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Madigan Army Medical Center
Madigan Army Medical Center
Located at Joint Base Lewis-McChord, Washington, Madigan Army Medical Center comprises a network of Army medical facilities located in Washington and California that serve more than 100,000 Active-Duty service members, their families and retirees. Madigan’s mission is to proudly promote the health and wellness of America’s military family, and the vision is to be “patient-centered in all we do.”
Since its opening in 1944 as a temporary hospital for war wounded, Madigan has grown into a tertiary care medical center providing a wide array of medical services, such as general medical and surgical care, patient-centered adult and pediatric primary care, a 24-hour emergency room, specialty clinics, behavioral health and wellness services. Madigan is proud to be a part of a dominant power projection platform for service members as a provider of safe, quality care; an unparalleled education facility; a state-of-the-art research platform; a leader in readiness and deployment medicine; and an engaged community partner.
Madigan maintains about 220 beds for inpatient care, and it can expand to accommodate more than 300 inpatients during periods of urgent need, including emergencies. Outpatients are seen at the hospital’s medical mall complex, handling nearly 1 million visits annually. Madigan performs more than 45 surgeries, fills nearly 4,000 prescriptions, and delivers eight babies daily.
As the U.S. Army’s second largest medical treatment facility and a state-of-the-art and technologically advanced medical center, Madigan is one of only two designated Level II trauma centers in Army Medicine and one of four in the state of Washington. Madigan participates in a unique partnership created in the late 1990s with civilian hospitals St. Joseph Medical Center and Tacoma General Hospital called the Tacoma Trauma Trust to provide care to non-beneficiary trauma victims beyond the gates of JBLM.
EDUCATION AND RESEARCH
In keeping with its reputation as an unparalleled teaching facility and modern research platform, Madigan also offers outstanding Graduate Medical and Nursing Education programs. In fact physician, nurse and medic students enrolled in Madigan’s Graduate Medical Education programs consistently score in the 90th percentile on state and national examinations. Additionally, Madigan’s Andersen Simulation Center, which helps train thousands of doctors, nurses and medics each year, holds the distinction of being the first educational institution in the Department of Defense accredited by the American College of Surgeons. Madigan also performs research across the entire spectrum of clinical trials, from phase I to phase IV, allowing critical safety and efficacy data to be collected for health interventions.
In 2016, Madigan added three new School-Based Health Centers for a total of seven clinics at community middle schools and high schools, allowing military dependent adolescent students to get care without even leaving their schools. Madigan also opened a Residential Treatment Facility, offering evidence-based medication treatments for substance abuse in a 28-day program to develop individual substance-use recovery plans for service members across the Pacific.
Madigan is proud of its achievements in delivering health care to its patients and for recognition as one of most wired hospitals by The Most Wired Survey, and for its environmentally friendly practices as recognized by Practice Greenhealth, a health care organization focusing on ways to reduce environmental footprints.
In early 2018, Madigan is partnering with the Intrepid Fallen Heroes Fund to open up an Intrepid Spirit Center to offer intensive outpatient therapy from a multi-disciplinary care team to service members dealing with traumatic brain injury, post-traumatic stress and pain management. Madigan is also leading the Department of Defense by establishing its first autism service center, the JBLM Center for Autism Resources, Education and Services, and by being the first large MTF to implement the new DOD electronic health record, MHS GENESIS.
Madigan First in Army to Use DOD Electronic Health Record
By Suzanne Ovel
Madigan Army Medical Center
The Department of Defense’s (DOD) new electronic health record, MHS GENESIS, is making its Army debut in Fall 2017 at Madigan Army Medical Center at Joint Base Lewis-McChord, Washington.
While MHS GENESIS first went live at the Fairchild Air Force Base clinic and Naval Hospital Oak Harbor (and is tentatively scheduled to go live at the Naval Hospital Bremerton in September), all in Washington State, Madigan is the first large military treatment facility to implement the DOD initiative.”
“Madigan was chosen to help lead the implementation of MHS GENESIS because of the breadth of our mission and our long-standing reputation for innovation. Our staff is intimately involved in the refining of MHS GENESIS for all of the Department of Defense; we are proud to help shape the future of military medicine,” said Col. Michael Place, commander of Madigan Army Medical Center.
Madigan offers inpatient, outpatient and in-house specialty services; the medical center is also considered a “Most Wired” hospital for the quality and innovativeness of its information technology and informatics programs.
With MHS GENESIS, DOD opted to purchase an established commercial electronic health record. The program will roll out to all DOD health care facilities in phases through 2022; it will replace multiple separate electronic health records currently used by the military services.
“Because MHS GENESIS will provide a single, comprehensive electronic health record for all services, all locations, and all patient settings, our patients — from the front lines to our medical centers — will benefit from improved continuity of care and patient safety,” Place said. “Our all-volunteer force deserves this increased level of care and capability, and we’re honored to be a part of the effort to provide it through MHS GENESIS.”
While many of the benefits to patients will be behind the scenes, patients will be able to use an enhanced patient portal which replaces the Army’s RelayHealth portal. The patient portal interfaces directly with MHS GENESIS, allowing patients to directly interact with their providers.
Using one integrated electronic health record across all services will also improve health care integration and interoperability as well as patient safety, said Maj. Jonpaul Trossi, DOD Healthcare Management Systems Modernization office Army liaison.
It also enhances systemic health care reports, quality measures and clinical decision-making. Because MHS GENESIS is a commercial product, any update to the software will occur system wide in real time.
The use of MHS GENESIS will lead to increased interoperability with the Department of Veterans Affairs and civilian health care systems as they all work toward establishing a Health Information Exchange.
In the meantime, Madigan is working with DOD and the MHS GENESIS contractor to provide feedback on how to refine MHS GENESIS to meet the needs of DOD health care staff and patients, Trossi said.
“We’re serving to provide a template or playbook as to how to roll out to the rest of DOD for implementation of MHS GENESIS, so they’re taking our lessons learned or how we implement it and applying what we learned into those implementations as well,” he said.
Precision of Medicine: The Future of Health
MADIGAN RESEARCH ON LEADING EDGE OF CREATING TAILORED MEDICINE
By Suzanne Ovel
Madigan Army Medical Center
Researchers at Madigan Army Medical Center are on the front edge of the new field of precision medicine, using patients’ unique differences in their genes, lifestyles and environments to predict what medical conditions they are susceptible to and what treatments work best for each individual.
While by default most medicine is designed to work for the “average patient,” the White House created a Precision Medicine Initiative in 2015 in recognition that people’s complex and unique makeups require more tailored medical solutions.
“Part of precision medicine, the central mantra really, is just predicting your health,” said Dr. Nicholas Ieronimakis, a clinical research scientist in Madigan’s Department of Clinical Investigations. “It’s really about predicting whether you’re predispositioned to diseases and also tailoring the treatment.”
Ieronimakis is part of a team of researchers who specialize in precision medicine at Madigan, building upon current research to study patients’ genetic makeups to refine the best tests, the best diagnoses, and even the best genes to focus on in studies.
The field is still in its infancy, since the human genome,which provides the underpinnings of precision medicine, was only fully mapped 10 years ago. Since then, the technology needed to conduct mass genetics studies has grown rapidly enough to make precision medicine research viable.
“It’s really the technology that is driving this. In the past precision medicine wasn’t feasible in a lot of ways because we could not generate enough information,” Ieronimakis said.
Technology not only allows for genetic testing, but it also allows for more precise information to be gathered on individual patients; for instance, mobile blood pressure devices can monitor patients at home and report electronically to physicians a fuller picture of one’s health.
At Madigan, researchers are using precision medicine to dig deeper into conditions that apply to patients both on and off the battlefield.
Mary McCarthy, the senior nurse scientist for Madigan’s Center for Nursing Science and Clinical Inquiry, is leading a study to discover the optimal amount of vitamin D to keep servicemembers healthy and less prone to injuries both at home and when deployed. In addition to helping to lower blood pressure and boost immune health, vitamin D can increase bone health and reduce stress fractures.
“Many factors are associated with an individual’s vitamin D status including diet, ethnicity, body composition, sun exposure and genes that regulate vitamin D metabolism. For this reason, it is important to look for genetic variants to understand a person’s risk for deficiency and their response to vitamin supplementation, as this will vary for each and every one of us,” McCarthy said.
Researchers in maternal medicine, meanwhile, are looking into predictors for maternal health conditions like preeclampsia. Preeclampsia is a pregnancy condition in which a mother’s blood pressure spikes right before labor, leading to serious or fatal results. Although about 10 percent of moms develop preeclampsia, researchers don’t know what causes it or why it develops. However, a Madigan researcher collected plasma from more than 300 patients and discovered a protein modification in the plasma that can predict the condition.
“That was a major discovery, a significant milestone that happened here at Madigan,” said Ieronimakis, who said that once women know they’re susceptible to preeclampsia, they can plan for safer deliveries.
By collecting hundreds of samples, researchers were able to develop a “biobank” to analyze enough plasma samples to pinpoint a predictor of the condition.
“That effort brought to light the power of precision medicine, the need for biobanking, and the empowerment the patients can give us by simply providing their samples, which we’re utterly grateful for because we can’t do these studies without them,” he said.
Ieronimakis stressed that the ability to analyze medical data from a large number of patients to include their patterns, genetic makeups, metabolism profiles and environmental factors, is crucial to furthering precision medicine.
“If we can harness large data sets that include a lot of these elements, we can start refining treatments and predicting what may happen to patients,” he said.
The key to all of the research is finding patients who are willing to participate in the studies, even if that is as simple as donating a blood sample.
“We actually need the patient’s help. We can only do as much as they will allow us to,” said Ieronimakis, who encourages patients to take part in studies to identify genetic markers. Even if the study may not immediately benefit the patient, the results of it may later benefit a family member or friend.
“Without patients’ involvement,” he said, “precision medicine won’t happen.”
Madigan Celebrates 25 Years in Hospital
By Suzanne Ovel
Madigan Army Medical Center
New and old commanders, staff and patients celebrated the 25th anniversary of the Madigan Army Medical Center hospital on Feb. 28, 2017, at Joint Base Lewis-McChord, Washington.
“Twenty-five years ago, the doors to this new hospital opened, and since then, Madigan has been leading the way in providing world-class military health care,” said Col. Michael Place, Madigan’s commander.
The ceremony became a day of reunions for many of the past commanders of the hospital, from guest speaker Maj. Gen. (ret.) Leslie Burger (1992 to 1994) to Col. Ramona Fiorey (2013-2015), and Lt. Gen. (ret.) James Peake (1994-1996) to Col. (ret.) Al Buck (1994), as well as Ellaworth Turner, spouse of Brig. Gen. (ret.) Guthrie Turner (1980-1983), and Command Sgt. Maj. (ret.) Billy King (2007-2009).
Another special reunion took place at the event between a doctor and patient in the audience; in 1995, the new hospital saw its first limb correction surgery when (then-major) Dr. Clyde Carpenter performed the surgery on 4-year-old Jeannine Johnson.
“The 10-hour surgery was a success, saving young Jeannine’s leg from amputation. Now, at age 26, Jeannine spends part time in a wheelchair… the other part is typically in a race car,” said Place.
In total, more than 100 audience members joined in the celebration, going on a journey with the speakers from the beginning of Madigan itself when the now-Madigan Annex was built in the 1940s to the opening of its doors here in 1992. In 1944, the “Fort Lewis Station Hospital” opened as a barracks-style complex, with nearly eight miles of ramps and corridors spread out over 75 acres. Thirty years later, proposals for a new building hit Congress, but it wasn’t until the 1980s that the plans got funding.
Five and half years after breaking ground, the doors opened to the new hospital, allowing service members, retirees and family members to get inpatient and outpatient care in a 1.2 million-square-foot facility.
“Since we began patient care in this new hospital, Madigan has set the bar for health care facilities and academic institutions, both military and civilian,” said Place.
The spirit of innovation that existed in the 1990s echoed over time to modern day medicine at Madigan. While in 1992 Madigan implemented the use of the Medical Diagnostic Imaging System which led to the hospital becoming the most modern medical center in the Army at the time, in 2007 Madigan’s Andersen Simulation Center became the first Department of Defense institution to be accredited by the American College of Surgeons as a Level I Educational Institution. Likewise, in 1994, Madigan opened a breast diagnostic center; today Madigan’s Breast Imaging Center is one of three in the Department of Defense to be awarded the American College of Radiology Gold Seal for Breast Imaging Excellence.
Burger, who took command of the new hospital one month after it opened from Brig. Gen. (ret.) John Hutton (who also served as President Ronald Reagan’s physician), oversaw Madigan becoming the first in military medicine to get digital imaging. Today, Madigan is the first large medical facility in all of the Department of Defense to implement its new electronic health record, MHS GENESIS.
This focus on information technology modernization is one of the bigger changes Peake’s seen in Army Medicine from his time at Madigan in the 1990s to today.
“(It’s) the recognition that the IT systems are fundamentally important to the care of patients and to the efficiency of the organization,” said Peake, who also served as the Army Surgeon General and the Secretary of Veterans Affairs.
In fact, Madigan is consistently recognized for being one of the “most wired” hospitals in America. The hospital continually seeks to make upgrades to both its IT and physical infrastructures, to include renovating its décor in the past few years.
“It looks as beautiful today as it did 25 years ago and that’s a credit to all of you who have served before and are serving here now, and who will be serving (in the future),” said Burger.