Verification and Improvement of the Medical Readiness and Reporting System (MRRS)

LCDR Wayne F. Homan Faculty Advisor: Dr. Jamie Pomeranz

Preceptor: Dr. Illy Dominitz

11 April 2014

Financial Disclosure

• Wayne Homan has no affiliation or financial interest/relationships with any corporate organizations that may be mentioned in this presentation

Commercial Support Acknowledgment/Disclosure

• Commercial support was not used for this presentationWayne Homan has acknowledged and verbally disclosed to the

participants that commercial support was not used for this presentation

• Unlabeled/investigational products and/or services will not be mentioned in this presentation

Caveats

• I speak in acronyms quite a bit. If I do this too much please remember to ask me in the Q&A

• Any opinions I might express are mine alone and do not necessarily represent those of the United States Government, Department of Defense, or the Department of the Navy

Competencies

• CPHC=Core Public Health Competency• PHPC=Public Health Practice Competency• CPHC 1: Monitoring health status to identify and solve community

health problems• CPHC 5: Developing policies and plans that support individual and

community health efforts• CPHC 6: Using laws and regulations that protect health and ensure

safety• PHPC 5: Demonstrate the principles of problem solving and crisis

management• PHPC 11: Identify, retrieve, summarize, manage and communicate

public health information• PHPC 13: Monitor and evaluate programs for their effectiveness

and quality

Objectives

• Background

• Methods

• Results

• Discussion

• Implications

Background-Organization

• Marine Infantry Division Organization

• Battalion (~1000)

• Regiment (~5 Bns)

• Division (~22000)

• Equivalent

• Surgery Dept

• Directorate of Surgical Services

• Hospital

Background-Nomenclature

• Marine Division/Battalion Organization

• G1/S1 Administration• G2/S2 Intelligence• G3/S3 Operations• G4/S4 Logistics• G5 Strategy and Plans• G6/S6 Communications

Background-Nomenclature

• Marine Division/Battalion Organization

• G1/S1 Administration• G2/S2 Intelligence• G3/S3 Operations• G4/S4 Logistics• G5 Strategy and Plans• G6/S6 Communications

Background-Military Public Health

• Military members from the five services have basic public health requirements *

• There are a battery of immunizations, training, and health parameters that are common to all members-Examples: tetanus, diphtheria, hearing conservation, tuberculosis status

* CPHC 6: Using laws and regulations that protect health and ensure safety

Background-Marine Public Health

• Some occupations have unique public health requirements *– Examples: ionizing radiation workers, food handlers, special

warfare

* CPHC 6: Using laws and regulations that protect health and ensure safety

Background-Marine Public Health

• Finally, some members have unique public health requirements based on their location/deployments *

• Each area of deployment usually has one or more special requirements– Examples: deployers to CENTCOM-anthrax, deployers to

PACOM-JEV

* CPHC 6: Using laws and regulations that protect health and ensure safety

Background-Marine Public Health

• Tracking all of these requirements is arduous and manpower intensive

• In the early 2000’s the military contracted to create a database system that would track the medical status of everyone automatically

• The electronic system developed and rolled out in 2006 was the Medical Readiness and Reporting System (MRRS) *

* CPHC 1: Monitoring health status to identify and solve community health problems

Background-Questions Arise

• Is MRRS actually giving us a clear picture on the readiness of the Division?

• Much anecdotal information that MRRS could not be trusted– This led to Battalions reworking the data by hand each week– Very manpower intensive

• If true, what can be done to fix the problem?

• Bottom line: are the numbers we tell the General every week correct or not?

Description of Methods

• A Lean Six Sigma (LSS) project was initiated by the Division Surgeon under the direction of Wayne Homan *– Most likely to last for years with multiple sub-projects

• Eight core participants (four officers, three enlisted, one civilian)

• Tasked with validating and improving MRRS to more accurately provide information to the commanders **

• Progress reported biweekly to MGen Nicholson ***

*** PHPC 11: Identify, retrieve, summarize, manage and communicate public health information

* PHPC 13: Monitor and evaluate programs for their effectiveness and quality ** PHPC 5: Demonstrate the principles of problem solving and crisis management

Description of Methods

• Step #1 Stake holder determination

Individual Battalion Surgeons (22)

Individual Battalion Commanders (22)

Division Surgeon

Division Commander

Marine Corps?

Description of Methods

• Step #2 Apply LSS methodology (DMAIC)

– Define

– Measure

– Analyze

– Improve

– Control

Description of Methods-Define

• Define

Description of Methods-Define

• Define

Description of Methods-Define

• Medical Readiness and Reporting System (MRRS)• Definitive database for medical readiness• Reports from G4/S4; medical unit where Marine is physically

located is usually responsible for maintaining

• Marine Corps Total Force System (MCTFS)• Definitive database for personnel assignment• Reports from G1/S1; base is responsible for maintaining

• Marine Online (MOL)• Definitive database for daily accountability• Reports obtained from Bn 1stSgts; G1/S1 responsible for

maintaining

Description of Methods-Measure

• Measure

– The most important MRRS input (initially): MCTFS

– Over several successive weeks data was collected from MRRS, MCTFs, and MOL

– Each database was then compare to the others for errors using Access

– Personnel were matched by first name, last name, and unit

Description of Methods-Measure/Analyze

• Measure

– MCTFS vs. MRRS consistently showed an error rate of ~20%

– After several weeks the validity of MCTFS started to look suspicious

– Therefore names in MCTFS and MOL were added together then compared to MRRS

• This should provide us with the best possible readiness number

– Each database is further complicated by Marines/Sailors that are deployed, on temporary assignment, deceased, in the brig, etc.

Results-Analyze

Report Date MRRS Total MCTFS Total MCTFS/MRRS Match % MCTFS/MRRS Match

MCTFS 1/29/2014 19975 22002 17744 80.6

MCTFS 1/31/2014 19825 21992 17669 80.3

MCTFS 2/3/2014 19820 22063 17595 79.8

MCTFS 2/18/2014 19877 22119 17464 78.9

MCTFS 2/25/2014 20107 22297 17648 79.1

MOL/MCTFS 2/28/2014 20110 22269 18986 85.2

MOL/MCTFS 3/4/2014 20142 22262 18875 84.8

MOL/MCTFS 3/18/2014 20149 22344 19129 85.6

MOL/MCTFS 4/2/2014 20335 22511 18053 80.2

MCTFS Avg MOL/MCTFS Avg

79.74 83.95

Results-Analyze

1/29

/201

4

1/31

/201

4

2/2/

2014

2/4/

2014

2/6/

2014

2/8/

2014

2/10

/201

4

2/12

/201

4

2/14

/201

4

2/16

/201

4

2/18

/201

4

2/20

/201

4

2/22

/201

4

2/24

/201

478

78.5

79

79.5

80

80.5

81

Series1

2/28

/201

4

3/3/

2014

3/6/

2014

3/9/

2014

3/12

/201

4

3/15

/201

4

3/18

/201

4

3/21

/201

4

3/24

/201

4

3/27

/201

4

3/30

/201

4

4/2/

2014

77

78

79

80

81

82

83

84

85

86

87

Series1

MCTFS vs. MRRS Avg

79.74

MOL/MCTFS vs. MRRS Avg

83.95

Discussion

• As part of the initial meetings an error rate of 95% was deemed acceptable

• Analysis shows that MRRS has a significant error rate

• The error rate is at best ~17% and is most likely ~20%

• One additional finding as we progressed was that the Corpsmen maintaining the MRRS database need to be trained. No two Corpsmen manipulate the database in the same way -> leads to errors *

* CPHC 5: Developing policies and plans that support individual and community health efforts

Implication

• MRRS shows significant error rates when compared to actual Marines/Sailors in the units

• MRRS is one of the data points used by commanders to determine which units respond to military emergencies– Could lead a commander to deploy the wrong unit– Wastes money by making Marines/Sailors receive unnecessary

care

• Further study has been initiated to determine which database is introducing the most error (microanalysis)– Database to be fixed first

Implication

• Significant errors may exist in other databases that are considered “definitive” by the Marine Corps

• Possible Headquarters Marine Corps interest

– Big bucks?

• Are there lessons to be learned as the United States struggles to shift to a preventive healthcare model?

Questions ?