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Armed Forces Health Surveillance Branch

View questions and answers about services offered by the Armed Forces Health Surveillance Branch.

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AFHSB FAQs
Q1:

What is the difference between the Defense Medical Epidemiology Database (DMED) and the Defense Medical Surveillance System (DMSS)?

A:

DMSS is a longitudinal, relational database of medical events (hospitalizations, outpatient visits, reportable medical events, immunizations and deaths), personal characteristics (rank, military occupation, demographic factors), and military deployments of all Army, Navy, Air Force, Marine and Coast Guard service members over their entire military careers. These data are captured for active components, and for reserve and guard members when utilizing the Military Health System (MHS)—or civilian health care if purchased through the MHS. DMSS also captures care provided to dependent and military retirees when utilizing the MHS or civilian healthcare if purchased through the MHS. >>Learn More about DMSS

DMED is a subset of DMSS and provides authorized users with queryable access to de-identified data limited to the active component of the U.S. Armed Forces. DMED can be accessed online or by downloading the DMED application. Most users will prefer to access DMED online. >>Learn More about DMED

Q2:

Who has access to DMED?

A:

DMED is available only for authorized users such as U.S. military medical providers, epidemiologists, medical researchers, safety officers and medical operations/clinical support staff responsible for surveying health conditions in the U.S. military. Civilian collaborators in military medical research and operations may also access DMED with documentation supporting their arrangements.

Q3:

What data sources are available in DMED?

A:

Demographic data (gender, age, race, grade and marital status) are provided by the Defense Manpower Data Center (DMDC), which receives updated data on a monthly basis from each service. The center also provides unit zip codes and Department of Defense (DoD) primary occupation codes, which allows for provision of data at the installation level and by occupational groupings.

Inpatient hospitalization data are provided by the Executive Information and Decision Support (EIDS) Program Office and are a subset of information from the Standard Inpatient Data Record, which receives inpatient treatment data. Standard Inpatient Data Record data are collected by the Composite Health Care System at each DoD medical treatment facility (MTF) and the outsourced (non-DoD hospital) inpatient health care provided to active duty service members. At the time of discharge, for each hospitalization of an active duty service member in a U.S. military hospital, up to eight diagnoses are recorded using standard diagnostic codes from the International Classification of Diseases, 9th Revision (ICD-9). The first diagnosis is generally indicative of the primary reason for admission and is the diagnosis code that is reflected in DMED.

Ambulatory data are provided by the EIDS Program Office. These data are a subset of the Standard Ambulatory Data Record, which records patient-level outpatient treatment data generated by the MTFs and the outsourced (non-DoD clinic) outpatient healthcare provided to active duty service members. Up to four diagnoses are recorded using standard ICD-9 diagnostic codes.

Reportable events data contains information on 70 reportable medical events. These data are reported to DMSS by the Medical Surveillance Centers run by the military services. Army reportable event data are available for calendar years 1995 to present. Navy and Air Force data are available from calendar years 2000 to 16 July 2012.

Q5:

Does AFHSB have access to other data not available in DMSS?

A:

Yes, other data resources include theater evacuations (TRANSCOM Regulating and Command and Control Evacuation System [TRAC2ES]).

Q6:

What kind of requests does AFHSB support?

A:

Primarily operational health surveillance.

Q7:

How do I request data from DMSS? What kind of information do I need to submit?

A:

Basic Requirements and Restrictions:

  • Anyone who requests data, analysis, or serum must be a military service member or government civilian employee working for a U.S. military organization.
  • The study/analysis must address a militarily relevant topic.
  • Unless an operational requirement is specified, the requester should be from the same organization or service as the population about whom the information is requested. Data summaries regarding members of the other services may be released only with the consent of the other services' public health leadership.
  • When operational requests involve information from a single authoritative data source and/or lack a health surveillance function, clients will be referred to the primary source of data archived in DMSS.
  • Physicians and other medical personnel involved in patient care may make specific individual requests using an Individual Clinical Data Request Form that can be obtained by calling the Epidemiology and Analysis division at (301) 319-3240.
  • Individuals with command authority over an outbreak investigation may make a request by using a tasking letter or memorandum with their signature and a clear description of the requested data and analysis plan.
Protection of Identifiers and Personal Health Information:
  • The AFHSB does not release personal identifying information or protected health information except in the following circumstances:
    • An Institutional Review Board/Human Use Committee–approved protocol (e.g., for chart reviews, patient interviews). In such cases, informed consent of each study subject is required.
    • Requests made by command authorities involved in conducting outbreak investigations, audits, or other operational investigations.
  • Operational health surveillance studies can be supported if all data and serum are irreversibly de-identified.

Minimum Information You Need to Provide Includes the Following:

  • Operational
    • Underlying question
    • Title/subject
    • Potential public health intervention
    • Date needed
    • Requestor name, organization, and authority
    • Population of interest (Army, Navy, Air Force, Marines, Coast Guard, All Department of Defense personnel and family members)
    • Component (Active, Guard or Reserves)
    • Population restrictions (deployed, trainee, etc.)
    • Time period (start and end)
    • Outcome of interest (counts and/or rates)
    • Case definition
    • ICD-9/CPT codes of interest (if applicable), diagnostic position (dx1, dx1-4, dx1-8, cpt1, cpt1-4, other)
    • Data fields of interest
    • Inclusion/exclusion criteria
  • Other studies
    • The study protocol must be submitted to AFHSB before submission to the military Institutional Review Board/Human Use Committee.
    • Protocols must contain a version number and date, which must be updated with each protocol change.
    • Identify the study population of interest.
    • Define the specific inclusion and exclusion criteria for case and/or control selection (if applicable).
    • Define the matching criteria for cases and controls (if applicable).
    • Specify the requirements for serum sample selection (if applicable).
    • Provide sufficient details on all required DMSS variables, their categorization, and handling of time-varying covariates.
  • Serum requests
    • Specific objectives pertaining to the use of the specimens
    • Serologic assays to be performed
    • Volume of serum required per assay to be performed
    • Specific requirements of the Department of Defense Serum Repository (DoDSR) (e.g., number, volume and delivery of aliquots)
Process Once You Provide the Information:
  • Operational requests for data are submitted via the requester's service liaison, the director of the Epidemiology and Analysis division or the assistant director.
  • All surveillance, public health practice, and other study protocol efforts will undergo formal review to determine if the activities are necessary and scientifically sound, and whether they constitute research involving human subjects or human anatomical substances.
  • Results of requests are usually sent via e-mail (preferably from ".mil" or ".gov," with encryption where appropriate) in the form of read-only spreadsheets or PDF documents. Identifiable, sensitive, or voluminous data may be sent via the U.S. Army Aviation and Missile Research Development and Engineering Center (AMRDEC) Web Application.
  • Any abstract, manuscript, or presentation resulting from the use of the DMSS data and/or DoDSR specimens shall be sent to AFHSB prior to publication for review of methodological accuracy. Non-compliance with this requirement may result in rejection of future requests.
  • Contact your service liaison for further assistance at (301) 319-3240.
Q8:

How does AFHSB provide data or serum that has been processed to eliminate a person's identity from being connected to the information?

A:

For data, a study identifier is generated in place of the Social Security number (SSN) and the date of birth is replaced with year of birth only; all dates are replaced with the number of days from a pre-defined reference date or as year and quarter; zip codes are provided only to the three-digit level; and locations are provided only at the region level.

For serum, a randomly generated serum identification number (10 characters beginning with "S" and followed by nine digits) is assigned. Temporary files that link original specimen numbers to serum IDs are used for this purpose. Serum IDs are printed on labels that are affixed to aliquot tubes.

Q9:

How do I contact my service liaison?

A:

To reach a service liaison, please call (301) 319-3240.

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

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