Fiscal Year 2016 Joint Warfighter Medical Research Program (JWMRP) Priority Areas: This proposal addresses the needs of at least two JWMRP Areas: The Combat Casualty Care Research Program and the Health Informatics and Health Information Technology Portfolio of the Medical Simulation and Information Sciences Research Program. These programs include work that uses advanced technology to create solutions for improving the care and outcomes for injured Warfighters in field medical care facilities and to bring a range of healthcare data and technology-driven solutions to implementation for military medicine.

Objectives and Rationale for Proposed Research: The MD PnP Program proposes to develop a software system that integrates data from different medical devices used with critically injured patients (e.g., devices that measure blood pressure, heart rate, respiratory rate, etc.) to enhance clinical decision-making in real time. This system will be based on software we developed over five years and which has been freely available to anyone who wants to use it; the version we develop for this project will be customized for the wounded Warfighter. We will develop several prototype apps, including clinical apps that can speed up clinical assessment and improve the medic's awareness of each patient's situation when caring for multiple soldiers in the field, and technical apps for identifying and troubleshooting equipment failures or similar problems. We will test these apps in field training exercises and improve the decision-support system based on feedback. We will develop processes and software tools for testing and certification of the integrity and effectiveness of device integration and of the security of medical devices and apps as they are networked together, and we will build out our vendor-neutral MD PnP Lab as a test lab for performing commercial testing and certification. We will work with military and civilian clinicians, federal agencies, medical device manufacturers, and other stakeholders through workshops to define medical device integration success metrics and standards, and to build consensus on how to identify, analyze, and mitigate threats related to cyber security of data and data transmission in networked medical device systems. We will develop a business plan that enables us to commercialize the provision of these testing and certification services to government and industry as they develop integrated medical device systems and apps.

Applicability of the Research: While the initial application is aimed at critically injured Warfighters, the research results will be equally valuable to many patients in other military healthcare environments as well as injured civilian patients, especially those needing medical evacuation transport from the site of an accident or those involved in mass casualty situations. The same principles of integrating data from multiple devices to improve clinical decision-making apply in many other high-risk clinical situations, such as using the data from medical monitors to prevent patients on receiving infusions of morphine from accidentally overdosing.

Projected Timeline: We expect to demonstrate the effectiveness of the clinical decision-making system and apps within the first 2 years of the project, and to pilot our testing and certification program during Years 3 and 4, while continuing to refine and expand our business plan for commercialization.

Relevance to the Healthcare Needs of Military Health System Beneficiaries: This research is relevant to the full spectrum of medical care for military personnel, from Warfighters in the field to active-duty Soldiers on the home front to Veterans, and the families of all of these. The real-time clinical decision support system is first intended to provide improved field support for wounded Warfighters in terms of care and early identification of deteriorating or increased-risk conditions. The same capabilities will be relevant to other military personnel and civilians who experience critical injury that requires evacuation or treatment in place (e.g., mass casualty situations, life-threatening accidents, etc.). The needs for threat mitigation for medical data and data transmission are the same.