The Defense Health Agency plans to advance its use of virtual technology with an aim to get the patient connected to the medical provider no matter where they are, according to one of the agency’s top doctors.

Dr. Brian Lein, assistant director for health care administration for the DHA, said the agency needs to invest in people, capabilities, systems, and processes to achieve a virtual future for DHA.

“What's the most important thing we need to invest in?” asked Lein. “It's culture. How do we invest in the culture within the military health care system to get to a virtual-first environment?”

The solution, he said, is all about the patient.

“It's investing in a culture change of who we are as a military health care system to truly put the patient first.”

Lein was one of several Military Health System leaders who talked about the future of using health care technology at the annual Healthcare Information and Management Systems Society conference, held in Chicago, Illinois, in April.

In his presentation, titled “Virtual First/Digital Always in the Defense Health Agency,” he talked about how the MHS can achieve integrated, digital-health capabilities. Lein discussed DHA’s current use of health technology across the enterprise and where it needs to invest to achieve modernization. 

While attending the annual Healthcare Information and Management Systems Society conference held in Chicago, Illinois on April 19 as a speaker, Dr. Brian Lein, assistant director for health care administration for the Defense Health Agency, is interviewed for a segment on HIMSS TV.
(Credit: Robert Hammer, MHS Communications)

Lein, who manages the administration of health care delivery across all Department of Defense hospitals and clinics around the world, noted DHA’s undertaking of “the biggest merger and acquisition the health care industry has seen. We've combined 48 inpatient hospitals, hundreds of clinics, urgent care centers, dental clinics, 180,000, health care professionals, 100,000 or so in uniform and 60,000 or so out of uniform wear all into one health care system.”

“Before connecting this network of military hospitals and clinics, there was no one system, and no “standardized workflow (or) standardized processes. We had three different analytics systems, three different budgets, three different resource allocation systems,” Lein said. “Now we're going to completely redesign that health care technology interface to better serve our patient population.”

“We need to implement a fundamental redesign of how we interact with the individual beneficiary and how that beneficiary interacts with an incredibly complex health care system,” he added.

Goals of Virtual Care

Currently almost 80% of all health care visits are in person with only about 20% being virtual, he added. “The downside is 95% of our virtual visits are telephone calls. We're not really leveraging the health technology that's out there.”

Lein shared the MHS’ goals to transition to virtual care, including:

• Enhance the system to be virtual-first with a digitally informed whole person-focused environment, where the individual beneficiary is at the center.
• Make individualized care based upon real-time analytics
• Apply best practices to leading-edge technologies to support our worldwide population.
• Drive and improve health outcomes for our people.

The DHA Transition to Virtual Health

“The patient is not involved in their care as much as they need to be,” noted Lein. “How do we improve that so you don't have to go to the doctor's office, so your encounter with the provider is seamless, and that the provider gets the information they need from you?”

He stressed the importance of getting the patient connected to the medical provider no matter where they are, saying that being “patient-centric” means coming to the patient, if possible.

“Imagine if you had a digital scale at home, that told the provider what you weigh, rather than telling the provider what you think you weigh. Imagine if that blood pressure cuff that you have at home was able to inform the provider on your blood pressure,” said Lein. “Imagine if you're an end stage heart patient, and I noticed you gained three pounds today and gained three pounds yesterday, now you’re six pounds up, and I pushed you way off at the other end of the heart curve. Instead of waiting until tomorrow, or until an ambulance ride to the emergency room to the ICU, I can interrupt that, and I can start taking care of you now.”

Lein also mentioned the importance of doctors having access to all of your health data at once, no matter how many health care providers you’ve visited in the past.

“We now have the electronic health record that captures every bit of data on our beneficiaries. And it's fielded to every place except for overseas and a couple of small hospitals within the United States,” said Lein. “There's no other health care system that has this. It's got that every bit of data, whether you're inpatient or outpatient, if you're in that military health care system and the Direct CareDirect care refers to military hospitals and clinics, also known as “military treatment facilities” and “MTFs.”direct care system, 2.3 million beneficiaries, we're capturing every bit of that data. The power of that is huge.”

Future of Virtual Care in the DHA

Lein noted three future focus areas, including:

• Robotic process automation
• Remote patient monitoring
• Virtual appointments

Lein said that “we've got to have a massive investment in infrastructure changes” because of the difficulty of delivering that level of care in brick-and-mortar military hospitals and clinics.

“I don't want to reinvent the wheel,” he said. “We should leverage the technological capabilities of the virtual health systems that are out there.”