Leveraging available technology to improve care and decrease cost in the Military Health System

Title of Work : Leveraging available technology to improve care and decrease cost in the Military Health System

The future is already here – it's just not evenly distributed. —William Gibson, quoted in The Economist, December 4, 2003 The Challenge: Shrinking healthcare dollar coupled with increasing demand for healthcare poses a major challenge of the 21st century Military Health System (MHS). Increasing demand for care, particularly specialty care at every echelon of MHS is an issue that needs to be address. This project will provide Tele-mental health services from a regional medical hub to an overseas location via Video Teleconferencing (VTC) where specialty care is very limited. Discussion: Telemedicine was pioneered by NASA during the Apollo mission, and has been widely accepted in the civilian community. Tele-mental health has been shown to be as effective as face to face assessments, and treatment. The Surgeon General of the Air Force has supported the dissemination of VTC equipment. Currently all 79 Air Force Medical Treatment facilities (MTF) and 5 Air National Guard clinics have VTC and network connections to support VTC. The Air Force Medical Support Agency (AFMSA) has set up an office dedicated to supporting Telemedince headed by Lt Col. Antonio Eppolito Immediate benefits are: Avoid TDY costs Improve access Decrease wait times Facilitate supervision Decrease need for outside MTF referrals

Avoid manning assist (back fill) if a provider is deployed

Avoid Exceptional Family Member Program (EFMP) reassignments.

Surprisingly, given these potential benefits, available infrastructure and support staff, the use of telemedicine in general and Tele-mental health in particular has been uneven. Common barriers seem to be difficulty credentialing providers, practicing medicine across state lines (and in our case across international borders ) prescribing medications to remote MTFs, documentation, equipment compatibility, establishing common procedures between two MTFs.

MTFs have started their own Tele-mental health program across the military (and the VA), the results have been mixed.

Pilot program : Kadena Air Base Mental Health Clinic (KMHC) will collaborate with Tripler Army Medical Center (TAMC) to provide mental health services over VTC. Initially adult patients needing psychotherapy will be seen, then we hope to expand it to children needing evaluation and psychotherapy, finally we plan to manage medication over VTC.

Results: Both sides have been in talks to start this pilot program, and see it as mutually beneficial. We have compatible equipment. Providers have already been credentialed. A memorandum of understating is in the final process of approval. This program will directly support MHS quadruple aim of improving readiness, improving experience of care and decrease total cost of health care.

We are hoping to implement this program in March 2013. Cost to MHS will be negligible as the equipment, clinician and infrastructure are all already in place.

Conclusion Innovative approaches to delivering medical care is necessary in this fiscal environment. This approach remains flexible, adaptable, and sustainable to meet our patient’s needs resulting in direct cost savings and improved patient care. If this program, is successful it can be replicated in other clinics throughout the MHS.

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