DOD, VA Announce Joint Health Record Milestone

By Cheryl Pellerin and Army Sgt. 1st Class Tyrone C. Marshall Jr.

American Forces Press Service

NORTH CHICAGO, Ill.  – The Defense and Veterans Affairs departments announced a milestone in their effort to combine their health records in what will become the world’s largest electronic system by 2017, the secretaries of both departments announced here today.

Defense Secretary Leon E. Panetta and VA Secretary Eric K. Shinseki briefed reporters after a tour of the Capt. James A. Lovell Federal Health Care Center, the nation's first fully integrated DOD-VA medical facility treating service members, veterans, military retirees and dependents.

“Over the past two days, as many of you know, world leaders have gathered in Chicago to affirm our commitment to finishing the job right in Afghanistan,” Panetta said. “This afternoon, Secretary Shinseki and I are coming together to affirm what in many ways is an equally important commitment: to care for and honor those who have protected our nation by serving it in uniform.”

The center -- named for retired Navy captain and former NASA astronaut Jim Lovell, who was in the audience today -- amounts to a proving ground for the DOD-VA joint operating concept. It incorporates facilities, services and resources from the North Chicago VA Medical Center and the Naval Health Clinic Great Lakes.

“In response to a challenge issued [by President Barack Obama] three years ago, DOD and VA have been working steadily to increase the amount of health information that's shared between our two departments,” Panetta said.

What Obama envisioned in 2009 was an initiative called the virtual lifetime electronic record, or VLER, for the future of electronic health data sharing. Since that time, Panetta said, the centerpiece of the DOD-VA effort has been an effort to build an integrated electronic health record for service members and veterans that can be accessed at any DOD and VA medical facility.

Such an integrated electronic health record, or iEHR, is “one that is open in architecture and nonproprietary in design to expand information sharing, eliminate gaps between our two robust health care systems,” Shinseki said.

“This is key to seamlessness, critical to enhancing quality of health care, and essential to controlling costs,” he added.

“Today,” Panetta said, “I want to affirm that we are fully committed to putting this system, which will be the world's largest electronic health record system, in place across the nation in 2017.”

The project’s first milestone will come in 2014, the defense secretary said. At that time, the departments will field initial operating capabilities of the integrated electronic health record at test sites in San Antonio and in Hampton Roads, Va., where DOD and the VA provide medical care to thousands of service members and veterans.

The iEHR will unify the departments’ now-separate legacy electronic health records systems into a common, secure system that makes service members’ and veterans’ health information available to them throughout their lifetimes.

During a media roundtable held today, experts from DOD and VA explained what a difference the new joint electronic health records could mean in someone’s daily life.

“If a service member is seen in a DOD hospital and the next week has an appointment in a VA hospital, you’d like all of that information to be available to the VA doctor, just like they’re being seen in the same hospital,” Roger Baker, VA assistant secretary for information and technology, told reporters.

“That really is our concept here,” he said, adding that something interesting happened during the first pilot test of a nationwide health information network.

As the first health record was shared between a VA facility and a private-sector facility, he said, the private-sector doctor said, “I didn’t know the patient had that allergy.”

“It was an allergy the VA knew about, but that the patient hadn’t told his private-sector doctor about, and clearly those kinds of allergies can have a tremendous impact on quality of care,” Baker said. “That ability to have a more comprehensive record can do life-saving things, frankly.”

In 2014, when the systems are rolled out in San Antonio and Hampton Roads, Baker explained, records for patients in the VA before then will be as they were.

“If you’ve recently moved from active service into veteran status,” he added, “the most important thing you will notice is that your VA doctor has a lot more access to information about your previous medical care in DOD than he or she may have had in the past.”

Probably more importantly, he said, doctors will see that information side by side with other treatment the patient may have had in the VA system, so they’ll have a more complete view of the patient’s entire medical history.

Beth McGrath, a DOD deputy chief management officer, said that in Hampton Roads and San Antonio in the 2014 time frame, “the clinical capabilities we’re deploying first are focused on laboratory and immunizations.”

Both experts said the Defense Department has sufficient funding in its budget for the effort.

At the news conference, Panetta said implementing and testing the new system over a period of years “will help us make sure that we are doing it right and that we have time to adjust based on experience in the field.”

Program Offers Paid Training for Unemployed Veterans

By Karen Parrish

American Forces Press Service

WASHINGTON  – Unemployed veterans ages 35 to 60 can apply for up to 12 months of paid training through a new program sponsored by the Departments of Labor and Veterans Affairs.

The population the Veterans Retraining Assistance Program will serve is particularly in need, Curtis L. Coy, the VA’s deputy undersecretary for economic opportunity, said in an email interview. Of about 900,000 U.S. veterans who are unemployed, nearly two-thirds are between 35 and 60 years old, according to the Labor Department.

“The program was created to provide assistance to unemployed veterans … who are not covered by any of our education programs and need training or [an] education boost for today's high-demand occupations,” Coy said.

“They may have had entitlement to education benefits at one time, but have either used them or the time frame to use them has passed,” he added. “This generous new benefit geared toward this specific cohort of veterans provides them the opportunity to 'jump start' a new career that they may not have otherwise been able to afford.”

The program, which began today, provides 12 months of training assistance equal to the monthly full-time payment rate under the Montgomery GI Bill-Active Duty program, which currently pays $1,473 per month.

Participants must be enrolled in a community college or technical school program approved for VA benefits. The program must lead to an associate degree, non-college degree or certificate.

To qualify, a veteran also must:

-- Be unemployed on the day of application;

-- Have a discharge that is not dishonorable;

-- Not be eligible for any other VA education benefit program, such as the Post-9/11 GI Bill or Montgomery GI Bill;

-- Not receive VA compensation for being unemployable;

-- Not be enrolled in a federal or state job training program; and

-- Pursue a program that leads to employment in one of 210 occupations the Labor Department designates as high-demand.

The list of occupations, available on the VA website, includes jobs in construction, machine operation, transportation, preschool education, health care and many other fields.

The program will fund up to 45,000 participants between July 1 and Sept. 30, and an additional 54,000 participants from Oct. 1, 2012 through March 31, 2014. Labor officials said the department will offer employment assistance to every veteran who completes the program.

“The overall aim of VRAP is to help veterans attain personal and economic success,” Coy said.

The retraining program is funded under the VOW to Hire Heroes Act of 2011. The law expanded education and training for veterans, strengthened the Transition Assistance Program for service members returning to civilian life, and provides tax credits for employers who hire unemployed or disabled veterans.

Eligible veterans may call 800-827-1000 to learn more about the program, or visit the websites listed below. Applicants will receive a letter in the mail letting them know if they are eligible to participate, Coy said.

How to Find Support Resources in Your Community

By Corina Notyce, DCoE Strategic Communications

Hopefully you have heard the advice “reach out if you need help,” but would you know where to go to find it? Real Warriors Campaign’s latest article, “Finding Support Resources in Your Community,” offers a quick overview of several resources and support services offered locally and nationally to help you with reintegration challenges, employment, housing, counseling, education assistance and more.

For those dealing with traumatic brain injury or psychological health concerns, including combat stress and depression, connect with the DCoE Outreach Center. Looking for information at night or during the wee hours of the morning? The center is available 24/7 to help everyone—military or civilian. Trained health resource consultants can provide information and resources on topics including:

■Resilience programs

■Suicide prevention initiatives
■Family and relationship support
■Alcohol/substance use programs
■Health care system navigation
■Resources about traumatic brain injury and psychological health

The DCoE Outreach Center is a free resource you can access from your home confidentially. Call 866-966-1020, email resources@dcoeoutreach.org or log on to live chat from your computer or smartphone.

The National Resource Directory, a partnership between the Departments of Defense, Labor and Veterans Affairs, connects wounded warriors, service members, veterans, their families and caregivers to thousands of services and resources that support recovery, rehabilitation and community reintegration. Whether you’re looking for one reliable resource, or possibly a few, you can get as specific as you need to in your search—search by city, state or zip code for resources on:

■Benefits and compensation

■Education and training
■Employment
■Family and caregiver support
■Health
■Homeless assistance
■Housing
■Transportation and travel
■Volunteer opportunities
■Other services and resources

As new resources and services are added to the directory, be in the know by signing up to receive email updates. Additionally, you can connect with the directory through Facebook, Twitter and LinkedIn.

MilitaryHOMEFRONT, a Defense Department resource, provides information to help service members and families, leadership and service providers. One example is its downloadable listing of public and government service organizations to help identify and navigate support resources available to address military-related issues. You’ll find a description of each organization and a link to the organization’s website in the guide.

Specifically for veterans, the Department of Veteran Affairs has a network of community-based counseling facilities called Vet Centers. To find a Vet Center near you, search the Vet Center National Directory or call 877-WAR-VETS (927-8387). Vet Centers provide readjustment counseling, individually or in group settings, and outreach services to all veterans who served in a combat zone at no cost. Additional support services offered include:

■Bereavement counseling for families who experience the death of a loved one serving on active duty

■Military sexual trauma counseling and referrals
■Substance abuse assessment and referral
■Employment assessment and referral
■Screening and referral for medical and psychological issues including traumatic brain injury, depression and other psychological health concerns

Changing careers and need help? The Department of Labor’s CareerOneStop, offers employment information and resources specifically to help service members transition from military service to civilian employment. Check out the Key to Career Success section of the website as well as Veterans ReEmployment for employment, training and financial assistance. To find a One-Stop Career Center near you, visit America’s Service Locator.

Organization Reaches Out to Wounded Warriors

By Donna Miles

American Forces Press Service

WASHINGTON, April 19, 2011 – In what started out as a small pilot program, members of Disabled American Veterans, working with the Defense and Veterans Affairs departments, began visiting wounded warriors at Fort Bragg, N.C., to talk about benefits and services available to them after they leave active duty.

Now 40 DAV transition service officers have become regulars at 144 military installations participating in the joint VA-DOD Benefits Delivery and Discharge Program, which provides transition assistance to separating service members who incurred disabilities related to their military service.

DAV National Commander Wallace E. “Wally” Tyson called DAV’s contribution a vital link to the newest generation of disabled veterans.

“We want to get to those veterans before they are released from active duty so we can help get them on a path toward reinstituting a life for themselves and making sure they know what benefits are available to them and their families,” he told American Forces Press Service.

As partners in military transition assistance programs and disability transition assistance programs, DAV transition service officers conduct or participate in pre-discharge briefings, review wounded warriors’ treatment records on request and confer with Defense and Labor Department officials and other participants in the discharge process.

The program, Tyson said, enables DAV to help service members through the process of developing evidence, completing applications and prosecuting claims for veterans benefits administered under federal, state and local laws. But one of the biggest benefits of the effort, he added, is ensuring that separating service members don’t find themselves in a situation where their military benefits are discontinued and VA benefits have not yet started.

“I can’t overemphasize the value of the complete package,” agreed Ron Minter, DAV’s national service officer supervisor for Maryland. “When [transition assistance officers] have that opportunity, it allows more prompt service and a smoother transition and, to a greater degree, a seamless transition” from military to civilian life.

And even if transitioning service members may not feel the need for DAV support now, Tyson said, that initial contact lays important groundwork for future help, when and if it is needed. DAV’s outreach to wounded warriors about to make this transition is a natural extension of its historic mission to serve veterans with service-connected disabilities and their families, he said.

Robert S. Marx, a captain who had been wounded in the Meuse-Argonne Offensive in France in November 1918, is credited with founding DAV to serve disabled World War I veterans who returned home to little government support. Congress, impressed with its effectiveness, chartered DAV in 1932 as the primary advocate for disabled veterans.

Ninety-one years since its founding, Tyson said, DAV is as relevant today as it’s been at any time in its history. He noted the growing number of veterans of the wars in Iraq and Afghanistan who have joined its 1.2 million-member ranks, benefiting from its claims and benefits assistance and its voluntary services program.

DAV offers a broad range of services to disabled veterans, all at no charge, thanks in large part to an army of more than 14,000 volunteers. Some drive a fleet of more than 1,400 vans, transporting veterans to VA medical centers, supermarkets or even barber shops. Others volunteer their services at VA medical facilities and regional clinics.

In addition, a cadre of highly trained national service officers, all with wartime-service-connected disabilities, reviews veterans’ claims and ensures veterans know what benefits and services they’re entitled to.

During 2010 alone, they interviewed almost 185,000 veterans and their families, Tyson reported. As a result, they filed more than 250,000 new claims for benefits, obtaining $5.1 billion in new and retroactive benefits for the disabled veterans they represented.

In addition, DAV employs nine national appeals officers who represent disabled veterans before the VA’s Board of Veterans’ Appeals. Last year, these national appeals officers represented appellants in about 5,000 cases. Of those cases, Tyson reported, almost three-quarters resulted in the original decisions being overturned or remanded to regional office rating boards for additional development and re-adjudication.

In an effort to better support disabled veterans, DAV is increasing its outreach into rural areas and other areas where veterans traditionally have been underserved. During 2010, DAV’s 10 new mobile service offices traveled almost 115,000 miles and visited 815 cities and towns to interview more than 20,000 veterans and other potential claimants, Tyson reported.

“This outreach effort generates a considerable amount of claims work from those veterans who may not otherwise have the opportunity to seek assistance at DAV national service offices,” he said.

One of the more popular outreach efforts, the “Harley’s Heroes” project, involves setting up DAV booths at local Harley-Davidson Motor Co. dealerships that underwrite the cost of the project. Mobile service offices visited 183 Harley-Davidson dealerships last year. In addition to serving up refreshments and distributing information, DAV national service officers offered to review veterans’ paperwork to help in determining whether they’re eligible for benefits or services.

“We want them to bring any evidence they have, if they never filed a claim or want to reopen a claim,” Tyson said. “And they’re getting the best of both worlds. They don’t have to travel [to a VA facility], and they are going to get an expert working on their claim. Our national service officers are the best-trained out there.”

With most of its current members from the Vietnam War era, Tyson said, it’s time for the organization to throw its support to the nation’s youngest disabled veterans and welcome them into the fold.

“We don’t want a repeat [of the Vietnam homecoming experience],” Tyson said. “We hope we have learned from those mistakes, and to a great degree, I believe we as a nation have. Now we want to incorporate the younger veterans. It’s our turn to mentor them and let them take some of the leadership roles” within DAV.

“I believe, personally, that we are the best advocates for disabled veterans, their wives, their widows, their children and their survivors,” Tyson said. “That is because we have one and only one mission: to build better lives for disabled American veterans and their families. We have struck to that since this organization was founded, and I believe that is the reason the organization is so successful.”

Gates, Shinseki Agree to Joint Electronic Records

By Donna Miles

American Forces Press Service

WASHINGTON, April 5, 2011 – Two years after they joined President Barack Obama in announcing plans to create a Joint Virtual Lifetime Electronic Record, Defense Secretary Robert M. Gates and Veterans Affairs Secretary Eric K. Shinseki have agreed to create a joint common platform for their departments’ electronic medical records.

Gates and Shinseki agreed in concept to create the joint common platform during a March 17 session, giving their staffs an early May deadline to come up with an implementation plan, VA Deputy Secretary W. Scott Gould told American Forces Press Service.

“They slapped the table and said, ‘Okay, in concept we agree,’” Gould said during an interview while attending the 25th National Disabled Veterans Winter Sports Clinic in Snowmass Village, Colo.

Now DOD and VA are at work to determine if a joint e-platform will support their separate processes. DOD currently uses the Armed Forces Health Longitudinal Technology Application, or AHLTA system, and is transitioning to the more comprehensive, real-time Electronic Health Record Way Ahead system. VA uses the 20-plus-year-old Veterans Health Information Systems and Technology Architecture, or VistA.

Gould expressed confidence that a joint system will work for both the Defense Department and VA.

“And the reasoning is pretty sound,” he said. “Ninety percent of the medicine in DoD and VA is the same. So why shouldn’t we have one system, and only have the taxpayer pay to build it once?”

The 2010 Defense-VA Interagency Program Office report to Congress noted that the two departments share nine of the 13 core functional capabilities for an electronic health record, Gould said.

“This shows the kind of leadership that both Secretary Shinseki and Secretary Gates bring to the table,” he said. “They are committed. They want to make a difference. And they are challenging both their deputies and their entire organizations to cut through the red tape and get it done. And [Deputy Defense Secretary] Bill Lynn and I are hard at work to make that happen.”

Shinseki told a Senate Appropriations Committee subcommittee March 31 the deal followed about two years of discussions. He said DOD is “looking for new direction” for its own electronics record system, while noting the need to update VA’s own aging system.

"We have a terrific electronic health record, but again, it's about 20 years in being,” Shinseki said of VA’s VistA system. “So, we're going to have to adjust also to ensure the sustainability of that system. It's a great opportunity for both of us to put our heads together.”

Undersecretary of Defense for Personnel and Readiness Clifford L. Stanley called the initiative an example of closer inter-departmental cooperation that’s improving efficiencies and providing better patient care.

“We are working even ever more closely with our colleagues in the Department of Veterans’ Affairs to ensure our activities are better coordinated to include the disability evaluation process, the sharing of personnel and health information, and collaboration on our future electronic health record,” Stanley told the House Armed Service Committee’s Military Personnel Subcommittee March 15.

During the same hearing Army Lt. Gen. Eric Schoomaker, Army surgeon general, said that creating a single electronic health record will increase information-sharing between the two departments and provide a better way to transfer patient data.

“No two health organizations in the nation share more non-billable health information than the DOD and the VA,” Schoomaker noted. “The departments continue to standardize this sharing activity under delivering information technology solutions that will significantly improve the sharing of appropriate electronic health information.”

The agreement to pursue a joint common platform for their electronic medical records follows the two departments’ decision in April 2009 to create a Joint Virtual Lifetime Electronic Record to smooth the flow of medical records between the Defense and Veterans Affairs departments.

Five pilot programs are up and running to test out the initiative before it goes nationwide, Gould said.

Obama, in announcing the joint initiative, described the advantages of a common joint lifetime record.

“When a member of the armed forces separates from the military, he or she will no longer have to walk paperwork from a [Defense Department] duty station to a local VA health center,” the president said. “Their electronic records will transition along with them and remain with them forever.”

Obama explained that the new system will include both administrative and medical information from the day recruits enter military service, throughout their military careers, and after they retire or leave the military.

“This would represent a huge step toward modernizing the way health care is delivered and benefits are administered for our nation's veterans," Obama added. “It would cut through red tape and reduce the number of administrative mistakes.”

VA Budget Request Signals Commitment to Vets

By Donna Miles

American Forces Press Service

WASHINGTON, April 4, 2011 – President Barack Obama’s $132 billion 2012 budget request for the Veterans Affairs Department demonstrates that despite a tight fiscal environment, the United States stands by its commitment to men and women who have served in uniform, Deputy VA Secretary W. Scott Gould told American Forces Press Service.

“It says that VA and veterans are the president’s top priority,” Gould said during an interview in Snowmass Village, Colo., last week at the 25th National Disabled Veterans Winter Sports Clinic.

Gould said the budget request reflects a renewed commitment to VA’s charter as President Abraham Lincoln enunciated it in his second inaugural address: “to care for him who shall have borne the battle, and for his widow and his orphan.”

“If you look at our fiscal year 2010 budget, it was the largest in 30 years,” Gould said. “It was followed by another roughly 7 and a half percent in 2011, and now we have another 3 and a half percent on top of that. So it is a striking level of investment by the administration.”

Gould cautioned, however, that VA can’t take this commitment for granted. “We are working really hard to make sure we use every dollar wisely,” he said.

The fiscal 2012 budget request supports VA’s five-year strategic plan, with priority goals to:

-- End veteran homelessness by 2015, with $940 million in the fiscal 2012 request for programs to reduce and prevent homelessness among veterans and their families;

-- Implement a paperless claims-processing system by 2012, a major step toward eliminating the disability claims backlog so no veteran has to wait more than 125 days for a decision;

-- Build and deploy an automated Post-9/11 GI Bill benefits system to speed tuition and housing payments for all eligible veterans;

-- Create the next-generation electronic record system that begins when service members enlist in the military and remains with them through retirement or after they return to civilian life;

-- Improve the quality, access and value of mental health care provided, with $6.2 million in the fiscal 2012 request for mental health programs, including $68 million for suicide prevention; and

-- Deploy a new management program to improve client access to VA services and benefits by June 2012.

“We have a very bold strategy,” Gould said. “And we are very focused on making sure that we get the resources to support it in a way that ties the budget to this strategic strategy.”

Much of VA’s focus is on making the organizational changes and systems improvements required for it to function more efficiently and effectively, Gould said.

“We want to invest in the people, their training and the systems that make our organization more intelligent, more able to deliver on the promise of these priorities and the overall strategy,” he explained.

VA is working to transform into Secretary Eric K. Shinseki’s vision of a veteran-centric, results-driven, forward-looking organization, Gould said.

This, Gould said, involves new management systems that ensure accountability as well as maximum efficiency and effectiveness, while eliminating waste and improving the delivery of high-quality and timely veterans benefits and services. Toward that end, VA is seeking nearly $3.2 billion for fiscal 2012 to maintain and improve its information technology systems.

Gould reported progress already made on the IT front. “Two years ago, only 20 percent of projects were on time, on budget and to technical standards,” he said. “Today, 80 percent are.”

Similar improvements are bearing fruit in how VA manages its human resources. “Two years ago when we started hiring people, it took us 108 days,” Gould said. “Now we have it down to 76, and will achieve a goal by the year’s end of 60 days, the private-sector standard.”

Another improvement uses strategic sourcing, with VA’s separate operating units pooling their buying power to get the best price for their goods and services. Previously, the department’s separate operating units did their buying separately.

In addition, VA adopted a strategic capital investment plan that improves the way it manages its capital infrastructure –- 6,500 buildings nationwide, with a replacement value of $87 billion.

“Two years ago, there was no integrated process for evaluating where you would invest your next dollar in that physical infrastructure,” Gould said. Today, VA makes a business case for every proposal, pools these proposals, then evaluates and prioritizes them to identify the best use of its infrastructure funding.

“So now we can go to the secretary and say, ‘For the limited dollars we have, here is the best investment we can make to improve the security and safety of our veterans and improve quality and access,’” Gould said.

Gould noted an adage in the health care realm: health care is 85 percent business systems and 15 percent medicine.

The VA’s health-care providers, who make up the country’s largest direct-care health system, receive consistently high marks in the quality of care they provide, he said. In fact, he added, many are on par with their counterparts at the nation’s most prestigious hospitals and medical centers.

“So think about how much cost [savings] and how much potential efficiency is created if you can improve the underlying systems” that support them, Gould said, “while giving the doctors the maximum freedom to make the best judgment they can based on health care principles.”

Commentary: Can I Hear a ‘Hooah?’

By Karen Parrish

American Forces Press Service

WASHINGTON, Jan. 25, 2011 – The 2011 Military Health System Conference opened yesterday morning at a very snazzy hotel in National Harbor, Md.

Thousands of trim, uniformed health care professionals –- some in navy, some in camouflage, some people in khaki, some in civvies, all with tidy hair –- milled around in an orderly way before settling into a huge room where the opening session would take place.

It was a decorous opening session –- good speakers, touches of humor, some serious talk about the serious issues military medical practitioners grapple with these days.

The program guide outlined what the conference offered in learning opportunities. Breakout sessions actually were good for continuing education credit. But then again, the sessions featured topics such as “New Emerging Technology Clinical Trials Participation – Policy and Processes.”

So the opening session was rolling right along. Then somebody -– you’ll find out who –- played a video.

An Army video.

The “Army Strong” video, to be exact.

The text that appears in the “Army Strong” video -- yellow on black, all caps, at a slow, one-line-at-a-time pace -- follows. If you watch this on the Web, you’ll swear you hear James Earl Jones in your head as you read, but there is no actual voice in the video.

Webster defines strong as having great physical power,

as having moral or intellectual power,

as striking or superior of its kind.

But with all due respect to Webster,

there’s strong,

and then there’s Army strong.

It is a strength like none other.

It is a physical strength.

It is an emotional strength.

It is a strength of character.

The strength to do good today,

And the strength to do well tomorrow.

The strength to obey,

and strength to command.

The strength to build,

and strength to tear down.

The strength to get yourself over,

and the strength to get over yourself.

There is nothing on this green Earth

that is stronger than the U.S. Army.

Because there is nothing on this green Earth

that is stronger than a U.S. Army soldier.

Strong.

Army Strong.

The video took that opening session straight out of decorous territory for a few minutes.

Those words, over what my broadcaster friends call a “music bed” both stately and stirring, alternated with photographs of men and women, young adults and 50-somethings, marching, running, parachuting, climbing, shooting, walking with children in other nations, holding their own children -- typical soldiers doing typical soldier things, in other words. Plus images of tanks, helicopters, and so on. It was powerful.

It wasn’t decorous.

It got me thinking about the nature of soldiers, and of military people in general. They’re disciplined and professional. Military bearing is something on which members of all the services justly pride themselves. The medical audience yesterday certainly had it, but so has every other military group I’ve ever seen standing in formation, firing at a range or attending a seminar.

It was what Army Staff Sgt. Salvatore Giunta’s composed, expressionless face and straight stance displayed as President Barack Obama hung the Medal of Honor around the young soldier’s neck.

Military people know decorum.

Another side of the military nature is harder to pin down. Navy Adm. Mike Mullen, chairman of the Joint Chiefs of Staff, did the best job I’ve ever seen in a piece he wrote a few years back. It was called “What I Have Learned About the Army,” but the chairman zeroed in on hooah.

“There are 1,000 or 10,000 or 100,000 different ways to say hooah,” the admiral wrote. “But I learned that it is more than just a battle cry; it is a way of life. It says that you will never quit, never surrender, never leave your buddy. It says that you are proud of the hardships you have endured because there is deep meaning in every one of them.”

The chairman, of course, is exactly right. But there’s another aspect to hooah too, I think. At the bottom of every soldier is the original hopeful, scared, determined, young or not-so-young civilian who raised his hand, or her hand, and swore to protect and defend. Hooah comes from both the overlaying warrior and the underlying person. It comes from the hybrid creature called a soldier, who has an impassive military bearing and a compassionate human heart.

In a sense, the conference’s medical audience was the perfect example of this psychological mash-up. Soldiers, sailors, airmen, Marines –- heroes, warriors, healers.

So yesterday, as the three-minute “Army Strong” video ended, I was delighted, but not surprised, to hear more than one full-throated “Hooah!” issue from the audience.

I don’t think the soldier responsible for playing it - Lt. Gen. (Dr.) Eric B. Schoomaker, Army surgeon general and commander of U.S. Army Medical Command - was surprised either.

“Isn’t this Army Strong video compelling?” he asked. In response: tremendous applause and a fainter “hooah, hooah” from the crowd.

He knew when he learned he would be speaking at the conference, Schoomaker said, that he wanted to open with that video.

These generals and admirals, they’re pretty sharp.

It wasn’t hard to work it in, he said, because he was asked to speak about how Army medicine supports strength and resilience among warriors and families.

Schoomaker made it clear that he respects all the services and all who wear the uniform. He speaks particularly of the Army, he said, because he’s a soldier.

“Let there be no doubt, the root of our readiness lies in the strength and resilience of this Army, and military families,” Schoomaker said. “And so it all starts with what it means to be Army strong.”

During the same opening session, Deborah Mullen, the chairman’s wife, spoke of the military families she talks to regularly around the world, and the physical and psychological toll nearly 10 years of combat have taken on uniformed men and women, their spouses and their children.

“Not unlike our troops, our families experience the same depression, anxiety, sleeplessness and headaches,” she said. “They break into cold sweats, lose concentration, suffer panic attacks, and come to dread contact with the outside world.”

Even the strongest need support.

A few hours after Schoomaker spoke, not too far away, the president announced a plan bringing in agencies across the government to strengthen military family support.

As my colleague Elaine Wilson reported, the president said, “Today, I'm proud to announce that for the first time ever, supporting the well-being of our military families will be a priority not just for the Department of Defense and the Department of Veterans Affairs, but all across the federal government.”