Since 1775, America's military medical personnel have supported America's sons and daughters, caring for them at home and putting their own lives on the line beside them in battle. Army Medicine's core business has always been health readiness. To achieve our mission, we are national leaders in medicine, dentistry, medical research, education and training, and public health. Although persistent conflict presents great challenges to health readiness, Army Medicine continues to focus on four enduring priorities: combat casualty care; readiness and health of the Force; a ready and deployable medical Force; and the health of Families and Retirees -- our partners in health.

We have made great strides leading the Army's cultural change towards a more ready and resilient Soldier, powered by the Performance Triad of sleep, activity and nutrition. In the coming year, Army Medicine will continue transforming from a healthcare system to a System for Health (SfH), and on its journey to become a High Reliability Organization (HRO).

UNWAVERING DEDICATION TO ENDURING MISSIONS

Warrior Care. Significant investment in the Warrior Care and Transition Program (WCTP) produced an unprecedented 45% return-to-duty rate. As the wounded, ill and injured populations continue to decline, right sizing the WCTP footprint ensures we will meet population needs while sustaining high-quality care. When Soldiers are unable to return to duty, Army Medicine is dedicated to a seamless transition by collaborating with the Department of Veterans Affairs (VA) to standardize and reduce variance within the Disability Evaluation System. These improvements not only benefit our Soldiers and their Families, but also maintain the overall health readiness of our total Force enabling the Army to fully support future engagements.

Behavioral Health (BH). The majority of our Soldiers have been extremely resilient during the longest period of conflict in our Nation's history. However, Army Medicine is keenly aware of the unique stressors facing Soldiers and Families today, and continues to address these issues on several fronts. We invest over $300M each year to support and sustain BH initiatives to take care of our own, physically and emotionally. These include 11 standardized clinical programs within our Medical Treatment Facilities; up to 65 Embedded BH teams that provide targeted care in close proximity to Soldiers' unit areas; and the Behavioral Health Data Portal that collects clinical outcome metrics at every outpatient visit. The Army's BH system identifies issues early, delivers evidence-based treatment, and leverages resources across the Army community to decrease stigma, suicide risk, and other adverse events.

Army Medicine implemented the Child and Family Behavioral Health System (CAFBHS) in response to the significant national shortage of child and adolescent BH providers. The CAFBHS collaborates with primary care teams, embeds BH providers in on-post schools, and leverages regional tele-consultations. Through 2017, CAFBHS will increase to 381 BH providers supporting 107 schools across 32 installations to deliver comprehensive BH support to Army Families.

Traumatic Brain Injury (TBI). The TBI Program continues to build on innovations, partnerships and research to better identify, treat and track concussions, in deployed and garrison settings. Army Medicine manages the largest portfolio of TBI research in the world, with an investment of over $800M since 2007.

Additionally, we are leveraging partnerships, with the Defense Centers of Excellence for Psychological Health and TBI, our sister Services, and the VA to translate research into guidelines, products, and technologies. In addition, through collaborations with the National Football League and the National Collegiate Athletic Association, Army Medicine is increasing awareness and scientific knowledge, and changing the culture regarding brain injuries not only on the battlefield but also at home. These collective efforts will ensure Soldiers without injury can stay in the fight, while those who are diagnosed are effectively treated to preserve their future health.

Telehealth (TH). TH is the use of telecommunications and information technologies to connect people to healthcare across distance. TH in the Army can be traced back to the early 90's when the Army pioneered its first satellite-based TH system in Somalia. TH revolves around one core concept -- connecting health globally to increase readiness, access, quality, and patient safety. TH helps Army Medicine distribute its medical capacity effectively across the world, leveraging clinical expertise when and where it is needed without having to physically move providers or patients.

Army TH currently provides clinical services across the largest geographic area of
any TH system in the world, civilian or military, including 18 time zones in over 30 countries and territories. During FYs 08-14, TH provided over 150,000 patient encounters and provider consultations in garrison and operational environments across 30 specialties. In FY15, Army Medicine is expanding TH to create a Connected, Consistent Patient Experience (CCPE). The CCPE is an innovative three-year expansion plan that creates a 360-degree care continuum around patients using advanced TH modalities.

Sexual Harassment/Assault Response and Prevention (SHARP). As an integral participant in the Army's SHARP program, Army Medicine continues to be at the forefront of the management, regulatory guidance and oversight of care for all sexual assault victims. Regardless of evidence of physical injury, all patients who allege sexual assault receive comprehensive and compassionate treatment by highly trained and certified Sexual Assault Medical Forensic Examiners (SAMFEs) within our Military Health System or by agreement in a local facility, followed by a care plan based upon the patients' input and needs, and developed by a designated multi-disciplinary group of healthcare providers including Sexual Assault Response Coordinators and Victim Advocates.

TRANSITIONING FROM A HEALTHCARE SYSTEM TO A SYSTEM FOR HEALTH (SFH)

Army Medicine has made great progress over the last three years in our transition from a healthcare system--a system that primarily focused on injuries and illness--to an SfH that promotes health, prevention and wellness as critical enablers of readiness. Army Medicine is a valuable partner in making our Force "Army Strong."

Performance Triad (P3). The Army must be prepared to win in a complex world even as it draws down. Yet, each day over 43,000 Soldiers, or the equivalent of 12 Brigade Combat Teams, are non-deployable due to medical profiles. Annually 10M duty days are limited or lost due to injuries or illnesses, of which 80% are preventable, and 1 in 20 active duty Soldiers fail the Army Physical Fitness Test.

To maintain a premier fighting force and influence the human dimension, the Army's P3 initiative provided training and tools to optimize human performance and enhance health readiness through sleep, physical activity, and nutrition. The P3 empowers leaders to support lasting cultural change through weekly instruction, competition, and the use of technology. The P3 also is reaching Family Members and Department of the Army Civilians, who also require a combination of physical, emotional, cognitive, and spiritual fitness to thrive.

A second P3 pilot program is underway in FY15 that will train up to 30,000 active duty Soldiers and their Families across U.S. Forces Command, and the U.S. Army Reserve and National Guard. In addition, Army Medicine initiated P3 pilots at the Army Medical Department (AMEDD) Health Readiness Center of Excellence and the Army Maneuver Center of Excellence. Plans are taking shape for eventual Army-wide implementation through the P3 University. The Army continues to invest in the P3 to achieve the collective vision set forth in the Army Warfighting Challenges, the Human Dimension, and the Ready and Resilient Campaign.

Medical Readiness Assessment Tool (MRAT). To enhance Commanders' ability to affect health readiness, Army Medicine developed the MRAT. The MRAT enables proactive identification and management of risk factors affecting health readiness using "big data" already in place. It provides monthly, rapidly-accessible, health readiness-related metric reports on Army units using a systematic format that does not require local data management. The chief goal of the MRAT is to provide early interventions to preserve unit readiness. Within the constraints of Health Insurance Portability and Accountability Act and privacy rules, the MRAT provides leaders and clinicians a powerful tool for mitigating factors that threaten individual medical readiness. MRAT is currently being rolled out to Army and Army Medicine leaders.

High Reliability Organization (HRO). Army Medicine has been on a longstanding, continuous journey to become a HRO and serve as a National example for its culture of safety in healthcare. A HRO is committed to achieving zero preventable harm in an environment marked by risk factors and complexity. The success of a HRO relies on leadership, a culture of safety, and robust process improvement initiatives. These contribute to enhanced efficiencies, more effective healthcare delivery, and improved patient outcomes.

The 2014 Military Health System Review on access, quality, and safety clearly validated that our transformation to a HRO is on the correct course. Even though Army Medicine provides high-quality care that is safe and timely compared to the best civilian healthcare facilities, we are not satisfied and will continue to strive to lead American healthcare. Over the next year, transparency will be increased regarding patient safety metrics so our patients and external stakeholders can measure our system against the best in the Nation. The journey to become a HRO is continuous and the AMEDD will continue to relentlessly pursue zero preventable harm.

CONCLUSION

Our medical force has remained ready and deployable, leveraging lessons learned in theater to improve care in garrison, and using evidenced-based practice and cutting-edge research to improve care delivered far forward. The increasing instability across the globe demands that we ensure the health readiness of our Soldiers, Retirees, Family Members and Army Civilians, while sustaining our ready medical force. Army Medicine delivers the health readiness required to "Win in a Complex World."