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DHA symposium brings together minds to get the most out of research dollars

Navy Vice Adm. Raquel Bono, director, Defense Health Agency, addresses attendees of the Return On Investment Symposium, Oct. 11, 2017, at the National Oceanic and Atmospheric Administration building in suburban Washington, D.C. (Courtesy photo) Navy Vice Adm. Raquel Bono, director, Defense Health Agency, addresses attendees of the Return On Investment Symposium, Oct. 11, 2017, at the National Oceanic and Atmospheric Administration building in suburban Washington, D.C. (Courtesy photo)

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Research and Innovation

FALLS CHURCH, Va. — On Wall Street, measuring return on investment is pretty straightforward: You invest a certain amount of money and get back either more or less than you put in. Results aren’t so clear cut for military medicine.

“With health care, it’s a challenge. What does it mean to optimize the care we’re giving within the Military Health System, and how do we translate that to the support we give to operational forces?” said Navy Vice Adm. Raquel Bono, director, Defense Health Agency. “We’re … aiming to provide better health, better care at a lower cost. By investing in our people, that’s where we’re going to get the greatest returns.”

Bono opened the DHA-sponsored Return On Investment Symposium, Oct. 11, 2017, at the National Oceanic and Atmospheric Administration building in suburban Washington, D.C. The gathering brought together Military Health System experts in the medical and acquisition fields with their counterparts from other federal government agencies, academia, and private industry, to discuss how best to get the most out of taxpayer dollars going into care for warfighters. DHA’s director of research and development, Dr. Sean Biggerstaff, said returns in military health care are not primarily measured in dollars and cents.

“We’re not incentivized by cost savings,” said Biggerstaff. “Saving the life of one warrior is a big deal,” and he pointed to a number of products that have justified the costs of development by saving lives.

Navy Capt. Joseph Cohn, who works for Biggerstaff administering the DHA’s research program, pointed to a program he ran for the Defense Advanced Research Projects Agency about 10 years ago that changed training for information technology specialists. According to Cohn, it ended up saving the military billions of training dollars, but more importantly, it made the people who worked on the IT system better at their jobs in less time. Cohn recognized developing IT training is decidedly different from developing a new vaccine, but the principle is the same.

“At some levels, there are commonalities between approaches,” said Cohn.

Another example discussed at the symposium involved a system that uses vacuum pressure to decrease the amount of time for wound healing. Air evacuation crews commonly use the box-shaped devices. The problem is, the old, single-channel system could handle just one wound at a time, which meant it took several of the devices - costing $30,000 each - for patients with severe injuries, a common occurrence on the battlefield. Patients with multiple injuries could literally be covered with these devices, which also made it difficult for caregivers to treat their patient.

A new multichannel system, which costs $39,000 and can handle four wounds simultaneously, saves money and makes it easier for a doctor, nurse, or medic to treat the patient.

Air Force Lt. Col. Brandi Ritter recalled a case where seven single-channel devices had been used on a patient with multiple injuries, creating great difficulty for the caregiver who was trying to work around the devices to treat the patient. “The reduction to just two of these pumps, instead of seven, makes it much easier for him to take care of his patient,” she said. “And that’s why we’re here. We want to save lives and make their lives better.”

Biggerstaff also added that returns on investment don’t come immediately; it takes time to develop and deliver products with a science base intended for warfighter care.

Bono reiterated the importance of bringing together a group such as the one attending the symposium.

“We are looking to work and partner with all elements of all different sectors, because we realize within DoD, we don’t have all the answers,” she said. “We know there are other things going on out there that may actually mirror what we’re trying do here.” 

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DHA-PI 3200.01: Research and Development (R&D) Enterprise Activity (EA)

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This Defense Health Agency-Procedural Instruction (DHA-PI), based on the authority of References (a) and (b), and in accordance with the guidance of References (c) through (p): a. Establishes the Defense Health Agency’s (DHA) procedures for the Deputy Assistant Director (DAD), R&D to manage and execute, on behalf of the Assistant Secretary of Defense for Health Affairs (ASD(HA)), the portion of the Defense Health Program (DHP) Research, Development, Test, and Evaluation (RDT&E) appropriation assigned to it (referred to as the “DHP Science and Technology (S&T) Program)”. The DHP S&T Program includes Budget Activities (BAs) 6.1-6.3 and 6.6. The ASD(HA) provides policy, direction, and guidance to inform planning, programming, budgeting, and execution of the DHP RDT&E appropriation in accordance with statute, regulation, and policy in Reference (a). The DAD-R&D, and Component Acquisition Executive (CAE) manage and execute DHP RDT&E Program funds aligned to them on behalf of the ASD(HA). The CAE is responsible for managing BAs 6.4, 6.5, and 6.7 funding, as well as Procurement and Operations and Maintenance funding required to support DHP-funded Acquisition Programs, regardless of acquisition activity. b. Supports the Director, DHA, in developing appropriate DHA management models to maximize efficiencies in the management and execution of DHP RDT&E-funded activities carried out by the Combatant Commands (CCMDs), Services, Uniformed Services University of the Health Sciences (USU), Defense Agencies, and other DoD Components, as applicable. c. Codifies processes to confirm DHP RDT&E funds are applied towards medical priorities and aligned to ASD(HA) policy, direction, and guidance to develop and deliver innovative medical products and solutions that increase the readiness of the DoD medical mission in accordance with Reference (a). d. Supports the following objectives of the R&D EA: (1) Increasing the quantity, quality, and pace of medical research through improved programmatic organization, processes, and oversight. (2) Ensuring DHP RDT&E funded efforts align to ASD(HA) published program guidance that provides resourcing guidance and translates national, departmental, and Service priorities into specific program objectives. (3) Verifying alignment of DHP RDT&E funds to medical priorities and to ASD(HA) policy, direction, and guidance to ensure the development and delivery of medical materiel and knowledge solutions. (4) Facilitating coordination with the CCMDs, Services, USU, Defense Agencies, and other DoD Components, as applicable, to ensure DHP RDT&E funded activities address joint medical capability gaps, and avoid unnecessary duplication.

Guidance on the Establishment of a Human Cell, Tissue, and Cellular and Tissue Based Products Program

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This memorandum requests the Services resource a Human Cell, Tissue, and Cellular and Tissue Based Products (HCT/Ps) Program that complies with regulatory standards for management and oversight of HCT/Ps, according to the best fit for their Service.

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