The approved Vision Center of Excellence (VCE) mission statement is “to continuously improve the health and quality of life for members of the Armed Forces and Veterans through advocacy and leadership in the development of initiatives focused on the prevention, diagnosis, mitigation, treatment and rehabilitation of disorders of the visual system”. The mission statement is consistent with the National Defense Authorization Act (NDAA) (Sections 1623-1624) of Public Law 110-181 (January 2008) authorizing the Secretary of Defense to establish a Center of Excellence in the prevention, diagnosis, mitigation, treatment, research and rehabilitation of military eye injuries and diseases including visual dysfunctions related to Traumatic Brain Injury (TBI).
The VCE established a Memorandum of Understanding (MOU) by and between the ASD(HA) and the Under Secretary for Health for Veterans Affairs (USH(VA)) to define the roles and responsibilities of the DoD and VA in the establishment and operation of the VCE. The DoD/VA MOU states that VCE shall be established under the authority of the Secretary of Defense in collaboration with the Secretary of Veterans Affairs and that that the Executive Director shall be appointed by the Secretary of Defense or designee upon recommendation of the ASD(HA) and that the Deputy Director shall be appointed by the Secretary of Veterans Affairs or designee upon recommendation of the USH(VA). Administrative support for the VCE shall be provided by the VA and DoD Components, as appropriate and consistent with applicable laws.
In February 2010, the responsibility was delegated to the Under Secretary of Defense for Personnel and Readiness (USD(P&R)). Additionally, USD(P&R) was given authority to further delegate the responsibility to the ASD(HA), if desired. In May 2010, the VCE was assigned to the Secretary of the Navy for operational and administrative support. VCE personnel will transition to the Navy Bureau of medicine (BUMED) in October, 2011.
The leadership roles and responsibilities of the VCE Executive Director and Deputy Director are supplemented with the position of VCE Executive Officer to form an Executive Leadership Team. The Executive Leadership Team is entrusted as the core decisional body of the VCE and is responsible for formulating the VCE strategic direction and integrating with other stakeholder organizations across the DoD and VA.
The operational development of the VCE is structured as a “virtual and distributed” organization that links together a virtual network of DoD and VA clinical and research centers around the world that are facilitated by regionally distributed VCE coordination centers. This integrated interagency capability will enable the capture of long term outcomes data that crosses the continuum from event to final intervention. This structure will maximize the potential for effective prevention, mitigation, and treatment of injuries and disorders of the visual system. It will also allow for the identification of research capabilities within and between DoD and VA. By leveraging information management systems, promoting integration and collaboration, identifying evidenced-based best practices, and engaging in a dynamic transfer of the scientific and medical knowledge, the VCE seeks to optimize outcomes for all Service Members, Veterans and other eligible beneficiaries being treated by DoD, VA and civilian programs.
The VCE promotes collaboration, facilitates integration and serves as an advocate across the DoD and VA healthcare systems. Further collaboration efforts with other Federal healthcare organizations, universities and the private sector providers allow the VCE to optimize research and quality of care initiatives.
As the VCE and other DoD and VA Centers of Excellence mature there may be opportunities to share materials and processes that are common support functions to similar organizations. The VCE is currently collaborating and integrating with the other Centers of Excellence in operations and opportunities for clinical care and research, including the National Intrepid Center of Excellence (NICoE); the Defense Centers of Excellence (DCoE) for Psychological Health and Traumatic Brain Injury; Hearing and Auditory System Injury Center of Excellence; Extremities and Amputation Center of Excellence; and the Defense and Veterans Brain Injury Center (DVBIC).
The VCE, with Tri-Service and VA subject matter experts, participated in and validated the development of the Joint DoD/VA Vision Registry ConOps, which was approved by the Military Health System (MHS) Clinical Portfolio Management Board (CPMB) and Clinical Proponency Steering Committee for implementation of the pilot Defense and Veterans Eye Injury and Vision Registry (now called the Vision Registry). The award for the Vision Registry pilot occurred in September 2010. This is the first centralized clinical database that will integrate both VA and DoD data sources and be accessible to providers in both departments across the continuum. An MHS Core Capability for Centers of Excellence and Registries, Capability 1203, was established to support the VCE registry and provide a framework for future Centers of Excellence registry requirements. The longitudinal analysis capability of the Vision Registry will provide the critical information management framework needed to optimize outcomes, guide the development of clinical best practices, and identify emerging research requirements. The patient tracking capability provided by the Vision Registry will facilitate case management and support longitudinal care across the continuum. In September 2011 VCE implemented the Defense and Veterans Eye Injury and Vision Registry (DVEIVR), the first joint registry shared by the DoD and VA. During FY12, the VCE seeks to fully implement the Vision Registry pilot and to demonstrate the ability to integrate and collaborate with existing trauma registries.
Concurrently, a DoD and VA Vision Clinical Systems Design Integrated Process Team (VCSD IPT) was chartered by the CPMB and is co-chaired by the VCE Executive Director and the Director for Wounded Warrior Information Management Systems. The purpose of the VCSD IPT is to develop recommendations for redesign of the clinical eye note for the electronic medical record strategy and to ensure standardization of documentation across the DoD and VA vision care continuum. This IPT will integrate recommendations with the ongoing MHS electronic health record way ahead strategy to provide standardization of clinical documentation.
The organizational structure of the VCE is comprised of six Directorates: Informatics/Information Management, Clinical Care, Research and Surveillance, Rehabilitation and Restoration, Global Outreach, and Education/Training/Medical Simulation and Readiness. Each of the Directorates is developing a strategic plan to include its goals and objectives for FY11 and beyond.
Executive Director Colonel Donald A. Gagliano, M.D. is a medical doctor, retinal ophthalmologist, and a Fellow of the American College of Health Care Executives. Dr. Gagliano has most recently served as Director of the Clinical Investigations Regulatory Office in the Army Medical Research and Materiel Command. He has led soldiers at every level of command, including the 30th Medical Brigade in Iraq from February 2003 until February 2004. He simultaneously served as the CJTF-7 Surgeon with responsibility for planning, integrating, and executing coalition combat health support in Iraq during the first year of the war. The 30th Medical Brigade was awarded the Meritorious Unit Citation for exemplary performance during Dr. Gagliano’s command.
Deputy Director Dr. Mary Lawrence, M.D. received her B.A. from Mt. Holyoke College in Massachusetts and her M.D. from Jefferson Medical College in Philadelphia. She completed an ophthalmology residency at Wills Eye Hospital in Philadelphia, one year doing glaucoma specialty training at the Massachusetts Eye and Ear Infirmary, and two years in private practice before joining the full-time faculty at Harvard Medical School as Director of the Cataract Consultation/General Eye Service at the Massachusetts Eye and Ear Infirmary. Dr. Lawrence is a member of the Glaucoma Service and the Director of Visual Rehabilitation Services at the University of Minnesota, and also serves as Associate Chief of Ophthalmology at the Minneapolis Veterans' Affairs Medical Center. Her research interests include studying the effectiveness of glaucoma treatment, diabetic retinopathy screening using telemedicine, and the psychosocial impact of visual impairment.
Associate Director of Research Dr. Felix Barker is Emeritus Professor at Salus University, Adjunct Associate Professor of Pathology (Comparative Medicine) at Wake Forest University and was the Dean of Research at Salus University. He is a clinical staff member at the Salisbury VAMC. In his VCE role, Dr. Barker works to facilitate clinical practice recommendations and the prioritization, development, and funding of vision rehabilitation research efforts within the VA, DoD and non-Federal Communities.
Director of Technology Patty Morris' responsibilities include the program management, acquisition execution and development oversight for the VCE’s registry capabilities, managing technologies for the VCE, and working in collaboration with the Department of Veterans Affairs in support of US service members and their families. Additionally, Mrs. Morris assists with integrating medical lessons learned from ongoing conflicts into current policy and emerging information technology to support ocular care.
Possessing more than 10 years in her field overall, Mrs. Morris has honed her expertise in information technology, information system security and program management. Accredited by Defense Acquisition University, Mrs. Morris is a certified acquisition professional is a DAWIA Level II Program Manager and LEVEL I Information Technology professional. Throughout Mrs. Morris’ professional career she has fulfilled leadership roles across the multiple disciplines of Technology. Leadership roles include Chief of Theater Operations and Product Line Manager for multi-million dollar programs for the Defense Health Information Management System, which enable quality healthcare for more than 9.2Million beneficiaries. She also served as the Chief Security Architect for the U.S. Army's Medical Logistics Enterprise Resource Planning (ERP) programs, responsible for designing and implementing integrated enterprise computer-based security solutions used to manage internal and external resources including tangible asset for the U.S. Army. In light of this accomplishment, Mrs. Morris has been honored with the Department of the Army Civilian Service Award.
Director, Education, Training, Simulation, and Readiness COL(Ret) Robert A. Mazzoli, MD FACS, has had an Army career spanning 34 years of active service in both the Signal and Medical Corps. He is a former Consultant in Ophthalmology to The Surgeon General of the Army, and Chief and Chairman,
Ophthalmology at Madigan Army Medical Center, Tacoma, WA. A native of Louisville, KY, he is a graduate of West Point and the
Uniformed Services University of the Health Sciences, Bethesda, MD. He received his ophthalmic training at Brooke Army Medical
Center in San Antonio, TX (residency) and The Wills Eye Hospital in Philadelphia, PA (Ophthalmic Plastic, Reconstructive, and
Dr Mazzoli is an active academician (Associate Professor of Ophthalmology, USUHS), with well over 130 presentations at
national and international meetings, and over 35 publications and book chapters. He is an active Fellow of the American
Academy of Ophthalmology, the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), the American
College of Surgeons, the Society for Simulation in Healthcare, the Association for Research in Vision and Ophthalmology,
and the Wills Eye Hospital Society, among others, and is past-President of the Society of Military Ophthalmologists.
He is a life member of the Katahdin Medical and Philosophical Society and is an examiner for both the American Board of
Ophthalmology and ASOPRS. His academic interests include surgical simulation in education, telemedicine and advanced
technologies, military ophthalmic readiness, and regenerative medicine. His awards include the AAO’s Secretariat and
Senior Achievement Honor Awards, the Legion of Merit, the Meritorious Service Medal, and Airborne wings. Additionally, he
has been awarded the military’s Honorable Order of St Barbara, the Order of Military Medical Merit, and The Surgeon
General’s “A” Proficiency Designator for Academic Excellence.
Director of Informatics and Information Management (I&IM) Helen A. White has more than thirty years’
experience in health care. The past five years she has work with the Department of Defense as a contractor and now as an employee in developing the requirements
for the clinical registries for the DoD/VA Vision Center of Excellence, Hearing Center of Excellence, Extremities and Amputation
Center of Excellence, and the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. She also assisted
with the development of the requirements for the VA Eye Injury Data Store. As Director of I&IM, Ms. White’s primary
responsibilities include functional oversight and management of the Defense and Veterans eye Injury and Vision Registry;
capabilities assessment; as well as assisting the Centers of Excellence in developing functional requirements and processes
related to their individual clinical registries.
Executive Officer - Vacant
Department of Defense/Veterans Affairs Responsibilities
The DoD/VA MOU tasks the VCE Executive Director with the responsibility for VCE programmatic policy, requirements, priorities, and operations. The roles and responsibilities of the VCE Executive Director include:
Serve as the principal adviser on vision and VCE matters.
Serve as the principal public spokesperson for the VCE.
Advocate for the VCE goals, objectives, programs and requirements to the DoD and VA.
Organize, direct, and manage the VCE and all assigned resources and activities.
Ensure the Vision Registry is developed and implemented.
Prepare the VCE Program Objective Memorandum and budget submissions in coordination with appropriate VA and DoD Components; make determinations regarding priorities and resources; provide recommendations on program budget decisions to the Comptroller of the DoD, and Director of Program Analysis and Evaluation, for incorporation into the planning, programming, and budgeting system process; collaborate with the VA to provide support for the VCE.
Create memorandums of understanding/agreement, data sharing agreements, and resource-sharing agreements to formally establish collaboration with additional centers and organizations, within authorized resources, necessary to perform its mission.
Serve and participate on boards, committees, and other groups pertaining to VCE activities, functions, and responsibilities.
The roles and responsibilities of the VCE Deputy Director, in addition to supporting the VCE Executive Director include:
Serve as an advisor to the National Director Ophthalmology, the Chief Officer Patient Care Services and the under Secretary for Health (VA) on eye care policies and procedures pertaining to delivery and assessment of services, as well as principal adviser on matters related to VCE programs and functions.
Collaborate and coordinate with other Patient Care Services’ offices as well as other Veterans Health Administration and DoD programs.
Provide recommendations on program budget decisions to the VA for incorporation into the planning, programming, and budgeting system process.
The leadership roles and authorities of the VCE Executive Director and Deputy Director will be supplemented with the position of the VCE Executive Officer to form an Executive Leadership Team. The Executive Leadership Team is entrusted as the core decisional body of the VCE and is responsible for formulating the VCE strategic direction and integrating with other stakeholder organizations across the DoD and VA.
The VCE Directorate Directors and Assistant Directors will focus on components of their mission areas as dictated by operational requirements and are responsible for developing and implementing their programs in accordance with the guidance provided by the Executive Director.
The VCE’s Directorates reflect the five primary mission areas:
Research and Surveillance Provide leadership in the identification, prioritization and implementation of research initiatives that will ensure the ongoing provision of high quality care and define new modalities to prevent and treat ocular injuries and diseases.
Informatics and Information Management Develop a registry and data repository to accurately capture and track ocular injuries and diseases and provide data to support the development of evidence based improvement initiatives and guide research.
Clinical Care Foster improved coordination of care between the DOD, VA and civilian resources to improve efficiency and maintain high quality and compassionate care for all service members and veterans.
Rehabilitation and Restoration Develop new strategies for visual rehabilitation based on the most current evidence and foster the expansion and enhancement of artificial vision research initiatives.
Education, Training, Modeling and Simulation Develop new strategies for knowledge management and distribution for vision care and provide adjunctive opportunities for enhanced training programs.
Defense and Veterans Eye Injury and Vision Registry (Vision Registry)
A major initiative in this effort is the establishment of a Defense and Veterans Eye Injury and Vision Registry (Vision Registry) to track eye injuries and vision impairment as well as to promote and facilitate improvements in research, treatment, rehabilitation and development of clinical best practices for trauma and diseases. Medical providers across both the VA and DoD will have the ability to add and share information pertaining to treatments, surgical procedures and visual outcomes for military service members and veterans who received treatment through out the entire spectrum of care.
October 14, 2010, marked the Kick-off for start of development of the Vision Registry Pilot; The Vision Registry will be the first to combine DoD and VA clinical information into a single data repository for tracking patients and assessing longitudinal outcomes. The registry records in the pilot will include current and historical eye ocular data. The pilot will be a baseline for other centers of excellence registries as well as provide additional electronic data sharing opportunities with other Federal and Non-Federal registries and data bases.
Vision Registry Pilot was kicked off in September 2011. It will be hosted on a platform at the Joint Information Technology Center in Maui. Requirements have been identified and a modular development approach will be used to facilitate the development of registry and comply with modern system engineering technology.