Education and Training Modernization is a Key Part of DoD Healthcare Restructuring

On October 1, 2019, the Defense Health Agency (DHA) assumed administrative and managerial responsibility from the Army, Navy, and Air Force for all military hospitals and clinics in the United States, as directed under the 2017 National Defense Authorization Act. This massive undertaking impacts thousands of military, civil service, and contractor personnel. It also necessitates the alignment and modernization of DHA education and training functions.

Today, the Military Health System’s workforce is trained and certified in a fragmented way. Dozens of different organizations offer a wide array of learning and development opportunities that are delivered using classrooms, simulation programs, digital learning tools, practice-based instruction, and many other methods. DHA is harmonizing these for consistency and taking steps to ensure data interoperability across the new enterprise. The modernization effort also aims to provide interoperability among the training organizations and educational technologies serving the DHA workforce. This will allow detailed learner data to be shared among stakeholder organizations to support improved metrics, enable enterprise-wide analytics, and allow data-driven decisions.

The DHA program is a “major effort to modernize the way we deliver and assess learning for the warfighter in their areas of operation,” according to Timothy Welch, an instructional technologist at the Naval Air Warfare Center Training Systems Division (NAWCTSD) who is supporting DHA. “This means a move out of the web-based learning management systems we have relied on for 20 years.”

To realize this vision, DHA has teamed with NAWCTSD to define the requirements and specifications for the DHA learning ecosystem. In 2019, NAWCTSD analyzed DHA’s existing systems, practices and infrastructure, as well as the operational goals for the Military Health System. Then NAWCTSD personnel began designing an overarching data strategy for DHA education and training.

With support from the ADL Initiative, DHA and NAWCTSD are adapting the Total Learning Architecture (TLA) as the core of this data strategy. The TLA is a framework of commercial standards, technical specifications, and business rules to ensure that learner data resources can be used, shared, and moved efficiently across an enterprise. The TLA specifications, along with other TLA architectural documents and results from the ADL Initiative’s TLA performance benchmark testing, helped to inform the DHA effort.

The DHA ecosystem includes a mix of legacy and newly developed services and applications. These were analyzed and found consistent with the overall TLA architectural approach, which was deliberately designed to accommodate the migration of heterogenous legacy technologies into an interoperable ecosystem. The TLA establishes a common data language for siloed education and training systems. Learner data created or transformed by different “learning activity providers” can be shared with other providers and with applications that support analytics, human resource functions, and other talent management activities throughout the DHA enterprise.

Building on the TLA work, NAWCTSD researchers were able to develop requirements for the Military Health System that: 1) provide an integrated and enterprise-wide education, training and human performance infrastructure; 2) provide a data-driven framework for education and training; 3) enable lifelong, blended, data-driven, and responsive training; 4) facilitate continuous competency maintenance; and 5) expedite the health system’s transition into a high-reliability, rapid-learning organization.

“In the DHA TLA effort we look to create a continuous pathway of learning from the operational environment to clinical practice and back again,” said NAWCTSD’s Welch. The DHA project is an example for how to knit this data topology across organizational boundaries using a system-of-systems approach proven effective in multiple domains over several decades of research.

Additional steps for the DHA TLA project include ADL Initiative support for performance assessment measures, competency framework development, credentialing strategies, and the use of ADL Initiative and USALearning “sandbox” resources for testing and evaluating DHA’s implementation of TLA tools.

For DHA, this transformation has great potential to increase readiness, improve patient outcomes, and promote overall efficiency of DoD’s health system while reducing costs. For the ADL Initiative, with its mission to modernize and expand digital learning, this effort is especially relevant because DHA’s systems and services thread throughout the DoD. DHA’s implementation of the TLA and its attendant technologies will help pave the way for their broader adoption by other DoD organizations.