virtual medical center from operational to garrison · 2021. 2. 22. · 8. vmc cooperative...

UNCLASSIFIED As of: 18 November 2019Slide 1LTC(P) Sean J. Hipp, MD/[email protected]/1-844-V-MEDCEN

LTC(P) Sean J. Hipp – Director Mr. Jeffery Burgwin – Deputy Director

MAJ Daniel Yourk – Deputy Director for Operations

“Medically Ready Force…Ready Medical Force”

VIRTUAL MEDICAL CENTERFROM OPERATIONAL TO GARRISON


Disclosure


Presenter’s have no relevant financial or non-financial interests to disclose.

Disclosure will be made when a product is discussed for an unapproved use.

This continuing education activity is managed and accredited by AffinityCE in collaboration with AMSUS. AffinityCE and AMSUS staff as well as Planners and Reviewers, have no relevant financial or non-financial interests to disclose.

Commercial Support was not received for this activity


Outline:

1. The Problem/ Multi-Domain Operations

2. Benefits of Virtual Health

3. Strategic Overview

4. Creating Solutions

5. Operational Programs

6. Virtually Integrated Patient Readiness & Remote (VIPRR) Clinic

7. Tele Behavioral Health Integration with the Enterprise

8. VMC Cooperative Initiatives

9. Administrative Initiatives

10. Summary

Purpose: To have a better understanding of the Virtual Medical Center and how it can be a force multiplier in the delivery of military medicine from operational to garrison.

Disclosure: The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, the Department of the Air Force and Department of Defense or the U.S. Government."

PURPOSE, OUTLINE AND DISCLOSURE



MULTI-DOMAIN OPERATIONS

“Medically Ready Force…Ready Medical Force”Ref: COL Jeremy Pamplin – Director TATRC


TYRANNY OF DISTANCE

“Medically Ready Force…Ready Medical Force” Ref: COL Jeremy Pamplin – Director TATRC


VH is a is a force multiplier in Operational AO’s to preserve combat power

Improves the readiness of our medical force

Projects medical capabilities to the point of need

Improves patient & peer-to-peer access to specialty providers regardless of geographic location

Mitigates travel risks and demands

Commanders must fight and win in acomplex environment. They do thisthrough maintaining lethality andpreserving combat power forward. Wemust leverage medical technology toenable treatment and managingSoldier care far-forward, in thefoxhole, whether through enhancingmedical capabilities of the Medic orconsultation to specialty providersfrom the point of need.

BENEFITS OF VIRTUAL HEALTH



Goal 1: Develop VH support for the Warfighter

Goal 2: Support the MHS Clinical Communities

Goal 3: Use VH to Improve Access to Quality Care for MHS Beneficiaries

Goal 4: Manage Costs Through and Within VH

Virtual Medical Center Initiatives 1 2 3 4

Centralized VH Privileging X X X XVirtual Health Care Coordination Application X X X XMobile Medic for the Enterprise X XADVISOR X XRemote Health Monitoring X X XAMEDDC&S Synchronization XCoding Auditing and Education X XIntegration with BH Resources X X X XTele-Critical Care Network X X XPATH/HELP Integration X X XCoordination of EHR access at MTFs XEducation of Providers and Staff X XCart Education and Training X XSynchronization with MHS X X XSynchronization with Joint Surgeons Office X X

∎ Service VH efforts now fall under a single MHS VH Strategy aligned to a single MHD VH POM which the DHA will manage effective Oct 19.

STRATEGIC OVERVIEW



MHS Virtual Medical Center Construct OCT19



CREATING SOLUTIONS


How do we make sure that there is a Ready Medical Force for Multi-Domain Operations?

VMC synchronizes medical services across the

enterprise supporting operational and garrison

forces anytime, anywhere

18 time zones30 countries and territoriesOver 30 clinical specialties


Mobile Medic team consists of a group of the Army’s Combat Health Specialists (68W) dedicated to providing mobile Virtual Health support at the point of need

Benefits Improve access to care Reduced time Service Members are away from training Increased 68W primary care skills Capability to bridge time/distance factors Medical force multiplier for prolonged field care situationsField Training

OperationalGarrison

MOBILE MEDIC – TRAIN AS YOU FIGHT



Call: 833-ADVSRLN (833-238-7756)

#1 Critical Care #2 Specialty Services

#3 Emergency Department

#4 USAISR Burn Center

#5 VeterinaryMWD

#6 Training Option

#7 Chemical Casualty

To provide a full spectrum of on-demand consultationservices to operational forces for contingency support.


To coordinate training with ADVISOR email [email protected]


Date Service Consulted Originating Site of Call

Disposition of Call Operational Impact Potential Cost

Avoidance

10 JUL 17 Infectious Disease West Africa AVOIDED EVACPatient remained in country and was managed by local provider rather than evacuating the patient to LRMC, Germany $115,000

12 NOV 17 General Surgery Africa (Specific location unknown) AVOIDED EVACConsult resulted in the development of a treatment plan that allowed the originating site provider to manage the patient locally $115,000

29 APR 18 Toxicology Al Udeid, Qatar AVOIDED EVACConsult resulted in the development of a treatment plan that allowed the originating site provider to manage the patient locally $42,000

30 MAY 18 Infectious Disease OB Felty, Afghanistan AVOIDED EVACConsult resulted in the development of a treatment plan that allowed the originating site provider to manage the patient locally $70,000

25 SEPT 17 Infectious Disease CameroonDowngradedUrgency of Evac

Downgraded the evacuation priority from Urgent to Routine: Prevented Urgent Evacuation

$80,000 (EstimatedDifference)

06 FEB 17 Critical Care CameroonDowngradedUrgency of Evac

Downgraded the evacuation priority from Urgent to Routine: Prevented Emergent Evacuation

$80,000 (Estimated Difference)

23 JUN 19 Orthopedic Surgery Africa AVOIDED EVAC Consult resulted in the development of a treatment plan that allowed the originating site provider to manage the patient locally

$115,000

02 JUL 19 Veterinary Services Egypt DowngradedUrgency of Evac

Downgraded the evacuation priority from Urgent to Routine: Prevented Emergent Evacuation

$80,000 (Estimated Difference)

27 OCT 19 Infectious Disease Niger AVOIDED EVAC - Severe Plasmodium falciparum malaria – ADVISOR provider provided recommended treatment plan and avoided EVAC.

$115,000

Potential Aircraft Cost Avoidance:(References for cost avoidance analysis listed in notes section of this slide)

$812K *Analysis does not include cost associated with EVAC Personnel/medical attendants, the Risk of an

Urgent evacuation or the degradation of operational capability to the unit*

REAL-WORLD EXAMPLES

UNCLASSIFIED As of: 18 November 2019Slide 14LTC(P) Sean J. Hipp, MD/[email protected]/1-844-V-MEDCEN“Medically Ready Force…Ready Medical Force”


VIPRR Clinic Metrics (FEB – OCT 2019)


Highlights:∎ The VIPRR Clinic completed 5,174 virtual medical readiness appointments from FEB – OCT 2019∎ VIPRR Clinic no-show rate = 2.84%∎ Overall Patient Satisfaction with Provider (JOES) = 94.5%∎ VIPRR Clinic providers have provided medical readiness support to Service Members Assigned to 948 different Unit Identification Codes (UICs)

and enrolled to 62 different MTFs (Parent DMIS ID) across the world.

92181 202

405

561

902

1062

811

1209

0

200

400

600

800

1000

1200

1400

0

200

400

600

800

1000

1200

Feb MAR APR MAY JUN JUL AUG SEP OCT

# of

VIP

RR C

linic

Enc

ount

ers

FEB - OCT 2019 Monthly VIPRR Clinic Encounters by Service

Army Air Force Marines Navy Not Listed Coast Guard Grand Total

4961

412

329 19 1

FEB - OCT 2019

Army Air Force Marines

Navy Not Listed Coast Guard


Global Support!



CONUS Support



VIRTUAL BEHAVIORAL HEALTH CONSTRUCT

There are 3 Army Behavioral Health hubs that are regionally aligned Regional Health Command Atlantic, Augusta, Georgia Regional Health Command Central, San Antonio, Texas Regional Health Command Pacific, Honolulu, Hawaii

3 hubs will fall under the VMC construct Oct 19 Gaps/Barriers

Need a leader to track and coordinate capacity across the enterprise

Connect to the operational space and report to leadership in theater

Enterprise education about services offered at the TBH hubs

Need to incorporate into VHCAA Need to track schedule with TELMED detail code Need to incorporate AF/NAVY BH paperwork Need to coordinate connection to AF/Navy resources

Hawaii, HILeader: LCDR

GraceyClinical personnel:

11

San Antonio, TX Leader: Dr. DulinClinical personnel:

21

Augusta, GALeader: Mr. Orr

Clinical personnel: 9

Leverage Capacity



PATH/HELP OVERVIEW


• Established 2004 at Tripler Army Medical Center• Asynchronous, web-based, HIPAA compliant, secure, provider-to-provider, multi-media, air evacuation / patient movement … not limited to just deployed providers• PATH: https://path.tamc.amedd.army.mil

• Established 2014 at Portsmouth NH as a hub-and-spoke linked to PATH server• HELP: https://help.nmcp.med.navy.mil


PATH/HELP Specialty Support

“Medically Ready Force…Ready Medical Force” 20


Virtual Medical Center-Europe: Bringing the MEDCEN to the Warfighter Every Day


Every Day across VMC-Europe:

• 41 ADSM Mission Days saved by not travelling for healthcare

• 35 synchronous video Virtual Health visits (sVH) are performed through 79 operational and 56 fixed sites across 3 COCOMs

• 10 Operational Virtual Health Visits are performed

• 300+ providers across 42 Specialties performing Virtual Health

• One in twenty surgeries started at LRMC with a sVH visit

VMC-Europe’s Capabilities:

• Integrated Asynchronous and Synchronous VH Operations Link HELP with sVH visits

• Interoperable, scalable web-based connectivity platform User platform & connectivity method immaterial

• Dynamic scheduling for patients, providers, and Nurse Presenters Bring the MEDCEN to the point of need

• Personalized training for Providers and Presenters Integrate VH into daily use

14,000 Mission Days saved for Commanders in 2018

6,000 sVH visits in 2018 Virtual Health Conserves the Fighting Force!

Ref: Regional Health Command Europe


Virtual Critical Care

Leveraging information and communication technologies allows a smaller number of doctors & nurses to care for a larger number of geographically isolated, critically ill, patients anytime and anywhere. This system enables: Standardization of best practice medicine (quality) Decreased network disengagements (cost savings) Higher acuity and volume of spoke site admissions (readiness) On-demand operational VH support for the warfighter (lethality)

Ref: CAPT Konrad Davis, MD, NMCSD“Medically Ready Force…Ready Medical Force”


∎ FY20-22 JIF Application The MHS is pursuing a JIF grant to begin

merger of the VA Tele-ICU and DOD Virtual Critical Care programs.

If approved, this will merge VA (VISN 10 + 23) with DOD (TCC) programs.

This will likely take 5-7 years for complete integration.

Long-Term Vision is a single federal TCC system involving DOD and VA hub & spoke sites, which allows DOD providers to transfer garrison beds to VA network for support if/when they need to focus their support on the operational space or even to provide garrison-based support for man-made and/or natural disasters.

Joint Incentive Fund (JIF)

Ref: CAPT Konrad Davis, MD, NMCSD“Medically Ready Force…Ready Medical Force”


Remote Health Monitoring


DHA Remote Health Monitoring

Healthy Lifestyle Symptom Monitoring Disease Management

SAMHS RHMVirtual Medical Center

NCR RHM NCR CMIO

Future Growth: • Expand to new sites for

enrollment• Add new categories

under each of the 3 arms

HLP B/P Monitoring DREAM


Virtual Video Visits (V3) Update


Description – VH at Patients’ Locations includes the utilization of two-way interactive audio video involving a health provider in a facility and a patient in their home or another secure location for primary and specialty care.

Access / Satisfaction• Another access point is created for beneficiaries• Immediate care at home, place of business, etc. should drive satisfaction

Productivity • Lower acuity triaged outside clinic• Likely to reduce no show and left without being seen rates• Likely to decrease ED and urgent care visits based on civ sector

Cost Avoidance• Decrease in cost per visit

- Primary Care- Specialty Care

• Decrease in PMPM

Provider and Patient interact via two-way interactive audio video platform. As appropriate, NAL can triage

patients who need to see another clinician.

Patient at Home w/ video device and necessary

peripherals

ProviderNurse

Advice LineSup

porte

d as

ap

prop

riate

by:

MHS V3 enterprise

solution on track for selection and funding in FY20VH IT PMO Executing

MHS Platform Purchase in FY20


DHA-PI 6025.13 – Quality (Credentialing)

CENTRALIZED VIRTUAL HEALTH PRIVILEGING



VIRTUAL HEALTH CARE COORDINATION APPLICATION

Virtual Health appointments, referral documents and clinic availability are easily updated by clinic staff

Coordinates provider, virtual health care coordinator & virtual health cart information across the enterprise

Automated notifications are sent to patients, referral coordinators and nurses

Periodic Health Assessments (PHA) are being scheduled through Virtually Integrated Patient Readiness and Remote Care Clinic (VIPRR) in VHCCA

Currently supports 12 Distant Site MTFs, 45 originating site clinics, 54 providers, 500+ appointments created and 260+ users around the world



SUMMARY


Focus Quad AimThe Virtual Medical Center construct is focused on creating programs and processes that support operational readiness and multi-domain operations

√ Increased Readiness√ Better Care√ Better Health

Future state increases synchronization between the military services and active connections between garrison and the operational space

√ Increased Readiness√ Better Care

Funding will continue to be aligned under the Military Health System and the Virtual Medical Center will be aligned under the Defense Health Agency

√ Lower Cost


QUESTIONS?

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virtual medical center from operational to garrison · 2021. 2. 22. · 8. vmc cooperative...

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