Focusing Skills Proficiency to Achieve Advanced Force Health
From its role as a key DoD support entity for guidance surrounding the Department’s COVID-19 pandemic response, the Defense Health Agency (DHA) continues to serve as lead for Military Health System (MHS) protocol including MHS GENESIS electronic health record, TRICARE health benefits, and combatant commands stationed worldwide.
By LTG Ronald Place, Director, Defense Health Agency
From Combat & Casualty Care, Summer 2021
Since January 2020, the Department of Defense (DoD) has dedicated resources to combat the COVID-19 threat with the support of the Defense Health Agency (DHA) and others across the Military Health System (MHS).
One of the first actions included publishing DoD Force Health Protection (FHP) Guidance. The Department has since published 22 FHP supplements. This guidance has helped to keep pace with the dynamic nature of an emerging, and then changing, pandemic environment. FHP guidance focuses on the safety and well-being of our active-duty service members, employees, and beneficiaries. Among a host of details, they include guidelines for public health risk mitigation, diagnostic testing, return-to-work protocols, and travel.
Leveraging Institutional Know-How
The MHS has been an active participant in the federal response, which has been a multiagency U.S. Government effort led by the Department of Health and Human Services (DHHS) and the DoD. The MHS’s medical research and development capability immediately offered support to the federal response effort, which leverages recognized experts from the federal government and private industry. The DHA quickly pivoted and responded by supporting convalescent plasma collection, testing, development of therapeutics and vaccines, development and implementation of the DoD Vaccine Administration Plan, vaccine safety, and monitoring much of this with a COVID-19 registry.
Early in the pandemic, when clinicians were still not sure what the most effective treatments were for COVID-19 infections, the Food and Drug Administration (FDA) authorized use of convalescent plasma as an investigational treatment for patients with moderate or severe COVID-19 infections. The DHA led a vigorous effort to collect 10,000 units of COVID-19 Convalescent Plasma (CCP) by September 30, 2020. To reach this goal, the DHA implemented a six-phase program to identify, recruit, assess, collect, store, and distribute CCP to assist researchers in the development of vaccine and therapeutics. By September 2020, the MHS surpassed the goal with more than 10,700 units collected.
From the beginning of the COVID-19 pandemic, the DoD has stood at the front lines of proactive testing for the COVID-19 virus. Health care providers continue to work closely with local and installation public health authorities or public health emergency officers to guide COVID-19 diagnostic testing. DoD testing facilities have become more robust since the outbreak began. To maintain military readiness and ensure our national security, the DoD significantly increased its COVID-19 testing capacity. Since March 2020, we grew from 15 testing sites to 185, including public health laboratories, and performed more than 3.5 million COVID-19 tests as of June 2021.
We leveraged prior investments that built an infectious disease research, development, and manufacturing infrastructure. Our ongoing research into medical countermeasures supported the all-of-government effort to develop and manufacture vaccines and therapeutics to fight the virus. The federal response funded clinical trials evaluating several vaccine candidates, and selected them based on promising data of immune response, protection in animal studies, safety and immune response data in early-stage trials in humans. Each of the trials collected data on how well a vaccine candidate protected against COVID-19 and on the safety of the vaccine candidate in a larger population, including people most at risk.
Pfizer-BioNTech and Moderna received the FDA’s emergency use authorization in the United States in mid-December 2020, followed by Janssen in March 2021. The DoD began executing the COVID-19 vaccination distribution plan for prioritizing and administering COVID-19 vaccines to 13 initial sites. Today, more than 360 sites are administering the emergency use authorized vaccines.
To meet COVID-19 data needs, the DHA’s Joint Trauma System staff developed a global COVID-19 registry to track patients and their outcomes. The COVID-19 registry began collecting real-time COVID-19 data in May 2020 and exceeded 220,000 DoD patients as of the first week of June 2021, with a detailed record review by trained abstractors of over 9,000. The registry provides a remarkably detailed capability to compare outcomes of COVID-19 to available treatments. The DoD can also track active-duty personnel’s annual physical fitness tests for lingering COVID-19 impacts. It also links to the annual periodic health assessment, where we plan to add questions related to mental health and the COVID-19 pandemic.
Laying a Framework for Future Healthcare
MHS GENESIS replaces a patchwork of numerous legacy systems with a single, integrated electronic health record across the continuum of care. It provides the DoD’s 9.6 million beneficiaries and approximately 200,000 medical providers with standardized medical workflows and a consistent electronic medical records tool. We are adopting modern, digital health technologies to offer greater access to care, and have already started capturing initial uptake at recruiting depots, routine care occurring both at home station and during deployment, and in the near future, will be able to continue the electronic health record through transition to Department of Veterans Affairs health care.
We first deployed our electronic health record to military treatment facilities in the Pacific Northwest in 2017. The MHS GENESIS base platform is already in wide use in civilian hospitals and we adapted it to meet our unique needs. Since 2017, we have been learning the MHS GENESIS system, conducted multiple upgrades, applied stabilization and adoption changes, and accomplished thousands of configuration changes to tailor it to meet our needs. With the activation of MHS GENESIS at U.S. Coast Guard pilot sites in September 2020, and the Department of Veterans Affairs Mann-Grandstaff VA Medical Center in October 2020, we are starting to see the full capability that this system offers us. Already this year, the DoD deployed MHS GENESIS to sites in Arizona, California, Colorado, Kansas, Missouri, Montana, Nebraska, New Mexico, North Dakota, South Dakota, Texas, Utah, and Wyoming.
We are involved in several efforts to support health readiness. First, the DHA is a combat support agency serving the combatant commanders and military services to support the delivery of high-quality, integrated, and affordable health services to service members, retirees, and their families. We serve the entire Military Health System, including managing the TRICARE health benefit.
Second, the DHA is engaged in an effort to assume responsibility for administration and management of all military medical and dental facilities from the military departments. That’s important to know, because military hospitals and clinics are “readiness platforms,” where medical professionals from the Army, Navy, and Air Force not only obtain – but sustain – their cognitive, technical and team skills. And those medical facilities are our first line of medical deployment in support of military operations. The Military Departments identify and define their readiness requirements – how many people of each skill type they need in support of their mission sets. It’s our job at the DHA to provide a working environment that enables and empowers each member of these uniformed medical teams to be ready to do that job.
Third, before the COVID-19 pandemic, the DoD began a major reform effort to boost health readiness. The fiscal year 2017 National Defense Authorization Act directed the DoD to submit plans for restructuring military hospitals and clinics to increase the MHS focus on military and medical force readiness.
In February 2020, we submitted a report to Congress proposing changes for a select group of military hospitals and clinics. We’re transforming the MHS to increase medical readiness and to serve our beneficiaries in new ways, like centralized management, developing the TRICARE provider network and bringing civilian providers into our health system. It is essential to restructure a portion of our medical facilities to maximize their contributions to warfighting readiness. We are doing all of this while continuing to offer access to outstanding health care for 9.6 million beneficiaries.
The thinking behind changes for some military hospitals and clinics is they exist to keep combat forces ready to go to war. We must sustain the readiness of medical personnel to support wartime requirements. Based on this premise, the MHS needs to match its infrastructure to its readiness and mission requirements by reducing services at some hospitals and clinics while potentially expanding services in other areas. The changes ultimately maintain medical services necessary to support the medical readiness of combat forces and mission-critical on-base activities while building readiness in the medical force, and ensuring continued access to quality care for our patients. We are making changes in a deliberate, phased fashion, to ensure every one of our 9.6 million beneficiaries continues to enjoy access to outstanding health care, even if the location where they receive care changes. As a physician and as husband, father, and grandfather, I recognize that health care is deeply personal and changes may cause concern. This is a major driving force for why we are being careful about the changes we make and will assist those whose care may be moving to another provider.
Of course, COVID-19 had a major impact on this work, but it did not stop during the pandemic. Today, as our COVID-19 response begins to settle into routine care, we are picking up the pace on changes to our health system. Obviously, the COVID-19 pandemic affected our military hospitals and clinics, along with the civilian provider network. We are revalidating our findings to help ensure TRICARE network providers have the capacity to welcome patients moving out of select military medical facilities and into our TRICARE provider networks. We are in the midst of examining provider networks now and expect to release an updated report later this year.
USING LESSONS LEARNED PROACTIVELY
The MHS is increasing medical readiness and beginning to serve our beneficiaries in new ways. COVID-19 has illustrated support of our warfighting capabilities requires a joint, synchronized effort across the Department. The pandemic confirmed that the Department is on the right path as we pursue the most comprehensive set of reforms ever undertaken in the history of military medicine. Centralized management of military medical facilities helps us standardize clinical and business processes that will improve health care delivery for both patients and health care providers. Reshaping the services offered at some of our hospitals and clinics will allow us to better support the readiness of our uniformed medical providers. And implementation of MHS GENESIS, the electronic health record, is yielding improvements in both the patient and provider experience of care.
The pandemic has also reaffirmed a need to find new, effective and efficient ways to protect, support, and promote the health and welfare of the military community. Rapid and extensive changes have reshaped today’s health care environment, and we are dedicated to modern, military medical innovation to protect, support, and advance the health and welfare of our military family. The DHA is taking specific actions to improve health care access, quality, safety, transparency, and patient engagement. We are working to standardize and spread these efforts, in a coordinated path to high reliability for the entire system. The lessons learned during the COVID-19 pandemic and the transformation efforts that are underway to standardize health care across the MHS position us well to rapidly respond to future health challenges and support the readiness of our Armed Forces.
The DHA stands ready to provide care to the warfighter and sustain the readiness of medical personnel to support wartime requirements. The MHS is changing the global military health care system to be even better, going where others cannot to provide care and assisting our TRICARE beneficiaries as we evolve.