CHICAGO – In a vast, integrated health ecosystem, the future is high-tech and high-touch, "right in line with this year's HIMSS23 theme, "Health that connects, tech that cares," said. Dr. Telita Crosland, Lieutenant General, director of the Defense Health Agency.

Crosland described the agency's virtual-first, data-driven focus for the next three years as a "fundamental shift" on Wednesday. 

"Our big data becomes smart, insightful and actionable. Data becomes a vital sign – it's our new pulse," she said. 

This summer, the agency will pick three facilities – hospitals or clinics – and go after that fundamental shift with technologies and processes that drive virtual-first care.

Bringing care to the point of need through convergence

Providing medical care to all armed forces is strategic with well-orchestrated support, Crosland said.

From the time Army, Air Force, Navy and Space Force service members join, and for the rest of their lives, DHA delivers healthcare to millions of service members, families and retirees worldwide, she noted. 

The agency manages an $11 billion medical supply chain annually, including about 560,000 medical devices, according to the announcement about Crosland's appointment in January. DHA also manages the TRICARE network, which provides civilian health benefits under military care to 9.6 million beneficiaries worldwide.

Since a Congressional mandate in 2017, DHA has consolidated, integrated and directly managed all military hospitals and clinics, with all those in the United States fully under the agency's authority by December 2021, according to its website.

Medicine, like other industries such as banking that have advanced over time into deeper personalization, will provide service in ways digital natives prefer – in her tenure, she said.

Citing the previous transformation from paper charting to the Armed Forces Health Longitudinal Technology Application, known as AHLTA, things changed in a big way, Crosland said. 

But it was still "brick and mortar-based, disease-centric and expensive." Data entry is laborious and time-consuming, and it takes time away from patients.

"The point of care is nowhere near the point of need," she said.

AHLTA is being replaced by MHS Genesis electronic health records, an Oracle Cerner EHR, with numerous deployments over the last year, most recently in the National Capital Region including at the Walter Reed National Military Medical Center.

According to Crosland, a fundamental shift she called "wave two" is happening, where DHA is taking military medicine – in the next three years – into a digitally-transformed ecosystem that will ultimately make care at home possible, she said.

"Medical community, we will reflect back and wonder, maybe with a little uncomfortableness, of the fact that we expected patients to travel to us in their most fragile and vulnerable states," she said.

"Bedrooms will become hospital rooms," when they are needed. In this virtual-first, high-tech and "high-touch" ecosystem, healthcare becomes more efficient, accessible and equitable, Crosland said.

"It's where the patient moves to the center of the tech-enabled ecosystem," and everyone else becomes support.

By leveraging data – owned by patients and shared with providers – and converging ecosystems, military medicine will predict problems before they occur, and truly get into the wellness space, she said.

"Helping patients help themselves is not a traditional hospital competency, but in wave two, digital technologies are laying out the pathway." To make this a reality, DHA will start working with the pilot facilities late this year to "remove legacy metrics and other barriers that are not congruent with value-based care." 

"Ideas are easy, execution is an art form," she said.

Empowered with resources to leverage technology, she said she sees DHA improving the care experience for both the patient and its healthcare teams.

The sites will be studied and the solutions and processes scaled and deployed.

Agility and the 'shop of yes' 

In response to a question about the barriers to deploying new technologies and government agencies feeling like the "shop of no," Crosland said her innovation team will examine where the pilot facilities' processes and tensions get hung up, that are not value-added. 

The agency must also change its mindset and improve collaboration – with the Veterans Administration, private industry or other Department of Defense entities – to be a better partner and move forward. Because "as a healthcare system, we have to become good" at using data and technology, she said. 

"If we don't become more agile, we're not going to enable to deliver the right capabilities to our force or our patients in medicine."

While her mission is not to implement MHS Genesis but to leverage it, she said the unified health records sets DHA up for success. As far as "cleaning up data so that it's usable across health, I think we're in a really good place for that," she said.

When asked about recruiting and maintaining the talent needed for DHA's digital transformation mission, Crosland said her first step is to find the talent the agency already has and put those service members who seek to earn informatics degrees on a better career path. 

For example, a member of her team may not have the title or the established credentials, "but he is absolutely filling the function as a data scientist," she said.

Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.