By Kirstin Grace-Simons (Madigan Army Medical Center)April 23, 2018
JOINT BASE LEWIS-MCCHORD, Wash. -- "Welcome to the future of health care," proffered Madigan Army Medical Center Commander Col. Michael Place just before helping to cut the ribbon on the Joint Tele-Critical Care Network's center in Madigan's hospital tower.
Designed for experienced providers to remotely provide consultation to care teams in need of support in critical care situations, virtual care capabilities are increasing in a number of Department of Defense (DOD) facilities.
"We are on the edge of the new frontier. It starts small, as all of these transformative changes do. It's a single room. And at some point, it's going to be the single room that changes everything about how we deliver health care, in garrison and on the field," Place said.
Lt. Col. (Dr.) Jeremy Pamplin, the director for "VC3" -- the Virtual Critical Care Center, welcomed a crowd of clinicians and technical staff who were eager to see the beginnings of highly connected medicine. He gave a view of the promise that room holds.
The center consists of two workstations outfitted with high-end computers, banks of monitors connected to cameras and monitoring equipment in patient care rooms, as well as a continually connected video link to other virtual facilities in the Defense Health Agency (DHA).
"(The center) has the ability to reach out and support both garrison and operational missions with not just critical care services," Pamplin noted. "Specialty services could come to those workstations and provide services wherever the need may arise."
Place made this advancement personal by adding, "I'm a family physician, actually a family physician who had ICU privileges for a number of years. I can remember -- vividly -- taking care of some really sick patients in the ICU, all by myself and saying, 'I wish I had some help here."
Virtual care proves its worth mostly in little wins, Pamplin said. It is having a second set of eyes on the remote team that catches the oversights and, on the whole, makes patient care safer and more reliable. Through those interventions, patient care is improved, he said.
In the military, virtual critical care has been piloted at two large programs -- at George Leonard Wood Army Community Hospital and the Naval Medical Center San Diego, which reaches out to support five different facilities and has been testing these capabilities since 2014.
In these programs, virtual critical care has been demonstrated to improve readiness for the providers at these small military treatment facilities (MTFs). That happens through increasing patient volume, the frequency of contacts, and the complexity of patient care. These increases lead to an all-important increase in confidence for the provider who may otherwise be untrained or inexperienced in critical care.
In addition to improving patient care, all of the pilot sites have also improved costs. They have reduced purchased care costs out to the civilian community centers, retained more patients and shown improved revenue.
Place and Lt. Col. (Dr.) Cristin Mount, chief of the Department of Medicine, partnered with the consultant for critical care to the surgeon general, Col. Kevin Chung, to bring this initiative to Madigan.
Madigan offers something no other large MTF has, yet -- MHS GENESIS, the DOD's new electronic health record.
"MHS GENESIS is a truly virtual electronic medical record. It can be used anywhere, from anywhere, to provide care to whoever is in it. So, it is a phenomenal system for supporting virtual health, and in this context, virtual critical care," Pamplin said.
An additional capability of these workstations, and virtual health overall, is to investigate new and innovative ways for delivering healthcare to warfighters. There may also be opportunities for it to augment the care that Madigan can provide, particularly in large or mass casualty scenarios.
"A remarkable part of virtual health is that it brings the collective knowledge and experience of our entire medical workforce, wherever we may be, to the point of need," Pamplin said.
The services being introduced at Madigan are provided by the Joint Tele-Critical Care Network -- a parallel effort between Madigan, San Diego and the new virtual medical center at Brooke Army Medical Center at Fort Sam Houston, Texas. This network is designed to provide staffing, resources and influence to the DHA system.
"The most amazing journey, I think, over the past year, is seeing how this project has influenced the strategic vision of the entire Defense Health Agency about how to apply virtual care services to combat casualties and beyond," Pamplin said
Place made a note of the shift this center represents.
"This is a disruption innovation for our system. It is a new way of providing care. It is a new way of delivering healthcare on the battlefield," Place said.
Thanking all involved, he said, "I'm looking forward to watching you go to the next step."