Managing the logistics needs of a brick-and-mortar military hospital, commonly referred to as a Medical Treatment Facility (MTF), does not compare to the operational environment experienced by an Army preparing for or at war. Functions traditionally performed by a U.S. Army Life-Cycle Management Command (LCMC) at the national level are the same functions performed locally by clinical experts such as medics, nurses, and maintainers within each MTF. An MTF procures what it requires when it requires it and decides how to acquire it. Thus, an MTF will broadly solicit local contracting for services and materiel, along with the liberal use of credit cards to facilitate the numerous and complicated tasks required to run a healthcare facility. Additionally, most of an MTF’s staff consists of DOD Civilians and contractors who are either full-time staff or service providers who perform specific tasks such as maintenance on radiographic equipment or the management of surgical sets on consignment.
MTFs are frequently visited by vendors who hold agreements with Defense Logistics Agency (DLA), local contracting, or vendors who seek to open contracts with the MTF. Since the logistics functions performed within an MTF are primarily local, the catalog data is also local. The MTF’s catalog data is directly populated in coordination with a clinical expert from the DLA or local vendors’ procurement records. Each MTF’s logistics operation is separate, causing an island stovepipe architecture with the medical supply system. The hospital’s non-enterprise business model is appropriate when managing an MTF since healthcare is dynamic and heavily reliant on the local economy. In contrast, the Army is staffed solely with Soldiers tasked with requisitioning and managing supplies, performing maintenance on medical equipment, or performing direct patient care in a wartime setting where copious contractor support in the forms of materiel, personnel, and information is simply not available.
For many decades, the medical logistics system has allocated substantial financial resources and countless person-hours to develop a host of logistics systems intended to bridge the logistics functions between the MTF and the operational force. Despite the number of resources provided, the medical supply system has been unsuccessful in fulfilling basic logistics functions such as maintenance, assemblage, or financial management for the tactical environment due to the absence of a single master data catalog. The medical supply system uses a set of unrelated or loosely related hard and software enablers with disparate lists of materiel offered from the DLA or a variety of local sources via the credit card or contracting; not a master standard enterprise catalog fully mapped from industry to requirement suitable for sustaining the Army at war. The Medical Communications for Combat Casualty Care is a hardware solution consisting of standalone laptops that support using a software package called the Defense Medical Logistics Standard Support (DMLSS) Customer Assistance Module (D-CAM). The D-CAM software synchronizes local product listings using a flat-file format with whatever host it is aligned to. For example, D-CAM can place orders to a single DMLSS or Theater Enterprise-Wide Logistics System (TEWLS) server; but not both or simultaneously because each server possesses a different catalog. When switching between platforms, the catalog within D-CAM must be reloaded to match its new host. The TEWLS application facilitates warehouse operations by receiving orders from D-CAM and passing those orders to the DLA for procurement. The Medical Material Mobilization Planning Tool (M3PT) is a separate web-based application that displays Army assemblages consisting of expendables, non-expendables, and durables.
The expectation is that an Army organization operating at the tactical level is to perform their inventory within M3PT; execute the order within D-CAM to address shortages and replenishment when the item is either consumed during combat or when the item reaches its expiration date; then maintain property accountability and perform maintenance operations within the Global Combat Support System-Army (GCSS-A). None of these systems, or the data they contain, communicate with each other, requiring manual reconciliations and qualitative analysis by a clinical expert between each process and computer system. This fractured logistics-computing umbrella of systems is called the Defense Medical Logistics— Enterprise Solution (DML-ES) portfolio and is coined “swivel chair logistics” by the customer.
Over the past decade, the medical supply system has trialed a concept called Central Medical Materiel Management to address the known gaps associated with its numerous non-standard catalogs. The goal is to collapse approximately 25 individual catalogs within the DMLSS environment into three to five “hub and spoke” environments within the continental U.S. The Defense Health Agency (DHA) also operates a standardization program to address the non-standard catalog that manages the MTF’s business model. Each MTF or, at best, each region operates its own standardization program with limited success because each MTF’s business model operates independently from each other. Suppose the DHA, along with the services, desires to develop a medical supply system that stretches between the MTF and operational forces. In that case, a close understanding of these two distinctly different business models should be fully understood before allocating additional resources to such an endeavor.
In the coming years, the DHA is positioned to unfold a new computer system named, LogiCole, which aims to refresh the DMLSS environment that facilitates the MTF’s logistics business model and may provide data sharing opportunities with the Army Enterprise Systems Integration Program and, consequently GCSS-A to develop what the medical logistician calls the “minimal viable solution.” If the medical supply system continues to maintain different catalogs propagated by numerous independently operated MTFs without a centralized catalog concept, the same stovepipe architecture experienced by the operational force today, will be the same experience in the future, no matter the computer system(s) employed.
The solution to the medical master data gap outlined within this article is first to recognize the distinct business differences between the MTF and the operational force; then collapse, in totality, the DML-ES portfolio within the operational force. Alleviate the national-level logistics burden from the medic, nurse, and maintainer within the operational force and develop a single robust LCMC capability within the AMLC to perform a disciplined clinically and technically driven item management function. This item management capability should cultivate a medical master catalog construct utilizing the Federal Logistics Information System. This will enable the Army logistics enterprise and its joint and combined customers to source materiel to support standard fielded medical technology and capabilities during war or when preparing for war within GCSS-A or any other logistics management system that utilizes the DOD’s data standards.
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Chief Warrant Officer 4 Kevin O’Reilly currently serves as the brigade maintenance officer for the 65th Medical Brigade. He has deployed to Iraq and Afghanistan with the 82nd Airborne Division 44th Medical Brigade; and 1st Medical Brigade; He served as the Chief for the Equipment Management Branch at the Kimbrough Ambulatory Care Center in Fort Meade, Maryland, and in Landstuhl, Germany. He holds a master’s in data analytics and a doctorate in business from the University of the Incarnate Word.
Chief Warrant Officer 3 Dae Kim is the property book officer for the 65th Medical Brigade. Kim has deployed to the United Arab Emirates with the 108th Air Defense Artillery Brigade, Iraq, the U.S. Army Security Assistance Command, and the 10th Mountain Division. Kim holds a master’s in business administration from Fayetteville State University, North Carolina.
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This content is published online in conjunction with the Summer 2022 issue of Army Sustainment.
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