LAS VEGAS – "I've been looking forward to this engagement since you first invited me ... in 2019," said Lt. Gen. Ronald Place, director of the Defense Health Agency, as he began his View from the Top session at HIMSS21 here on Wednesday.

Yes, the world looks quite a bit different since March of 2020, when the novel coronavirus first upended the world and forced the cancellation of that year's edition of this conference.

But for all the pain and disruption over the past year and half, it's worth noting how much the healthcare system has learned since then.

"It's important to pause and recognize the work that all of you put in," said Place. "The sacrifices that each of you individually and collectively have made over the past 18 months have gone into the solutions that we have in place today."

Across the U.S. and the world, hospitals and health systems, public health authorities, government leaders and others have responded to the COVID-19 pandemic the only way they can, he said: "trying to make sense of the information that we had, and then using that to make decisions."

The same process occurred across the Department of Defense, as the enormous national security implications of COVID-19 became apparent in early 2020, said Place.

"How can we safely keep ships at sea? How can we launch submarines and aircraft? How do we manage troop movements around the world with … this?

"And the answer is information. We need it right. We need it fast. And we need it to make decisions on how to manage the pandemic and still preserve our ability to project a fighting force."

The DoD quickly stood up a task force to develop a testing strategy across the entire Armed Forces, he said.

"How much testing could we do, what was our capacity, how accurate were we, how soon can we get results from our laboratories in the Military Health System? The pandemic reminded us of the connectivity between disease and readiness."

There's a reason the U.S. military will soon be requiring COVID-19 vaccines, after all.

"It takes away from the mission," he said. "It takes aircraft carriers away from the mission. It has the potential to ground airplanes, keep submarines in port. Takes healthcare workers out of their usual work and makes them do other things, perhaps in other areas of the country. It slows down our process for training new recruits."

The Military Health System is the largest organization of its kind in the world, said Place, with 600 hospitals and clinics serving 9.6 million Americans, staffed by 150,000 people and a budget of $54 billion.

One of its major initiatives over the past several years, of course, has been its massive electronic health record modernization project with Cerner.

MHS Genesis is now operational in about 30% of MHS facilities around the world, said Place, and implementation work continued all during the pandemic.

"Unlike many in the private sector, we in the military don't really have the luxury to work from home," he said. "Home is where the mission takes us."

Place said the technology enabled fast response to testing and treatment – helping laboratory leaders and health informaticists standardize nomenclatures for the novel virus, for instance.

More recently, EHR workflows were updated to prime the system for mass vaccinations.

"In the military, we do a lot of vaccinations," said Place. "It's just part of our culture to have mass vaccinations in the Department of Defense."

Case numbers and vaccination totals are still updated daily and posted on Defense.gov – all part of a "disciplined process to capture what the science was telling us."

The MHS has updated its decision support mechanisms since the start of the pandemic and has "adapted clinical practices to treat unknown effects and symptoms of COVID-19 exposure."

It stood up a COVID-19 registry with nearly 200 separate data elements for every positive patient – enabling continuous learning as the virus evolves.

"COVID-19 is not going away," he said. "But how much it occupies our waking hours is largely up to us."

Place said a technology-enabled and data-driven response like the DoD's – with leaders and stakeholders who understand how to explain and manage risk, have trust and confidence in information integrity and embrace transparency – will help enable more effective management of "the most serious public health crisis of our lifetime."

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com
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