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Forward to the Sea: Navy Medicine West Leads Virtual Health Care Delivery to Warfighters

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Story by Regena Kowitz on 03/25/2019
Navy Medicine West (NMW) kicked off the fifth annual virtual health program review at its headquarters in San Diego March 5 to discuss the current and future states of using technology to connect warfighters with medical care, no matter the distance.

"Navy Medicine is renewing its emphasis on readiness and focusing on the warfighter," said Rear Adm. Paul Pearigen, NMW commander and chief of the Navy Medical Corps. "As we do this, we are looking beyond brick and mortar hospitals and clinics to provide care to our Sailors and Marines, wherever they operate. We are embracing technology and building partnerships that allow us to expand delivery of medical care to the Fleet and Fleet Marine Forceunderway on a warship or forward deployed in a remote location. Virtual health allows us to take medicine to the warfighter, keeping them on mission and in the fight."

Led by Cmdr. David Paz, radiologist and NMW's chief medical informatics officer, the program review brought together participants from around the region, several of whom either presented or attended virtually.

"Why virtual health?" Paz asked during opening remarks. "It's an important means to provide health care to our patients and improve the experience and value of care."

It's also how Navy Medicine can provide care to Sailors and Marines, anytime, anywhere. Paz went on to say virtual health has been identified by Vice Adm. C. Forrest Faison, Navy surgeon general, as a priority for Navy Medicine.

By leveraging telecommunication and information technologies and collaborating with colleagues from the Army, Air Force, and Defense Health Agency (DHA), Navy Medicine can provide care to warfighters around the globe, on land or at sea.

Specialized medical care that is available in one location such as Naval Medical Center San Diego (NMCSD) with a concentration of specialists and sub-specialists can be delivered to patients in distant locations, such as Diego Garcia, where those types of specialty services may be limited or non-existent.

The lineup for the program review included an overview of all current virtual health services and locations. Services run the gamut from orthopedics and mental health to pediatric nephrology and speech therapy. Locations where patients can be seen virtually include Naval Hospital Twentynine Palms, branch health clinics in Bridgeport and China Lake, and overseas Navy Medicine facilities in Okinawa, Yokosuka, Guam, and Diego Garcia, to name a few.

As more services and locations have come online, improving the patient experience with choices and timely care, the demand has grown. From fiscal year 2016 to 2017, the number of virtual health encounters across Navy Medicine increased 27 percent. From 2017 to 2018, that number has grown by 157 percent. Projected increases for the 2019 fiscal year are expected to rise even faster.

Virtual health isn't just good for patients, it's good for the Department of the Navy's bottom line. By bringing care to the patients, via technology, costs for travel and lost work days are avoided. But the true benefit is providing safe, high quality patient care by the most effective and efficient means possiblein person or, by leaning into the future and harnessing advances in technology, virtually.

"We want to ensure the care received with virtual health is as good as or better than regular, in-person care," said Capt. Valerie Riege, Navy Medicine's chief integration and innovation officer. "We will never compromise on patient care."

As military hospitals and clinics transition to administration and management by the DHA, Navy Medicine is homing in on support to operational forces.

"We used to look at virtual health from the medical treatment facility side," said Riege. "Now we're looking at it from the operational setting and that's really driving the way we're going forward."

In April 2018, NMW partnered with Naval Surface and Mine Warfighting Development Center (SMWDC) and guided-missile destroyer USS Chung-Hoon (DDG-93) to test Medical VT-Sea, the use of video teleconference (VTC) to extend the reach of medical specialists to a warship at sea.

Establishing VTC capability on a warship underway isn't a simple task, though. The connection must be secure, using equipment organic to the ship, and have high bandwidth to connect with medical specialists ashore. Working together, SWMDC, Chung-Hoon, and NMW made it happen.

"We have to work with how ships operate, not the other way around," said Paz, who was the NMW lead on the project.

He gained support from Chung-Hoon leadership by explaining the potential long-term benefits of VT-Seaunnecessary medical evacuations, expedited care for Sailors after long periods at sea, and providing specialty training and education to the ship's independent duty corpsman (IDC).

To test the capability, Chung-Hoon's IDC submitted an orthopedic consult for a crew member via the Pacific Asynchronous Telehealth (PATH) system. After the consult was received and reviewed by NMCSD, an orthopedic surgeon in San Diego was able to examine the patient who was underway on the ship through the ship's IDC and the virtual connection, make a diagnosis, and establish a treatment plan. The test was a success, proving the concept in practice.

Ships like Chung-Hoon have a small medical department, usually consisting of an IDC and a few other hospital corpsmen. Specialty care is typically only available when the ship is in port or by transferring the patient by medevac from the ship at sea and requires the patient to take time away from work to go to the provider's location.

With virtual health, it's the reversethe medical care goes to the patient, wherever they may be.

"What this has done is kept them available to do the job they need to do but, at the same time, they get the care they need without having to go anywhere and without impacting the mission," said Riege.

Next steps for virtual health include presenting capabilities to Navy and Marine Corps operational forces, letting them know what types of virtual care Navy Medicine has available to them and finding out what their needs are.

One need that has been identified is virtual mental health. Virtual services include VTC for provider-to-patient interactions for the evaluation, diagnosis, and treatment of psychiatric disorders. Currently, this capability is available in limited locations but program champions are looking to grow those numbers.

An important part of expanding virtual health services is preparing providers throughout Navy Medicine to deliver virtual medical care by exposing them to evolving technologies through training, education, and practical experience.

Cmdr. Victor Lin, who spoke during the program review about his informatics fellowship and the future of virtual health, said it's a force multiplier that support's Navy's warfighting mission.

Looking to potential future scenarios that could require prolonged field care, virtual health capabilities could be a game-changer for injured warfighters. Bringing specialists to frontline providers when medical evacuation isn't possible could save lives on the battlefields of the future.

"We want to provide optimal healthnot just health care, health," said Lin. "I want to maximize readiness and I want to provide unparalleled combat and operational care. Together, we can change Navy Medicine."

Navy Medicine West leads (NMW) Navy Medicine's Western Pacific health care system and global research and development enterprise. Throughout the region, NMW provides medical care to nearly 700,000 beneficiaries across 10 naval hospitals, two dental battalions, and 51 branch clinics located throughout the West Coast of the U.S., Asia, and the Pacific. Globally, NMW also has oversight of eight research laboratories across the U.S. and overseas that deliver high-value, high-impact research products to support and protect the health and readiness of service members.


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