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DHA Leaders Talk About Future Mix of In-Person and Virtual Health Care

Defense Health Agency Director Army Lt. Gen. (Dr.) Ronald Place speaking at an Expo Defense Health Agency Director Army Lt. Gen. (Dr.) Ronald Place was the keynote speaker for a panel discussion entitled, “Quality of Life at Your Fingertips,” at the Association of the United States Army’s Annual Meeting and Exposition in Washington, D.C., Oct. 11. (Photo by: Jacob Moore, MHS Communications)

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We use apps for almost everything these days - driving, shopping, gaming and keeping in touch with friends and family.

Why not use apps and other online resources for our health care?

The future of health care technology was a common theme for leaders from the Defense Health Agency who spoke at the Association of the United States Army's Annual Meeting and Exposition in Washington, D.C., Oct. 11 and 12.

DHA Director Army Lt. Gen. (Dr.) Ronald Place; Regina Julian, chief of DHA's Healthcare Optimization Division; and DHA Assistant Director Dr. Brian Lein spoke about the COVID-19 pandemic's impact on the use of digital tools for the Military Health System and its 9.6 million beneficiaries.

DHA Director Army Lt. Gen. (Dr.) Ronald Place

"The pandemic has changed much of the way that we work, the way that we go to school, get our healthcare, shop, interact - really, innumerable things," said Place, who was the keynote speaker for the AUSA Family Forum panel discussion entitled "Quality of Life at Your Fingertips."

Place shared his thoughts on how to evaluate virtual tools for military families in the present digital landscape, some of which have their genesis in the current pandemic.

"These are exciting times," Place said. "And the developments that emerged or accelerated during the pandemic will be sustained and strengthened where it allows us to better serve our families."

These developments present opportunities to enhance quality of life for soldiers and families, and also have the potential to increase job opportunities for spouses and family members in virtual settings.

Place compared digital health care to digital banking in the sense that, although many things can be done online or on an app, there is still a need for face-to-face interaction in many cases.

"Even though most financial activity is transactional and can be managed through virtual platforms," he said, "there is still a need for person-to-person relationship interactions when things go wrong, or the transactions become increasingly complex."

A speaking panel at the Association of the United States Army's Annual Meeting and Exposition
Regina Julian (center), chief of the Defense Health Agency’s Healthcare Optimization Division, was one of six panelists for a panel discussion entitled, “Quality of Life at Your Fingertips,” at the Association of the United States Army’s Annual Meeting and Exposition in Washington, D.C., Oct. 11. (Photo by: Jacob Moore, MHS Communications)

Place, a general surgeon, said some aspects of health care will never be replaced by technology. He said his greatest privilege when he was in the operating room was cultivating the trust of his patients. The military medical community is still searching for the ideal mix of in-person and electronic services and interactions.

"Sometimes the experience requires a human touch," Place said. "I'm a fan of virtual medical visits and surgical follow-ups when it's appropriate. We're still trying to find the right balance."

A cautionary tale from the pandemic are the undiagnosed cases of colon, lung and skin cancer, diabetes, hypertension and other ailments.

"The literal art of diagnosing when it's not the primary reason that someone came for their appointment has suffered."

When considering virtual applications, Place said: "It's not all or nothing; it's not good or bad - it's the proper application of virtual technology that produces effective outcomes"

Place said a key question for health care professionals is: "Does the virtual encounter accomplish the same outcome as the actual encounter? If so, it's a win for everybody."

Chief of Healthcare Optimization Regina Julian

Julian, one of six Family Forum panelists covering everything from health care to community and family support, said DHA is working to make patient-facing processes easy, seamless and consistent so that beneficiaries don't have to learn how to navigate new health care systems every time they change duty stations or retire.

"One of those capabilities we're working on standardizing is virtual health," Julian said.

She cited capabilities like the MHS Nurse Advice Line, which allows beneficiaries access to a nurse over the phone toll-free 24/7, that existed before the pandemic.

"We also enhanced our legacy TRICARE Online Patient Portal. We integrated secure messaging into the system and with a one-stop shop, you can connect to the Nurse Advice Line, see your test results, read your medical clinical results, read your medical notes and also make appointments," she said.

Defense Health Agency Assistant Director speaks to a group of active-duty military and retirees
Defense Health Agency Assistant Director for Healthcare Administration Dr. Brian Lein speaks to a group of active-duty military and retirees about how to best use their TRICARE benefits for virtual health at the Association of the United States Army’s Annual Meeting and Exposition in Washington, D.C., Oct. 11. (Photo by: Jacob Moore, MHS Communications)

As DHA has assumed responsibility for the administration of military medical treatment facilities, Julian said, her team has brought their entire portfolio of virtual health capabilities together to consistently apply them to the military health care system.

"Do most people think of virtual visits as just video visits? It's true," she said. "But we have a wide suite of tools that we use in both our military medical treatment facilities, our TRICARE network and in support our most important mission - readiness in operational environments."

During COVID-19, Julian said, agility has been key.

At the onset of the pandemic, private civilian practices were concerned about going out of business.

"They were afraid to see their patients. Their patients were afraid to come in to see them...and we didn't want that to happen to us," said Julian. "Within two weeks, we put out guidance, standard processes, and we authorized a number of easy-to-use software capabilities for our patients and staff. The result is that, throughout the pandemic and continuing now, we were able to provide medically necessary care which could not safely be delayed, while protecting both our patients and staff."

On the horizon for virtual health within the DHA, Julian said, is "MHS Video Connect," a new industry-standard video visit system; a patient-facing smartphone app; and expanding TRICARE to better cover video visits for behavioral health.

Assistant Director of Healthcare Administration Dr. Brian Lein

In a separate session at the conference, DHA Assistant Director for Healthcare Administration Dr. Brian Lein spoke to a group of active-duty service members and retirees about how to best use their TRICARE benefits through virtual health.

Among the benefits available to TRICARE For Life beneficiaries, Lein said, is remote physiologic monitoring. TRICARE For Life is Medicare-wraparound coverage for TRICARE beneficiaries who have Medicare Part A and Part B.

"Instead of being admitted to the hospital, they can send you home with [technology] that hooks up to your smartphone and hooks up to Bluetooth and it can measure your [heart] rate. It can measure your oxygen levels. It can measure your blood pressure. It can measure your pulse," he said, adding that technological advances like these are covered by TRICARE.

Lein said he sees an increasing amount of virtual and telehealth options being covered by TRICARE going forward. He, like Julian, also stressed the importance of tele-behavioral health.

"It makes a huge readiness impact and it's something that we clearly recognize and something that we truly have to figure out how to manage," he said.

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