DHA Connects Its Care To Protect the Warfighter
The Defense Health Agency is relying on information technology as it grows as an agency and standardizes its operations around the globe.
For the last six months, the U.S. military has been on the frontlines in the fight against the pandemic, providing necessary supplies and medical support across the country. Meanwhile, internally, the U.S. Defense Department has faced the threat of the virus with its warfighters. More than 55,000 Defense Department personnel have had the COVID-19 virus, and there have been 79 deaths—including one active-duty member, seven reservists or National Guard personnel and 71 dependents, retirees or family members, reported Lt. Gen. Ronald Place, USA, director, Defense Health Agency (DHA).
Gen. Place, a physician and combat surgeon who became DHA’s third director in September of 2019, spoke on October 8 to reporters during a Defense Writers Group call hosted by David Ensor, director of the Project for Media and National Security at George Washington University.
In addition to providing military heath care and services, the DHA performs medical-related tasks as requested by DOD and the U.S. Combatant Commands, whether it is COVID-19-related or for operational missions around the world, the general shared. Through the Military Health System (MHS), the agency is responsible for delivering care at more than 700 hospitals, clinics and medical centers across the world, and it does so in collaboration with DOD’s Tricare Health Plans and providers.
“In terms of tackling the pandemic and how we're handling those challenges, it really gets back to the core mission of the Defense Health Agency, which is to become an integrated system of readiness and health,” Gen. Place said. “With COVID, our responsibility is to then balance the delivery of health care along with the readiness of the force.”
The agency helps to optimize medical surveillance and research to identify health threats—including infectious disease threats—and then develops proposals or clinical practice guidelines to aid in the care of the 9.6 million beneficiaries in the MHS, the general said.
“That means understanding at the individual level, and taking care of individual people or assuring the readiness of individual service members, but also collectively having a scale and scope that supports all 2.9 million of the active-duty personnel and family members, and an entire beneficiary population of 9.6 million,” Gen. Place stated.
At its core mandate, the DHA is working to standardize its operations and platforms. The agency is only seven years old and was created to be a centralized health leader, as opposed to each service’s standalone efforts.
“Standardization is useful to drive improvements in our outcomes,” he noted. “Those outcomes may be clinical outcomes. They may be administrative outcomes or some combination thereof, but standardization, where standardization is appropriate. And in so doing, we have chosen health information technology tools that are in support of that standardization process.”
Gen. Place emphasized that over the next year DHA would continue to focus on the further development of GENESIS, the MHS’ comprehensive electronic health platform. GENESIS will securely integrate inpatient and outpatient information and connect medical and dental patient data, providing a full picture in the continuum of care for warfighters and their families. The agency is leveraging commercial off-the-shelf equipment and technology for the platform, which, when fully deployed, will provide a single health record for service members, veterans and their families, according to the agency.
The GENESIS platform is employing tools such as voice recognition. For notes to a patient’s chart, physicians or care providers no longer have to write or use dictation services. The agency is fitting another tool, natural language processing, into data analysis efforts, to allow providers to perform “the same sort of data elements or data review and help us see things that perhaps that we didn't see before,” he added. Other improved imaging capabilities are needed—whether advances in plain film imagery, X-Rays, computed tomography, magnetic resonance imaging or ultrasound—which then could be combined with artificial intelligence, the surgeon shared.
“How can we use those artificial intelligence protocols to do first-pass reviews of those imaging studies, to either put clues to the human being, the radiologist who is interpreting them,” Gen. Place said. “Or in some cases, if the computers demonstrate that they do better than humans, how do we transition some of that reading over to the computer systems, so that we can improve both the speed and accuracy in the reading of those imaging systems. That is the direction in which we are going.”
The agency has already seen success from a ground-breaking cloud project from the Program Executive Office, Defense Healthcare Management Systems (DHMS), completed in June. Called the Accelerated Migration Project, or AMP, DHMS, working with more than 20 vendors, constructed a cloud platform and moved petabytes of secondary health care data and related applications to that cloud, digitally transforming access to U.S. Defense Department medical records.
Data management also will play a role in administering a COVID-19 vaccine across the DOD, when such a treatment becomes available under Operation Warp Speed, the general said.
“A significant amount of effort has been done by my organization, the Defense Health Agency, because we have the requirement for the immunization system for the Department of Defense,” he specified. “And we exercise that plan every single year with our Influenza Plan. So, we've utilized the year-over-year Influenza Plan as the skeleton, the backbone, so to speak, for developing a COVID-19 vaccination implementation plan. And of course, there will likely be some differences.”
DHA’s plan will have to account for the fact that up to six separate manufacturers may present different types of COVID-19 vaccines, which may require one or two injections. In contrast, “the influenza vaccine is the same thing, no matter who the maker is, and in generation it is a single injection,” the surgeon said. “And so, we have to be able to figure out not just how we transport it, how we hold it, how we inject it, but also how does it fit in the system with six different makers? And how, if you get one injection, how do we make sure that the second dose is from the same maker, that sort of thing.”