, and Emergencies.................................................55
     5.6
      5.6.1 Typical Application Errors .................................................................................. 56
  5.7 Messages .........................................................................................................................63
APPENDIX A: ACRONYMS AND ABBREVIATIONS................................................... A-1




                                                         LIST OF FIGURES
Figure                                                                                                                                     Page
Figure 1-1 TMIP-J Top-Level Operational Concept View............................................................. 2
Figure 1-2 TMIP-J Information System’s Support of Theater Operations across Functional Areas
           ....................................................................................................................................... 2
Figure 3-1 TMIP-J B2R1 System Components ............................................................................ 15
Figure 4-1 Select Features Screen................................................................................................. 49
Figure 4-2 Logon Information Screen .......................................................................................... 52
Figure 4-3 Display Properties Screen ........................................................................................... 53
Figure 5-1 Starting EF Services (Screen 1 of 3) ........................................................................... 59
Figure 5-2 Starting EF Services (Screen 2 of 3) ........................................................................... 60
Figure 5-3 Starting EF Services (Screen 3 of 3) ........................................................................... 61




                                                          LIST OF TABLES
Table                                                                                                                                      Page
Table 1-1 TMIP-J Block 2 Functional Capabilities........................................................................ 5
Table 1-2 Integrated Software Components ................................................................................... 6
Table 1-3 Non-Integrated TMIP-J Software Components.............................................................. 7
Table 1-4 External Systems (Non-TMIP-J Systems, Which Receive TMIP-J Data or Provide
           Data to TMIP-J) ............................................................................................................ 7
Table 2-1 External Source Documents ........................................................................................... 9
Table 2-2 DoD Source Documents ................................................................................................. 9
Table 2-3 Military Health System Source Documents ................................................................. 11
Table 2-4 TMIP-J Source Documents .......................................................................................... 11



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Table 2-5 Joint Source Document................................................................................................. 13
Table 3-1 Integrated Software Components ................................................................................. 19
Table 3-2 Non-Integrated Software Components ......................................................................... 20
Table 3-3 External Systems .......................................................................................................... 20
Table 3-4 TMIP-J Foundation Components ................................................................................. 21
Table 3-5 Healthcare Delivery Components................................................................................. 24
Table 3-6 Medical Reference Library 1....................................................................................... 34
Table 3-7 Stat!Ref Medical Reference Library 2 ......................................................................... 35
Table 3-8 Medical Logistics Components .................................................................................... 37
Table 3-9 Patient Movement Components ................................................................................... 40
Table 3-10 Command and Control Components .......................................................................... 41
Table 4-1 TMIP-J B2 FY07 SP1 Workstation Components ........................................................ 49




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1.0    TMIP-J SYSTEM OVERVIEW
The Defense Health Information Management System (DHIMS) is a Military Health System
(MHS) program with participation from the Assistant Secretary of Defense for Health Affairs
(ASD/HA), Deputy Assistant Secretary of Defense (DASD), Force Health Protection and
Readiness (FHP&R), Army, Navy, Marine Corps, Air Force, United States Transportation
Command (USTRANSCOM), Joint Forces Command (JFCOM), and Joint Staff (J4) Health
Service Support Division (HSSD).
The Defense Health Information Management System (DHIMS) Program Management Office
(PMO) provides the suite of Theater Medical software components for the Military Services. The
TMIP-J approach integrates and adapts sustaining base medical information software
components to ensure timely, interoperable medical support that provides for rapid mobilization,
deployment, and sustainment of all military forces anywhere and anytime. With this approach in
mind, the PMO defined the DHIMS Vision “to provide an interoperable medical system to
protect the combat power worldwide,” and the DHIMS Mission “to provide an integrated suite of
automated medical information software components to support the warfighter.”

1.1    TMIP-J INFORMATION SYSTEM
The TMIP-J Information System electronically bridges documentation of healthcare delivery in
   the “Theater of Conflict” to the sustaining base. The TMIP-J Information System captures
  clinical information and other data and passes it to the Theater Medical Data Store (TMDS),
where it can be viewed by authorized healthcare providers and analysts all over the world. Data
     in TMDS is sent to the MHS Clinical Data Repository (CDR) and Joint Medical Asset
Repository (JMAR) Systems-of-Record for enterprise use by MHS stakeholders. Data in TMDS
is also made available on a classified network where Combatant Commanders can access it via
  Joint Medical Workstation (JMeWS). The TMIP-J Top-Level Operational Concept View is
                                            depicted in
Figure 1-1.




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                   Figure 1-1 TMIP-J Top-Level Operational Concept View
The military Services provide the computer, network, and communications infrastructures to host
the TMIP-J Information System in deployed settings. The TMIP-J 1.1.2.2 Block 1 (B1) baseline
was delivered to the Military Services in July 2004 and is currently in use in Iraq, Afghanistan,
Qatar, Kuwait, and United Arab Emirates. TMIP-J Block 2 (B2) is the second release and
updates technology and adds capabilities to the TMIP-J B1 baseline.
As depicted in Figure 1-2, the TMIP-J Information System supports theater operations with
interoperable medical information across the functional areas of Medical Command and Control
(C2), Medical Logistics (MedLog), Patient Movement (Medical Regulation), and Electronic
Health Record (EHR).




Figure 1-2 TMIP-J Information System’s Support of Theater Operations across Functional Areas



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TMIP-J is also the medical component of the Department of Defense (DoD) Global Combat
Support System (GCSS) Family of Systems (FoS). TMIP-J supports Force Health Protection
(FHP) and complies with Presidential, Congressional, and DoD Health Affairs mandates to
maintain a longitudinal (i.e., life long) electronic patient record for the warfighter in the
battlefield and during peacetime. In the theater environment, TMIP-J supports Combatant and
Joint Task Force Commanders by providing medical readiness data for the combat force and by
making recommendations to protect the combat force from medical threats.

1.2     ACQUISITION STRATEGY
The DHIMS PMO strategy follows a block release, low risk mid-cycle release, and maintenance
release strategy to incorporate appropriate DoD MHS Information Management/Information
Technology (IM/IT) capabilities in a phased manner. The Program Acquisition Strategy
incorporates a spiral software development life cycle to address the incrementally delivered,
sustainment-based, software components and their periodically updated functional capabilities
and technologies.
The TMIP-J Information System is based on a federation of software components which are used
in the sustaining base to support non-deployed force requirements. The sustaining base software
is adapted and integrated to provide interoperable theater information management support. The
TMIP-J Information System adaptations support theater business processes, mobile users, and
stand-alone users in a communications constrained environment. The components are also
adapted and integrated enabling TMIP-J deployment on Services-provided computer hardware
and communications infrastructures. Each MHS PMO and its Project Manager(s) are in charge of
the individual software components and are responsible for developing new software modules or
enhancements, if and when required, to support the TMIP-J integrated environment. When
adapted and integrated, these individual components become the TMIP-J Information System.

1.3   TMIP-J BLOCK 1
TMIP-J Block 1 focused on the Initial Operating Capability (IOC) mission areas of:
       EHR Services (Patient Encounter and Care Plan documentation):
       − Composite Health Care System II-Theater (CHCS II-T) (C2T)/AHLTA-Theater
         (AHLTA-T) – Immunization tracking, clinical data collection (in theater and
         Outpatient facilities)
       − Battlefield Medical Information System Tactical-Joint (BMIST-J)/AHLTA-Mobile –
         Personal digital Assistant (PDA) support for clinical data collection in theater used
         primarily for medical care at Level I
       − Composite Health Care System-New Technology (CHCS-NT) – Level III Inpatient
         Capability and Ancillary Services
       − Micromedex – Automated Physician’s Desk Reference
       − Medical Environmental Disease Intelligence and Countermeasures (MEDIC) –
         Medical Intelligence Tool
       − Interface with a single encounter Electronic Information Carrier (EIC)
       − Interface with a Common Access Card (CAC) for demographic data



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       Medical Logistics Capabilities – Management of blood/blood product inventories and
       product identification:
       − Defense Blood Standard System (DBSS) – Blood management
       C2 (Medical Planning/Surveillance) – Medical surveillance, decision support tools,
       analysis of medical sustainability, and supportability assessments of medical supplies and
       resources:
       − JMeWS – Advanced Concept Technology Demonstration (ACTD) system added to
         support Operation Iraqi Freedom (OIF)
       − TMIP-J Reports – Medical Treatment Facility (MTF) reporting capability
       − TMDS – A repository for theater medical encounter information
       − Medical Analysis Tool (MAT) – TMIP-J tool used on the GCSS

1.4    TMIP-J BLOCK 2
TMIP-J Block 2’s first release, Block 2 Fiscal Year 07 (B2 FY07), provides a loosely coupled
communications framework and reporting tool. In addition to B1 functionality, B2FY07 adds
additional patient healthcare, medical logistics, patient movement tracking, and C2 medical
analysis and planning functionalities as summarized in Table 1-1.
At Full Operational Capability (FOC), TMIP-J includes the sustaining base capabilities of
Composite Health Care System (CHCS), AHLTA (formerly known as CHCS II), TRANSCOM
Regulating and Command & Control Evacuation System (TRAC2ES), Defense Medical
Logistics Standard Support (DMLSS), DBSS, and DoD Occupational and Environmental Health
Readiness System (DOEHRS). TMIP-J’s ultimate data repositories are the MHS CDR and the
JMAR. Demographic data can be preloaded into TMIP-J from the Defense Manpower Data
Center (DMDC) Defense Enrollment Eligibility Reporting System (DEERS) via the MHS CDR,
or from an individual soldier’s CAC. DMLSS Customer Assistance Module (DCAM) replaces
the legacy Theater Army Medical Management Information System (TAMMIS) Customer
Assistance Module (TCAM). DCAM and its TCAM predecessor are browser-based applications
which attach to the DMLSS and TAMMIS logistics servers, respectively. TMIP-J is the medical
component of the GCSS FoS.




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                      Table 1-1 TMIP-J Block 2 Functional Capabilities
                   B2FY07                                         B2 FOC
                               Electronic Health Care Records
Outpatient Theater Electronic Medical Record: Inpatient and Outpatient Theater Electronic
  Drug-to-Drug Interaction and Allergy Alerts Medical Record including:
Initial Inpatient Care Documentation             Drug-to-Drug Interaction and Allergy Alerts
Initial Ancillary Capabilities                   Clinical Specialties Support
Demographic Data Validation                      Pharmacy Order Entry and Results Retrieval
                                                 Laboratory Order Entry and Results Retrieval
                                                 Radiology Order Entry and Results Retrieval
                                               Optometric Documentation and Spectacle
                                               Requisitioning
                                               Dental Encounter Documentation
                                               Occupational and Environmental Health
                                               Documentation
                                               Patient Safety Reporting (PSR)
                                               Patient Self Reporting (e.g., Pre-/Post-
                                               Deployment Surveys [PPDS])
                                               Digital Images (e.g., Telemedicine)
                                       Medical Logistics
Resource Management:                           Resource Management:
  Ordering and Tracking (for Levels I & II)      Ordering and Tracking (for Levels I, II, III)
  Patient Movement Item Tracking                 Patient Movement Item Tracking
                                                 Blood Management
                                               Facilities Management (for Level III)
                                      Patient Movement
In-Transit Patient Visibility                  In-Transit Patient Visibility
                                               Inter-/Intra-Theater Medical Regulating
                               Medical Command And Control
Medical Situational Awareness                  Medical Situational Awareness
Medical Reporting                              Medical Reporting
Medical Surveillance                           Medical Surveillance
Medical Analysis and Planning Tools            Medical Analysis and Planning Tools
                                     Technology Upgrades
Operating System
Database System
Local Reports using Business Objects




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1.5     BLOCK 2 FISCAL YEAR 07 (B2 FY07)
TMIP-J B2 FY07 is the TMIP-J B2 baseline that introduces numerous features beyond TMIP-J
B1. The TMIP-J B2 Communications Framework is a secure messaging framework that meets
the needs of organizations in a communications challenged environment. Within TMIP-J B2
FY07, integrated software components are those contained within the Installation Wrapper. If
necessary, these components can pass messages via the TMIP-J Communications Framework
directly between software components or manually on removable media. In addition, the defined
TMIP-J Communications Framework is used to compress, encrypt, send, and receive data among
TMIP-J B2 FY07 communications integrated software systems.
Table 1-2 through Table 1-4 include the TMIP-J categories of system software components. In
addition to the components listed in these tables, the TMIP-J program will ensure that the
Windows Operating System and Internet Explorer will be available.

                                    Table 1-2 Integrated Software Components
                       Software Component                                              Mission/Functional Area
AHLTA Warrior Web Client                                                       EHR
Business Objects (for TMIP-J Reporting)                                        EHR
AHLTA-Theater (THLTA-T)                                                        EHR
DCAM                                                                           Medical Logistics
Desktop Icon (URL link) to DoD Occupational and                                EHR
Environmental Health Readiness System-Industrial
Hygiene (DOEHRS-IH)
Desktop Icon (Universal Resource Locator [URL] link)                           Medical Logistics
to JMAR
Desktop Icon (URL link) to JMeWS                                               Medical C2
Desktop Icon (URL link) to Joint Patient Tracking                              Patient Movement
Application (JPTA)
Desktop Icon (URL link) to TRAC2ES                                             Patient Movement
MEDIC                                                                          EHR
Micromedex                                                                     EHR
Patient Movement Items Tracking System (PMITS)                                 Medical Logistics
Shipboard Non-Tactical Automated Data Processing                               Medical Logistics
Program Automated Medical System (SAMS)                                        EHR
                                                                               Radiation Health
TMIP-J B2 Communications Framework                                             TMIP-J Foundation
Utilities (Data & Messages)                                                    TMIP-J Foundation
Note: There are several office and productivity applications also available in support of TMIP-J Suite.




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                       Table 1-3 Non-Integrated TMIP-J Software Components
    Software Component                                       Mission/Functional Area
AHLTA-Mobile *                       EHR
TC2                                  EHR
JMeWS **                             Medical C2 (Secret Internet Protocol Router Network
                                     [SIPRNet])
MAT                                  Medical Planning
TMDS                                 Medical C2 (Non-Secure Internet Protocol Router Network
                                     [NIPRNet])
* AHLTA Mobile can export data to AHLTA-T. AHLTA-T transmits the AHLTA-Mobile data using the Communications
Framework.
** JMeWS receives data from TMDS. The JMeWS and TMDS servers are separated by an air gap.




  Table 1-4 External Systems (Non-TMIP-J Systems, Which Receive TMIP-J Data or Provide
                                    Data to TMIP-J)
  Software Component             Mission/Functional                               Notes
                                        Area
CDR                              EHR                       The MHS Clinical Data Repository
DMLSS                            Medical Logistics         Receives DCAM data
DOEHRS-IH                        EHR                       URL link on TMIP-J desktop
Global Expeditionary             EHR                       Legacy System which sends medical
Medical System (GEMS)                                      surveillance data to TMDS
Integrated Clinical              EHR                       Receives AHLTA-T clinical data
Database (ICDB)
JMAR                             Medical Logistics         URL link on TMIP-J desktop
                                                           DCAM sends level II status to JMAR
JPTA                             Patient Movement          URL link on TMIP-J desktop; links to TMDS
TAMMIS (legacy)                  Medical Logistics         Legacy system which receives DCAM data
Theater (T)-DBSS                 Medical Logistics         Version 3.04 self standing blood system
TRAC2ES                          Patient Movement          URL link on TMIP-J desktop. In-Transit
                                                           Visibility (ITV) file periodically sent to
                                                           TMDS


1.6     POST-DEPLOYMENT SOFTWARE SUPPORT
The MHS provides Service Help Desk operational sustainment support. In general, any software
issues should be reported first to the Service Help Desk. The Service Help Desk will then
escalate issues up through the MHS Help Desk tier levels, as deemed necessary.




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TMIP-J supports the Service Help Desk(s), including operational sustainment support and mid-
cycle low risk and maintenance releases for technology updates and problem fixes. The site
System Administrator will provide the Service a Help Desk telephone number once the TMIP-J
software is deployed. The MHS Service Help Desk is available via the following:
       http://www.mhs-helpdesk.com
       help@mhs-helpdesk.com
       800.600.9332 (Continental United States [CONUS])
       210.767.5250 (Direct)
       866.637.8725 (Outside Continental United States [OCONUS])

1.7     DOCUMENT OVERVIEW
The intent of the System User’s Manual is to provide an overview of the TMIP-J system and its
components as well as how the system is being developed and deployed. This document provides
the TMIP-J B1 capabilities as a baseline for understanding what is being developed and released
as TMIP-J B2, and especially, in TMIP-J B2 FY07. This manual provides summary descriptions
of the commercial and Government software components that comprise the TMIP-J Block 2
Fiscal Year 07 Service Pack 1 (B2 FY07 SP1) system and discusses the components from a
patient centric continuum of care viewpoint, a mission area or functional viewpoint, and an
integration standpoint. The System User’s Manual provides information that will enable the user
to gain a basic understanding of the TMIP-J B2 FY07 system capabilities as well as an
understanding of the software that may be installed on the user’s TMIP-J workstation. When
used in conjunction with the TMIP-J training course, the user will be able to gain a more
comprehensive understanding and knowledge of the TMIP-J system. Sections in this manual are
arranged to reveal the system to the user in the logical order moving from the conceptual to the
practical. This manual also provides the user references to other documentation where more
detailed information may be found on a specific application or topic. Terminology used to
identify applications includes words such as ‘system,’ ‘component,’ and ‘module’ and should not
be interpreted to mean anything other than the name of the application. The System User’s
Manual is divided into sections as follows:
Section 1 provides an introduction to TMIP-J and the TMIP-J B2 FY07 Service Pack 1
integration goals. It categorizes the software that comprises TMIP-J B2 FY07 SP1 into
Integrated Components, Non-Integrated Components, and Related Systems. Section 1 also
summarizes the contents of this document.
Section 2 provides a summary of the source documents for TMIP-J B2 FY07 SP1.
Section 3 provides a summary of each software component in TMIP-J B2 FY07 SP1.
Section 4 provides an overview of the integrated software unit, its installation and setup
procedures, and procedures for starting and stopping the integrated TMIP-J B2 FY07 SP1
system.
Section 5 defines the process guidelines and procedures for the TMIP-J B2 FY07 SP1 system.
Appendix A contains a list of acronyms and abbreviations.




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2.0    SOURCE DOCUMENTS
This section identifies all source documents for TMIP-J B2 FY07 SP1. The documents are
identified by Document Name and Number, Title, Revision, and Date in Table 2-1 through Table
2-5. Where a document is not available through normal government channels, the source of the
document is also provided.

                             Table 2-1 External Source Documents
                                                                       Revision/
                       Document Name/Title                                             Date
                                                                       Version
American National Standards Institute (ANSI)/Institute of Electrical               April 1998
and Electronic Engineers (IEEE) 12207.1997 Guide for International
Standards Organization (ISO)/International Electrotechnical
Commission (IEC) 12207, Standard for information technology—
Software life cycle processes—Life cycle data
IEEE Standard (Std) 830-1998 IEEE Recommended Practice for                         25 June 1998
Software Requirements Specifications
Health Level 7 (HL7) Organization web site for latest HL7 version      2.3.1       14 April 1999
information: http://www.h17.org/library/standards.cfm version2.3.1
National Computer Security Center (NCSC)-TG-005, Trusted                           31 July 1987
Network Interpretation of the Trusted Computer System Evaluation
Criteria (TCSEC)
PL 104-191, Health Insurance Portability and Accountability Act of                 21 August
1996 (HIPAA)                                                                       1996
PL 93-5795, Privacy Act of 1974 (See also 5 United States Code         Amended 16 January
[USC] Sec. 552 a: 88 Stat. 1896).                                              2004
This law requires the safeguarding individual personal information.


                               Table 2-2 DoD Source Documents
                                                                       Revision/
                       Document Name/Title                                             Date
                                                                       Version
Chairman of the Joint Chiefs of Staff Instruction (CJCSI) 3170.01B,                15 April 2001
Requirements Generation System
CJCSI 3170.01C, Joint Capabilities Integration and Development                     24 June 2003
System (JCIDS)
CJCSI 6212.01C interoperability and Supportability of Information                  20 November
Technology and National Security Systems                                           2003
Defense Information Systems Agency (DISA) Common Operating                         21 October
Environment (COE) Web page - http://diicoe.disa.mil/coe/                           2004




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                                                                     Revision/
                       Document Name/Title                                           Date
                                                                     Version
Defense Information Infrastructure (DII) COE Developer               2.0         23 January
Documentation Requirements                                                       1998
                                                                     4.3         27 October
DII COE Integration and Runtime Specification (I&RTS)
                                                                                 2003
Department of Defense Directive (DoDD) 5200.28, Security                         21 March
Requirements for Automated Information Systems. Rescinded and                    1988
new regulations are 8500.1 and 8500.2
Department of Defense Instruction (DoDI) 5200.40, Department of                  30 December
Defense (DoD) Information Technology Security Certification and                  1997
Accreditation Process (DITSCAP)
Enclosure 6: System Security Authorization Agreement (SSAA)
Outline.
Deputy Secretary of Defense Memorandum, Global Information Grid                  12 November
Enterprise Services (GIG ES): Core Enterprise Services (CES)                     2003
Implementation
                                                                                 6 February
DoD 8500.2, Information Assurance (IA) Implementation
                                                                                 2003
DoD 5200.2-R, Mandatory Procedures for Major Defense Acquisition                 27 February
Programs (MDAP) and Major Automated Information System (MAIS)                    1998
Acquisition Programs
                                                                                 31 August
DoD Regulation 5400.11-R, Privacy Program
                                                                                 1983
                                                                                 September
DoD Regulation 5400.7-R, DoD Freedom of Information Act Program
                                                                                 1998
DoD 8510.1-M, DITSCAP Application Manual                                         31 July 2000
                                                                     1.0         21 February
DoD Architecture Framework
                                                                                 2004
DoD Directive 4630.5, “Interoperability and Supportability of                    11 January
Information Technology and National Security Systems (NSS)”                      2002
DoD Directive 5000.1, “The Defense Acquisition System”                           12 May 2003
DoD Instruction 5000.2, “Operation of the Defense Acquisition                    12 May 2003
System”
                                                                     6.0         3 October
DoD Joint Technical Architecture
                                                                                 2003
DODI 4630.8 “Procedures for Interoperability and Supportability of               30 June 2004
IT and NSS”
Global Information Grid (GIG) Capstone Requirements Document,                    30 August
Joint Requirements Oversight Council Memorandum (JROCM) 134-1                    2001




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                                                                      Revision/
                      Document Name/Title                                              Date
                                                                      Version
NavImmune System Interface Control Document (ICD), SAMS DII           2.8          23 June 2004
COE
Health Services Module
Space and Naval Warfare Systems Center, Norfolk, VA
                                                                      1.0          25 October
Navy Enterprise Application Development Guide
                                                                                   2002
Office of the Secretary of Defense, Health Affairs Website                         04 April 2004
http://www.tricare.osd.mil/
Clinical Information Technology Program Office (CITPO) Website -
http://www.tricare.osd.mil/peo/citpo/default.htm
Defense Medical Logistics Standard Support (DMLSS) Website -
http://www.tricare.osd.mil/peo/dmlss/default.htm
TMIP-J Website - http://www.tricare.osd.mil/peo/TMIP/default.htm
SD-15 -- Defense Standardization Program Performance Specification                 29 June 1995
Guide


                     Table 2-3 Military Health System Source Documents
                                                                     Revision/
                      Document Name/Title                                              Date
                                                                     Version
Composite Health Care System II-Theater (AHLTA-T) ICD for                         18 October
AHLTA-T, DHIMS PMO to Complete Block 1                                            2002
The AHLTA PMO and the Military Health System (MHS) Clinical
Information Technology Program Office, Falls Church, VA
Dynamic Object-Oriented Requirements System (DOORS)net
(https://199.211.83.172). Document library including background
Block 2 requirements documents.
Security Policy Manual, MHS Automated Information Systems (AIS) 1.0               April 1996
                            Table 2-4 TMIP-J Source Documents
                                                                     Revision/
                      Document Name/Title                                             Date
                                                                     Version
Defense Medical Logistics Standard Support-Assemblage                4.0          21 August
Management (DMLSS-AM) - Joint Medical Asset Repository                            2002
(JMAR) ICD for TMIP, Block 1
Global Combat Support System Capstone Requirements Document                       5 June 2000
Global Expeditionary Medical System Patient Encounter Module,                     19 July 2004
ICD, TMIP




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                                                                    Revision/
                     Document Name/Title                                            Date
                                                                    Version
HIV Management Service Loader (HMSL) – Shipboard Non-                           25 August
Tactical Automated Data Processing Program Automated Medical                    2004
System (SAMS) ICD for HIV Management Service (HMS)
Navy Central HIV Program (NCHP)
National Naval Medical Center (NNMC)
ICD for External Interfaces to the Joint Medical Workstation        3.1.5       24 June 2004
Theater Medical Information System – Joint, Joint Program Office,
Falls Church, VA
ICD for Medical Situation Awareness (MSA) Project, Prototype 2,     1.0         25 June 2004
TMIP
ICD for Component Integration to TMIP, Battlefield Medical          1.9.6       15 August
Information System-Tactical (BMIS-T), TMIP Block 1, TRICARE                     2004
Management Activity, Falls Church, VA
Interface Requirements Specification, TMIP Block 2 Release 1,                   14 April 2005
Lockheed Martin Information Technology (LMIT), Falls Church,
VA
JROCM 005-90, dated 29 January 1990 and revalidated J8/                         29 January
Redundant Array of Independent Disks (RAID) [Mission Needs                      1996
Statement]
Mission Need Statement (MNS) for the TMIP Assistant Secretary of                29 January
Defense Health Affairs (ASD[HA])                                                1996
Operational Requirements Document for TMIP-J Block 2                            18 October
Integration                                                                     2002
Performance Specification (PS) for TMIP Block 2 Release 1, LMIT                 14 April 2005
SAMS, Naval Dosimetry Center, ICD, Medical Systems                              11 May 2004
Development Division, Space and Naval Warfare Systems Center,
Norfolk, VA
Software Design Description (SDD) for the TMIP Block 2 Release 1                14 April 2005
Northrop Grumman, Chantilly, VA
TMIP-J Capstone Requirements Document (CRD), TMIP-J                 1.0         25 February
TRICARE Management Activity, Falls Church, VA                                   1999
TMIP-J ICD for Component Integration to TMIP                        Block 1,    21 August
Northrop Grumman, Chantilly, VA                                     Build       2002
                                                                    0.3.5.0/
                                                                    0.3.6.0
TMIP-J Operational Requirements Document (ORD) for TMIP-J           1.2         15 May 2001
Block 1 Integration
TMIP-J, TRICARE Management Activity, Falls Church, VA




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                                                                       Revision/
                       Document Name/Title                                             Date
                                                                       Version
TMIP-J ORD for TMIP Block 2 Integration                                            October 2002
TMIP-J, TRICARE Management Activity, Falls Church, VA
TMIP-J Security Features User’s Guide (SFUG) for TMIP-J Block 2                    19 June 2006
Release 1
LMIT, Falls Church, VA
TMIP-J Trusted Facility Manual (TFM) for TMIP-J Block 2 Release
1
LMIT, Falls Church, VA
TMIP-J System Subsystem Specification (SSS) for TMIP-J Block 2                     14 April 2005
Release 1
LMIT, Falls Church, VA
TMIP-J System/Subsystem Design Description (SSDD) for TMIP-J                       14 April 2005
Block 2 Release 1
LMIT, Falls Church, VA
TMIP-J Requirements Traceability Matrix (RTM) for TMIP-J Block                     31 March 2005
2 Release 1
LMIT, Falls Church, VA
TMIP-J Software Requirements Specification (SRS) for TMIP-J                        14 April 2005
Block 2 Release 1
LMIT, Falls Church, VA
                                                                                   25 February
TMIP-J CRD JROCM 021-99
                                                                                   1999
TRANSCOM Regulating And Command and Control Evacuation                             24 April 2004
System (TRAC2ES)/TMIP-J
The TRAC2ES Program Office, Brooks AFB, TX


                                Table 2-5 Joint Source Document
                                                                       Revision/
                       Document Name/Title                                              Date
                                                                       Version
Joint Publication 4-02, Doctrine for Health Service Support in Joint
                                                                                   30 July 2001
Operations




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3.0    SYSTEM SUMMARY
The TMIP-J B2 FY07 SP1 system provides interoperable software components to support the
warfighting capability of the United States Armed Forces. The TMIP-J system consists of
integrated, interoperable Government off-the-shelf (GOTS) software components built upon a
foundation of commercial off-the-shelf (COTS) software operating systems, databases,
supporting software applications, and reference material that reside on hardware and
communications infrastructures provided by the Services.
Not all TMIP-J system component applications are installed on a single platform. Some
component applications are installed on stand-alone personal computers or laptops, some are
installed on client workstations connected to servers, and other components are installed on
servers that are accessed remotely. In the case of AHLTA-Mobile, the component software is
installed on a PDA. Regardless of where a given component is installed or whether the
component exists within or outside the Theater of Operations, each component is part of the
larger TMIP-J system. Some components such as AHLTA-T, are adapted from existing
sustaining base applications to operate in a “stand-alone” mode in a theater environment; others
were specifically developed for the theater, which is characterized by a lack of reliable
communications. When communications are available, data is exchanged with other components
using the “store and forward” capability provided by the Communications Framework. Users can
access other systems remotely (e.g., JMeWS and AHLTA Warrior).
The GOTS components support the provision of healthcare to patients from the battlefield to a
theater hospital to sustaining base MTFs outside of the Theater of Operations. In addition, these
components support three distinct user communities: (1) healthcare providers, (2) military
Commanders, and (3) medical staffs. The system also interfaces with other non-integrated
systems and agencies (e.g., force health protection, medical logistics, patient movement, the
Surgeons General, and medical planners).
Excluding the COTS foundation software, the TMIP-J system GOTS components can be
described from a number of different viewpoints. One viewpoint looks at the system from a
patient-centric continuum of care (e.g., the corpsman in the battlefield, battalion aid station,
theater hospital, hospital ship, and CONUS MTF). The system also can be viewed functionally
with components supporting (1) Healthcare Delivery, (2) Medical Logistics, (3) Patient
Movement, and (4) Command and Control. Finally, the system can be viewed from a software
integration viewpoint (i.e., Integrated components, Non-Integrated components, and External
systems). Figure 3-1 depicts the components and their interrelationships from these separate
viewpoints.




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                         Figure 3-1 TMIP-J B2R1 System Components

3.1      SOFTWARE APPLICATIONS
In this section, the TMIP-J system software components are discussed from the viewpoints of
Levels of Care, Functional Components, and Software Component Integration.

3.1.1 Levels of Care
TMIP-J users, depending on their Service, operate in different organizational structures based on
the Joint Concept of Operations (CONOPS) and Concepts of Employment (COE) defined for
each Service. While the organizational structures that deliver healthcare differ from Service to
Service, the provision of healthcare among the Services can be defined in terms of “levels of
care” and “capabilities of care” as defined in Joint Publication 4-02, Doctrine for Health Service
Support in Joint Operations. As shown in Figure 3-1, the TMIP-J B2 FY07 SP1 Systems
Components are intended for use in Levels I, II, and III, while sustaining base systems, like
AHLTA, are envisioned for Levels IV and V. The JP 4-02 descriptions for the levels of care are
as follows:




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       Level I (First Responder) – Level I care consists of care rendered at the unit level. It
       includes self-aid, buddy aid, and combat lifesaver skills; examination, and emergency
       lifesaving measures such as the maintenance of the airway, control of bleeding,
       prevention and control of shock, splinting or immobilizing fractures, and the prevention
       of further injury. Treatment may include restoration of the airway by invasive procedures,
       use of intravenous fluids and antibiotics, and the application of splints and bandages.
       These elements of medical management prepare patients for return to duty or for
       transportation to a higher level of care.
       Level II (Forward Resuscitative Surgery) – At a minimum, Level II care includes
       physician-directed resuscitation and stabilization and may include advanced trauma
       management, emergency medical procedures, and forward resuscitative surgery.
       Supporting capabilities include basic laboratory, limited x-ray, pharmacy, and temporary
       holding facilities. Patients are treated and returned to duty or are stabilized for movement
       to an MTF capable of providing a higher level of care. Level II is the first level where
       Group O packed red blood cells will be available for transfusion.
       Level III (Theater Hospitalization) – Level III care is administered and requires clinical
       capabilities normally found in a facility that is typically located in a reduced-level enemy
       threat environment. The facility is staffed and equipped to provide resuscitation, initial
       wound surgery, and postoperative treatment. This level of care may be the first step
       toward restoration of functional health as compared to procedures that stabilize a
       condition to prolong life. Blood products available may include fresh frozen plasma,
       Groups A, B, and O packed red blood cells, and may include frozen Group O red cells
       and platelets.
       Level IV (En Route Care) – In addition to providing surgical capabilities found at Level
       III, this level also provides rehabilitative and recovery therapy for those who can return to
       duty within the theater patient movement policy. This level of care may only be available
       in mature theaters.
       Level V (Care Outside the Theater) – Level V definitive care includes the full range of
       acute convalescent, restorative, and rehabilitative care and is normally provided in
       CONUS by military and Department of Veterans Affairs hospitals or civilian hospitals
       that have committed beds for casualty treatment as part of the National Defense Medical
       System. On occasion, OCONUS military or allied and/or host nation hospitals in
       Commander in Chief (CINC)-approved safe havens may also be used. This level may
       include a period of minimal care and increasing physical activity necessary to restore
       patients to functional health and allow them to return to duty or to a useful and productive
       life.

3.1.2 Functional Components
The TMIP-J system supports the functional component applications in the mission areas of
Healthcare Delivery, Medical Logistics, Patient Movement, and Command and Control as
described in the following sub-paragraphs.




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3.1.2.1 Healthcare Delivery
TMIP-J users can manage patient, encounter, hospital, and order information through AHLTA-
Mobile, AHLTA-T, TC2, SAMS, and TMIP-J Reporting, which provide the following functional
capabilities:
       User Access – TMIP-J falls under the HIPAA regulations for patient confidentiality.
       TMIP-J users are given appropriate role-based access to each TMIP-J software
       application by the System Administrator (SA). Each user’s access level is determined by
       the privileges needed for the user’s role.
       Patient Registration – Proper patient identification is essential to maintaining a lifelong
       electronic patient record. All patient demographic data is ultimately verified in DEERS.
       AHLTA-T can be pre-loaded with patient demographic data. When communications are
       available, AHLTA-T can update the demographic data for patients in its database.
       Patient Encounters –AHLTA-Mobile, AHLTA-T, SAMS, and TC2 can be used to
       document the provision of healthcare at Level I, Level II, and Level III. Data is
       automatically routed to appropriate mission support system (e.g., JMeWS, TMDS, CDR,
       etc.). Patient encounter documentation can be accomplished off line and sent to other
       systems when communications are available.
       Ancillary Services – At larger Level III MTFs, TC2 can be used for pharmacy,
       laboratory, and radiology order entry and results retrieval as well as bed management and
       inpatient Admissions, Discharges, and Transfers. AHLTA-T provides basic order
       management functions for smaller MTFs and Level II facilities.
       Share Clinical Information – AHLTA-T can send clinical data to another AHLTA-T
       system. Clinical data may be sent from one AHLTA-T system to another using the
       Expeditionary Framework or removable media such as the EIC. When communications
       are available, AHLTA Warrior, which provides remote access to AHLTA, can be used to
       view a patient’s longitudinal record in the CDR; and AHLTA-T’s Patient Demographic
       Verification and Population utility can be used to update a patient’s demographic
       information from the CDR.
       Reports – TMIP-J Reporting, using the COTS product Business Objects, allows users to
       run both Standard and Ad Hoc Reports on the data contained in the local AHLTA-T
       database. SAMS and TC2 have their own reporting capabilities.

3.1.2.2 Medical Logistics
TMIP-J B2R1 enables users to access DCAM and SAMS to order medical supplies and PMITS
to track Patient Movement Items (PMI). DCAM also interfaces with DMLSS, and both systems
pass information to JMAR. TMIP-J B2R1 provides a URL link for access to JMAR when
communications are available. TMIP-J B2R1 also makes Theater-Defense Blood Standard
System (T-DBSS) available as a stand-alone system to manage blood products.

3.1.2.3 Patient Movement
TMIP-J B2 FY07 SP1 provides user’s access to TRAC2ES and Joint Patient Tracking
Application (JPTA) via URL links on the TMIP-J workstation desktop. A URL link is similarly
provided to access JMeWS to view data and reports.




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3.1.2.4 Command and Control (C2)
JMeWS receives data from TMIP-J systems and provides medical C2 information to the
Combatant Commanders and their staffs. Medical planning and course-of-action analysis by
Combatant Commanders and the Joint Staff is supported by The Medical Analysis Tool/Joint
Medical Analysis Tool (MAT/JMAT) and Common User Database (CUD). Defense Medical
Surveillance System (DMSS) provides medical surveillance and epidemiological information to
medical staffs and Combatant Commanders. Medical C2 includes the following functional
capabilities:
       Medical Surveillance
       Medical Intelligence
       Medical Situation Awareness – Common Operational Picture
       Patient Visibility

3.1.3 Software Component Integration
The TMIP-J system comprises a suite of COTS and GOTS software components that are
installed on different platforms at different locations both within and outside of the Theater of
Operations. Within the TMIP-J system, GOTS components either interoperate with other GOTS
components or are accessible to users in the theater. Some components are MHS systems while
others are not. Some components have direct links to other components to pass data while others
receive data indirectly or are accessed remotely by the user to view information. As such, the
TMIP-J system may be viewed from a system integration standpoint (i.e., the degree to which the
components either interface or are integrated to share data) as follows:
       Integrated Software Components (Table 3-1) are TMIP-J specific software items or MHS
       systems that have TMIP-J interfaces.
       Non-Integrated Software Components (Table 3-2) are TMIP-J systems that do not have
       interfaces to TMIP-J components.
       External Systems (Table 3-3) are non-TMIP-J systems that have interfaces to TMIP-J
       components.

3.1.3.1 Integrated Software Components
Within TMIP-J B2R1, integrated software components are those TMIP-J or MHS components
that are interoperable within the Communications Framework such that messages may be
transferred via the Framework directly between software components or, in the absence of
communications, manually on removable media. This definition of an “integrated component”
means the major application components (e.g., AHLTA-T and SAMS), can pass patient data
between them. It does not mean all components shown in Table 3-1 will be installed on the same
platform. The components installed on any given platform consist of (1) basic components
installed independent of the selections made by the user (e.g., Framework and certain utility and
reference materials); and (2) components required to support the primary use of that platform
(e.g., AHLTA-T or SAMS), as determined by the user in the installation process. Moreover,
while AHLTA-T and SAMS might exist on the same platform, other components (e.g., AHLTA-
Mobile and JMeWS) will not exist on the same platform as AHLTA-T and SAMS. Table 3-1
identifies the integrated software components and the mission area supported by each software



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component. Where the software component is part of the general suite of software needed to
support other mission area applications, “TMIP-J Foundation” is shown in the
Mission/Functional Area.

                          Table 3-1 Integrated Software Components
           Software Component               Mission/Functional          Version/Status
                                                   Area
AHLTA-T                                     Healthcare Delivery 301.9FY07SP1c
DCAM                                        Medical Logistics     35.1.106.0
PMITS                                       Medical Logistics     1.0.2.0
SAMS                                        Medical Logistics   029-09.01.00
                                            Healthcare Delivery
TMIP-J Reporting                            Healthcare Delivery 6.5
                                         References
MEDIC                                       Healthcare Delivery June 2006
Micromedex                                  Healthcare Delivery V136 - Quarterly Updates
Stat!Ref                                    Healthcare Delivery Quarterly Updates
TMIP-J Documentation                        Healthcare Delivery User & System Manuals &
                                                                training materials in
                                                                Documentation folder
United States Army Medical Material         Medical Logistics     Quarterly Updates
Center, Europe (USAMMCE) Catalog
Photo Disk
                        Utilities (TMIP-J, Framework, & AHLTA-T)
AHLTA-T Data Retirement                     Healthcare Delivery
AHLTA-T Patient Demographic                 Healthcare Delivery
Verification and Population
TMIP-J Data Migration                       Healthcare Delivery
TMIP-J Electronic Information Carrier       Healthcare Delivery
Server


3.1.3.2 Non-Integrated Software Components
Non-integrated software components, which are also called “Bundled Components”, are stand-
alone TMIP-J software components that do not have communications interfaces with the other
components. Table 3-2 identifies the non-integrated components and the mission area supported
by the individual component.




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                       Table 3-2 Non-Integrated Software Components
   Software Component         Mission/Functional                 Version/Status
                                     Area
AHLTA-Mobile                 Healthcare Delivery     2.3.3
TC2                          Healthcare Delivery     1.0.08
JMeWS                        Medical C2              2.2.3.4
MAT                          Medical Planning        Currently 2.0.0.0 at Joint Staff
                                                     JMAT 3.0 replacement is in progress
TMDS                         Medical C2              2.2.4.1


3.1.3.3 External Systems
External systems are non-TMIP-J systems that have interfaces with TMIP-J software
components. Table 3-3 identifies each non-TMIP-J system and the mission area supported by
the individual system.

                                 Table 3-3 External Systems
          System              Mission/Functional                    Purpose
                                     Area
AHLTA Warrior (Web           Healthcare Delivery     AHLTA Warrior client, installed on the
Service)                                             TMIP-J Workstation, accesses AHLTA
                                                     Warrior web service via a URL link on
                                                     TMIP-J desktop to access AHLTA.
CDR                          Healthcare Delivery     Receives AHLTA-T clinical data
DMLSS                        Medical Logistics       Receives DCAM data
DMSS-AMSS                    Medical Surveillance    Receives Pre-/Post-Deployment Surveys
DOEHRS-IH                    Healthcare Delivery     URL link on TMIP-J desktop
GEMS                         Healthcare Delivery     Legacy System which sends medical
                                                     surveillance data to JMeWS
ICDB (Madigan Army           Healthcare Delivery     Receives AHLTA-T clinical data
Medical Center [MAMC])
JMAR                         Medical Logistics       URL link on TMIP-J desktop; DCAM
                                                     sends Level II status to JMAR
TAMMIS                       Medical Logistics       Receives DCAM data
T-DBSS                       Medical Logistics       Version 3.04 self standing blood system
TRAC2ES                      Patient Movement        URL link on TMIP-J desktop; ITV file
                                                     periodically sent to TMDS




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3.2    SOFTWARE COMPONENT DESCRIPTIONS
TMIP-J B2 FY07 SP1 is a system of integrated component systems which includes a
combination of GOTS and COTS software. The components discussed in this section are those
applications to which the user would be exposed. It does not include those system components
such as .NET, Microsoft Data Access Component (MDAC), etc., that are “behind the scenes”
components the user would not typically encounter or need to understand to use the TMIP-J
system applications. Each of these application components is described in the following
subsections beginning with descriptions of the general components (TMIP-J Foundation
Components) that support the TMIP-J system and continuing with the component applications
supporting each of the mission areas of Healthcare Delivery, Medical Logistics, Patient
Movement, and Command and Control.
Table 3-4 identifies the TMIP-J Foundation Components software by type and platform on
which it is used, (i.e., TMIP-J Workstation, AHLTA-Mobile, or JMeWS). The TMIP-J
Foundation software supports the operation of the TMIP-J system as whole and other mission
specific components on the system. The following paragraphs briefly discuss the TMIP-J
Foundation software.

                          Table 3-4 TMIP-J Foundation Components
        Type                      Description                            Platform
                     Microsoft (MS) Windows XP               TMIP-J Workstation
                     Professional
                     MS Windows Mobile 2003
Operating Systems MS Windows Pocket Personal                 AHLTA-Mobile
                  Computer (PC) 2002 or 2003
                     MS Windows 2003                         JMeWS, TMIP-J Servers
                     Caché                                   TC2
                     Caché                                   TC2
                     Oracle 10g                              TMIP-J Workstation & JMeWS
Databases
                     MS Structured Query Language (SQL) AHLTA-Mobile
                     Server Compact Edition
                     Adobe Acrobat 8.1.2
                     Business Objects 6.5.1
                     Expeditionary Framework
Applications                                                 TMIP-J Workstation
                     Microsoft Internet Explorer
                     Microsoft Office XP
                     Norton AntiVirus
Utilities            Module with EF                          TMIP-J Workstation
                     TMIP-J Backup and Restore
                     TMIP-J Oracle Change Password




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        Type                        Description                            Platform
                      TMIP-J Oracle TNSNames Manager
                      TMIP-J Oracle Stats Scheduler
                      TMIP-J STIG Correction
                      TMIP-J UIC Update Utility


3.2.1   Foundation Components
3.2.1.1 Operating Systems
The Operating System (OS) for the TMIP-J Workstation is MS Windows XP Professional.
AHLTA-Mobile OS is Microsoft Windows Mobile 2003 or Microsoft Windows Pocket PC 2002
or 2003. JMeWS OS and TMIP-J servers is Windows 2003. TC2 OS is Caché.

3.2.1.2 Databases
The Database (DB) for the TMIP-J Workstation and JMeWS is Oracle 10g, Relational Database
Management System. The AHLTA-Mobile database is Microsoft SQL Server Compact Edition.
The TC2 database is Caché.

3.2.1.3 COTS Applications
A suite of commercial software is used to create the foundation for TMIP-J B2 FY07. This
foundation supports the operation of other component applications targeted to support specific
mission areas. The descriptions of these products assume the user is already familiar with these
software products and can readily access the electronic documentation provided with these
products to gain further information on the use of each product. Each of these foundation COTS
products is described in the paragraphs that follow.

3.2.1.3.1      Adobe Acrobat Reader
Produced by Adobe, Acrobat Reader version 8.1.2 enables the user to view Portable Document
Format (PDF) files. By using PDF files, users are able to share documents independently of the
applications used to create them. Refer to Help in the application for further information.

3.2.1.3.2      Business Objects
Produced by the company of the same name, Business Objects version 6.5.1 is the reporting tool
used to create TMIP-J Reporting Reports and to provide users the ability to create Ad Hoc
Reports from the AHLTA-T database. Business Objects provides a functional view of the
AHLTA-T database and the mechanisms that allow the user to create and run reports without
having to understand SQL and the relationships of the data elements and tables in the AHLTA-T
database. Refer to Help in the application or to the TMIP-J Reporting User’s Manual for further
information.

3.2.1.3.3     Expeditionary Framework
The Expeditionary Framework (EF) provides a single standard approach for communications in
Theater. The EF is a loosely coupled, secure message-based framework that supports local and
remote application integration. The EF’s Service Oriented Architecture (SOA) simplifies



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application integration because EF services hide infrastructure and communication protocol
complexity from the applications.
EF supports the ability to export and import communication node descriptions. In general, the EF
interface with applications consists of files placed in designated directories in the local Windows
file system. The EF supports a store-and-forward communications paradigm. When
communications are down, the EF will hold messages from applications until they can be
transmitted. Alternatively, the EF can export and import from removable media much like the B1
Storage Transfer Encapsulation Method (STEM). For more detailed information on the EF, refer
to the Expeditionary Framework Administration User’s Guide.

3.2.1.3.4    Microsoft Internet Explorer
Produced by Microsoft, Internet Explorer (IE) is the web browser provided as part of the
Microsoft Windows operating system. Refer to Help in the application for further information.

3.2.1.3.5     Microsoft Office XP
MS Office XP provides a suite of office products including Word, Excel, PowerPoint, Outlook,
and Access. Refer to Help in the individual MS Office applications for further information.

3.2.1.3.6     Norton AntiVirus
Produced by Symantec, Norton AntiVirus provides virus protection for the individual
workstation. Refer to Help in the application for further information.

3.2.1.4 Utilities
The TMIP-J B2 FY07 system installs a number of utilities as part of the TMIP-J
Communications Framework. These utilities support the TMIP-J system and are described in the
following paragraphs.

3.2.1.4.1        EF Message Archive Management
The Message Archive Management utility provides the ability to track, import, export, and
resend messages submitted to the Framework. The Framework archives all messages submitted
to it before the messages are sent. The Message Archive Management utility enables the user to
manually move messages (export) to another node, evaluate whether the messages have been
delivered, and resend messages as needed. Refer to the TMIP-J System Administration Manual
(SAM) for further information.

3.2.1.4.2      TMIP-J Backup and Restore
TMIP-J Backup and Restore utility provides a graphical user interface application for backing up
and restoring TMIP-J data. Refer to the TMIP-J SAM for further information.

3.2.1.4.3     TMIP-J Oracle Change Password
The TMIP-J Oracle Change Password utility allows the user to change Oracle passwords. Refer
to the TMIP-J SAM for further information.




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3.2.1.4.4      TMIP-J Oracle Host Name Configuration
The TMIP-J Oracle Host Name Configuration utility is used to manage the Oracle
TNSNAMES.ORA file for configuring Client-Server Mode. Refer to the TMIP-J SAM for
further information.

3.2.1.4.5      TMIP-J Oracle Statistics Scheduler
The TMIP-J Oracle Statistics Scheduler utility allows the user to schedule and automatically run
the Oracle scripts needed to optimize Oracle’s index tables. Refer to the TMIP-J SAM for further
information.

3.2.1.4.6       TMIP-J Security Technical Implementation Guide Correction
The TMIP-J Security Technical Implementation Guide (STIG) Correction utility applies
modifications to the system to insure adherence to the STIG. Specifically, the utility grants the
Windows Users group Read and Execute privileges on the root system drive and Modify
privileges on the TMIP-J B2 folder. Refer to the TMIP-J SAM for further information.

3.2.1.4.7      TMIP-J Unit Identification Code Update
The TMIP-J Unit Identification Code (UIC) utility is used to update the UIC Code for AHLTA-T
in the system registry. The utility allows the user to select the UIC from a list, search for a UIC
in the database, or manually enter a UIC into the system. Refer to the TMIP-J SAM for further
information.

3.2.2 Healthcare Delivery Components
Table 3-5 identifies the TMIP-J Healthcare Delivery software components by type of component
and depicts whether the component is integrated, non-integrated, or an external system as
discussed in Section 3.1.3. Healthcare Delivery components consist of applications, references,
and utilities as described in the following paragraphs.

                            Table 3-5 Healthcare Delivery Components
        Type                        Component                                  Status
                      AHLTA-T
                      SAMS                                       Integrated (TMIP-J Workstation)
                      TMIP-J Reporting
                      AHLTA-Mobile
                                                                 Non-Integrated
GOTS                  TC2
Applications          AHLTA Warrior (Web Service)
                      CDR
                      DOEHRS-Industrial Hygiene (IH)             External System
                      GEMS
                      ICDB (MAMC)




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        Type                        Component                                 Status
                      Contingency Pest Management Guide
                      MEDIC
References            Micromedex                                Not Applicable
                      Stat!Ref
                      TMIP-J Documentation
                      AHLTA-T Data Retirement
                      AHLTA-T Patient Demographic
                      Verification and Population
Utilities                                                       Integrated (TMIP-J Workstation)
                      TMIP-J Data Migration
                      TMIP-J Electronic Information Carrier
                      Server


3.2.2.1 GOTS Applications
The Healthcare Delivery applications are comprised of GOTS software components that span the
continuum of healthcare provided in the theater at Levels I, II, and III, and provide access to the
MHS CDR for patient demographic information. These component applications are described in
the following sections.

3.2.2.1.1      AHLTA-T
AHLTA-T is a theater configuration of AHLTA. AHLTA-T can work in a stand-alone mode or
networked together to form field clinics or hospitals with some or all of the AHLTA-T systems
sharing data. Clinical templates can be shared between AHLTA and AHLTA-T, and the
graphical user interface between the two systems is the same. Often AHLTA-T is loaded on a
stand-alone notebook computer. When communications are available, patient data moves
upstream using TMIP-J Framework to TMDS, and TMDS sends data to JMeWS and the MHS
CDR where theater data can be accessed then by AHLTA, AHLTA Warrior, or TMDS. Using a
High Assurance Guard (HAG), AHLTA-T data is also sent to JMeWS on SIPRNet for
surveillance reporting.
AHLTA-T supports outpatient care and simple inpatient capabilities suitable for a Level II MTF.
TC2 supports comprehensive inpatient care and ancillary services for large Level III MTFs.
When a patient is registered in a Level III MTF AHLTA-T system, it sends a patient
demographic message to TC2. AHLTA-T enhances the information workflow of MHS
healthcare providers and supports collaborative care. All theater data is documented
electronically from the patient check-in to the completion of the encounter. An electronically
accessible and comparable medical record is generated and maintained by AHLTA-T. At the
close of the encounter, coding is accomplished electronically, eliminating the need for intensive
manual coding processes.
AHLTA-T has the following functional capabilities to document Level II and Level III
healthcare:




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Allergy Module – Provides the capability to add, edit, and delete allergies on a patient
using the coded allergy information in First DataBank.
Assessment & Plans (A/P) Module – Provides the capability to document the
assessment of an outpatient’s or inpatient’s condition and the plan of treatment by
entering coded diagnoses, procedures, orders, and patient instructions. The module also
enables providers to document laboratory tests, radiology procedures, and medications
and to use order sets and order summaries for inpatients.
Clinical Notes Module – Provides the capability to create, edit, and save clinical notes
on patients.
Co-signs Module – Displays a list of all the encounters a provider needs to co-sign. The
provider is able to view the encounter details, amend the encounter, add narrative text,
and sign the encounter.
Couplers Module – Provides the ability to administer questionnaires associated with the
Problem Knowledge Couplers, Inc. (PKC) and automate the collection of demographic
and health data for patients. The Health Evaluation, Assessment, and Review (HEAR)
questionnaire provides the provider a “snapshot” of the patient's health, habits, and other
factors that can affect his/her overall health and can be “coupled” with a healthcare
knowledge network to produce reports for the patient and the patient’s provider. The data
is then used to assess preventive service needs, identify services routinely used, and
determine the appropriate level of medical expertise/care required for each patient.
Military couplers provided include HEAR 3.0 Full, HEAR Operational, HEAR 3.0
Screen/Full, HEAR 3.0 Screening, Pre-Deployment, and Post-Deployment.
Data Manager Module – Provides the ability to manage the movement of various types
of data between various forms of information carrier devices and systems (i.e., the CDR
and the Light Duty Data Base [LDDB] AHLTA-T DB). Data Manager sets include
AHLTA-Mobile, CDR, LDDB, Personal Information Carrier (PIC), EIC, Disk (floppy,
Compact Disk-Read Only Memory [CD/ROM], etc.), and Patient View File (PVF). The
EIC is used to transfer AHLTA-T demographic and last encounter data with SAMS. PIC
is used to transfer a single patient’s clinical data from one AHLTA-T system to another
AHLTA-T system. Disk is used to transfer data for multiple patients from one AHLTA-T
system to another AHLTA-T system. AHLTA-Mobile is used to transfer BMIST data to
an AHLTA-T system. PVF is used to transfer all the AHLTA-T information on a patient
to another AHLTA-T system or to higher headquarters.
Demographics Module – Displays the patient's demographic information and enables
the user to update certain demographic information on the patient (i.e., home address,
city, state, zip code, country, home and work phone, e-mail address, religion, comments,
and the location of the records). Special Work Status can also be viewed and modified,
provided an encounter has been opened. Information on a patient's primary care manager
and DEERS eligibility can be viewed but not modified.
Disposition Module – Enables the provider to document the disposition of the patient
and Evaluation and Management (E&M) codes of an encounter. This includes discharge
status of the patient from the clinic, follow-up information, and the patient's
understanding of the assessment and plan. The module automatically calculates E&M




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codes in accordance with the 1997 Health Care Finance Administration (HCFA)
Documentation Guidelines using parameters from the encounter note (i.e., History,
Exam, and Medical Decision).
Documents Module – Provides a single place to view all documentation on a patient
including outpatient visits and inpatient admissions. It has multiple filters available for
organizing the views with defaults based upon the patient’s current status (e.g., “This
Admission Only” when the patient is currently admitted). The module also enables the
provider to add, amend, or sign a note; enter new orders; create a new encounter
template; and print selected notes and labels.
Health History Module – Displays patient historical data from various modules in one
window. The window can be customized to show different modules containing the
patient's historical information.
Hospital Setup Module – Enables the user to create an AHLTA-T hospital and add
required specialties to permit patient tracking during the period of the hospital stay.
Inpatient List Module – Provides a listing of all patients currently admitted to the
Theater hospital. To facilitate awareness of new orders, an Orders flag displays in the
Notices column. This flag indicates a new order or a change to an order that has not yet
been “nurse acknowledged.” This module provides the ability to admit a patient, edit
admission details, add notes, transfer a patient, discharge a patient, and administratively
close an admission.
Inpatient Orders Module – Provides the ability for a clinician to view patient-specific
inpatient Laboratory (Lab), Radiological (Rad), Medication (Med), and Other orders
outside of an encounter and enables the user to discontinue, modify, hold, release, sign,
and print an order as well as “Nurse Acknowledge” an order.
Lab/Rad Results Module – Enables a provider to review all laboratory and radiology
results posted to a patient’s record. Filters are provided for viewing order results as well
as the ability to search for orders within a specified time interval.
List Management Module – Enables a provider to create and manage various lists
including Diagnosis and Procedure lists. The customized lists are linked to the individual
provider and are made available in the Problems and A/P modules.
Medications Module – Lists the patient's past and present medications including all
Over-the-Counter (OTC) and outside medications. Current medications can be viewed
and new medications can be documented. Active medications are presented in bold text
while inactive meds are presented in regular text. The provider is also able to add OTC or
outside meds to the patient’s profile, display details of medications, and discontinue a
medication.
Order Administration Module – Enables the user to establish and maintain a
customized formulary of Laboratory, Radiology, Medications, and Other Orders available
to clinicians for selection in the Order Entry tabs of the A/P module and the Orders
Summary tab of the A/P module for other orders. Functionality includes the ability to
customize a med order; add, remove, import, export, activate, inactivate, and delete
orders.




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Order Management Module – Enables a user to document the results of all Inpatient
and Outpatient Lab, Rad, and Med orders; fill and dispense medications for both
inpatients and outpatients; and to have those actions documented to the appropriate
patient’s encounter. Specific functionality includes the ability to document a hardcopy
prescription, view the history of all dispensed meds, refill outpatient meds, document
radiology and laboratory results, sign an encounter, discontinue an order, and print labels
and patient monographs.
Outpatient Encounter Summary Module – Acts as the main documentation area for
the Chronological Record of Medical Care (SF600). The section buttons included
represent the basic steps of an encounter. As each step is completed, the information is
displayed. Specific capabilities include Opening an Encounter; Adding, Editing, and
Deleting a Note; Adding an Additional Provider; Selecting an Encounter Template; and
Signing, Unlocking, and Saving an Encounter.
Outpatient Tracking Module – Enables the user to view outpatient visits and filter them
by clinics, providers, dates, or statuses. Specific functionality includes Scheduling a Visit,
Checking Out a Patient, Adding a Provider, Transferring a Visit, Canceling a Visit, and
Adding a Comment to a Visit.
Patient List Module – Displays a customized list of patients for the provider. Providers
may customize the patient list to contain patients specific to their caseloads. Typically,
this module is used to manage patients frequently seen or patients with common
problems. Patient records may also be accessed through this module. Specific
functionality includes the ability to Add a Patient Name and Delete a Patient Name from
the list.
Patient Maintenance Module – Enables the user to enroll new patients if they are not
already in the AHLTA-T database and create a record for a patient whose identity has not
been determined. Information input by the user includes demographic, address, phone
number, work status, and forensics.
Patient Search – Provides the ability to search for a patient based on last name, first
name, or Social Security Number (SSN). The minimum information required for a search
is the first two characters of the patient’s last name. The module also provides the ability
to select a patient with-out performing a search.
Problems List Module – Displays problems and historical procedures for a specific
patient and historical procedures in the top pane of the module. Healthcare Maintenance
is not functional in AHLTA-T. Specific functionality includes the ability to add a
problem or historical procedure and to update a problem or procedure.
Readiness Module – Displays information relevant to the patient’s readiness for
deployment. Most of the data displayed comes from other sources, and although some
data may be edited in this module, the changes are not updated to the original source.
Screening Module – Enables the user to document the reason for the patient’s visit.
Specific functionality includes the ability to input or modify the reason for visit, add an
additional provider, verify allergies, and input vitals.
Subjective/Objective (S/O) Module – Provides the ability to document the exam. Coded
terms to describe the exam findings are available to select into the note. The coded terms



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       are used to determine the E&M code in the Disposition module. Templates are used to
       rapidly document the patient visit. Once the exam is documented and saved, the notes
       appear in the Encounter window. Providers may access the Disposition Module and also
       sign the encounter.
       Template Management Module – Enables the provider to create and maintain personal
       templates to streamline the encounter documentation process. Each encounter template
       contains placeholders for diagnoses, procedures, S/O Notes templates, AutoCited items,
       and the associated reason for visit. Once an encounter template has been selected and
       loaded into the encounter, the pre-positioned lists are available within the S/O and A/P
       modules. Specific functionality includes Search, View, Edit, Create, Merge, Delete,
       Import, Export, Save As, Add to Favorites list, and Set Columns (user defined display of
       columns).
       Theater Administration Module – Provides the ability to create and maintain specific
       users and clinics in AHLTA-T. Users are identified by name, SSN, medical specialty, and
       signature class. Optional information such as home phone, work phone, e-mail address,
       and initials may also be captured. Other data such as Unit Number and Primary Care
       Manager (PCM) code are provided by the system. This module also enables the creation
       and maintenance of clinic and related information and the ability to assign users to
       specific clinics.
       Vital Signs Module – Enables the user to view and graph a patient’s vital signs history
       and to enter vital signs for the current encounter. Vital signs may be displayed in English
       or metric units for three categories: Adults, Obstetric, and Pediatric.
AHLTA-T is a TMIP-J B2 FY07 SP1 fully integrated software component. Refer to the
AHLTA-T User Manual and Training Documentation for further information on using this
application. Electronic copies of all TMIP-J B2 FY07 SP1 documentation are available in a
documentation folder on the installed TMIP-J Windows desktop.

3.2.2.1.2       SAMS
SAMS provides automated medical support to improve Naval healthcare by reducing the
administrative burden on healthcare providers. The TMIP-J Communications Framework can be
configured to deliver SAMS data to the appropriate destinations such as AHLTA-T and
ultimately JMeWS; however, in TMIP-J B2FY07, SAMS data is sent to AHLTA-T only via the
EIC. SAMS handles Navy specific Healthcare Delivery mission area functional requirements.
SAMS addresses requirements of automated operational/shipboard medical departments to store,
process, and retrieve data; to monitor the medical environment of personnel who live and work
on the ship or facility; and to contribute to the overall readiness of the operational shipboard
medical department. Although SAMS has a legacy Medical Encounters Module, AHLTA-T is
used to perform medical encounters.
SAMS provides the following Level I and Level II functional capabilities:
       Environmental Health
       Health Services
       Medical Encounters (Replaced by AHLTA-T)




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       Medical Materials
       Radiation Health
       System Management


SAMS is a TMIP-J B2 FY07 SP1 fully integrated software component. Refer to the SAMS
Software User’s Manual and Training Documentation for information on using this application.
Electronic copies of all TMIP-J B2 FY07 SP1 documentation are available in a documentation
folder on the installed TMIP-J Windows desktop.

3.2.2.1.3       TMIP-J Reporting
TMIP-J Reporting implements local reporting for TMIP-J by using a COTS product, Business
Objects version 6.5.1, to provide Standard Reports and Ad Hoc reporting capability against data
in the local AHLTA-T database. The use of Business Objects insulates the user from having to
understand the underlying structure of the AHLTA-T relational database, the relationships
between the tables and data elements, or the use of SQL. TMIP-J Reporting exposes a “view” of
the AHLTA-T database to the user in a Business Objects Universe which the user then accesses
through a Business Objects graphical user interface. The TMIP-J B1 Lower Echelon Reporting
System Module (LERSM) capability has been replaced with standard Business Objects Reports
which began with the LERSM Reports as a baseline but incorporated refinements and
enhancements based on Subject Matter Expert input and Business Objects capabilities. In
addition, five Standard Reports from AHLTA-T were added to the suite for a total of 20
Standard Reports. For Ad Hoc reporting, approximately 400 data elements, based on the use of
the AHLTA-T application, have been exposed in the Business Objects universe.
TMIP-J Reporting is a TMIP-J B2 FY07 SP1 fully integrated software component. Refer to the
TMIP-J Reporting User’s Manual and Training Documentation for information on using this
application. Electronic copies of all TMIP-J B2 FY07 SP1 documentation are available in a
documentation folder on the installed TMIP-J Windows desktop.

3.2.2.1.4        AHLTA-Mobile
AHLTA-Mobile is an electronic handheld device designed for use by a first responder to record
the essential elements of a medical history, physical examination, and administration of care in a
battlefield setting. AHLTA-Mobile also provides medical analysis and decision support
capability and uses a flexible and scalable PDA for military healthcare providers at all levels of
care from the foxhole to the medical center. It meets the military objective to provide useful
medical informatics and telemedicine support for first responders across the spectrum of the
military healthcare operations and levels-of-care continuum. AHLTA-Mobile enables first
responders (and other healthcare staff) to quickly and accurately capture, integrate, transmit, and
display patient data. AHLTA-Mobile can synchronize data with AHLTA-T. AHLTA-Mobile
imports demographics from AHLTA-T and exports clinical encounters (with demographics) to
AHLTA-T. AHLTA-T sends the AHLTA-Mobile data using the TMIP-J Communications
Framework.
AHLTA-Mobile has the following functional capabilities for documenting Level I and Level II
healthcare:




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       Clinical Encounters
       Epidemiology Survey
       Interface Control Document, Ninth Revision (ICD-9) Coding
       Document Immunization Dates
       Medical Evacuation Patient Medical Record (PMR) Form
       Pre-/Post-Deployment Surveys
       Display Reference Manuals
       ICDB data via TMIP-J Expeditionary Framework
       ICDB Medical History
AHLTA-Mobile is a non-integrated TMIP-J B2 FY07 SP1 software component. Refer to the
AHLTA-Mobile User Manual in the TMIP-J B2 FY07 SP1 document folder for detailed
information on using the AHLTA-Mobile component system.

3.2.2.1.5     TC2
TC2, formerly known as CHCS-NT, is a theater configured version of the sustaining base CHCS
Legacy system. It supports inpatient care and ancillary services for Level III MTFs. TC2 has the
following functional capabilities to manage Level III healthcare:
       Manage Laboratory Data:
       − Automated Results Notification
       − Sample Tracking
       − Laboratory Test Results
       Manage Patient & Provider Administration:
       − Mass Casualty Registration
       − Patient Appointment Scheduling
       − Provider Workload
       − Patient Registration including Admission, Disposition, and Transfer (ADT)
       − Inpatient Activity Documentation
       − Clinical Dietetic Administration
       Manage Pharmacy Data:
       − Formulary Data
       − Label Printing
       − Medication Audit Trails/ Prescription History
       − Patient Instructions for Medications
       Manage Radiology Data:



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       − Radiology Test Scheduling
       − Radiology Test Results
       Manage Reporting:
       − Bed Status Reporting
       − Patient Count Reporting
       − Workload Reporting
CHCS Caché is a non-integrated self-standing internal TMIP-J B2R1 software component.

3.2.2.1.6       AHLTA Warrior
When communications are available, AHLTA Warrior provides theater healthcare providers
read-only access to patient data in the MHS CDR by remotely logging into a CITRIX server
containing an AHLTA system. Access to AHLTA Warrior is limited to users on the .mil domain
who have valid AHLTA accounts. AHLTA Warrior consists of an internet shortcut configured
with either an Internet Protocol (IP) address or URL. Because TMIP-J security policy prevents
allowing Active X downloads at run time, the TMIP-J B2 FY07 SP1 installation adds an Active
X component required to use AHLTA Warrior.
The AHLTA Warrior remote access link is installed on the TMIP-J B2 FY07 SP1 workstation.
AHLTA Warrior is an external system to TMIP-J B2 FY07 SP1.

3.2.2.1.7       Clinical Data Repository (CDR)
The CDR is the MHS enterprise clinical data repository that stores clinical information on all
patients in the DoD. Most data in the CDR is input through the AHLTA application at MTFs;
however, some data (e.g., appointments, medication, lab, and radiology orders and results) are
sent to the CDR from CHCS. The CDR also receives patient data from AHLTA-T via Theater
Medical Data Store (TMDS). AHLTA connectivity to the CDR is dependent on the availability
of communications. CDR data can be viewed using AHLTA at MTFs or AHLTA Warrior in
theater. The MHS CDR uses the capabilities of the COTS 3M Care Innovation (CI) Suite. The
3M suite includes a Health Data Dictionary (HDD) that provides a common lexicon for clinical
terminology. The HDD is common across all MTFs overcoming the problems inherent in
different terminology usage at different MTFs and systems. The 3M suite also includes a Master
Patient Index/Master Patient Locator (MPI/MPL) allowing for the discreet identification of a
single patient instance even when several patients may have the same name. Finally, the MHS
CDR allows all of a patient’s records to be stored electronically at a single location. Thus, the
CDR allows for the nearly instantaneous update and retrieval of a patient’s complete longitudinal
medical record regardless of the number or geographic locations in the MHS enterprise where
the patient may have been provided healthcare.
The CDR is an external system to TMIP-J B2 FY07 SP1. Refer to the AHLTA-T User’s Manual
and System Administration Manual as well as AHLTA and CDR documentation for further
information.




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3.2.2.1.8      Defense Occupational and Environmental Health Readiness System-
        Industrial Hygiene (DOEHRS-IH)
DOEHRS-IH contains records of workplace exposures to identify health risks, protective
measures the employee can take, and information for healthcare providers to make better medical
diagnosis and treatment decisions. DOEHRS-IH is a web-based, broad-spectrum, occupational
exposure database having data on Chemical Hazards, Physical Hazards, and Biological Hazards
(including warfare agents) for unique military operations (deployments).
DOEHRS-IH is an external system to TMIP-J B2 FY07 SP1. Refer to the DOEHRS-IH
documentation for further information. The TMIP-J Windows desktop has a URL link to the
DOEHRS web site.

3.2.2.1.9      Global Expeditionary Medical System (GEMS)
GEMS is a legacy Air Force system developed to support deployed forces. It sends medical
surveillance data to JMeWS. The GEMS application comprises four modules:
   1. Patient Encounter Module (PEM) – Collects patient encounter information and creates an
      electronic medical record.
   2. Theater Occupational Module (TOM) – Documents industrial and environmental
      exposures.
   3. Public Health Deployed (PHD) Module – Documents all preventative medicine related
      information and exposures.
   4. Theater Epidemiological Module (TEM) – Analyzes the data collected by the other
      modules to enable the users to make decisions regarding force protection, medical condition or
      events, occupational and environmental exposure, environmental impact, and disease
      management.
GEMS is an external system to TMIP-J B2 FY07 SP1 and is outside the scope of this document.
Refer to GEMS documentation for further information.

3.2.2.1.10      Integrated Clinical Database (ICDB)
The MAMC ICDB provider portal presents clinical data extracted from various sources
including TMIP-J. In TMIP-J B2 FY07 SP1, AHLTA-T passes specific patient clinical
information via PVF to the ICDB for soldiers assigned to the MAMC. The ICDB is an external
system to TMIP-J B2 FY07 SP1 and is outside the scope of this manual. Additional information
is available at https://icdb.tricarenw.mamc.amedd.army.mil/icdb/.

3.2.2.1.11     References
Healthcare Delivery reference material from a number of commercial and Government sources is
provided by TMIP-J B2 FY07 SP1. The user should refer to the documentation that accompanies
each reference for specific information on the use of the particular reference. All TMIP-J B2
FY07 SP1 documentation is available in a documentation folder installed on the TMIP-J
workstation desktop. An overview of each reference is provided in the following paragraphs.




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3.2.2.1.12      Contingency Pest Management Guide
Technical Guide No. 24, published by Defense Pest Management Information Analysis Center
(DPMIAC), Armed Forces Pest Management Board (AFPMB), provides information for using
pesticides to control insects that transmit disease and other pests during field situations
worldwide as part of an Integrated Pest Management (IPM) program. The IPM approach
combines various techniques including physical, mechanical, educational, biological, and
chemical, to prevent economic damage or medical injury from disease vectors and includes
requirements for recording, reporting, and archiving pesticide use during contingency operations.
Further information is available at http://www.afpmb.org/pubs/tims/tg24/tg24.pdf.

3.2.2.1.13      MEDIC
The U.S. Army Center for Health Promotion and Preventive Medicine (USACHPPM) MEDIC
contains country specific infectious diseases (e.g., disease vectors, operational & environmental
health risk information, and reference documents including medical planning methodology,
venomous snake/antivenin information, and preventive medicine guidelines).

3.2.2.1.14      Micromedex
The Micromedex subscription service provides quarterly updates covering full-text databases on
chemical, pharmaceutical, and related biological substances used in clinical patient care;
teratogenicity, toxicology, alternative medicine, and pharmaceutical information on trade and
generic drugs; drug reviews, guidelines, clinical reviews, and information from package inserts
and drug texts; dosing, side effects, interactions, toxicity, and drug identification; and the
CareNotes System for providing healthcare and medication information to patients.

3.2.2.1.15      Stat!Ref
Stat!Ref is a commercial electronic medical library for healthcare professionals that lets the user
cross-search medical texts. The contents of the two reference libraries are depicted as hyperlinks
in Table 3-6 and Table 3-7.

                             Table 3-6 Medical Reference Library 1
                                            References
AHFS Drug Information                          Basic & Clinical Pharmacology
Current Critical Care Diagnosis &              Current Diagnosis & Treatment in Cardiology
Treatment
Current Diagnosis & Treatment in               Current Diagnosis & Treatment in Orthopedics
Gastroenterology
Current Emergency Diagnosis & Treatment Current Emergency Diagnosis & Treatment
Current Obstetric/Gynecological Diagnosis      Current Pediatric Diagnosis & Treatment
& Treatment
Current Surgical Diagnosis & Treatment         Diagnostic and Statistical Manual IV TR™
Dictionary of Medical Acronyms &               Family Medicine: Principles & Practice
Abbreviations
Geriatric Medicine: An Evidence-Based          Current Diagnosis & Treatment in Cardiology



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                                          References
Approach
Williams Obstetrics                         Goldfrank’s Toxicologic Emergencies
Griffith's 5 Minute Clinical Consult        ICD-9-CM VOLS 1, 2 & 3
Ingenix CPT® with RVU Data Files            Internal Medicine
Medical Immunology                          Merck Manual of Diagnosis & Therapy
Mosby’s Drug Consult                        Review of General Psychiatry
Review of Medical Physiology                Rudolph’s Pediatrics
Smith’s General Urology                     Stedman’s Medical Dictionary
Treatments of Psychiatric Disorders         USP DI® Vol I, Drug Information for the
                                            Healthcare Professional
USP DI® Vol II, Advice for the Patient®


                        Table 3-7 Stat!Ref Medical Reference Library 2
                                          References
ACP Medicine                                 DeGowin’s Diagnostic Examination
Emergency Medicine: A Comprehensive          Fitzpatricks Color Atlas & Synopsis of Clinical
Study Guide                                  Dermatology
Review of Natural Products                   Schwartz’s Principles of Surgery
Trauma                                       DeGowin’s Diagnostic Examination


3.2.2.1.16     TMIP-J Documentation
TMIP-J documentation consists of the System Overview, System Administration Manual
(SAM), System Installation Guide (SIG), EF Administration User Guide, and associated training
materials as well as the User and System Manuals and training materials for each of the TMIP-J
components. The materials are accessible through a documentation folder on the TMIP-J B2
FY07 SP1 workstation desktop.

3.2.2.2 Utilities
Healthcare Delivery utilities in TMIP-J B2 FY07 SP1 consist of AHLTA-T and TMIP-J utilities
as described in the following paragraphs.

3.2.2.2.1       AHLTA-T Data Retirement
The AHLTA-T Data Retirement utility provides the ability to copy patient data from the active
AHLTA-T database to an AHLTA-T archive database based on the input of a “Retirement Date”
by the user. Completed encounters in the active database having a date when they were signed
earlier than the retirement date input by the user are copied from the active database to the
archive database and then deleted from the active database. After deletion of the applicable
records, the active database tables are re-indexed to improve AHLTA-T application



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performance. The utility also provides the user the option to delete any previously retired records
from the archive database. Refer to the AHLTA-T User’s Manual and the AHLTA-T System
Administration Manual for further information.

3.2.2.2.2       AHLTA-T Patient Demographic Verification and Population
The AHLTA-T Patient Demographic Verification and Population utility provides a mechanism
for extracting sponsor demographic data from the CDR and making it available as an
authoritative source for Theater users. When a Theater user searches for a patient, the AHLTA-T
application first searches the local LDDB. If the patient is not found in the LDDB, the
application searches the authoritative source and returns all patients meeting the search criteria.
Data available are First Name, Last Name, Middle Initial, SSN, Sponsor SSN, Date of Birth
(DOB), Gender, Family Member Prefix (FMP), Marital Status, Race, Specialty Code, Religion,
Rank, Service, Patient Category, UIC, and Electronic Data Interchange Patient Number (EDIPN)
(DEERS unique identifier). Refer to the AHLTA-T User’s Manual and the AHLTA-T System
Administration Manual for further information.

3.2.2.2.3      TMIP-J AHLTA-Mobile GuestSync
The TMIP-J AHLTA-Mobile GuestSync utility enables an AHLTA-Mobile device to exchange
data with an AHLTA-T workstation automatically when the PDA is cradled at the workstation.
GuestSync provides a Wizard for the user to configure the synchronization of the AHLTA-
MOBILE PDA with the workstation. The “Guest” synchronization allows any AHLTA-Mobile
device to exchange data with the AHLTA-T workstation without having to configure the synch
for each individual AHLTA-Mobile device.

3.2.2.2.4       TMIP-J Data Migration
The TMIP-J Data Migration utility moves data from a AHLTA-T B1 SP2 database to a AHLTA-
T B2 FY07 SP1 database. The Data Migration Utility checks to ensure the database to be
migrated is a AHLTA-T B1 SP2 database, checks sufficient disk space exists, saves the AHLTA-
T B1 data, executes AHLTA-T database migration scripts, reports the migration status, and
handles error messaging to the user. This utility also migrates the “My Documents” folder from
the existing system to the new system. Refer to the TMIP-J Data Migration Guide for further
information.

3.2.2.2.5      TMIP-J Electronic Information Carrier Server
The TMIP-J Electronic Information Carrier Server is implemented as an Application
Programming Interface (API) that can be called by applications (e.g., AHLTA-T and SAMS) to
read and write patient demographic and encounter data to an EIC (i.e., a floppy disk or some
other removable media). Currently, this capability is used only to move data between SAMS and
AHLTA-T for TMIP-J B2 FY07 SP1. Refer to the TMIP-J SAM for further information.

3.2.3 Medical Logistics Components
Table 3-8 identifies the Medical Logistics software components by type of component and
depicts whether the component is integrated, non-integrated, or an external system as discussed
in Section 3.1.3. Medical Logistics components consist of GOTS applications and a reference as
described in the following sections.




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                           Table 3-8 Medical Logistics Components
       Type                        Component                                Status
                      DCAM
                      PMITS                                   Integrated (TMIP-J Workstation)
                      SAMS
GOTS
                      DMLSS
Applications
                      JMAR
                                                              External System
                      TAMMIS
                      T-DBSS
Reference             USAMMCE Catalog Photo Disk              Integrated (TMIP-J Workstation)


3.2.3.1 GOTS Applications
3.2.3.1.1       Defense Medical Logistics Standard Support Customer Assistance Module
        (DCAM)
DCAM is a medical logistics ordering and status tool which allows theater users to view their
supplier’s catalog and generate electronic orders. DCAM automates the medical “Class VIII”
supply process at the lower Levels of Care and allows non-logisticians, who maintain their
medical supplies as an additional duty, to electronically exchange catalog, order, and status
information with their supply activity. DCAM does this without the complexity, management
requirements, and additional hardware infrastructure of a more robust medical logistics system
such as DMLSS or TAMMIS which require dedicated personnel who are not available below
Level III organizations. DCAM can interface with another DCAM, TAMMIS, DMLSS, or
JMAR. TAMMIS and DMLSS both provide catalog information to DCAM and process orders
from DCAM.
DCAM has the following functional capabilities to manage Level I and Level II logistics:
       Manage Materials
       − Request Catalogue
       − Place Orders
       − Status Orders
       − Manage Customer Inventory
       System Administration Tool
DCAM is a TMIP-J B2 FY07 SP1 fully integrated software component. Refer to the DCAM
System User Manual for information on using this application. Electronic copies of all TMIP-J
B2 FY07 SP1 documentation are available in a documentation folder on the installed TMIP-J
Windows desktop.




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3.2.3.1.2       Patient Movement Item Tracking System (PMITS)
PMITS facilitates management of PMIs used by the Services with an integrated management
system for peacetime, contingency, and wartime operations which decreases management costs
and inventory requirements. The most important element is to ensure the critical medical
equipment designated as a PMI is available at the right place at the right time. PMITS enables
Commanders to manage and redistribute assets as needed to avoid shortages in their support of
patient healthcare during medical evacuations and other operations. PMITS is the Plexus COTS
product modified to work on DoD networks. DMLSS has renamed the Plexus product to
PlexusD to denote the DoD version. All PMI data is pushed to a designated collection location
prior to being placed on the PMITS web server. The aggregated worldwide PMI data on the
PMITS web server is accessed in a read-only format directly or via a link from the DMLSS
JMAR web server. A centralized PMITS Data Collection Hub pushes the aggregated data to
subordinate units for data synchronization if required, but the lowest levels of care can complete
their missions without data synchronization.
PMITS is a TMIP-J B2 FY07 SP1 fully integrated software component. Refer to the TMIP-J B2
FY07 SP1 PMITS User Manual and Training Documentation for information on using this
application. Electronic copies of all TMIP-J B2 FY07 SP1 documentation are available in a
documentation folder on the installed TMIP-J Windows desktop.

3.2.3.1.3    Shipboard Non-Tactical Automated Data Processing Program Automated
             Medical System (SAMS)
SAMS is described in Section 3.2.2.1.2. One of the SAMS’ modules provides medical logistics
information.

3.2.3.1.4       Defense Medical Logistics Standard Support (DMLSS)
DMLSS automated information system was developed and deployed to enhance healthcare
delivery in peacetime and to promote wartime readiness and sustainability. DMLSS replaces the
legacy TAMMIS. DMLSS provides automation support of reengineered medical logistics
business practices and delivers a comprehensive range of material, equipment, and facilities
management information systems including computer aided drawing capabilities, e-commerce
capability, stock fund level inventory management, quality control, medical technology
management, and management of readiness material.
DMLSS has the following functional capabilities to manage Level III logistics:
       Facilities management
       Material management
       Equipment and equipment maintenance management
       Contract services
       Customer support
       System services
       Patient movement items
       Spectacle requisition




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       Blood requisition
TMIP-J B2 FY07 SP1 DCAM interfaces with DMLSS. DMLSS is an external system to TMIP-J
B2 FY07 SP1 and, therefore, outside of the scope of this document. DCAM and DMLSS pass
theater status information to JMAR. Refer to DMLSS documentation for further information.
Additional DMLSS information is available at: www.tricare.osd.mil/dmlss/ and
https://dmmonline.dscp.dla.mil/dmlss. Medical logistics information is available at the
warfighter’s medical logistics portal https://dmmonline.dscp.dla.mil. Note that these web sites
require access via a .mil domain.

3.2.3.1.5       Joint Medical Asset Repository (JMAR)
JMAR is designated by the Joint Total Asset Visibility (JTAV) Program as the single source to
acquire, manage, and provide timely and accurate joint medical asset visibility information to the
quad-service medical logistics community. Customers include military logisticians, military
planners, C2 personnel, and healthcare providers. The DMLSS Program Office manages the
JMAR Project. JMAR support agencies are the Army, Navy, Air Force, and Marine Corps.
Moreover, JMAR provides military Commanders with a management tool for decision making
regarding the best use of medical material. Although JMAR offers numerous benefits during
peacetime, its primary value is during wartime and contingency operations. JMAR addresses the
following stages of total asset visibility:
       In-Process – Material being acquired from vendors but not yet shipped or being repaired
       at intermediate and depot-level organic or commercial maintenance facilities.
       In-Storage – Material being stored at retail and wholesale inventory sites, either organic
       or commercial sites, and at disposal activities.
       In-Transit – Material assets being shipped or moved from origin (e.g., units, vendors,
       storage activities, or maintenance facilities).
       In-Theater – Material stored, procured, maintained, and shipped within the geographical
       boundaries of a theater.
A JMAR URL link is on the TMIP-J Windows desktop. TMIP-J B2 FY07 SP1 DCAM passes
status information to JMAR. JMAR is an external system to TMIP-J B2 FY07 SP1 and outside
of the scope of this manual. Refer to JMAR documentation for further information. The TMIP-J
Windows desktop has a URL link to the JMAR web site. Additional information is available at
https://jmar.detrick.army.mil. Note that JMAR can only be accessed via the .mil domain.

3.2.3.1.6       Theater Army Medical and Management Information System (TAMMIS)
TAMMIS supports the information management requirements of Army field medical units
during war in the functional areas of Medical Patient Accounting and Reporting (MEDPAR),
Medical Regulating (MEDREG), and Medical Logistics (MEDLOG). The MEDLOG functional
area is further divided into medical supply, medical maintenance, medical optical fabrication,
and medical assembly management. TAMMIS interfaces with medical supply systems in both
fixed and deployable medical treatment facilities. TAMMIS interfaces with DCAM for medical
logistics information and is an external system to TMIP-J B2 FY07 SP1.




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3.2.3.1.7      Theater Defense Blood Standard System (T-DBSS)
T-DBSS is a Food and Drug Administration (FDA) Medical Class II device which is an
automated information system for MHS blood management and the management and operation
of blood donor centers, transfusion services, Armed Services Whole Blood Processing
Laboratories, and deployed field units. Blood requirements include the collecting, testing,
processing, manufacturing, shipping, distributing, and transfusing of blood and blood
components; and the tracking of blood donors and transfusion recipients to satisfy infectious
disease reporting requirements.
This GOTS TMIP-J component is an external system and is not loaded as a part of the TMIP-J
B2 FY07 SP1 delivery; however, it is available through the TMIP-J Program Office as a stand-
alone notebook. Documentation is included with the software.

3.2.3.2 Reference
USAMMCE Catalog Photo Disk for DCAM – Refer to the documentation that accompanies this
reference material for specific information on using the material. TMIP-J B2 FY07 SP1
documentation is available in a documentation folder installed on the TMIP-J workstation
desktop.

3.2.4 Patient Movement Components
Table 3-9 identifies the Patient Movement software components by type of component and
depicts whether the component is integrated, non-integrated, or an external system as discussed
in Section 3.1.3. Patient Movement components comprise GOTS applications described in the
following paragraphs.

                           Table 3-9 Patient Movement Components
       Type                        Component                                Status
GOTS                  JPTA
                                                               External Systems
Applications          TRAC2ES


3.2.4.1 Joint Patient Tracking Application (JPTA)
JPTA is a computerized tool that allows users to get real-time information about the status of
injured troops as they make their way through the medical system. JPTA tracks theater patients,
their locations, and their statuses within the MHS as opposed to TRAC2ES which manages
world-wide patient movement. JPTA was developed at Landstuhl Army Regional Medical
Center (LARMC) in Germany to more efficiently track and manage care for patients arriving
from OIF and Operation Enduring Freedom (OEF). The system was developed in 2003 to
streamline Landstuhl’s overburdened Deployed Warrior Medical Management Center
(DWMMC). The DWMMC tracks patient’s medical evacuations; monitors patient departures
and arrivals from Theaters of operation; records medical information before patients arrive;
ensures patients are met when the medical evacuation helicopter lands at Landstuhl; and ensures
everything is ready to accommodate the patients, from billeting to meals and medical
appointments.




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JMeWS periodically exchanges patient status information with JPTA. A JPTA URL link is on
the TMIP-J Windows desktop. JPTA is an external system to TMIP-J B2 FY07 SP1 and is
outside of the scope of this document. Refer to JPTA documentation for further information. The
TMIP-J Windows desktop has a URL link to the JPTA site.

3.2.4.2 TRAC2ES
TRAC2ES provides patient transportation information and in-transit visibility to the defense
transportation community and medical support information to the medical community. A
periodic TRAC2ES to JMeWS data transfer is handled directly between the two CONUS
component servers.
TRAC2ES is an external system to TMIP-J B2 FY07 SP1 and is outside of the scope of this
document. Refer to the TRAC2ES documentation for further information. The TMIP-J Windows
desktop has a URL link to the TRAC2ES site.

3.2.5 Command and Control (C2) Components
Table 3-10 identifies the medical C2 components which include Medical Planning and Medical
Surveillance software components and depicts whether the component is integrated, non-
integrated, or an external system as discussed in Section 3.1.3. C2 components comprise three
GOTS applications and a GOTS database to provide medical surveillance, analysis, and planning
capabilities in TMIP-J B2 FY07 SP1. These component applications are described in the
following paragraphs. In addition, a description of the Common User Database is provided since
it will be used by the JMAT currently under development.

                        Table 3-10 Command and Control Components
       Type                        Component                                 Status
                      DMSS                                     External System
                      JMeWS
GOTS
                      MAT/JMAT
Applications                                                   Non-Integrated
                      TMDS
                      CUD


3.2.5.1 Defense Medical Surveillance System (DMSS)
DMSS is an automated information system that provides medical surveillance and
epidemiological information to policy makers, medical planners, and researchers. The Army
Medical Surveillance Activity (AMSA) operates the DMSS, an executive information system
whose database contains up-to-date and historical data on diseases and medical events (e.g.,
hospitalizations, ambulatory visits, reportable diseases, HIV tests, acute respiratory diseases,
health risk appraisals, and longitudinal data on personnel and deployments). AMSA routinely
publishes summaries of notifiable diseases, trends of illnesses of special surveillance interest,
and field reports describing outbreaks and case occurrences in the Medical Surveillance Monthly
Report (MSMR) - the principal vehicle for disseminating medical surveillance information of
broad interest. Through DMSS, the AMSA provides the sole link between the DoD Serum




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Repository and other databases. This repository contains over 30 million frozen serum specimens
and is the largest of its kind in the world.
The TMIP-J system sends pre- and post-deployment survey data to DMSS-AMSA. DMSS-
AMSA is an external system to TMIP-J B2 FY07 SP1 and, therefore, outside the scope of this
document. Additional information is available at http://amsa.army.mil.

3.2.5.2 Joint Medical Workstation (JMeWS)
JMeWS is TMIP-J’s B2 medical C2 software component. JMeWS provides consolidated reports
and replaces the TMIP-J B1 Medical Surveillance System (MSS). JMeWS resides on the
SIPRNet and consists of the JMeWS database, the Watchboard medical C2 display tool, and the
MDSS epidemiological data analysis tool. TMDS receives C2 data from TMIP-J’s Healthcare
Delivery and Logistics software components and patient tracking information from TRAC2ES.
JMeWS provides medical situation awareness information and responds to requests for
specialized medical information searches, analyses, or recommendations to support medical
surveillance. JMeWS is on the GCSS network and provides medical information to the
Combatant Commander/Joint Task Force (CC/JTF) Common Operational Picture (COP) and
reporting system.
JMeWS has the following medical C2 functional capabilities:
       Medical Surveillance (data access and aggregation):
       − Detection of disease outbreak and chemical and biological exposure
       − Syndromic surveillance of ancillary service orders and results
       − Deployment health and health hazard monitoring
       − Individual medical readiness
       − Population at Risk
       − Environmental and occupational health hazard monitoring
       − Preventable disease and injury control – Disease Non-Battle Injury (DNBI) reporting
         and analysis
       Access Medical Intelligence Information:
       − Medical threat
       − National and local medical infrastructure capabilities in deployed locations
       Medical Situation Awareness (data access and aggregation):
       − Medical personnel readiness and status information
       − Medical facilities readiness and status information
       − Medical unit readiness and status information
       − Medical asset visibility – medical supplies and equipment on-hand and en-route
       Patient Visibility:
       − Admissions



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       − Location within medical treatment facilities
       − Disposition
       − In-Transit visibility
JMeWS is a TMIP-J B2 FY07 SP1 non-integrated software component located at the Office of
the Deputy Assistant Secretary of Defense for FHP&R. Contact DASD, FHP&R to obtain
JMeWS access and user information. Further information is available at
http://www.ha.osd.mil/fhpr/.

3.2.5.3 Medical Analysis Tool/Joint Medical Analysis Tool (MAT/JMAT)
MAT/JMAT is used by the Combatant Commanders to create medical estimates within the
Annex Q (Medical Annex) of all Operations Plans (OPLAN) and Contingency Plan
(CONPLAN). MAT is the only Joint Staff and DoD approved tool that provides accredited,
predictive, modeling, and simulation analytical capability for medical planners. MAT is being
upgraded and will be called JMAT. The upgraded JMAT will use data from the Common User
Database (CUD). This capability provides the operational Commander with a computer-aided
support tool to assist and enable medical planners worldwide to generate theater medical support
requirements. Using MAT, medical planners determine the level and scope of medical support
needed for each joint operation. They also develop and evaluate various Courses of Action
(COA) for probable scenarios and provide recommendations to the Commander based on
adequacy, feasibility, supportability, and applicability compared to other COAs.
MAT is a non-integrated software component being developed under the DHIMS PMO. Its use
is independent of TMIP-J B2 FY07 SP1 and its operational documentation is outside of the
scope of this document. Contact the DHIMS PMO for further information.

3.2.5.4 Theater Medical Data Store (TMDS)
TMDS is a web-based application that enables users to view individual patient encounters.
Providers can view a patient’s medical data no matter where it may have been entered or
completed. Patient encounters in theater are entered through AHLTA-T workstations and sent to
the TMDS server where the records can be accessed via JMeWS and TMDS. The records are
also transferred to the CDR. TMDS is a non-integrated software component of TMIP-J B2 FY07
SP1.

3.2.5.5 Common User Database (CUD)
CUD is the responsibility of the Joint Readiness Clinical Advisory Board (JRCAB) of the
Defense Medical Standardization Board (DMSB). CUD serves as a more flexible version of the
Time, Task, Theater (TTT) files in meeting the requirements of the deployed medical care
system. The DMSB provides medical and planning data for effectively treating a deployed force.
This data comprises Trauma Treatment Briefs; DNBI Treatment Briefs; and Chemical,
Biological, Radiological, Nuclear, and Explosive (CBRNE) Treatment Briefs. In addition, the
DMSB supports DoD’s transformation of Standardized Medical Material data.
The CUD is being developed to support the MHS by providing information resources concerning
patient care for peacetime, national disasters, humanitarian, and wartime operations. The CUD
architecture supports medical planners, modelers, logisticians, trainers, and personnel to enable
them to apply flexibility in using medical planning data characteristics in their tools as well as



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define standards to optimize reliability of each tool’s output. CUD is intended to expand
availability of clinically verified treatment data for additional sectors of the medical community
as well as other governmental agencies to optimize each organization’s ability to identify and
develop resource needs (e.g., collaborating treatment data for bioterrorism-related issues). JMAT
will use data from the CUD.
CUD is a non-integrated component being developed under the authority of the DHIMS PMO.
Its use is independent of TMIP-J B2 FY07 SP1 and its operational documentation is outside of
the scope of this document. Contact the JRCAB for further information. JRCAB and DMSB
information is available at http://www.jrcab.army.mil/.

3.3     MODES OF OPERATION
Currently, there are no specific modes of operation within the TMIP-J B2 FY07 SP1 system. The
TMIP-J system is designed to operate regardless of communications availability. When
communications are functioning properly, data passes from node to node on the Framework on a
regularly scheduled basis. When communications are unavailable, data is saved until
communications are restored or, if necessary, the data can be transported to any other node via
removable media.
The AHLTA-T PIC/Disk capability can be used to move all clinical data from one MTF to
another. The term ‘PIC’ is not in any way related to the Army’s PIC project. In TMIP-J, PIC
represents a way to move a patient’s demographics and clinical data to any type of removable
media. The DISK option enables a user to move more than one patient’s demographic and
clinical data to any type of removable media. Either of these options are the preferred method of
moving clinical data from one AHLTA-T system to another. The EIC only contains the last
medical encounter and demographics, whereas PIC/DISK will contain all encounters and related
clinical data to include allergies, immunizations, problems, clinical notes, etc. The EIC should
only be used to transfer data between SAMS and AHLTA-T.

3.4      SECURITY AND PRIVACY
TMIP-J users are expected to have received security awareness training that includes information
on the proper operation and security of an AIS as well as TMIP-J-specific user security issues.
The TMIP-J-specific user security issues are covered in the TMIP-J TFM and the TMIP-J SFUG.
The TFM presents the functions and privileges that must be controlled and presents the
procedures for examining and maintaining audit files. The SFUG describes the protection
mechanisms provided by the Trusted Computing Base (TCB), the guidelines for their use, and
how they interact with one another. User questions on security and privacy should be directed to
the site SA or the Information Systems Security Officer (ISSO).
Each user will be provided a valid user identification (ID) and password by the SA to allow
access to TMIP-J B2 FY07 SP1 workstations and components. This protects medical records that
contain personal information from unauthorized access or disclosure.
WARNING: Authorized users of the TMIP-J system are expected to respect the privacy of
      individuals and not make unauthorized copies of software or documents nor to release
      any personal medical information to unauthorized individuals. Unauthorized release
      of personal or medical information can result in civil penalties. See the Privacy Act of
      1974, DoD Freedom of Information Act Program (DoD 5400.7-R), and DoD
      Directive 5400.11R-DoD Privacy Program for more information.



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DISCLAIMER: The names, demographic information, and medical data contained in all of the
         TMIP-J documentation are for training and/or educational use only. Any similarity
         to the name, demographic information, or medical data of any person, living or
         dead, is entirely coincidental and unintentional.

3.5    ASSISTANCE AND PROBLEM REPORTING
See the site SA for assistance as directed by the plan of operation. The SA’s course of action will
depend on the type of issue the user is experiencing. If the user encounters an application error,
follow these general steps:
   1. Capture a screen shot. Whenever an application error occurs, create a screen shot and save it to
      a Microsoft PowerPoint or Word file.
       − To capture the entire display, press the Print Screen key.
       − To capture only the active window, press the Alt + Print Screen keys together.
       − To paste the captured screen shot into a PowerPoint or Word document, press Ctrl +
         V or use the paste options in the Edit menu. If possible, note which application
         caused the error message.
   2. Acknowledge the error, close all applications, and reboot the system if needed.
   3. If the problem persists, contact the service Help Desk.

3.5.1 Help Desk Support
The TMIP-J B2 FY07 SP1 Help Desk Support is separated into four tiers. A description of each
tier and the services provided by that tier is as follows:
       Tier 0: Service Help Desk
       − “How to” questions
       − Login problems
       − Operational or navigational issues
       − Local system administrative problems
       − Password problems
       Tier I: MHS Help Desk
       − First level of support after receiving unresolved report from the Service Help Desk
       − Resolve problem/provide information and assistance
       − Requires more specific knowledge of system
       Tier II: TMIP-J Help Desk – The Tier II Customer Support Representative (CSR) is the
       functional expert with knowledge of the system components and is capable of
       troubleshooting and resolving problems that are beyond the capabilities of Tier I.
       − Calls are logged into a Call Management System
       − Trouble ticket opened in ManageNow



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       − When resolved, ticket is closed in ManageNow
       − E-mail notification sent to TMIP-J Triage user group
       Tier III: TMIP-J Help Desk – Tier III support is provided by system functional experts,
       often personnel who have written the application software code. Tier III support is
       provided to troubleshoot and resolve problems that are beyond the capabilities of Tier II.

3.5.2 Triage
TMIP-J’s Triage organization is a PMO-based administrative and advisory group established to
develop, implement, and administer a standard process for classifying, tracking, and monitoring
software issues from the point of origin to their full and final resolution.
Issues that make it to Tier II are categorized into the following types of issues in the Triage
meeting and are handled accordingly:
       Training/user issue
       Documentation Problem Report (DocPR)
       System Problem Report (SPR)
       Software Change Request (SCR)

3.5.3 Contacting the Help Desk
The site SA will be able to provide the Service Help Desk phone number. See Section 1.6. When
contacting the Help Desk, provide the following information:
       Status: Is it an emergency or non-emergency situation?
       Severity:
       − Loss of system or degradation of patient information or of life
       − Essential capability lost and no work around
       − Essential capability lost but can work around
       Primary Contact Information:
       − Full name
       − Organization\Service\Unit\Site
       − Phone
       − E-mail address
       − Open Date and Time
       Alternate Contact Information:
       − Alternate full name
       − Phone
       − E-mail address




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       System and software configuration:
       − Which software version of TMIP-J is running?
       − Which version of the Windows operating system is installed?
       − Which component applications are open on the TMIP-J system?
       − What is the system configuration (stand-alone or server)?
       − If the system is a server, how is it configured for communications?
       − Type of equipment (Dell/Gateway/Micron, etc.)
       − Equipment serial number
       Description/Abstract:
       − What is the sequence of activities that resulted in the error or abnormal system
         behavior?
       − Can the error or abnormal system behavior be recreated?
       − Was a screen capture of the error or abnormal system behavior taken?
All issues are first reported to the Service Help Desk. The Service Help Desk will escalate as
required to provide assistance or resolve the issue.




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4.0    TMIP-J B2 FY07 SP1 WORKSTATION
In Section 3, the components of the TMIP-J system being delivered in B2 FY07 SP1 were
discussed from the contexts of Levels of Care, functional orientation, and component integration.
As pointed out in Section 3, the components that comprise the TMIP-J system may be installed
on various pieces of hardware both within and outside the Theater of Operations. In this section,
the focus is on the components that may be installed on the TMIP-J workstation or laptop and
how the user accesses the TMIP-J B2 FY07 SP1 workstation and the software components
installed on it. This section does not provide details on using each component application. For
such information, the user should consult the specific User Manual, training material, and online
Help provided for the component.

4.1     TMIP-J B2 FY07 SP1 WORKSTATION INSTALLATION AND CONFIGURATION
The TMIP-J B2 FY07 SP1 SIG describes procedures to install, configure, and uninstall the
TMIP-J B2R1 software component systems on TMIP-J hardware. The TMIP-J B2 FY07 SP1
SIG also describes the software files including databases and data files that must be installed for
TMIP-J B2R1 to operate properly and the software applications necessary to continue or resume
operation in case of an emergency. Because each Service has its own policies and directives
regarding the installation of software and configuration of hardware, the intent is the local SA
will install and configure the TMIP-J B2 FY07 SP1 workstation and the components needed on a
given workstation. Some components, like the operating system, will have already been installed
on the workstation by the individual Service SA. For other components like Oracle 10g,
Microsoft Office, and AHLTA-T, TMIP-J provides an installation program to install and
configure the components. As shown in Figure 4-1, the system will select the Foundation
components and the TMIP-J components that will be installed on the TMIP-J workstation.




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                               Figure 4-1 Select Features Screen

4.2     TMIP-J B2 FY07 SP1 WORKSTATION COMPONENTS
Table 4-1 identifies the various components that comprise the TMIP-J B2 FY07 SP1 system.
Regardless of how the components are installed and which components are selected for
installation, there are certain mandatory components that need to be on the TMIP-J workstation.
These mandatory components are identified in Table 4-1 with an asterisks (*) following the
component name.

                   Table 4-1 TMIP-J B2 FY07 SP1 Workstation Components
             Software Component                                    Comments
                                      Operating Systems
Microsoft Windows XP *                          XP Professional, SP2
                                          Databases
Oracle 10g                                      Single instance for all applications
                                     COTS Applications
Adobe Acrobat                                   Reader version 8.2.1
Business Objects                                Installed with TMIP-J Reporting version 6.5.1
Expeditionary Framework *                       .Net Framework, Web Services Extensions
Microsoft Internet Explorer                     Installed with MS Windows OS
Microsoft Office XP                             XP, SP3



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             Software Component                                     Comments
Norton AntiVirus                                 9.0
                                    GOTS Applications
AHLTA-T                                          Server or Client
DCAM                                             35.1.106.0
DOEHRS-IH *                                      Icon (URL link) on desktop
JMAR *                                           Icon (URL link) on desktop
JMeWS *                                          Icon (URL link) on desktop
JPTA *                                           Icon (URL link) on desktop
PMITS                                            1.0.2.0
SAMS                                             29-9.01.00
TMIP-J Reporting                                 Business Objects 6.5
TRAC2ES *                                        Icon (URL link) on desktop
AHLTA Warrior *                                  10.00.52110
                                         References
MEDIC                                            2006
Micromedex                                       Stand-alone or Network
Stat!Ref *                                       Icon on desktop
TMIP-J Documentation *                           User Manuals, System Manuals, and training
                                                 materials; Documentation folder on desktop
                        Utilities (TMIP-J, Framework & AHLTA-T)
AHLTA-T Data Retirement                          Installed with AHLTA-T
AHLTA-T Patient Demographic Verification         Installed with AHLTA-T
and Population
Message Archive Management                       Installed with Framework
TMIP-J Backup and Restore *
TMIP-J Data Migration
TMIP-J Electronic Information Carrier Server *
TMIP-J Oracle Change Password *
TMIP-J Oracle Host Name Configuration *
TMIP-J Oracle Stats Scheduler *
TMIP-J STIG Correction *
TMIP-J UIC Update *




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4.3      ACCESS TO SOFTWARE
Access and level of access to the TMIP-J applications are controlled by the SA who provides
user ID and initial passwords, selects the password change policy, and grants the user
membership to one or more TMIP-J-specific user groups. Access and level of access to
applications are determined by user type and group membership. A component system has the
ability to limit a user’s access based on the user type. For example, SAMS and AHLTA-T can
each turn on or off different modules within its application depending upon the user type. These
SA activities are performed in the Microsoft Windows operating system environment and within
the appropriate component application.

4.3.1 Equipment Familiarization
Procedures to power on, adjust, and power off equipment are described in the hardware
documentation. Information on the Microsoft Windows operating system is available in the
online Help on the desktop. To access the online Help, click the Start button on the bottom of
the display screen, and click Help.

4.3.2 Access Control
Password administration is one of the most important security features. It is expected the
Services will develop a concept of operations that includes procedures for password protection.
General guidance is provided in the following subsections. Additional guidance is provided in
the SFUG and the TFM.

4.3.2.1 Obtain Password
The Windows operating system and TMIP-J Component systems require the site SA provides
each user with a separate, valid user ID and password for the operating system and TMIP-J
Component Systems. The SA can set password expiration in accordance with site policy. This
protects medical records that contain personal information from unauthorized access or
disclosure.

4.3.2.2 Add, Delete, or Change Passwords
The SA is responsible for setting password requirements in accordance with site policy. The SA
can specify that the user must change his or her password at stated intervals. The user can change
his or her password but cannot change his or her user ID.
After the SA specifies the interval at which the user will be required to change his or her
password, the system will prompt the user to change the password in accordance with the
specified frequency. The user must be logged on to change his or her password.
To change the Password:
   1. Log on to the system.
   2. Simultaneously press the Ctrl + Alt + Delete keys.
   3. Click the Change Password button on the Windows Security dialog box.
   4. On the Change Password dialog box, enter the old Password and press the Tab key.
   5. Enter the new Password and press the Tab key.




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   6. Type the new Password again and click the OK button.
Refer to the component specific User Manuals for application specific password procedures.

4.3.2.3 Safeguarding Personal Information
Authorized users of the TMIP-J system are required to safeguard the privacy of individuals and
to not disclose any medical or other personal information to unauthorized individuals. All TMIP-
J applications adhere to HIPAA guidelines and all users should be HIPAA certified. The site SA
can assist the user in obtaining the HIPAA certification. Further information can be found at
http://www.hhs.gov/ocr/hipaa/privacy.html.
The Privacy Act of 1974 requires the safeguarding of personal information on U.S. Citizens and
legal aliens against unauthorized disclosure and imposes personal and organizational civil and
criminal penalties for unauthorized disclosures. DoD Regulation 5400.11-R, Privacy Program,
DoD Regulation 5400.7-R, DoD Freedom of Information Act Program, and Service directives
provide specific information and guidance on the implementation of these two related programs
and the marking and safeguarding of documents and media containing personal information.
General guidance is provided in the TMIP-J SFUG.

4.4     INITIATING A TMIP-J SESSION
To initiate a TMIP-J session (refer to Figure 4-2):
   1. Start the computer’s operating system.
   2. Enter the User name and Password provided by the SA to log on Windows.




                              Figure 4-2 Logon Information Screen
   3. Click the OK button. The logon process will verify the entries are a valid User name and
      Password combination.


4.5    STOPPING AND SUSPENDING WORK
The procedure to stop and suspend TMIP-J activity is consistent with the procedures found in
Windows documentation and Windows on-line Help.
A user who leaves a workstation for any length of time should either log off or lock down the
workstation to protect it and the TMIP-J data from unauthorized use. Logging off a workstation
is preferable because it lets other users with valid accounts use the machine without disrupting



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the previous user data. Locking the workstation locks the interactive user interface but does not
close the currently logged on user’s processes.
To lock a workstation:
   1. Simultaneously press the Ctrl + Alt + Delete keys.
   2. Click the Lock Workstation button (on a stand-alone workstation, click the Lock Computer
      option) in the Windows Security dialog box.
To unlock a workstation:
   1. Simultaneously press the Ctrl + Alt + Delete keys.
   2. Enter the Password into the Workstation Locked (Computer Locked) dialog box.
As a backup, a TMIP-J user can configure the workstation to automatically lock itself after a set
period of inactivity by selecting a screen saver that has the Password Protect option.
To configure the workstation’s automatic lock function (refer to Figure 4-3):
   1. Return to the Desktop screen.
   2. Double click the My Computer icon on the desktop.
   3. Double click Control Panel in the Address drop down list box.
   4. Double click the Display icon. The Display Properties window will appear.




                              Figure 4-3 Display Properties Screen



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5. Click the Screen Saver tab.
6. Select a screen saver in the Screen saver drop down list box.
7. Set the amount of time before the screen saver will be invoked in the Wait box (e.g., 10
   minutes).
8. Click the On resume, password protect checkbox (a check mark will be displayed).
9. Click the Apply button.
10. Click the OK button to close the Display Properties screen.
11. Close the Control Panel screen.




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5.0    PROCESSING REFERENCE GUIDE
The TMIP-J system comprises various component systems or applications. These component
systems have their own processing guides. Refer to the User Manuals for each component
system for applicable processing guides and procedures.

5.1     CAPABILITIES
The TMIP-J system has many software requirements that span all its subsystems and their
component applications. Each of these applications is designed to operate independently with the
interchange of information among them being not only event-driven but also dependent on the
availability of communications. The interrelationships of the transactions, menus, functions, and
other processes for each component application are described in the individual component
documentation.

5.2     CONVENTIONS
The TMIP-J system integrates various component systems that were largely developed
independently. Each component system may have used specific conventions during its
development, but there are no overarching conventions for the TMIP-J system as a whole. Refer
to the User Manual for each component system for conventions used.

5.3     PROCESSING PROCEDURES
This document references component User Manuals and other documentation for the user to gain
information needed to use each of the TMIP-J system components. The individual component
documentation describes the functions, menus, transactions, and other processes and provides
options and examples, as applicable, of menus, icons, data entry forms, user input/output, alarms
and messages, diagnostics, on-line Help or tutorial capabilities, and conditions affecting the user
interface.

5.4     RELATED PROCESSING
The individual component user manuals provide directions to users for launching the COTS and
GOTS software applications that are required by the individual component application to enable
the user to use the component application.

5.5    DATA BACKUP
The TMIP-J backup and restore procedures are outlined within the TMIP-J B2 FY07 SP1 SAM.
Security issues are presented in the TMIP-J SFUG and the TMIP-J TFM.

5.6    RECOVERY FROM ERRORS, MALFUNCTIONS, AND EMERGENCIES
The TMIP-J SAM provides procedures for restarting the system and for recovering from errors
or malfunctions occurring during processing as well as for ensuring continuity of operations
during emergencies. The user should contact the site SA in the event of a problem.




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5.6.1   Typical Application Errors
5.6.1.1 TMIP-J Framework
    1. Error messages: “Message expired, unable to process message, unable to reach destination.”
        − What causes this to occur?
           The WebService channel uses MS Web Service Extension (WSE) for transporting the
           actual SOAP message between two end points (sender/receiver). Part of the Simple
           Object Access Protocol (SOAP)/specification is message expiration. This expiration
           is a Time to Live (TTL). The current setting is 86,400 seconds (or 24 hours). This
           allows EF to work between two machines which may have clocks that are out of sync
           by as much as one day. As an example, if the user’s clock is off by 9 months, 4 days,
           and 3 hours, then the receiving machine refuses to process the message as it might be
           a security attack in the flavor of message replay.
        − How can this be mitigated? What is the work around?
           There are two possible solutions:
           •   Have all machine clocks synched within 24 hours of each other.
           •   Increase the TTL in the config file.
   2. When using network icons on the EF Administration window, the Collapse, Expand, and
      Update Directory menu items do not always work.
        − What causes this to occur?
           When first starting the EF, the local node is only aware of locally configured virtual
           applications and remote nodes that were previously configured. Additional
           information (e.g., what applications are configured on the remote nodes) may not be
           visible to the local node.
        − How can this be mitigated? What is the work around?
           To retrieve this information, right click the remote node and select Update Directory
           from the pop-up menu. This generates a message to the selected node requesting
           configuration information. If network connectivity is established, the remote node
           should reply with information about its virtual applications and the known remote EF
           nodes.
           It is possible for this information to be unavailable. If operating in a "No Comms"
           mode for instance, remote directory information will be impossible to retrieve. Since
           the EF operates in a very asynchronous manner, it is very difficult to predict when the
           remote information may be returned even with communications established.
           However, this transfer usually happens very quickly when network connectivity
           exists between the nodes in question.
   3. Upon start of the EF Service, a Log message declares that the WebService channel can’t start
      because a configured port is in use.
        − What causes this to occur?




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       Typically, other applications and services on the same computer running the EF either
       will be or are already using ports opened by these processes. When a WebService
       channel is created, started, and configured on a port number in use by other processes,
       the above log message is shown. For example, if Internet Information Server (IIS) is
       installed on the same machine as the EF and the EF is configured to use the
       WebServices channel on the same port as IIS, it will cause conflicts between the
       applications.
   − How can this be mitigated? What is the work around?
       The user must reconfigure the WebService channel to use another port not in use
       through the Node Configuration Wizard for the node using the WebService channel
       on the specified in-use port. The WebServices Configuration Wizard allows the user
       to choose any port not currently in use. If IIS is running when the EF is being
       configured, the WebServices Configuration Wizard will not allow the user to pick the
       same port in use by IIS.
4. Error Message: “Web services cannot communicate with remote node.”
   − What causes this to occur?
       This means there is no connectivity to the other node. The problem is not EF-specific.
       It is a network connectivity issue that can occur on either end of the attempted
       connection.
   − How can this be mitigated? What is the work around?
       Messages which are not sent due to a lack of connectivity will remain in the message
       queue for 24 hours. If connectivity is restored before this 24 hour time period expires,
       then the queued messages is sent with no further action needed by the user. If the
       period of non-connectivity lasts longer than 24 hours, then non-sent messages must
       be manually resent by the user from the message archive once connectivity is
       restored. If the problem is due to the local node and connectivity cannot be restored
       between this node and the rest of the system, then the non-sent messages can be
       exported to removable media, carried to a node with connectivity, and resent.
5. Error Message: “EF services did not appear.”
   − What causes this to occur?
       This would only occur if installation of EF was unsuccessful.
   − How can this be mitigated? What is the work around?
       The user must conduct an uninstall followed by a reinstall.
6. Error Message: “Automation Error, no mapping between accounts and security id.”
   − What causes this to occur?
       This occurs when the user enters the wrong password or user name for the local
       administrator account.
   − How can this be mitigated? What is the work around?
       Enter the correct user name and password.



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7. Warning Message: “There is already an application registered with the name <app>. Do you
   want to replace the existing application?”
   − What causes this to occur?
       This occurs when the user attempts to import an .NCF file that already exists locally.
       For example, suppose AHLTA-T has already been configured on a local node via the
       importing of the appropriate .NCF file. Attempting to import the AHLTA-T .NCF file
       again will lead to this error.
   − How can this be mitigated? What is the work around?
       If the user actually wishes to re-import the .NCF file, then select Yes on the duplicate
       item dialog box. Otherwise select No.
8. Error Message: “Unable to obtain the security descriptor. This operation is not supported for a
   WORKGROUP installation computer.”
   − What causes this to occur?
       This message only appears when operating in a Workgroup configuration. The
       security descriptor is necessary when operating in a Domain configuration. It is not
       used when operating in a Workgroup configuration and it cannot be obtained when
       configured as a Workgroup.
   − How can this be mitigated? What is the work around?
       Select OK on the dialog box and proceed.
9. EF service errors: “There was a problem starting the EF logging service” or “There was a
   problem starting the EF log service.”
   − What causes this to occur?
       When the EF is started, two services should start: the EF logging service and the EF
       service itself. If any of these services fail to start, the corresponding error message
       will appear.
   − How can this be mitigated? What is the work around?
       This problem can be fixed by restarting the appropriate service. This can be done by
       performing the following steps:
       •   Open the Control Panel from the Settings menu available by clicking on the Start
           button in the lower left of the screen.
       •   In Control Panel, click on Administrative Tools and then on Computer
           Management.
       •   In the Computer Management screen, expand the Services and Applications
           item in the tree view. The list of services should now be available. See Figure 5-1.




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Figure 5-1 Starting EF Services (Screen 1 of 3)




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•   Right click on the desired EF service and select Properties. See Figure 5-2.




              Figure 5-2 Starting EF Services (Screen 2 of 3)




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           •   In the Properties screen that appears, select the Log On tab and enter the correct
               password for .\Administrator or xAdministrator. Then click OK. See Figure 5-3.




                         Figure 5-3 Starting EF Services (Screen 3 of 3)

5.6.1.2 Business Objects
    1. Business Objects Reporting does not automatically time out.
       − What causes this to occur?
           When using the Business Objects application to generate reports for AHLTA-T, the
           Business Objects application cannot be configured to time out.
       − How can this be mitigated? What is the work around?
           Use the Windows operating system screen saver with the password enabled to allow a
           time out to occur. For help in setting this up, refer to the Windows Help support
           section.
   2. When and why would a user need to use the Business Objects Security Tool?
       − How to use Business Objects Security Tool.
           The Business Objects Security Tool is used to determine the type of security that is
           used to connect to the Business Objects universe.




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           •   The default option is "Business Objects” which lets Business Objects manage
               users’ access and passwords. All user information is stored within the Business
               Objects tablespace in Oracle.
           •   The next option is "Windows.” This allows users and passwords to be managed
               on a local or domain level while access is managed in Business Objects. The user
               Id used to log in to Windows is the user Id used to connect to the Business
               Objects universe.
           •   When "Windows" is selected, the user will not be prompted for a user Id and
               password when logging into the Business Objects universe. The Business Objects
               administrator should make an Administrator or xAdministrator user in Business
               Objects before selecting this option.
           •   The Business Objects Administrator must still create a user in the Business
               Objects Supervisor for each Windows login that will be allowed to connect to the
               Business Objects universe.
           •   The other two options, “Single Sign-On” and “Basic,” are not recommended.
               They require web services or other technologies beyond the scope of this
               document.
   3. TNS Listener dies when Business Objects is launched.
       − What causes this to occur?
           Occasionally, multiple installs/uninstalls of Business Objects can cause the Winsock
           registry entries to become corrupt. This corruption will manifest itself in several
           ways, most notably in the fact that the TNS Listener will die. When this occurs it will
           not be possible to connect to the Oracle database and users will be unable to log in to
           the Oracle-dependent applications, AHLTA-T, SAMS, and Business Objects.
       − How can this be mitigated? What is the work around?
           Users should contact the Help Desk in the event this issue presents itself. It should be
           emphasized that this is only a potential issue if multiple installs/uninstalls of Business
           Objects are performed. This will not be an issue when the initial TMIP-J installation
           is being performed.

5.6.1.3 Oracle 10g
    1. When integrating AHLTA-T on a Panasonic cf48, the client drops the connection to Oracle.
       − What causes this to occur?
           Issued was caused by the enabled wireless Network Interface Card (NIC) in the client
           box.
       − How can this be mitigated? What is the work around?
           In the client box, disable the wireless NIC and then restart Oracle services on the
           server and resume installation.
       If the problem persists:




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       − On the server, add the following line to the listener.ora:
         INBOUND_CONNECT_TIMEOUT_Listener = 120
       − On the server, add the following line to the sqlnet.ora:
         SQLNET.CONNECT_TIMEOUT_= 120

5.7     MESSAGES
Error messages generated by the system or component applications appear in message or dialog
boxes and should be self-explanatory. If the user does not understand a message, the user should
refer to the documentation associated with the application or operating system generating the
error message and contact the site SA for further assistance. The processing guides discuss error
messages in relation to the application procedures and provide screen captures of representative
messages. Windows error messages are detailed in Windows online Help and documentation.




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APPENDIX A:       ACRONYMS AND ABBREVIATIONS
Acronym/Abbreviation                                 Definition
ACTD                   Advanced Concept Technology Demonstration
ADT                    Admission, Disposition, and Transfer
AFPMB                  Armed Forces Pest Management Board
AHLTA-T                AHLTA-Theater
AIS                    Automated Information System
AMSA                   Army Medical Surveillance Activity
ANSI                   American National Standards Institute
A/P                    Assessment and Plans
API                    Application Programming Interface
ASD/HA                 Assistant Secretary of Defense for Health Affairs
B1                     Block 1
B2                     Block 2
B2 FY07 SP1            Block 2 Fiscal Year 07 Service Pack 1
BMIS-T                 Battlefield Medical Information System-Tactical
BMIST-J                Battlefield Medical Information System Tactical-Joint
C2                     Command and Control
C2T                    Composite Health Care System II-Theater (CHCS II-T)
CAC                    Common Access Card
CBRNE                  Chemical, Biological, Radiological, Nuclear & Explosive
CC                     Combatant Commander
CDR                    Clinical Data Repository
CD-ROM                 Compact Disk-Read Only Memory
CES                    Core Enterprise Services
CHCS                   Composite Health Care System
CHCS II-T              Composite Health Care System II-Theater
CHCS-NT                Composite Health Care System-New Technology
CI                     Care Innovation
CINC                   Commander in Chief
CITPO                  Clinical Information Technology Program Office
CJCSI                  Chairman of the Joint Chiefs of Staff Instruction
COA                    Course of Action
COE                    Common Operating Environment




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Acronym/Abbreviation                                Definition
                       Concepts of Employment
CONOPS                 Concept of Operations
CONPLAN                Contingency Plan
CONUS                  Continental United States
COP                    Common Operational Picture
COTS                   Commercial off-the-shelf
CRD                    Capstone Requirements Document
CSR                    Customer Support Representative
CUD                    Common User Database
DASD                   Deputy Assistant Secretary of Defense
DB                     Database
DBSS                   Defense Blood Standard System
DCAM                   DMLSS Customer Assistance Module
DEERS                  Defense Enrollment Eligibility Reporting System
DHIMS                  Defense Health Information Management System
DII                    Defense Information Infrastructure
DISA                   Defense Information Systems Agency
DITSCAP                DoD Information Technology Security Certification and Accreditation
                       Process
DMDC                   Defense Manpower Data Center
DMLSS                  Defense Medical Logistics Standard Support
DMLSS-AM               Defense Medical Logistics Standard Support-Assemblage
                       Management
DMSB                   Defense Medical Standardization Board
DMSS                   Defense Medical Surveillance System
DNBI                   Disease Non-Battle Injury
DocPR                  Documentation Problem Report
DOB                    Date of Birth
DoD                    Department of Defense
DoDD                   DoD Directive
DoDI                   DoD Instruction
DOEHRS                 Defense Occupational and Environmental Health Readiness System
DOEHRS-IH              Defense Occupational and Environmental Health Readiness System-
                       Industrial Hygiene
DOORS                  Dynamic Object-Oriented Requirements System



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Acronym/Abbreviation                                  Definition
DPMIAC                 Defense Pest Management Information Analysis Center
DWMMC                  Deployed Warrior Medical Management Center
E&M                    Evaluation and Management
EDIPN                  Electronic Data Interchange Patient Number
EHR                    Electronic Health Record
EIC                    Electronic Information Carrier
EF                     Expeditionary Framework
FDA                    Food and Drug Administration
FHP                    Force Health Protection
FHP&R                  Force Health Protection & Readiness
FMP                    Family Member Prefix
FOC                    Full Operational Capability
FoS                    Family of Systems
GCSS                   Global Combat Support System
GEMS                   Global Expeditionary Medical System
GIG                    Global Information Grid
GIG ES                 GIG Enterprise Services
GOTS                   Government off-the-shelf
HAG                    High Assurance Guard
HCD                    Healthcare Delivery
HCFA                   Health Care Finance Administration
HDD                    Health Data Dictionary
HEAR                   Health Evaluation, Assessment, and Review
HIPAA                  Health Insurance Portability and Accountability Act
HL7                    Health Level 7
HMS                    HIV Management Service
HMSL                   HIV Management Service Loader
HSSD                   Health Service Support Division
IA                     Information Assurance
ICD                    Interface Control Document
ICDB                   Integrated Clinical Database
ICD-9                  Interface Control Document, Ninth Revision
ID                     Identification
IE                     Internet Explorer



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Acronym/Abbreviation                                  Definition
IEC                    International Electrotechnical Commission
IEEE                   Institute of Electrical and Electronic Engineers
IIS                    Internet Information Server
IM/IT                  Information Management/Information Technology
IOC                    Initial Operating Capability
IP                     Internet Protocol
IPM                    Integrated Pest Management
I&RTS                  Integration and Runtime Specification
ISO                    International Standards Organization
ISSO                   Information Systems Security Officer
ITV                    In-Transit Visibility
J4                     Joint Staff
JCIDS                  Joint Capabilities Integration and Development System
JFCOM                  Joint Forces Command
JMAR                   Joint Medical Asset Repository
JMAT                   Joint Medical Analysis Tool
JMeWS                  Joint Medical Workstation
JPTA                   Joint Patient Tracking Application
JRCAB                  Joint Readiness Clinical Advisory Board
JROCM                  Joint Requirements Oversight Council Memorandum
JTAV                   Joint Total Asset Visibility
JTF                    Joint Task Force
Lab                    Laboratory
LARMC                  Landstuhl Army Regional Medical Center
LDDB                   Light Duty Data Base
LERSM                  Lower Echelon Reporting Surveillance Module
LMIT                   Lockheed Martin Information Technology
MAIS                   Major Automated Information System
MAMC                   Madigan Army Medical Center
MAT                    Medical Analysis Tool
MDAC                   Microsoft Data Access Component
MDAP                   Major Defense Acquisition Program
MEDIC                  Medical Environmental Disease Intelligence and Countermeasures
MedLog                 Medical Logistics



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Acronym/Abbreviation                                  Definition
MEDLOG
Med                    Medication
MEDPAR                 Medical Patient Accounting & Reporting
MEDREG                 Medical Regulating
MHS                    Military Health System
MNS                    Mission Needs Statement
MPI                    Master Patient Index
MPL                    Master Patient Locator
MS                     Microsoft
MSA                    Medical Situation Awareness
MSMR                   Medical Surveillance Monthly Report
MSS                    Medical Surveillance System
MTF                    Medical Treatment Facility
NCHP                   Navy Central HIV Program
NCSC                   National Computer Security Center
NIC                    Network Interface Card
NIPRNet                Non-secure Internet Protocol Router Network
NNMC                   National Naval Medical Center
NSS                    National Security Systems
OCONUS                 Outside the Continental United States
OEF                    Operation Enduring Freedom
OIF                    Operation Iraqi Freedom
OPLAN                  Operations Plan
ORD                    Operational Requirements Document
OS                     Operating System
OTC                    Over-the-Counter
PC                     Personal Computer
PCM                    Primary Care Manager
PDA                    Personal Digital Assistant
PDF                    Portable Document Format
PEM                    Patient Encounter Module
PHD                    Public Health Deployed
PIC                    Personal Information Carrier
PKC                    Problem Knowledge Couplers



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Acronym/Abbreviation                                   Definition
PMI                    Patient Movement Item
PMITS                  Patient Movement Item Tracking System
PMO                    Program Management Office
PMR                    Patient Medical Record
PPDS                   Pre-/Post-Deployment Survey
PS                     Performance Specification
PSR                    Patient Safety Reporting
PVF                    Patient View File
Rad                    Radiological
RAID                   Redundant Array of Independent Disks
RTM                    Requirements Traceability Matrix
SA                     System Administrator
SAM                    System Administration Manual
SAMS                   Shipboard Non-Tactical Automated Data Processing Program
                       Automated Medical System
SCR                    Software Change Request
SDD                    Software Design Description
SFUG                   Security Features User’s Guide
SIG                    System Installation Guide
SIPRNet                Secret Internet Protocol Router Network
S/O                    Subjective/Objective
SOA                    Service Oriented Architecture
SOAP                   Simple Object Access Protocol
SP                     Service Pack
SPR                    System Problem Report
SQL                    Structured Query Language
SRS                    Software Requirements Specification
SSAA                   System Security Authorization Agreement
SSDD                   System/Subsystem Design Description
SSN                    Social Security Number
SSS                    System Subsystem Specification
STEM                   Storage Transfer Encapsulation Method
STIG                   Security Technical Implementation Guide
TAMMIS                 Theater Army Medical Management Information System




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                                                         SAIC D/SIDDOMS Doc. D3-TMIP-5017A
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Acronym/Abbreviation                                 Definition
TC2                    CHCS Caché
TCAM                   TAMMIS Customer Assistance Module
TCB                    Trusted Computing Base
TCSEC                  Trusted Computer System Evaluation Criteria
T-DBSS                 Theater-Defense Blood Standard System
TEM                    Theater Epidemiological Module
TFM                    Trusted Facility Manual
TMDS                   Theater Medical Data Store
TMIP-J                 Theater Medical Information Program-Joint
TOM                    Theater Occupational Module
TRAC2ES                TRANSCOM Regulating and Command & Control Evacuation
                       System
TRANSCOM               Transportation Command
TTL                    Time to Live
TTT                    Time, Task, Theater
UIC                    Unit Identification Code
URL                    Universal Resource Locator
USACHPPM               United States Army Center for Health Promotion & Preventive
                       Medicine
USAMMCE                United States Army Medical Material Center, Europe
USC                    United States Code
USTRANSCOM             United States Transportation Command
WSE                    Web Service Extension




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