DHA Director outlines how MHS standardization bolsters reform

As Army Lt. Gen. (Dr.) Ronald Place outlined his vision for his second year as director of the Defense Health Agency on a call with reporters from the Defense Writer’s Group on Thursday, Oct. 8, he emphasized the common goal shared across the Department of Defense: provide the best clinical outcomes for the 9.6 million beneficiaries within the Military Health System.

Much of the way the general is seeking to achieve that aim is through the standardization of technology and processes within the MHS. He described the roll out of the electronic health record known as MHS GENESIS as a key aspect to improving the delivery of quality care regardless of location for both providers and patients.

“That standardization leads to similar expectation of care from our patients as they go from place to place because everything is the same,” Place said. “It also means as you transition from the DoD to becoming a veteran, the same system and the same methodology would be used in a DoD facility or Veterans Administration facility.”

The MHS is relying on the use of health information technology to advance and streamline care for patients both locally and nationally. Place mentioned the joint health information exchange which securely connects TRICARE contract partners and select federal and private sector partners to share and seamlessly transfer patient information. “So that no matter where our patients get care, the depth and breadth of the entirety of their medical problems can be viewed by each practitioner who’s participating in their care,” said Place. “Ultimately this health information technology is a tool that is in support of optimizing the clinical outcomes of our beneficiaries. “

Standardization improves outcomes, whether clinical outcomes or administrative outcomes, said Place. The MHS plans to utilize health information technology as well other forms of emerging technology such as voice recognition technology for transcription, natural language processing for quick data sort and review and even artificial intelligence in aiding physician review. Place cited imaging as an example, such as X-rays, CT, MRI and ultrasound, and the incorporation of AI protocols to do first pass reviews or aid the radiologists who interpret them. “In some cases if they can demonstrate that they do better than humans, do we transition some of that reading over to the computer systems so that we can improve both the speed and accuracy of the reading of those imaging systems?” he said. “That is the direction we are going ... The whole driver though is improved outcomes.”

The DoD is a continuous learning organization, learning lessons from whatever it faces, be it a pandemic, combat operation, or natural disaster, said Place. As such, the COVID-19 pandemic led the DoD to learn and develop clinical practice guidelines to standardize the care and the treatment of COVID-19 patients within the MHS. The clinical practice guideline now on the verge of publishing its sixth version, outlines the care for a person diagnosed with COVID-19 from asymptomatic to critically ill, he said. “We are constantly evaluating both our own internal outcomes as well as the broad spectrum of what’s being published in medical literature about the care of COVID-19 [patients],” he added.

In March, when the national emergency due to the COVID-19 pandemic led to the pause of elective medical procedures across the MHS in order to protect staff and patients, it also halted the MHS transformation as the DoD moved resources to fight COVID-19. To date, 47 out of 451 MTFs around the world have moved into the DHA. But the effects of COVID-19 around the country has led the DHA to revalidate the recommendation made to realign about 18,000 uniformed medical force positions from the MHS into operational forces and move 190,000 beneficiaries into private care.

“Some outpatient physicians’ offices have either downsized or closed. Some hospitals across America have either downsized or closed. So some of the information that we were relying on to make recommendations to the department about where the capability may exist in the civilian community to effectively provide access to safe high quality care for some of these beneficiaries, that information may no longer be true,” he said. “[The DHA] just recently, in fact, earlier this fall, started the process to revalidate every single bit of that information before I go back to the Assistant Secretary of Defense for Health Affairs to make recommendations on whether or not we should proceed in some of these areas or not.”

The military departments are reviewing the potential downsizing of some of the uniformed medical staff. Place said he provided information to the Deputy Secretary of Defense David Norquist on the transition of hospitals and clinics into the DHA. “I know that he’s still collecting other information from other locations. I expect that decision to be made in the really short-term future, perhaps this month some time,” said Place. “In terms of the potential downsizing or de-scoping of facilities, that data gathering again, just restarted here in the fall,” he said, adding he does not expect to make a recommendation until early 2021.

While the DHA made recommendations for restarting the transformation process, Place acknowledged some leaders within the military departments brought forth additional concerns that they believe that the leaders of the DoD should take into consideration to inform a future state for the MHS.

“I think this is a good thing there are so many people invested in making sure the future state of the MHS is absolutely the best that it can be in support of the best clinical outcomes for America’s sons and daughters, both those serving today and their families, as well as those retired,” said Place.