DMLSS as Trailblazer

Written by Michael Burnett

If military medical treatment facilities require new equipment or supplies, the Defense Medical Logistics Standard Support (DMLSS) system knows exactly what to get and when.

A trailblazer in the integration of logistics support systems across the Department of Defense, DMLSS began rolling out defense medical sites around 1996 in the first of three major increments. The second increment followed around 2000 and the third began in 2003.

Each increment brought increased functionality for tracking—not only necessary supplies and pharmaceuticals, but also the life cycle of medical equipment and facilities, explained Dr. George Magee, acting DMLSS program manager.

“It has a broad range of functionality,” Magee said of DMLSS. “It manages the supply chain. It manages the ordering of the product, the distribution of both pharmaceuticals and medical surgical supplies within the medical treatment facility itself. It also manages the approval and ordering of medical equipment and the life cycle tracking of medical equipment.

“It manages the facility itself, so it has features to help manage the building and the installed equipment in the building,” Magee added. “It was one of the first systems in DoD to adapt commercial electronic data interchange and e-commerce. That allowed us to go to just-in-time features using prime vendors. So we get next day delivery of our products, which allowed us to drastically reduce inventory and eliminate warehouses.”

By DoD estimates, DMLSS has reduced procurement lead times from 45 days to two or fewer days, with 85 percent of items delivered in less than 24 hours. By saving time and reducing needs for space, DMLSS has contributed significantly to cost savings at DoD. According to the Military Health System, DMLSS returns $6.40 to taxpayers in benefits or costs savings for every dollar spent.

The Military Health System serves as the primary integrator for DMLSS, hiring contractor support to deal with specific facets of the system. At the time DMLSS first rolled out, DoD was beginning to examine corporate information management, looking at business practices and building systems around facilitating those practices, Magee said.

Over the years, DMLSS has grown to support 178 medical treatment facilities and about 19,000 users, extending into operations in Afghanistan and Iraq. The users include medical administration support staff and logistics personnel. Medical personnel such as doctors and nurses rely on the system, although it is invisible to them.

“It is designed to be transparent to the health care provider,” Magee said. “Physicians and nurses shouldn’t have to touch the system. We should have built a business process and the system should bring the supplies and make them available at their fingertips.”

Each of the services maintains operational control over their medical treatment facilities and thus their part of DMLSS, Magee said. Pooling resources across the military branches also has resulted in cost savings. The Military Health Service reports that e-commerce sales throughout the system increased from $744 million in fiscal 1997 to $2.4 billion in fiscal 2006. The services reaped price discounts of more than $185 million in fiscal 2006 due to their collective purchasing capabilities through DMLSS.

“As we look at what we have done and what we need to do in the future, one of the real keys to do a joint system is bringing the services together in a cooperative fashion and really looking at the business process and getting them to agree to a business process that you are going to implement with the technology. The technology piece is much simpler than the actual determination and agreement on a business process,” he said.

RFID

One of the latest efforts in the DMLSS program involves introducing radio frequency identification (RFID) tags to DMLSS shipments.

Currently, equipment and supplies ordered under DMLSS use a bar code system. A technician can go to a supply shelf, scan the bar codes, and DMLSS knows how many items are present and how many should be in stock. So the system will reorder low supplies and replenish them as necessary.

“Right now, RFID is just emerging in this particular commodity,” Magee said. “We are building the capability and working with the vendors who distribute the product to start using RFID. It already did that using bar code technology. When someone is on the loading dock receiving the product, they scan the bar code, match it with what was ordered, and then move it to the location where it is needed.” With RFID capability, facilities, manufacturers and distributors would use the technology to track receipt processing for pallets and cases that arrive at medical treatment facilities.

Implementing RFID in DMLSS is a top priority for the Military Health System in fiscal 2008. In the first quarter of fiscal 2008, the Military Health System plans to complete RFID capability coding development and development testing for RFID in DMLSS.

In the second quarter, the Military Health System plans to conduct formal operational testing with medical distributor Owens and Minor by processing electronic data interchange transactions from vendors to DMLSS. In the third quarter, the Military Health System seeks to deploy RFID within DMLSS to test sites at Fort Belvoir, Va., Bethesda Naval Medical Center, Md., and Dover Air Force Base, Del. In the fourth quarter, the agency will analyze the results of RFID deployment at the test sites to determine the effectiveness of changes in business processes at those sites.

Implementation at these test sites follows a successful pilot run by EDS Corp., headquartered in Plano, Texas, in fiscal 2006. The pilot tested the use of RFID in DMLSS and the best uses of RFID in a medical supply chain. It also evaluated the effort necessary to integrate RFID within DMLSS and the costs and benefits of using RFID.

The pilot ran in three phases, with the first phase focused on analysis of workflow processes and the selection of hardware and middleware for the project. The second phase addressed necessary software changes in DMLSS to support RFID technology. The third and final phase tested the application at Port San Antonio in Texas through installation of hardware and software, integration, data collection and operational analysis, according to EDS.

VENDOR SUPPORT

EDS is not the only vendor supporting DMLSS, although the company also helped develop the DMLSS custom software, which has been running on Microsoft Windows 2000. IBM and Akimek assisted in software development.

EDS received a $15 million contract in 2005 to continue support for information assurance, enhancement and upgrades; coordination of version control, architecture and infrastructure development; online help support; and customer service for DMLSS.

CACI International Inc. received a fiveyear, $16 million contract in April 2007 to support DMLSS at the Joint Medical Logistics Functional Development Center in Fort Detrick, Md. Under the contract, CACI provides support to define development requirements for DMLSS, including identification of requirements for enhancing DMLSS services and quality assurance and documentation. The contract encompasses business systems modernization, database expansion, integration of DMLSS into medical facilities, customer support, and a medical logistics function to assure supplies reach their destinations most efficiently, according to CACI.

“The Department of Defense award to support initiatives for medical facilities worldwide is gratifying, because it helps assure that critical medical supplies reach their destinations, from hospitals in the U.S. to field hospitals in combat zones. It’s one more facet of CACI’s continuing mission to support the nation in helping our warfighters,” said Jack London, CACI chairman, president and CEO, in a press release at the time of the contract award.

The joint contract to CACI for DMLSS support followed a five-year, $25 million contract from the U.S. Air Force to support its DMLSS operations. Under the Air Force contract, CACI provides comprehensive information technology support to the DMLSS Facility Management module (DMLSS-FM). The contract supports CACI personnel who support and standardize management of DMLSS-FM onsite at Air Force facilities. CACI also provides help desk services to troubleshoot DMLSS and computer-aided design expertise for updating medical facility drawings to Air Force facilities.

In addition, the military services have purchased Intermec 750 mobile computer systems that run DMLSS at various hospital facilities. The computers have integrated scanners that read the bar codes on the supplies and equipment ordered by the system.

The Military Health System will undoubtedly need additional software and hardware support for DMLSS, outside of its RFID needs, as the system expands in the future.

“We look to extend the reach both farther and closer to the actual clinical encounter with technology at the point of use, which is now beginning to consider embedding RFID capability, and interfaces with ancillary systems like pharmacy and radiology and other areas, so directly from the patient encounter, we get the information needed to run the logistics chain,” Magee said. ♦

“That will also allow us to glue information together between the resources used in an encounter in terms of the facilities, equipment and supplies, so that the cost associated with a given outcome can be viewed. We wouldn’t do that in the logistics system, but by getting closer to that encounter, we can make that information available in other decision support systems,” he said. ♦