System for Occupational, Environmental Health Risks Goes Online in 2004

Jeff McClaflin, an industrial hygienist at the National Naval Medical Center in Bethesda, Md., has been part of a team that includes members of the Army, Navy, Air Force and other agencies working on the design of the system since 1998.

"The Gulf War illness question was the driver for our whole software development program," McClaflin said. "DOEHRS is designed to be able to answer questions like that." DOEHRS will provide individual longitudinal exposure records occupational and environmental exposure histories -- for all DoD personnel, both military and civilian.

When fully operational, DOEHRS will serve all three military departments.

DOEHRS will provide military leaders with a Web-based computer program. The program will support data collection, storage and analysis to give operational commanders risk-based information for tactical decision-making and occupational medicine professionals the kind of exposure data that can reduce future health risks to the military and civilian force.

As an occupational exposure database, DOEHRS will hold information on potentially harmful exposures primarily documented in paper files today. One example McClaflin pointed to is overexposure to noise.

"There's no way to look at the impact for hearing loss to all DoD affected personnel, or even across all of the Navy," McClaflin said. "If we're looking at noise exposure to sailors on the flight deck of an aircraft carrier, it's hard to pull that information together now."

Although DOEHRS will collect data on occupational exposures, its use won't be limited to industrial hygienists and bio-environmental engineers. Occupational health physicians, technicians, audiologists and nurses who want to track the effects of various exposures will use the information as a way to see the big picture.

"In the Navy, we have groups of professionals, industrial hygiene officers, preventive medicine officers and preventive medicine technicians that do a lot of work with deployed troops," McClaflin said. "In the Air Force, there are the bio-environmental engineers and their technicians who do a lot of the data collection. The Army has environmental science officers, preventive medicine officers and technicians that support the troops. Public health professionals will also be users."

McClaflin said part of the challenge in dealing with Gulf War illnesses was trying to answer the health questions with limited exposure data. After DOEHRS is fully fielded, he said, any similar situation would be easier to investigate.

"If we have folks sitting in a base camp, and we find out there's an environmental exposure associated with that location, then that information can be captured," McClaflin said.

When the people at that location are associated with that environmental data, the system will create an occupational exposure database record that experts can examine later if that group develops any health issues. The services will provide the technical resources for that kind of analysis.

"We have the Naval Environmental Health Center," McClaflin said, "similar to the Army's Center for Health Promotion and Preventive Medicine in Aberdeen, Md., and the Air Force's Institute for Operational Health at Brooks Air Force Base, Texas. They each have a group that would do the epidemiological analysis, looking at all of the collected data."

When in place, DOEHRS will tie a lot of valuable information together, McClaflin said. It will have an interface with the Composite Health Care System II, the military electronic medical record, and with the DoD Hazardous Substance Management System of the Environmental Information Technology Management Program.

McClaflin expects basic work on the DOEHRS program to be completed in the spring, allowing the system to begin deployment to sustaining base units, such as garrison locations, as early as June. The majority of DOEHRS capabilities will be added into the Theater Medical Information Program, an integrated suite of medical information systems that provide automated information management support in deployed environments.

TMIP is the medical component of both the Global Command and Control System and the Global Combat Support System. TMIP's Medical Surveillance System monitors medical treatment data to detect disease outbreaks and injury trends among deployed service members.

DOEHRS will add exposure data to that mix of information. As a component of Theater Medical Information Program, DOEHRS will support risk identification for environmental and occupational hazards among deployed civilian and military personnel.

"Where we document specific exposures to DoD personnel, we can assist commanders in making informed tactical decisions. And, we can provide specific medical surveillance and personal protection recommendations," McClaflin said. "That information can be transmitted to the operational commanders, as well as health care providers, so that they know what's going on in the workplace -- whether it's a deployment-type workplace or the industrial workplace where we're making parts for the aircraft carrier or plane."

McClaflin said he sees DOEHRS flexibility as a major asset. Aside from its applications to overseas deployments and industrial applications, the system could hold information that could be used to measure national readiness for homeland security.

"How many people at every installation are trained in (hazardous materials) response? How many have been issued respiratory protection? How many have appropriate chemical protective clothing? Just to be able to answer questions like that now, with a simple Web-based query, would be great." McClaflin said.

Even the actual data entry for the DOEHRS system will be cutting edge, he added. Industrial hygienists, doctors, nurses and other health care professionals will compile the longitudinal data in the course of doing their regular jobs, using the latest technology.

"We are transitioning from a pad of paper and note-taking in the field to a tablet (personal computer) with all the data collection forms on the tablet," McClaflin said.

"This means that while the person is collecting data at a base camp or industrial site, their critical reference databases will be there. They will be able to capture all the necessary information," he continued. "There will be no need to recreate their notes or any information they have collected. They will just input to their tablet, then plug it into a docking station in their office and upload to the web based system.

"And once it is completely operational," he said, "the value of the DOEHRS system will steadily increase as more and more data is entered into the system.

McClaflin said it will be a long-term, ongoing project.

"Just getting all the initial data collected for all of our initial work sites throughout DoD might take three to five years," McClaflin said.

However, once enough health, location and exposure data are loaded into the DOEHRS system, he said, it could make military service safer and reduce fears of illnesses from unknown causes.

(Austin Camacho works in the Defense Department's Deployment Health Support Directorate.)