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Health care of the future: Virtual doctor-patient visits a reality at NCR

In a demonstration of the telehealth process at Fort Campbell’s Blanchfield Army Community Hospital, clinical staff nurse Army Lt. Maxx Mamula examines mock patient Army Master Sgt. Jason Alexander using a digital external ocular camera. The image is immediately available to a provider at Fort Gordon’s Eisenhower Medical Center, offering remote consultation. (U.S. Army photo by David E. Gillespie) In a demonstration of the telehealth process at Fort Campbell’s Blanchfield Army Community Hospital, clinical staff nurse Army Lt. Maxx Mamula examines mock patient Army Master Sgt. Jason Alexander using a digital external ocular camera. The image is immediately available to a provider at Fort Gordon’s Eisenhower Medical Center, offering remote consultation. (U.S. Army photo by David E. Gillespie)

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FALLS CHURCH, Va. — Technology has helped people from every corner of the world connect with friends, family, and colleagues – and, soon, technology will connect physicians and patients in the Military Health System. The once far-fetched concept of virtual health care may soon become reality in military medicine as experts help the Military Health System transform its offerings to connect doctors and patients in remote locations through a secure medium.

“We can’t afford not to think about this today,” said Dr. Christine Bruzek-Kohler, director of clinical operations at National Capital Region Medical Directorate, also known as NCR. The NCR is one of six regional, multi-service health care markets across the country and a leader in the pursuit of virtual health services in the MHS. “It’s time to get health care out to beneficiaries in ways we’ve never done before,” Said Bruzek-Kohler.

Military Health System leaders devoted a day to the future of telehealth services in a gathering at Walter Reed National Military Medical Center for the Virtual Health Summit on Jan. 30. Participants learned about current virtual health capabilities at military treatment facilities in the NCR and explored ideas to help MHS meet new requirements outlined in a Congressional mandate due Oct. 1. According to the National Defense Authorization Act, section 718 requires the enhancement of telehealth services use within the Military Health System.

What does this mean for beneficiaries?

The term telehealth, also referred to as virtual health within the MHS, includes secure messaging between providers and beneficiaries and appointment scheduling. It allows providers to complete actions through videoconference, phone, tablet, or home monitoring devices. These actions include assessing and evaluating diseases and symptoms, diagnosing disease, supervising treatment, and monitoring health outcomes.

Providers and patients will be able to connect without an in-person visit for primary and specialty care. Providers will also be able to connect with one another for consultation and share medical information. Restrictions, which are being worked out as the MHS maps its virtual course, will apply.

How the MHS will satisfy these new requirements was the primary focus of the summit, but not its only goal. Dr. Bruzek-Kohler challenged participants to think beyond the basics.

“Don’t be limited – be creative and think about what virtual health should be for our patients,” said Bruzek-Kohler. “We are here to change the direction of health care delivery for our beneficiaries.”

Dr. Jamie Adler, lead of the MHS Virtual Health Strategic Plan and Connected Health Office for the Defense Health Agency, called virtual health a ‘positively disruptive’ force within the enterprise. He discussed some of the unique challenges that have come up during the process, such as low provider adoption, technical platform interoperability issues, and differing policies, practices, workflows, and metrics. Other challenges include training variances and the lack of budget planning for virtual health, he said. Some of these issues are similar to those in civilian health care, while others are unique to the military.

“We have certain security issues to deal with,” said Adler, adding that he’s looking for solutions that would be translatable down range. “We want to train how we fight. This is part of our unique experience developing an enterprise solution.” 

Navy Commander Melissa Austin, director of Clinical Support Services at Fort Belvoir Community Hospital, said her team was able to get the task done because IT became willing partners.

“We found a gap in the system that allowed us to do this,” said Austin. “We went through trials, errors, and we make a lot of tradeoffs.”

At WRNMMC, 16 clinics currently provide a mix of telehealth services. In February, seven new clinics will start offering telehealth, including child psychology – a service in high demand.

Dr. Thomas Handler, research vice president at Gartner, said the foundation is forming for virtual health in the MHS. The work ahead will not only involve changes in process, technology, and policy, but also fundamental shifts in how leaders and providers think about health care, he added.

“At MHS, we are rewarded for being in the room with a patient versus being rewarded for doing something for a patient,” said Handler. “Virtual health requires a mindset change.”

Handler said the MHS needs to look far ahead in the future and take a shot as the vision, whether or not it seems like a longshot, is divided into incremental pieces. Beneficiaries can expect to hear about developments in the coming months as the system finalizes the course to its virtual future.

Beneficiaries interested in learning about current telehealth or virtual health care options are encouraged to speak with their providers. Patients can also inquire about these services while scheduling follow-up appointments with the NCR Appointment Line, available at (855) 227-6331.

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