Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
Developing the Military Medical Digital Patient ExperienceSes s ion # 32, Augus t 10 , 2021
1
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.
2#HIMSS21
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.
3
#HIMSS21
Agenda
• The Military Health System (MHS) COVID Response
• The MHS Digital Engagement Strategy
• The MHS Patient Experience Portfolio
4
#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
5
#HIMSS21
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.
8
#HIMSS21
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
11
• Uses analysis for both trauma and COVID to predict outcomes and deliver life-saving treatments
#HIMSS21 14
Rapidly accelerated expansion
and support during COVID
Pre COVID
Post COVID
End State
MHS Joint Tele-Critical Care Network (JTCCN)
1
4
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.
5
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.
15
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
3
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/
2
6
16
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
#HIMSS21 17
Digital Patient
Engagement Strategy is
Virtual Health
Provider -to -Provider
Complex real-time monitoring
Patient -to -Provider
Artificial Intelligence
#HIMSS21
Patient -to -Provider
18
Virtually Integrated Patient Readiness and Remote Care Clinic (VIPRR) Tele-behavioral Health (TBH ) Hubs1 2
#HIMSS21 19
• 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
#HIMSS21
RPM – Continuous near-real time monitoring to the home
20
• 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:
21
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
#HIMSS21
Enhancing the Patient Portfolio
26
Patient and Staff adoption Enterprise virtual video visit solution
DoD/VA Continued Partnership 3
Standardized processes and workflows for MTF and Markets4
1 2
Joint Health Information Exchange (JHIE) and Data Exchange5
#HIMSS21
Joint Health Information Exchange (JHIE)
27
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
#HIMSS21
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.
28
#HIMSS21
Thank you!• Dr. Brian Lein
Assistant Director, Health Care Administration• Phone: (703) 681-8433• E-mail: [email protected]
• 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
30