2020 tele-critical care successes will help 2021 COVID-19 response
JOINT BASE LEWIS-MCCHORD, WA, UNITED STATES
Defense Health Agency Connected Health
The COVID-19 pandemic, the deadliest global health threat in more than a century, galvanized the Military Health System in 2020. Virtual health and particularly tele-critical care for critically ill patients assumed frontline roles in sustaining care while keeping beneficiaries and health care teams safe. As we head into the new year, we MHS providers should recognize that the successes of virtual health and particularly tele-critical care in 2020 can play an essential role in bringing COVID-19 under control in 2021 and handling other crises to come.
The Defense Health Agency’s tele-critical care programs have cared for thousands of patients, leveraging information and communications technologies to dynamically allocate and extend critical care capacity to the point of need, anytime and anywhere, especially to community hospitals and smaller intensive care units in remote locations. The effectiveness of the virtual health programs has made tele-critical care an ever more important enterprise capability, and its popularity with providers and patients alike has made it integral to health care going forward.
Applying What We Have
A notable DHA success in 2020 was the expansion of the Joint Tele-Critical Care Network, an important force multiplier that leverages virtual health resources to extend critical care expertise and treatment at a distance. Critical care physicians, also known as intensivists, and critical care nurses located at three hub sites treat patients located at a growing number of spoke sites worldwide.
Once fully deployed, the JTCCN will allow intensivists to monitor hundreds of intensive care unit beds simultaneously through a setup conceptually similar to how air traffic control systems ensure planes—and their passengers—safely reach their destinations. The system tracks and analyzes vital signs, lab results, progress notes, and other real-time data, which helps providers quickly identify patients at risk for deterioration and more effectively intervene to improve outcomes.
From January 2020 to October 2020, the JTCCN provided 1,808 days of ICU coverage to 323 unique patients in 87 ICU beds spread across 13 spoke site hospitals. The JTCCN is also actively working to bring three additional sites online in the beginning of calendar year 2021, while planning for expansion to all 400 critical care beds in the MHS.
Creating What We Need
In addition to leveraging existing resources such as the JTCCN, the DHA is working with the Telehealth and Advanced Technology Research Center, leaders at the Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response, academia, and industry to develop a rapidly deployable, hardware-light TCC capability. Launched in March 2020, the National Emergency Tele-Critical Care Network seeks to expand capabilities and capacity by augmenting bedside personnel who may lack the knowledge and skills to care for critically ill patients.
One NETCCN prototype has already demonstrated its effectiveness at a civilian hospital in Guam. In late August 2020, COVID-19 case numbers there spiked to more than 200 percent their normal volume, outstripping local resources. Guam Memorial Hospital reached out to the Federal Emergency Management Agency, which coordinated with the Defense Security Cooperation Agency. Roughly 72 hours after receiving its official DSCA mission assignment, the DHA shared a NETCCN mobile technology solution enabling the JTCCN to provide cyber-secure and HIPAA-compliant on-demand consultative support and monitoring for critically ill civilian patients.
Intensivists and nurses at DHA tele-critical care hub sites in California, Texas, and Washington state provided real-time guidance to bedside staff providing hands-on care. The system—still in use—vastly improved the ability of Guam’s civilian providers to treat patients and save lives. Over a one-month period at the peak of the surge, the JTCCN fielded 64 physician calls and supported the care of 473 patient-ICU days, including 14 events of cardiac arrest.
Partnering for the Future
The on-the-ground successes of the JTCCN, NETCCN, and tele-critical care would not have been possible without partnerships the Department of Defense is cultivating among its own components, between itself and other U.S. government agencies, and between DoD and commercial and non-governmental organizations. These collaborations help ensure tele-critical care capabilities can seamlessly reach across organizations through compatible technology, training, and protocols.
To increase surge capacity and technologic resiliency, the DoD is also pursuing a partnership with the Department of Veterans Affairs to create a single federal tele-critical care network for all U.S. forces globally. This network would enable any DoD or VA hub site to provide tele-critical care to any of the 1,700 VA or 400 DoD ICU beds through real-time distribution of workload to locations with capacity. The resulting partnership will enhance technological resiliency while also improving surge capability in response to pandemics and other crises. The goal is to have completely interoperable systems between the two largest users of tele-critical care in the U.S. government.
The number of COVID-19 cases continues to underscore the need for proactive virtual health planning and implementation. Fortunately, being prepared—especially for contingencies—runs deep in our military DNA. We identify evolving challenges and overcome them. We use and improve what we have, create what we need, and work with partners and allies to make sure it all works for the people who depend on us.
Virtual health and tele-critical care play to these strengths. The recent, rapid maturation of virtual health capabilities have made it possible to not only respond to the COVID-19 pandemic but to also prepare for future disasters as well—both natural and human-made. To accomplish our mission to ensure military readiness, MHS providers will keep applying the lessons learned in 2020 to help protect all service members, their families, and the country in 2021 and beyond.
Capt. Konrad L. Davis is director of DHA Tele-Critical Care.