partnership for continuity of care around the world · veterans affairs efmp - assignment decision...
TRANSCRIPT
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1
Military Medical Care Symposium: Partnership for Continuity of Care Around the World
Session # MH6, February 11, 2019
James B. Peake, MD, CGI
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2
James B. Peake, MD
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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3
• Introduction
• Recap
• Military Health Unique Environment
• Challenges
• Changing Landscape
• Opportunities
• Cautions
• Purpose
Agenda
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4
• Summarize the information from the topics discussed to formulate
the impact of these activities on continuity of patient care
• Recognize how interoperability, cyber security and data migration
activities improve the experience of the military medical force and
our patients
Learning Objectives
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Military Medical Care Symposium: Partnerships for Continuity of Care Around the World
What’s Our Why?
James B. Peake, MD
Lieutenant General, USA (Ret)
SVP, CGI Federal
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An Agenda of Perspectives
• MG Lee Payne – Clinical Champion – Asst Dir, CSA, DHA
• Surg Cdr Melanie Doherty
• Dr Schnitzer… civilian academics, DARPA, MITRE
• Glenn Lanteigne, CEO, Tectonic Advisory Services Inc
• Panel of our clinical boots on the ground
– Andrew Harriman – Flight Nurse, GlobalMed Services
– Brian Jones, DO Guidehouse
– Kelly Christy, Col USAF
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Perspectives
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The Global Environment
Terrorism
Failed and Failing States
Transnational Threats
Asymmetric Challenges
Rise of Major Military
Competitor
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Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTO& ETO& E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE . . . J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers,
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
Forward Medic
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
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https://taskandpurpose.com/trump-troops-border-deployment-chart
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ONE LONGITUDINAL RECORD
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More Than Technology
GENESIS
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MILITARY
Assignment Eligibility
Benefits Determination
VETERANS
AFFAIRS
EFMP - Assignment Decision
Medical Care / Clinical DECISIONS
Deployment Decisions
Separation Decision
What Outcome?
Informed Decisions
Research for Impact
Projecting System Requirements
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Patient
Data
Population
Health
Clinical
Decision
Prevention
Medical
Logistics
Patient
Education
VACCINES
SUPPLIES
OR SUPPORT
DENTAL SPT, MOB
DEMOB HEALTH RQTS
REQUIREMENTS
Real Time
Population Based
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TRANSITION
MORE THAN
PATIENT INFORMATION
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WHAT WILL BE DIFFERENT ABOUT
SURVIELLANCE
Hazard 1•Type
•Location
•Time Period
Hazard 2•Type
•Location
- GRID A
•Time Period
Hazard 2•Type
•Location
- GRID B
•Time Period
Blue Force Tracking
OVERLAY
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HEALTHY &
FIT
RETURN
TO
DUTY
SPECIALIZED
RECOVERY
LONG
TERM
REHAB
Two GREAT Systems
Two GREAT Missions
Health Industry In America
Health Information Ecosystem
REINTEGRATION
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GOAL: By the year 2020, ninety percent
of clinical decisions will be supported by
accurate, timely, and up-to-date clinical
information, and will reflect the best
available evidence.
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DATA TO INFORMATION TO INSIGHT TO ACTION
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Data
• Clinical
• Management
• Training
• Personnel
• Surveillance
• Point of Care Decision Support
• Optimization
• Force Readiness
• Policy Development
• Preventive Measures
Analytics / BI
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Protecting the Warfighter
Force
Protection
Environmental Hazards
Industrial Hazards
Bio Weapons
Chemical Weapons
Radiation
Heat/Cold Extremes
Fatigue
Weapons Fire
Land mines
Endemic Diseases
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NDAA 2019
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Health System Management
• (b) OBJECTIVES.—In carrying out the requirement in subsection (a), the
Secretary shall meet the following objectives: (1) The referral process shall
model best industry practices for referrals from primary care managers to
specialty care providers. (2) The process shall limit administrative
requirements for enrolled beneficiaries.
• Beneficiary preferences for communications relating to appointment referrals
using state-of-the-art information technology shall be used to expedite the
process. (4) There shall be effective and efficient processes to
determine the availability of appointments at military medical treatment
facilities and, when unavailable, to make prompt referrals to network
providers under the TRICARE program.
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Joint Markets / Joint Operations
. . . Moving Beyond Artificial Boundaries
Synergy, Efficiency,Quality
Multi Service Market
Areas & Joint Medical
Operations
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Multi Market Management
• Data
• Analytics
• Direct Care System AND the
Network
• Population health
Legal Terms, Policy Requirements, Technical
Specifications, And Governance Processes
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Secretary Wilkie
More Than Clinical
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• We cannot repeat the institutionalization of:–Poor process
–Old organizations
– Inadequate training focused around system navigation
–Poorly prepared leaders
– Inflexible facilities
• IM/IT is a forcing function to shape behavior
Avoiding the Pitfalls
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Readiness
• The Surgeon General of each Armed Force shall, on behalf of
the Secretary concerned, ensure that the uniformed medical and
dental personnel serving in such Armed Force receive training
and clinical practice opportunities necessary to ensure that such
personnel are capable of meeting the operational medical
force requirements of the combatant commands applicable to
such personnel. Such training and practice opportunities shall be
provided through programs and activities of the Defense
Health Agency and by such other mechanisms as the Secretary
of Defense shall designate for purposes of this paragraph.
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Best Practice
Unpracticed skills are first addressed in the safety of simulation rather than with live patients.
The Coming And Going
Challenge Of Relevant Skills
Mobilization / Demobilization
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Advanced Modular Manikin
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Medical Simulation
• Mannequin-based simulators can train medics and PAs on chest tube insertion and hemorrhage
• Virtual reality medical trainers present immersion environment superimposed over medical tasks for realistic embedded training capability in FCS
• Computer-based training can incorporate haptics, tissue-tool interactions, and real-time graphics to augment reality (allows for embedded training)
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Military Medicine, Volume 182, Issue suppl_1, 1 March 2017, Pages 310–315
Teletraining – Telementoring
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HoloLens
2018 CAE Healthcare
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Name, Title, Email Slide 36 01 Jan 2018
Role 1 Role 2 Role 3 Role 4 Role 5
EnrouteCare
EnrouteCare
EnrouteCare
EnrouteCare
First Responder
Preventative and Protective
Forward Resuscitative
Theater Hospital
Definitive Care
RehabilitativeCare
WarPREP
Warfighter Perform, Resilience, Effectiveness and Protection
Theater Hospital Operations Replication
Simulated Hospital Operations & Treatment System
Rehabilitation Simulation for Treatment
THOR SHOTS ReSTJETSPOINTS
DoD Medical Simulation Enterprise
(Integrated & Federated)
DoD // Inter-Governmental // Coalition Partner
Integrated
USA USNUSAFUSMC USSOCOM Intergovernmental Coalition PartnerOther DoD
POI
Integrated
Federated
Medical Simulation Enterprise (MSE)
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BASICSKILL
INTEGRATIONOF STEPS
INTEGRATIONOF PROCESSES
NEWTECHNOLOGY,PROCEDURES,STANDARDS
SKILLDEVELOPMENT
SKILLSUSTAINMENT
Teach
Correct
Assess
Do
ENVIRONMENTAL RELEVANCE
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Lessons learned• Artz, C.P. 1956. Battle casualties in Korea; studies of the Surgical Research Team. Volume
III. The battle wound; clinical experiences. Army Medical Service Graduate School, Walter Reed Army Medical Center. Washington: GPO.
• Meroney, W. H., ed. Battle casualties in Korea; studies of the Surgical Research Team. volume IV. Post-traumatic renal insufficiency. Washington: GPO.
• Tom Whelan, Surgical lessons learned and relearned in Vietnam, Surgery Annals, 7(1): 1–23 1975
• CINCPAC-1. 1967. Commander in Chief, Pacific. First CINCPAC Conference on War Surgery. Tri-service surgical conference conducted at John Hay Air Base, Baguio, the Philippines, 20-25 May 1967, Incl with cover ltr, J.S. Cowan, RADM USN, CINCPAC Medical Officer, 12 Jul 1967.
• CINCPAC-4. 1970. Commander in Chief, Pacific. Fourth CINCPAC Conference on War Surgery. Tri-service conference on war surgery conducted in Tokyo, Japan, 16-19 February 1970. Incl with Cover ltr, Frank B. Voris, M.D., RADM USN, CINCPAC Surgeon, 2 Mar 70.
Bernie Rostker, RAND
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94 Buildings In The Compound
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1,917
9,426
TOTAL
EVAC’D
72TOTAL
INPATIENTS
00NEW
INPATIENTS
OEF
3645TOTAL
INPATIENTS
16NEW
INPATIENTS
OIF
CONUSEUROPE
STRATEGIC EVACUATION
OPERATION IRAQI FREEDOM /
OPERATION ENDURING FREEDOM
12 HOURS
TO
48 HOURS
DOOR TO DOOR – ICU TO ICU
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4
Army Medical Footprint
DS/DS
OEF
OIF
DNBI = .261
DNBI = .107
DNBI = .143
% = Personnel Assets in Theater
DNBI Episodes / 1000 Soldiers
Combat Service Support, (-) Medical
Medical
Combat
Combat Support
Other
35%
24%
23%
14%5% 32%
41%
35%
22%
5%6%
24%
26%
5%4%
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Cyber Challenges
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Power of Information
What we don’t know WILL hurt us!
Act Decisively
KnowledgeData
TIME
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Peacetime Health System Supporting the Warfighting Force
Integrating into the Formations
Flowing into the TPFDL
Efficiently Managing Shared Services
Efficiently Managing A Delivery System
Efficiently Managing Contracts
Ready Medical ForceForce StructureRecruitingRetentionTraining
Guard & Reserve Integration
DHA SERVICES
Provide a readiness training platform
Medically Ready Force
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What’s Our
Why?
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49
Please complete online session evaluation
Questions
Wednesday – 13 February10:00 am – 11:00 am
EHR: The Road to Transforming Military & Veteran Health Care-
Speakers:
Stacy Cummings, Program Executive Officer for the Program Executive Office, Defense Healthcare Management Systems
John Windom, VA Executive Director for the Office of Electronic Health Record Modernization (OEHRM)Session 112, W304E
FYI
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STRATEGIC PRINCIPLES
•SEAMLESS - SUPPORT READINESS
•BUSINESS CASE
•BENCH MARKING
•CHOICES – PROVIDERS / PATIENTS
•INTERCHANGEABLE, INTEROPERABLE, REUSABLE
•INFO WHEN AND WHERE NEEDED / PROTECTED
•PROCESS REENGINEERING
•UNIFORM DATA PROCESSES AND TECH STANDARDS
•USER-BASED RAPID PROTOTYPING
•OFF THE SHELF WHEN POSSIBLE
•DATA ENTERED ONCE AS BY PRODUCT OF PROCESS
•CONSISTENT, EASY, ACCEPTABLE TO USERS
•INCREMENTAL DEPLOYMENT - UNIFORM BENEFIT
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