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How COVID-19 fast-tracked innovation in the Military Health System

Image of Military personnel receiving the COVID-19 test. An Ohio National Guard soldier conducts a COVID-19 test during a pop-up testing drive-thru at Anthony Wayne Junior High School in Whitehouse, Ohio, on October 2020. (Photo by: Senior Airman Kregg York, 180th Fighter Wing Ohio National Guard).

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In early 2020, as the Sars-CoV-2 virus was just beginning to spread across the United States, the Defense Health Agency was already working to coordinate epidemiological data on the emerging threat.

By March of 2020, as the virus was reaching nearly every state in America, the Military Health System was using new, molecular-based COVID-19 tests that enabled sample analysis and delivered results in just four to six hours.

Since then, it's been off to the races for the DHA and the MHS in general with regard to heath care innovations in the face of the virus.

The urgent demands of the pandemic forced the MHS to adjust quickly by building out new capabilities, implementing new customer-care techniques and launching massive new research efforts.

As a result, new and rapidly developed health care procedures have kept warfighters on post, ships at sea, and military medical professionals on the front lines in the fight against the coronavirus.

"We can't ignore that COVID-19 has already irrevocably changed how we deliver care and will continue to do so," Army Lt. Col. (Dr.) Sean Hipp, Director of DHA's Virtual Medical Center, said in July 2020.

"We must use the terrible clarity these unprecedented circumstances provide to honestly evaluate our tools and practices, and apply that wisdom to make real, lasting improvements to health care. This mindset of embracing innovation for the sake of our patients is already a hallmark of MHS providers. We find creative, clinically sound ways to treat our patients - no matter the obstacle."

The MHS has been a leader in virtual health, otherwise known as telehealth or telemedicine, using secure, accessible and compliant technology. The MHS Virtual Medical Center (VMC) has expanded virtual health tools for military patients and medical personnel across the services to ensure continuity of care during the COVID-19 pandemic. That's included mobile mental health tools and apps that have provided valuable support to people experiencing anxiety, depression, substance abuse and other problems during the COVID-19 crisis and its accompanying periods of isolation.

Another example is the MHS Nurse Advice Line, which since the earliest weeks of the crisis has provided patients with reliable access - via web chat, video, and phone - to registered nurses who are trained to triage beneficiaries.

The nurses provide advice on self-care, refer beneficiaries for COVID-19 testing and vaccinations, or coordinate clinically appropriate care. The care could be a virtual appointment with a provider, a referral to an urgent care center, or a visit to the emergency room.

The pillars of MHS efforts to fight COVID-19 have been the execution of testing for the virus, and, more recently, rolling out vaccinations. Military and civilian lab managers and technicians have been among those on the front lines. Their work goes beyond that uncomfortable swab to the back of the nose that many have experienced.

"In addition to adding COVID-19 testing platforms … our team also vetted many additional products," said Air Force Lt. Col. Paul Nelson, chief of the Air Force Medical Service COVID Lab Team.

"We have advised on an array of testing methodologies to include diagnostic and asymptomatic pooling, wastewater surveillance and whole genome sequencing - mostly done on the research side of the house."

Military health personnel handling a patient sample  to test for COVID-19
Air Force Staff Sgt. Nathan Harris, 96th Medical Group laboratory technician, handles a patient sample to test for COVID-19 in May 2020 at Eglin Air Force Base, Florida. All samples were handled within the biological safety cabinet, known as the “hood” to ensure no particles came into the room (Photo by: Ilka Cole, 96th Test Wing Public Affairs).

Customer Service

Other, more ground-level approaches to testing have played out across the country. The North Dakota Army National Guard coordinated drive-through testing sites with civilian counterparts and developed a system using an electronic tablet and a bar-coded label, speeding up the process and enabling about 1,000 tests to be done in just a couple of hours.

Elsewhere, staff at military hospitals and clinics quickly pivoted from mass vaccination events to pop-up events at high-traffic locations like installation exchanges and cafeterias.

And at Keesler Medical Center in Biloxi, Mississippi, the medical staff took advantage of the CDC's recommended 15-minute waiting period for patients after the COVID-19 vaccines are given. The staff has been making appointments for routine care with patients who missed some of these checkups during the many months of quarantines.

"People weren't coming in to get their screenings at all - because of COVID they just didn't want to come in," said Tommy Franklin, Keesler Medical Center's director of staff.

"We tried to close that gap while they were coming in for the vaccines. It was 'Hey, oh by the way, we see you're behind on your pap smear, we see you're behind on your colon screening. Would you like to go ahead and get that screening scheduled now that you're here?'"

The goal was "to be able to use that window of opportunity to communicate with these folks and make eye-to-eye contact and let them know that "Hey, we're open and available to do this for you,'" Franklin said.

Keesler uses CarePoint, a DHA information delivery portal that's been around for a while, to check the medical records of those coming in for a vaccine. A new innovation, called the DHA Appointing Portal (DAP), made its debut earlier this spring after a pilot project launched in December. DAP is an easy-to-use online tool to help patients schedule a time and date for their COVID-19 vaccine appointment at a nearby military hospital or clinic.

At roughly the same time this spring, MHS GENESIS, the Department of Defense’s new electronic health record system, was developing a large digital record of COVID-19 vaccinations administered to service members and their families. Referred to as 'MassVax,' the archive more accurately tracks and ensures that the DOD's patient population has received COVID-19 vaccinations, considered essential to both a ready medical force and medically ready force.

New Research

Scientific studies on the disease by the military have proceeded apace, too. One involved clinical trials of a long-acting antibody combination medicine to prevent COVID-19 among people who have been exposed to the disease, a DOD initiative that involved the Uniformed Services University of the Health Science's Infectious Diseases Clinical Research Program.

Called STORM CHASER, the program coordinated teams of physicians, nurses, pharmacists, and clinical research staff at five MHS locations from Maryland to Hawaii. Another objective of the study was examining whether the antibody injection could reduce viral shedding in those who may develop COVID-19 after receiving the injection. (Viral shedding occurs when the virus replicates inside the body and is released into the environment, making the host person contagious to others.)

Other solutions were less sophisticated. For instance, staff at many military hospitals and clinics developed inexpensive, easily constructed ventilators for use in hospital and field settings to make up for shortfalls in national stockpiles.

"The individual MTFs did an astounding job of expanding day-to-day testing," said Nelson, in a recent issue of the Biomedical Sciences Corps newsletter. "The organizational response to SARS-CoV-2 proved without a doubt that necessity truly is the mother of invention...and innovation!"

"One of the things that we were really impressed with in March, April, May and June of last year, was how fast DHA was cranking out guidance and policy to help the facilities as they navigated these waters," said Franklin.

"With another pandemic, God forbid, the rules and the way we play the game will change again. But at least for now we have a script and a foundation to start with."

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