“We also have several training modules, focusing on two specific areas. One is policies and procedures, such as differing legal requirements. We want to make those … standard as our military personnel change stations every two or three years. The second is ‘connect and communicate,’ which looks at what it takes to develop rapport with the patient online that differs from person-to-person, such as where the provider is looking while on camera.”
The Telehealth Service Line also is partnered with the Integrated Disability Evaluation System, enabling the use of telehealth to help service members deal with a lot of the requirements involved in transitioning from military health care to the VA without the need to travel as much.
“Our capabilities today are more robust, with more services and entryways into primary care. Many of our clinics offer in-house clinical pharmacists, physical therapy (PT), dieticians, case management for active duty, consultants who work with the primary care team,” Nguyen said.
“We see the future of Army telehealth as a connected, consistent patient experience. We have just begun a three-year telehealth expansion plan that creates a 360-degree care continuum. We’re trying to augment our current system to work with partner nations,” Rye continued. “At the end of the day, we will have a single global telehealth platform that connects everyone from battlefield to bedside, providing telehealth expertise wherever and whenever it is needed.
“Remote health monitoring using advanced biometric devices will have a significant impact on our ability to reach patients wherever they live and work, especially those with chronic conditions. One of our evaluations shows 70 percent of patient encounters with deployed assets in a combat zone would not have happened without telehealth. In that particular theater, travel is very difficult, and when providers did go out to see patients, they often got stuck due to weather or combat problems and patients elsewhere on the route had to postpone or skip their meetings. We’re looking at ways to leverage telemedicine further in those kinds of situations.”
That is being done within what MEDCOM calls an operating company model. The Surgeon General established the service line to promote and support telehealth, developing tools and programs to push it out to health care centers, making it faster and more standardized so a patient gets the same services in Guam as in Virginia.
“Our capabilities today are more robust, with more services and entryways into primary care. Many of our clinics offer in-house clinical pharmacists, physical therapy (PT), dieticians, case management for active duty, consultants who work with the primary care team,” Nguyen said.
“If an active duty soldier sustains an ankle injury during training, he would be referred to PT within the clinic, but also might be set up with a nutritionist to lose some weight, see a clinical pharmacist to ensure there are no complications with any pain medications prescribed, etc. In the past, those operated separately and independently; today that care is more coordinated and located in one location rather than sending the patient to multiple facilities. That means a lot more capability for primary care than a decade or two ago.”
“At this time, the Reserve does not employ any telemedicine or telehealth care because we have a number of providers through TRICARE Select or on active duty with TRICARE Prime,” according to Army Reserve deputy surgeon for Health Affairs, Policy & Fiscal Administration Col. Joe Ignazzitto. “There is eligibility for telehealth for 180 days after return from deployment.”
The SCMH is a major change from how military medicine was conducted in the past, where having primary doctors as gatekeepers created bottlenecks. Now the patient is the focus through and around which everything flows, he added. Providers are no longer gatekeepers, but part of a larger corps of caregivers, including nurses, physical therapists, dieticians, behavioral health consultants, case management for long-term care – a whole team talking to each other with the patient at the center.
Nguyen said such changes serve two purposes – getting soldiers ready for deployment as healthy as possible and ensuring those leaving service do so with complete and up-to-date health records.
“All separating service members, including Reserve and National Guard activated longer than 30 days, undergo a full head-to-toe exam. That’s how we ensure we haven’t neglected anything or the soldier hasn’t told us about any problems before being released into the general population. We started that 1 April [2015] for active duty and will officially start for the Guard and Reserve on 1 Jan. 2016,” he said.
“We’ve asked the VA to join us in doing the separation health exam; if the soldier plans to apply for VA benefits, then they don’t have to do two exams but would get their separation physical from the VA. The VA is still working on that, but we’ve already implemented those exams on the military side.”