Developing the Military Medical Digital Patient ExperienceSes s ion # 32, Augus t 10 , 2021

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Assistant Director, Healthcare Administration, Defense Health Agency

Brian Lein, MD

DISCLAIMER: The views and opinions expressed in this presentation are solely those of the author/presenter and do not necessarily represent any policy or position of HIMSS.

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Welcome

Assistant Director, Healthcare AdministrationDefense Health Agency

Dr. Brian C. Lein

#HIMSS21

Conflict of Interest

Brian Lein, MD

Has no real or apparent conflicts of interest to report.

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#HIMSS21

Agenda

• The Military Health System (MHS) COVID Response

• The MHS Digital Engagement Strategy

• The MHS Patient Experience Portfolio

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#HIMSS21

Learning Objectives• Describe the focus areas of improvement that were successful for COVID

response

• Identify the priority of effort for the Military Health System (MHS) Digital Patient Engagement Strategy

• Discuss major gaps in understanding and implementation in the MHS current patient experience portfolio

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The Military Health System COVID Response

The Military Health SystemCOVID Response

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Concentrated Health Care Throughout The Pandemic• Provided guidance to all military Medical Treatment Facilities (MTFs) enabled use of additional,

privacy-compliant software tools for video visits.

• Virtually 70 percent of primary care and behavioral health visits were conducted over the phone

or using video capabilities.

• DHA increased the Advanced Virtual Support for Operational Forces system (ADVISOR) hotline to

provide real-time provider expertise in critical care and infectious disease to MTFs world-wide.

• To increase bed capacity, DHA expanded the tele-critical care program to support more MTFs

with 24/7 access to critical care specialists and implemented a COVID remote health monitoring

pilot to allow affected patients to remain safely at home while minimizing exposure risk for other

patient and medical staff.

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Clinical Phone by Specialty

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Video Visits by Specialty

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Identified the risk factors to predict severe COVID disease and

prioritized these patients to receive early treatment with COVID

monoclonal antibody.

Identified that massively bleeding trauma patients have improved

survival if they receive blood transfusion within 30 minutes

Identified that trauma patients with torso hemorrhage have improved survival if they arrive to a damage control surgery team within 1 hour

1HOUR

24HOURS

30MINUTES

DoD Joint Trauma Registry – Predictive Analysis

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• Uses analysis for both trauma and COVID to predict outcomes and deliver life-saving treatments

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Joint Trauma SystemCoronavirus Vaccine Administration

Data as of 13 July 21

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Coronavirus Vaccine AdministrationData as of 13 July 21

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Rapidly accelerated expansion

and support during COVID

Pre COVID

Post COVID

End State

MHS Joint Tele-Critical Care Network (JTCCN)

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EMERGENCY: Island of Guam experiences a significant surge in COVID-related sepsis and pneumonia, overwhelming local resources. Guam reaches out to FEMA for support.

MITIGATION: Critical Care Physician from BAMC and JTCCN Nurse from NMCSD leverage NETCCN application to quickly evaluate the unstable patient.

COMPLICATION: Patient with COVID pneumonia on mechanical ventilation becomes unstable. On-site intensivist is running a “code” for another patient. Bedside nurse calls JTCCN for assistance.

IMPACT: The DoD lead capability proves the unparalleled effectiveness of TCC while also highlighting the ease and efficiency of multi-service interoperability to achieve a common goal.

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MISSION: Tasking to deploy Tele-Critical Care capabilities in support of Guam Memorial Hospital. Support is rapidly established using application.

DIAGNOSIS & RAPID TREATMENT: Pneumothorax is identified. Emergent needle decompression followed by chest tube insertion is performed by on-site staff to stabilize the patient.

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Tele-Crit ica l Care…Leveraging Technology to Extend Expert is e!

GUAM

Actual shared image.

GLOSSARY

BAMC – Brooke Army Medical CenterCOVID – Corona Virus DiseaseDISCA – Defense in Support of Civil AuthoritiesDoD – Department of DefenseFEMA – Federal Emergency Management AgencyJTCCN – Joint Tele-Critical Care NetworkNMCSD – Naval Medical Center San DiegoNETCCN –National Emergency Tele-Critical Care NetworkTCC – Tele-Critical Care

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Photo 2: https://www.dvidshub.net/image/6171821/sailor-transfer-patient; Photo 3: https://www.dvidshub.net/image/6159097/usns-mercy-sailors-transport-patient; Photo 4: Courtesy of BAMC; Photo 6 https://www.nextgov.com/emerging-tech/2020/04/medical-consortium-aims-create-network-virtual-critical-care-wards/164717/

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The Military Health System Digital Patient Engagement Strategy

The Military Health SystemDigital Patient Engagement Strategy

Photo: https://www.army.mil/article/141020/telehealth_brings_long_distance_specialists_to_you

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Digital Patient

Engagement Strategy is

Virtual Health

Provider -to -Provider

Complex real-time monitoring

Patient -to -Provider

Artificial Intelligence

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Patient -to -Provider

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Virtually Integrated Patient Readiness and Remote Care Clinic (VIPRR) Tele-behavioral Health (TBH ) Hubs1 2

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• ADVISOR is available to active duty, DoD, and other U.S. Government entities.

• It provides virtual sub-specialty consultation on-demand through scalable and flexible telecommunications technologies.

• Patient “eligibility” is based on Medical Rules of Engagement (MROE); if a DoD medical caregiver is able to care for the patient, then the caregiver may engage ADVISOR for help.

• Two providers on call at all times. Failover to Medical Center within patient evacuation lines.

• Currently 15 specialties, including Veterinary for operational support.

• Expanded five Specialties to support the DOD COVID-19 pandemic for several critical specialties involved in the management of COVID-19 patients.

Provider to Provider

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RPM – Continuous near-real time monitoring to the home

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• Decrease volume and length of COVID-19 inpatient admissions

• Reduce ER in-patient admissions of COVID-19 suspected/positive patients to the MTF

• Decrease COVID-19 exposure to hospital staff through continuous RPM of SPO2, HR, temperature and movement of enrolled patients based on clinical protocols at each participating MTF

• Improve inpatient and outpatient outcomes• Decrease exposure of hospital acquired

infections to high-risk patients

Remote Patient Monitoring (RPM) pilot provides support to ten MTF location across the DHA in response to the COVID-19 pandemic in order to:

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VS

Artificial Intelligence is important for the MHSColon Biopsy

Machine learning heat maphighlighting the presence of

amoebic organisms in a colon

Entamoeba histolytica(amoebic colitis)

Entamoeba histolytica(amoebic colitis)

Transforming our world Supports our highest prioritiesHigh quality data1 2 3

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FY 2021–2026 MHS VH Initiatives

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FY 2021–2026 MHS VH Initiatives

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FY 2021–2026 MHS VH Initiatives

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The Military Health System COVID Response

The Military Health SystemPatient Experience Portfolio

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Enhancing the Patient Portfolio

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Patient and Staff adoption Enterprise virtual video visit solution

DoD/VA Continued Partnership 3

Standardized processes and workflows for MTF and Markets4

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Joint Health Information Exchange (JHIE) and Data Exchange5

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Joint Health Information Exchange (JHIE)

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Benefits of the joint HIE to patients

Enhances how healthcare systems are able to quickly and securely share patient records

More comprehensive picture of patient health data

Benefits of the joint HIE to providers

DOD and VA providers access the joint HIE

More complete patient information

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Summary• Understand the focus areas of improvement that were successful for COVID response

• DHA rapidly exploited existing VH capabilities to enable the MTFs/Markets to provide medically necessary care to beneficiaries which could not be delayed. Areas in which the MHS improved or increased use of VH included a major increase in virtual visits, expanding the ADVISOR hotline to provide real-time critical care and infectious disease support to MTFs world-wide and increased ICU bed-capacity through the Tele-critical care program.

• Identify the priority of effort for the Military Health System (MHS) Digital Patient Engagement Strategy

• MHS VH program is prioritized and broken down into three main capabilities: patient-to-provider, provider-to-provider and complex, real-time monitoring. Each capability type differs slightly in how DHA measures adoption rates.

• Identify major gaps in understanding and implementation in the MHS current patient experience portfolio

• DHA's approach is to standardize workflows and processes in MTFs and Markets to optimize the direct care system and then validate and implement additional innovations to improve overall system performance without introducing unwarranted variance.

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Questions

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?

#HIMSS21

Thank you!• Dr. Brian Lein

Assistant Director, Health Care Administration• Phone: (703) 681-8433• E-mail: brian.c.lein.civ@mail.mil

• Follow DHA on Social Media• Twitter: https://twitter.com/DoD_DHA• LinkedIn: https://www.linkedin.com/company/defense-health-agency• Facebook: https://www.facebook.com/DefenseHealthAgency• Website: https://www.health.mil/About-MHS/OASDHA/Defense-Health-Agency

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