Back to Top Skip to main content Skip to sub-navigation

MHS quickly adapted to improve patient experience during pandemic

Image of Military health personnel waiting for the next phone call on the COVID-19 advice line. Regina Andrews, a registered nurse at Fort Carson’s Evans Army Community Hospital Department of Surgery in Colorado, awaits her next phone call Aug. 5, 2020, from the COVID-19 patient advice line (Photo by: Emily Klinkenborg, Fort Carson Evans Army Community Hospital).

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus

Faced with the onslaught of the COVID-19 pandemic, the Military Health System (MHS) responded swiftly to fight the novel coronavirus and deliver necessary medical care, routine health care and services to maintain a medical ready force.

"At the beginning, the goal was to continue providing medically necessary and readiness-related care, which could not be delayed in order to protect patients and staff from unnecessary exposure to COVID," said Regina Julian, chief of the Healthcare Optimization Division at the Defense Health Agency (DHA). Julian cited dialysis services, the delivery of babies, well-infant examinations, emergency surgeries, and cancer-drug infusions as examples.

"We did these services in safe cohort areas" at military medical treatment facilities (MTFs), she said.

"We based our model on what we learned from our own high-performing MTFs and consistent with what civilian hospitals such as Brigham & Women's (in Boston), Columbia-Presbyterian (in New York) and Cedars-Sinai (in Los Angeles) were doing," Julian said.

"This ability to develop standard processes based on best practices and then to codify those practices in DHA guidance to continue care that is medically necessary and necessary to keep the force operating fully is all part of DHA being a high-reliability organization," she said.

"We were able to be nimble by leveraging and modifying our existing DHA Healthcare Optimization Division guidance for primary and specialty care, access, referrals, patient experience and virtual health for all MTFs world-wide" to reflect new COVID-19 processes, Julian said.

Because of this, "the Direct CareDirect care refers to military hospitals and clinics, also known as “military treatment facilities” and “MTFs.”direct care system remained open throughout the pandemic" and delayed elective care, Julian said. "We took advantage of being able to shift additional patient visits to telephone visits, video visits, the Nurse Advice Line and asynchronously using secure messaging and e-visits.

To establish standard processes during the COVID-19 pandemic, DHA released more than 37 new clinical and operational guidance documents. The lessons learned during COVID-19 and the rapid implementation of new guidance enabled continuous process improvement. As a result, DHA will incorporate these new best practices into permanent DHA guidance by October 2021.

"Our focus was on the safety of patients and staff," said Army Col. Timothy Switaj, the Healthcare Optimization Division's Primary Care lead and the chair, Department of Family and Community Medicine, Brooke Army Medical Center (BAMC) at Joint Base-San Antonio in Texas.

"We transitioned a lot of care to virtual primarily via telephone to minimize the number of people who needed to physically come to the medical treatment facilities," Switaj said.

"Our biggest focus was on safety, but a close second was ensuring adequate communication with our patients via any medium informing them of what care we were providing, how we were providing that care, and the safety protocols put in place," Switaj said.

Survey data demonstrated patients appreciated the care MTFs took to ensure their safety and the convenience of virtual care, which demonstrated the MHS' efforts to communicate with patients was successful.

Switaj leads the primary care effort in San Antonio with collaboration from primary care leaders at all MTFs. The ongoing collaboration "ensured everyone spoke with one voice in primary care," he said.

"We would send changes in operations out to patients as soon as possible," Switaj said. "For patients worried about potential COVID-19 symptoms, we established a local nurse information line (for all of San Antonio). They used standard scripts, algorithms, and protocols to triage patients helping to determine who should be tested, and for those who had been tested, how to interpret their results, what precautions they should take, and how to manage their symptoms.

"Additionally, the nurse information line provided general information such as testing site locations, hours, and, later, vaccine information as it became available," he said.

The BAMC market has approximately 250,000 beneficiaries, and primary care services are provided to more than 150,000, Switaj said.

"Initially we transitioned about 90% of care to virtual means so that we could minimize the number of patients and staff in the clinics," he said. "By June 2020, we started gradually transitioning back to more face-to-face appointments, ultimately looking for the right balance for more long-term operations."

Switaj said in the first four to six months of the pandemic there was hesitancy from patients to return to in-person visits, "but, at this point, we are not seeing any issues."

As the world returns to a new normal with the advent of vaccines and better treatments for COVID-19, DHA is developing a patient-facing application for use on any device to enhance patient access, improve patient outcomes, experience, and engagement, said Beth Adoue-Polk, a member of the patient experience branch under Julian.

"We are working to leverage this patient-facing application to improve access and convenience for patients to manage their appointments, access pharmacy services, receive reminders/notifications and also to send secure messages to their health care teams," Adoue-Polk said. "We will have subject matter experts as well as patient feedback to develop the features and requirements for this app."

The TRICARE Online Patient Portal (TOLPP) was very responsive and receptive to the changing needs of DHA during the COVID-19 pandemic, she noted. TOLPP very quickly added virtual appointments, new prescriptions activation, laboratory appointments, and COVID-19 vaccination appointments, Adoue-Polk added. Since starting in March 2020, more than 260,000 virtual visit appointments have been booked via TOLPP across the MHS, according to DHA.

Enrollment and utilization also increased for TOLPP Secure Messaging, which continued to provide patient access to their health care team during the COVID-19 crisis. Using broadcast/blast messaging, MTFs were able to communicate quickly and effectively to inform patients about any changes in operations. More than 2.6 million broadcast messages went out in March 2020. These broadcast messages are now being used as part of the COVID-19 vaccination campaign.

While being nimble helped the MHS to adapt quickly to the COVID-19 crisis, it also helped the system identify new ways of caring for patients, according to Julian.

"If there is a bright silver lining to COVID-19 and to honor those who suffered, it required us to stop looking at the past, and to look to even better ways to establish a new normal," she said.

You also may be interested in...

COVID-19 Testing and Treatment Main Graphic

Infographic
4/21/2022
COVID-19 Testing and Treatment Main Graphic

If your military hospital or clinic offers these antiviral treatments as part of the COVID-19 Test to Treat Initiative, use these graphics to promote your services to your beneficiaries.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | COVID-19 Treatment

COVID-19 Testing and Treatment Graphic 2

Infographic
4/21/2022
COVID-19 Testing and Treatment Graphic 2

If your military hospital or clinic offers these antiviral treatments as part of the COVID-19 Test to Treat Initiative, use these graphics to promote your services to your beneficiaries.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | COVID-19 Treatment

Make Guidance for DOD Facilities

Infographic
2/3/2022
Make Guidance for DOD Facilities

Mask Guidance for Department of Defense Facilities.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Prevent COVID-19

Additional Dose of mRNA

Infographic
2/3/2022
Additional Dose of mRNA

Should I get an additional dose of the mRNA Vccine?

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Get to Know the COVID-19 Vaccines

VaxFacts: Should I get a booster?

Infographic
2/3/2022
VaxFacts: Should I get a booster?

Should I get a COVID-19 Booster Shot?

Recommended Content:

Coronavirus and the COVID-19 Vaccine | COVID-19 Vax Facts

VAXFacts TRICARE coverage Vaccine

Infographic
2/3/2022
VAXFacts TRICARE coverage Vaccine

Will TRICARE cover the COVID-19 Vaccine? Yes. TRICARE offers the vaccine itself at no cost, but there may be a cost based on your plan for an office visit or if you require follow-on care.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | COVID-19 Vax Facts

Preteens Teens Can Get Boosted Too

Infographic
2/3/2022
Preteens Teens Can Get Boosted Too

Preteens and Teens can get boosted, too! The CDC recommends a booster shot of Pfizer-BioNTech vaccine for preteens/teens ages 12 and older, 5 months after their second shot.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Vaccines for Children

Compromised Immune System

Infographic
2/3/2022
Compromised Immune System

Do you have a compromised immune system? The CDC recommends you get an additional primary dose of the mRNA COVID-19 vaccine.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Get to Know the COVID-19 Vaccines

Formulary Search Tool Buckslip (Page 2)

Infographic
1/27/2022
Formulary Search Tool Buckslip (Page 2)

The back side of a buck slip. Educates beneficiaries what the search tool is and what information can be found. QR code is on the right and links to the search tool. The TRICARE and Express Scripts logo are on the bottom left.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Pharmacy Operations Toolkit

Formulary Search Tool Buckslip (Page 1)

Infographic
1/27/2022
Formulary Search Tool Buckslip (Page 1)

The front side of a buck slip. Educates beneficiaries what the search tool is and what information can be found. Links to esrx.com/tform. Has three graphics grouped together on the right hand side.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Pharmacy Operations Toolkit

We Can Do It (1201 x 901)

Infographic
1/10/2022
We Can Do It  (1201 x 901)

We can do it: Simple measures can protect you and your community. Wear a mask, get vaccinated, and check out where and when you can get your booster! https://tricare.mil/coronavirus

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Prevent COVID-19

Quarantine vs Isolation

Infographic
1/10/2022
Quarantine vs Isolation

Been exposed or feeling symptoms of COVID-19? Make sure you understand the difference between quarantine and isolation to keep your community safe. https://tricare.mil/coronavirus

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Prevent COVID-19

We Can Do It (1081 x 1081)

Infographic
1/10/2022
We Can Do It  (1081 x 1081)

We can do it: Simple measures can protect you and your community. Wear a mask, get vaccinated, and check out where and when you can get your booster! https://tricare.mil/coronavirus

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Prevent COVID-19

We Have the Tools

Infographic
1/10/2022
We Have the Tools

We have the tools to fight: Protect yourself and your community from the spread of COVID-19 with the right tools. Make sure you wear your mask, get vaccinated, and find your nearest testing site. Learn more https://tricare.mil/coronavirus

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Prevent COVID-19

Vaccine for Children TLDR

Infographic
11/4/2021
Vaccine for Children TLDR

Vaccination is our best defense against the spread of COVID-19.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Vaccines for Children
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 6
Refine your search
Last Updated: May 19, 2021

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.