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DHA’s IT innovation continues during COVID-19 pandemic

Three military personnel, wearing masks, in front of a computer screen Capt. Bradford Smith, Naval Medical Center San Diego’s (NMCSD) commanding officer (left), enrolls in Military Health System (MHS) GENESIS with the help of Lt. Donny Le (center) and Hospital Corpsman 2nd Class Terrance Stevens, training coordinators assigned to NMCSD. MHS GENESIS, the new electronic health record system, provides enhanced, secure technology to manage health information and integrates inpatient and outpatient solutions. (Photo by Petty Officer 3rd Class Jacob L Greenberg, Naval Medical Center San Diego.)

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Coronavirus | Research and Innovation | Technology | MHS GENESIS

The Defense Health Agency’s innovations in Information Technology in 2020 not only aided the immediate response to the COVID-19 pandemic, but also proved that such challenges cannot dim the future of IT utility, convenience, and interoperability.

The DHA is moving forward with the nationwide installment of its MHS GENESIS electronic health records (EHR) system, which should be finished – on time – by the end of 2023, Holly Joers, acting program executive officer, Program Executive Office-Defense Healthcare Management Systems, told a recent media roundtable.

The momentum has continued despite competing priorities from the COVID-19 pandemic on military health care centers across the U.S., Joers noted. In fact, the installation of MHS GENESIS, the joint EHR for the DOD and the Department of Veterans Affairs, already has proven helpful in adding system alerts for COVID-19, opioid overuse, and mass inoculations, she said.

MHS GENESIS offers a patient portal as one of its key features. The portal is a one-stop shop, around-the-clock access point for viewing personal health care and history. It also provides two-way communication between patient and provider. Beneficiaries can use the secure website to access individual and family health information and to aid in online prescription renewal.

In October, CommonWell Health Alliance was added to the joint health information exchange (HIE), bringing with it a network of more than 15,000 health care providers.

The joint HIE was launched in April 2020 and is a network of private sector providers across the United States who have agreed to securely share clinical information with DOD, Department of Veterans Affairs and U.S. Coast Guard providers. Shared clinical information includes prescriptions, allergies, illnesses, lab and radiology results, immunizations, medical procedures, and medical notes in the form of electronic health records, “resulting in more informed care for patients who are navigating between different health care providers” in both the public and private sectors,” DOD said.

The CommonWell connection was a “critical step forward in significantly expanding DOD, VA and the U.S. Coast Guard’s private sector partnerships and interoperability capabilities,” according to DOD. The deal provides a single point of entry for providers to the more than 2,000 hospitals, 8,800 pharmacies, 33,000 clinics, 1,100 labs, 800 federal qualified health centers, and 300 nursing homes participating in joint HIE.

Healthcare worker, wearing personal protective gear, leans into a car at a pharmacy drive-thru
U.S. Army Pvt. Daniel Murtagh, a combat medic specialist, wears personal protective gear as a frontline worker testing drive-thru patients for COVID-19 at Joint Base Elmendorf-Richardson, Alaska in November 2020. (Photo by Airman 1st Class Emily Farnsworth)

To ensure a seamless, standardized experience for beneficiaries, the DHA is migrating public-facing military medical treatment facility (MTF) websites to TRICARE.mil. Each migrated site will have the same look and feel to improve ease of access for beneficiaries to quickly locate information. The DHA has established 18 guest wireless sites for the continental U.S. to keep patients and their families up to date on the delivery of care. 

The medical community of interest (Med-COI) is a single, enterprise-wide network designed to support military health IT requirements. The desktop-to-datacenter (D2D) program helps standardize the delivery of enterprise services. D2D enables providers and staff access to their personal clinical desktop via any clinical desktop in any MTF.

All Army and Navy MTFs, as well as an increasing number of Air Force MTFs, have received the infrastructure to support the migration to D2D/Med-COI. More than 20 MTFs and their associated clinics have been fully migrated to make them MHS GENESIS ready.

A different, but no less fruitful, creation was a provider “resilience toolkit” for COVID-19 by DHA Connected Health’s mHealth team. The toolkit highlights evidence-based research on self-care tips and health technology tools to promote the resilience of frontline providers and reduce burnout during the pandemic. The toolkit, launched in late March, is being updated to feature a lead video, a series of interview videos with providers, blog posts, a social media toolkit, and more.

“These were existing tools in the DHA digital health portfolio that, when packaged together, met a pressing need in the military health community. The use of digital tools supports social and physical distancing while also allowing our providers an avenue to monitor and improve their stress and anxiety,” said Kelly Blasko, MHS Connected Health Branch mHealth Clinical Integration section lead.

“Based on research from past health crises, we knew that providers were at-risk for the psychological effects of burnout. We saw a drastic increase in the usage of DHA’s recommended digital health tools, ranging from 16% to over 1,000%, during the first six weeks of an awareness campaign,” Blasko said.

The revamped toolkit takes into account lessons learned on provider burnout months into the pandemic. “The self-care strategy and tools continue to fill a need to prevent and alleviate any effects of burnout, increasing provider resilience,” she noted.

In addition, DHA’s Antimicrobial Stewardship app is a centralized platform for promoting standardized practice in treating infectious diseases, including COVID-19.

“The app gathers all the evidence-based resources in one place and is available at your fingertips,” said Dr. Twee Sim, senior medical advisor and chief of the Office of Advanced Clinical Quality Management & Policy Analysis for the DHA. “This is especially important during this pandemic, when providers may be overwhelmed by the multiple and different sources for information.”

The app also supports providers at the point-of-care with relevant guidelines and evidence-based recommendations for treatment.

The app’s information has been reviewed by DHA infectious diseases providers and gives recommendations based on nationally recognized organizations such as the Infectious Diseases Society of America, Centers for Disease Control and Prevention, National Institutes of Health and on the DOD COVID-19 Practice Management Guide.

DHA’s Information Technology & Multimedia Branch (ITMB) is helping to support the needs of the Medical Education and Training Campus (METC) and its students.

The ITMB acquired funding to enhance the cellular signal in the Medical Instructional Facilities, which will help with training and emergency response, METC Public Affairs said. ITMB is migrating its network from the Army to the Med-COI. ITMB coordinated an improved Wi-Fi network across dorms, ships and barracks to support students with remote access to training materials.

The METC has transferred a number of programs of instruction to the College of Allied Health Sciences (CAHS), Uniformed Services University, making CAHS the institution of record for college credit. METC plans to move more programs to CAHS.

In addition, the METC formed a distance and blended learning working group because of the COVID-19 crisis. Although much of the education and training is hands on, several programs stepped up to provide students with remote access to training materials. These actions helped to ensure the safety of students and instructors, as well as to assist students in isolation to keep up with their classmates. To date, 11 programs can use distance and blended learning.

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Policy

This DHA-PI establishes Defense Health Agency’s (DHA) procedures to provide key stakeholders’ responsibilities for connecting medical devices to MHS GENESIS; establish clinical expectations for connecting medical devices to MHS GENESIS; provide references for MTFs to use in procuring medical devices that will be connected to MHS GENESIS; and provide process for MTFs to elevate medical device connection issues related to MHS GENESIS.

DHA IPM 18-013: Risk Management Framework (RMF)

Policy

This Defense Health Agency-Interim Procedures Memorandum (DHA-IPM), based on the authority of References (a) through (c), and in accordance with the guidance of References (d) through (ac): • Incorporates cybersecurity strategy, policy, awareness/training, assessment, continuous monitoring, authorization, implementation, and remediation. • Aligns with the Deputy Assistant Director, Information Operations (DAD IO) J-6/Chief Information Officer’s (CIO) key concept of increasing cybersecurity of Defense Health Agency’s (DHA) Information Technology (IT); therefore, robust risk assessment and management is required. • Encompasses lifecycle risk management to determine and manage the residual cybersecurity risk. • This DHA-IPM is effective immediately; it will be converted into a DHA-Procedural Instruction. This DHA-IPM will expire effective 12 months from the date of issue.

  • Identification #: 18-013
  • Date: 9/20/2019
  • Type: DHA Interim Procedures Memorandum
  • Topics: Technology

DHA IPM 18-011: Video Network Center (VNC) Endpoint Standards

Policy

This Defense Health Agency-Interim Procedures Memorandum (DHA-IPM), based on the authority of References (a) through (c), and in accordance with the guidance of References (d) through (g): - Provides guidance for video network endpoint standards required for sites to connect to the Defense Health Agency (DHA) VNC network. These standards will help ensure security compliance, efficiency, and best practices are maintained across the DHA network. Meeting certification requirements brings many benefits, including: increased assurances of a successful video teleconference (VTC) experience, full access to bridge and point-to-point calls, and access to peer video networks, including the Department of Veterans Affairs, academia, and industry partners. Compliance with stated standards does not preclude users connecting to other DoD approved networks. - This DHA-IPM is effective immediately; it will be converted into a DHA-Procedural Instruction. This DHA-IPM will expire effective 12 months from the date of issue.

  • Identification #: 18-011
  • Date: 9/20/2019
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DHA-PI 3200.01: Research and Development (R&D) Enterprise Activity (EA)

Policy

This Defense Health Agency-Procedural Instruction (DHA-PI), based on the authority of References (a) and (b), and in accordance with the guidance of References (c) through (p): a. Establishes the Defense Health Agency’s (DHA) procedures for the Deputy Assistant Director (DAD), R&D to manage and execute, on behalf of the Assistant Secretary of Defense for Health Affairs (ASD(HA)), the portion of the Defense Health Program (DHP) Research, Development, Test, and Evaluation (RDT&E) appropriation assigned to it (referred to as the “DHP Science and Technology (S&T) Program)”. The DHP S&T Program includes Budget Activities (BAs) 6.1-6.3 and 6.6. The ASD(HA) provides policy, direction, and guidance to inform planning, programming, budgeting, and execution of the DHP RDT&E appropriation in accordance with statute, regulation, and policy in Reference (a). The DAD-R&D, and Component Acquisition Executive (CAE) manage and execute DHP RDT&E Program funds aligned to them on behalf of the ASD(HA). The CAE is responsible for managing BAs 6.4, 6.5, and 6.7 funding, as well as Procurement and Operations and Maintenance funding required to support DHP-funded Acquisition Programs, regardless of acquisition activity. b. Supports the Director, DHA, in developing appropriate DHA management models to maximize efficiencies in the management and execution of DHP RDT&E-funded activities carried out by the Combatant Commands (CCMDs), Services, Uniformed Services University of the Health Sciences (USU), Defense Agencies, and other DoD Components, as applicable. c. Codifies processes to confirm DHP RDT&E funds are applied towards medical priorities and aligned to ASD(HA) policy, direction, and guidance to develop and deliver innovative medical products and solutions that increase the readiness of the DoD medical mission in accordance with Reference (a). d. Supports the following objectives of the R&D EA: (1) Increasing the quantity, quality, and pace of medical research through improved programmatic organization, processes, and oversight. (2) Ensuring DHP RDT&E funded efforts align to ASD(HA) published program guidance that provides resourcing guidance and translates national, departmental, and Service priorities into specific program objectives. (3) Verifying alignment of DHP RDT&E funds to medical priorities and to ASD(HA) policy, direction, and guidance to ensure the development and delivery of medical materiel and knowledge solutions. (4) Facilitating coordination with the CCMDs, Services, USU, Defense Agencies, and other DoD Components, as applicable, to ensure DHP RDT&E funded activities address joint medical capability gaps, and avoid unnecessary duplication.

DHA PI 3201.05: Technology Transfer (T2) Program

Policy

This Defense Health Agency-Procedural Instruction (DHA-PI) based on the authority of References (a) and (b), and in accordance with the guidance of References (c) through (t), establishes responsibilities, procedures, and guidance for the Defense Health Agency’s (DHA) T2 program.

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DHA IPM 18-021: Guidance for Immediate Completion and Closure of Open Encounters and Records in Legacy Systems

Policy

This Defense Health Agency-Interim Procedures Memorandum (DHA-IPM), based on the authority of References (a) through (c), and in accordance with the guidance of References (d) and (e): • Establishes the Defense Health Agency’s (DHA) procedures to complete and close open encounters within the legacy systems in preparation for the implementation of Military Health System (MHS) GENESIS. • Identifies and delineates responsibilities associated with completing and closing open encounters within the legacy systems in preparation for the implementation of MHS GENESIS. • Should be used by DoD military treatment facilities (MTFs) to update procedures and workflows that pertain to the DoD Health Record Management, Patient Administration, and other MTF functions impacted by these decisions. • Is effective immediately; it must be incorporated into a DHA-Procedural Instruction. This DHA-IPM will expire effective 12 months from the date of issue.

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DHA IPM 18-017: Military Health System (MHS) Information Technology (IT) Investment Management Framework

Policy

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  • Identification #: 18-017
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MHS Enterprise Architecture Signed Memo and Guide 20120730

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Guidance on the Establishment of a Human Cell, Tissue, and Cellular and Tissue Based Products Program

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MHS Cloud First Adoption Directive and Policy Guidance Signed Memo and Attachment

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