September 26, 2016
Retirement program for Kathleen, September 26, 2016, Defense Health Agency, Falls Church, Virginia. Retirement biographies in the military and Department of Defense have a very awkward, stilted format. The following biography, while accurate, is definitely not the usual style.
Notes: Following the biography is the text of remarks by Charles Gabriel at the ceremony, plus a Glossary of terms used; clicking on any photo will open a larger size.
☆☆☆
Kathleen Charters
Dr. Kathleen Grace James Charters, CDR, USN (Ret.), started life as a child. A year and a half later, Kathleen was promoted to elder child, and repeated this process five more times over the next decade. The chaos and ambiguity of her role as oldest of seven proved to be foundational training for a career in health care and the military.
Kathleen entered the Honors Program at Washington State University and did “normal” things such as talking her history major boyfriend into taking a computer programming course because “it would be fun.” She graduated with a BS in Psychology (Cum Laude) and BS in Nursing (Cum Laude). Immediately commissioned as Lieutenant (junior grade) in the U.S. Public Health Service, she was assigned to Public Health Service Hospital San Francisco, CA, in 1977.
In San Francisco, she worked in critical care; gave health examinations to several thousand refugees from Vietnam; did some of the initial screenings for what we now know as HIV, and spent 40 straight hours in the Critical Care Unit after an earthquake caused the CCU to separate from the rest of the hospital, stranding the patients. She wrote some of the first hospital scheduling and inventory programs using a forgotten Wang minicomputer, and attended the University of California, San Francisco.
Following presentations and papers on computers in health care, Kathleen came to the attention of the U.S. Navy. Attending a health fair to recruit people into the Public Health Service, the Navy recruited her into the Navy, and in 1980 Kathleen was promoted to Lieutenant and assigned to the brand-new, fully computerized Naval Hospital Bremerton, WA. On arrival, Kathleen found the most powerful computer in the building was her HP-45 calculator; the Navy had run out of funds to buy computers beyond one old punch card-driven 1950s antique.
While leading the hospital CCU, she worked, via telephone, with Captain (later Admiral) Grace Murray Hopper to purchase a Radio Shack TRS-80 Model III for the hospital. Kathleen used it to refine her work on hospital scheduling and inventory programs, and develop experimental decision support software. She also learned APL programming and added an MS in Systems Management from the University of Southern California in 1982.
The Navy recognized her great gifts in 1983 by sending her far, far away to Naval Hospital Yokosuka, Japan. Her orders allowed her to take a “dress sword, and spouse,” and her spouse continues to chafe at playing second fiddle to a sword that didn’t exist. Kathleen served as charge nurse of the ICU/CCU before being promoted to Lieutenant Commander and assigned as Director of Education and Training for military health care in the Western Pacific, which included Diego Garcia, in the center of the Indian Ocean, but did not include Okinawa, which is in the Western Pacific.
Working with the Japan Medical Society, Kathleen established the first BCLS and ACLS programs in the country, teaching classes and assisting in translating manuals and protocols compatible with the Japanese healthcare system. Japan lacked a certification system, so she certified students through the Stockton, California, American Red Cross, helping make Stockton the most productive chapter in the U.S.
In 1987 the Navy stopped extending her Japanese tour of duty and returned Kathleen to the U.S. with spouse and newly acquired daughter, but no dress sword, to work in the PACU at Naval Hospital San Diego. While there she helped move staff, patients, and equipment from the “old” hospital to the “new” hospital, without any break in care. She also wrote procedures, protocols, templates, and reports for the brand-new CliniComp hospital information system, piloting adoption by other U.S. military hospitals.
The Navy next sent Kathleen to “duty under instruction” at the University of Maryland, Baltimore, to study nursing informatics. The Navy then changed its mind, promoted her to Commander, and assigned her to various duties in the DC area such as senior health program analyst for the Office of the Assistant Secretary of Defense for Health Affairs, and to TRICARE Northeast as a configuration management project manager, systems integrator and quality manager, and information technology project manager, all while still attending school. Nevertheless, Kathleen completed her Ph.D. in Nursing Informatics in 1998.
Kathleen was next assigned to National Naval Medical Center, Bethesda, MD, as a systems administrator and Deputy Corporate Information Officer, managing 400 pieces of equipment and 85 staff members, in addition to serving as a supervisory nurse. Still, no sword.
Kathleen’s final active duty assignment was as National Capital Area Composite Health Care System Consolidation Project Manager, a boon to business card printers charging by the word. In sixteen months she consolidated 44 Army, Navy, Air Force, and Coast Guard healthcare sites in the Northeast into one comprehensive healthcare information system, upgraded the computer networks, and coordinated the training of the 22,000 system users. She retired from active duty in October 2001.
Kathleen taught for several years as an associate professor and Director of the Nursing Informatics Program at the University of Maryland, Baltimore. There followed five and a half years as senior health care consultant and health content team lead for the VA’s MyHealtheVet patient portal, dabbling occasionally in telehealth applications. Over time, she also authored a number of peer-reviewed journal articles, authored or co-authored five book chapters, and was a co-investigator on several NIH grants. She added an MA in Church Ministries-Parish Nursing from St. Mary’s Seminary and Ecumenical Institute of Theology in 2009.
Now steeped in the synergistic disciplines of psychology, nursing, systems management, computer science, theology, military culture, academic culture, commercial consultant culture, and child rearing, Kathleen returned to DOD in 2011 to apply these skills at the TRICARE Management Activity, which became the Defense Health Agency. As senior nurse consultant for clinical information systems, she worked as liaison between clinicians, information managers, systems managers, programmers and project managers of various hues – Army green, Air Force and Coast Guard blue, Navy blue and gold, and civilian pinstripe gray. These skills proved inadequate for all the projects at hand, so she sought divine help and in 2014 was commissioned in the United Methodist Order of Deacons. In 2015 AMSUS awarded Kathleen the Federal Civilian Senior Nurse Excellence Award.
Reverend Kathleen prayerfully wishes the Defense Health Agency the best as she leaves to pursue other activities.
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Remarks by Charles Gabriel
I don’t know where to begin to describe Kathleen and what it has been like working with her for nearly five years.
I come from engineering.
She’s a nurse clinician.
And a PhD…
….a Reverend…
…a retired Naval Officer…
…a former director of nurse informatics at the University of Maryland Nursing school…
To cover it all, I would have to recite her very long CV.
Instead, I’ll try to illustrate her CV in action.
Oil and water, Kathleen and myself.
Different disciplines.
Different approaches to problems.
Think about it: the engineering solution to a sick machine is to shut down all the functions and then start them over again.
That’s exactly what a clinician took an oath not to do.
Engineers cannot operate on a machine while vital signs are running.
In contrast clinicians must have the vital signs up and running before they operate.
I think you get the point!
Our differences become our assets — not liabilities.
Kathleen managed those differences to make a difference.
Here are some of our successes.
With her leadership and perseverance, we applied advanced analytics to standardize an inpatient system for 20,000 individual data elements that made the legacy system highly tuned for patient safety and quality.
Recently, we were recognized by our director, Vice Admiral Raquel Bono, for a catheter-associated urinary tract infection study that matches with The Institute for Healthcare Improvement best practice recommendations.
We worked together to prove that a well-designed interoperability and data exchange can improve health outcome and can be tracked and measured. The methodology was well received and we’re planning to publish a paper to enrich industry best practices.
Let me give you a behind-the-scenes look at how Kathleen and I worked so well together.
I would propose an approach and ask for her clinical expertise.
Always polite, Kathleen would listen, patiently and very carefully. She seemed to be taking it all in.
Once I had finished, Kathleen would look me right in the eye and say, “Charles, it’s not gonna work.”
End of conversation.
Kathleen had said what she thought, and now, for me, it was back to the drawing board.
I knew, in my heart, that she was right. She always stood for high standards and quality.
Let me share another story to show how steadfast and opinionated Kathleen is.
On many occasions we were asked to review a proposed solution.
Kathleen would assess the situation, and then let me know, in no uncertain terms, that there were many, many gaps.
She doesn’t hold back.
She speaks her mind. And yes, she can be blunt. She has little time to gloss over things.
And when she would start to openly share her assessment with the stakeholders in a straightforward way — I would think to myself, here it comes! The stakeholder would throw us out of the room and never ask us back.
But do you know what?
The exact opposite would happen!
Those stakeholders would immediately understand what Kathleen was saying, because of her rationale, and how much she is on the side of the patient, and how obsessed she is with quality of care. They always saw that there was work to be done.
They had to fill in the gaps with a better workflow and add the capabilities that Kathleen had pointed out.
And let me tell you, that was a proud moment for me.
Just to be a partner with a colleague like Kathleen, so steadfast, so unwavering in her advocacy for our patients.
How much I have learned from you, Kathleen.
How much of an honor, and a privilege, it has been to work beside you, almost daily, all these years.
I could go on forever, singing the praises of this remarkable lady, but I won’t. That would contradict her humble style.
I’m going to sum up Kathleen with the following passages from the Bible, the Book of Proverbs:
She perceives that her merchandise is good, and her lamp does not go out by night…
She opens her mouth with wisdom, and on her tongue is the law of kindness.
Wisdom.
Kindness.
And I will add to that…
Respect.
Dedication to the DHA mission.
Kathleen, you are truly blessed, and I will never forget all the accomplishments, leading by example, and the fellowship we all enjoyed.
I will imagine you in my office, every morning, praying, as you used to do.
That office is long gone, with the relocation of the clinical support division, and now I have a cube.
I am not complaining about my cube, or asking you to pray that I get my office back, Kathleen.
I want you to pray for things dear to our hearts, for the things you have always believed in…
Pray for our patients.
Pray for Total Force Fitness.
Pray for a healthier military community.
Pray for our leaders, for our colleagues, for Maria and her family, for me and my family…
And pray for our great country, the United States of America!
☆☆☆
Glossary
ACLS – Advanced Cardiac Life Support.
AMSUS – Association of Military Surgeons of the United States.
Annapolis – Port city in Maryland, near Parole, home of the US Naval Academy. The city is named after Princess Anne of Denmark and Norway.
APL – A Programming Language. Yes, that really is the name of a programming language: APL.
Baltimore – Large port city in Maryland, near Glen Burnie, and the westernmost Atlantic seaport in the U.S. The city is named after Cecilius Calvert, the second Lord Baltimore.
Bethesda – Land-locked city in Maryland, near Wheaton, named after Bethesda Meeting House, a church that took its name from Jerusalem’s Pool of Bethesda, mentioned in the New Testament.
BCLS – Basic Cardiac Life Support.
Bremerton – Port city in Washington state, on the Kitsap Peninsula, near Gorst. Named after German immigrant George Bremer.
BS – Bachelor of Science.
CAPT – Captain (US Navy).
CCU – Critical Care Unit.
CDR – Commander (US Navy).
CIO – Corporate Information Officer.
CliniComp – CliniComp, Inc., is the oldest continuously operational EHR.
College Park – Land-locked city in Maryland, northeast of the District of Columbia, and home to the University of Maryland.
Cum Laude – “With Honors,” from the Latin cum, (with), and laude, (praise).
DHA – Defense Health Agency.
Diego Garcia – Atoll in the central Indian Ocean, named after a confusing collection of mistranslations and misunderstandings not at all related to San Diego.
District of Columbia – Port city between Maryland and Virginia, named after Article One, Section Eight, of the U.S. Constitution, and Christopher Columbus.
DOD – Department of Defense.
DUINS – Duty Under Instruction, active duty military education at a university.
EHR – Electronic Health Record.
Falls Church – Semi-land-locked city in northern Virginia, named for The Falls Church, an 18th century Anglican church near the falls of the Potomac River.
Gettysburg – Land-locked town in southern Pennsylvania, scene of the deadliest battle of the American Civil War. The town is named after Samuel Gettys, who built a tavern at a crossroad.
Greenwich – Port city in southern England, best known for the Royal Observatory and Royal Naval College. The name comes from Danish settlers, and means “green place on the bay.”
HIS – Hospital Information System.
HIV – Human Immunodeficiency Virus.
HP-45 – Hewlett-Packard Calculator Model 45.
ICU – Intensive Care Unit.
Kenko Shimbun – Japanese for “Healthy Newspaper,” newspaper of US Naval Hospital, Yokosuka, Japan.
LT – Lieutenant (US Navy).
Lt. (j.g.) – Lieutenant, Junior Grade (US Navy).
MA – Master of Arts.
MS – Master of Science.
MyHealtheVet – Web-based patient portal for patients and beneficiaries of the Veterans Administration.
NIH – National Institutes of Health
NMMC – National Military Medical Center, Bethesda, Maryland. Formerly NNMC.
NNMC – National Naval Medical Center, Bethesda, Maryland.
Okinawa – Island chain south of Kyushu, the southernmost of the four “main” Japanese islands.
Outer Banks – Series of barrier islands separating North Carolina from the Atlantic Ocean.
PACU – Post Anesthesia Care Unit.
Ph.D. – Doctor of Philosophy, from the Latin philosophize doctor.
Philadelphia – Port city in Pennsylvania, named after a city in Asia Minor mentioned in Revelations in the New Testament. From the Greek phileo (to love) and adelphos (brother).
Pullman – Land-locked town in Washington state, near Moscow, Idaho. The town was named by the residents after railroad industrialist George Pullman in hopes of attracting investment. Pullman did not invest in the town, and instead it became the home of Washington State University.
RADM – Rear Admiral (US Navy).
San Diego – Port city in California, near La Jolla, named for Saint Didacus, better known by his Spanish name of Diego de Alcala.
San Francisco – Port city in California, near Daly City, named for St. Francis of Assisi
Sapporo – Land-locked city on the northern Japanese island of Hokkaido. The name is taken from the Ainu language, sat port pet, which means “dry, great river.” Sapporo is at the same latitude as Milwaukee and München, and is famed for its beer.
Silver Spring – Land-locked city in Maryland, home of National Ocean Service, named after a mica-flecked spring discovered by Francis Preston Blair, one of the founders of the Republican Party.
Stockton – Land-locked city in northern California named after Robert Stockton, a US Navy Commodore who captured California in the Mexican-American War.
Tampa – Port city on Florida’s Gulf Coast, named after one of many possible things, and home to U.S. Central Command, which covers parts of Africa and Asia. Note: Tampa is thousands of miles from either Africa or Asia.
Tokyo – Port city on Honshu island, Japan. Largest city in the world, with 40 million people and 285 subway stations. Formerly named Edo (Japanese for “estuary”), the city was renamed Tokyo (“Eastern Capital”) in 1868.
TRICARE – Tri-service health and medical program.
TRS-80 – Tandy Radio Shack computer Model 80. The 80 indicates it had a Zilog Z-80 central processing unit.
UCSF – University of California San Francisco.
Uraga – Port city southeast of Tokyo, Japan, on the Miura Peninsula, near Yokosuka.
USC – University of Southern California.
USN – United States Navy.
USPHS – United States Public Health Service.
VA – Department of Veterans Affairs.
Wang – Short for Wang Laboratories, former computer company named after An Wang, the inventor of iron core digital memory.
Warrington – Land-locked city in northern England, founded by the Romans at a crossing point for the River Mersey. It is near Higher Walton, which is not too far from ordinary Walton.
WSU – Washington State University, in Pullman, Washington.
Yokosuka – Port city southeast of Tokyo, Japan, on the Miura Peninsula, near Uraga.
Z-80 – Microprocessor made by Zilog, Inc., it was the most popular microprocessor in the 1980s, and is still manufactured and in use today.