Flight Medicine / AFMS Transformations

[Guest]

I recently had the opportunity to hear some some folks from AFMSA and AFMOA speak, plus Lt Gen Robb. He was really good at talking without actually saying anything.

https://www.health.mil/About-MHS/Leadership-Biographies/Lt-Gen-Douglas-J-Robb

A common sentiment was that if one service has an existing medical program or solution that does 95+% of what that service wants, but one or two of the other services has a program or solution that can perform 80+% for the whole DOD, the DOD MHS will push to adopt that 80% solution in the belief of interoperability and work to make it a 95% solution at a later date. The logic is that division and stovepiping capabilities, though likely highly efficient in the present, ultimately costs the DOD money, as we will eventually need interoperability at some later date anyway, and the money spent maintaining and developing a program that will later be shut down is essentially money better spent elsewhere. This boiled down to his favorite saying, "You're not as special as you think you are," meaning that interoperability is a reachable goal despite every service claiming it's a unique snowflake in oh-so-many ways. The other big bullet to bite is more funding is going to DHA rather than the individual services medical budget, so they get to call more shots (not all, but more) on what systems we will use, so "we're going to unplug you anyway, so you might as well go with a joint solution."

An example of this is the Air Force will lose AIMWTS in the next 2-5 years, adopting AERO for flight physicals. The hearing of this news was not without a fair amount of groaning, but the word is to swallow the bitter pill now and work to make it what you want.

Other things of note are:

Upcoming re-write of AFI 10-203. I was lucky enough to flip through the draft. Nothing gigantic for a non-medic to know, but several administrative changes internal to the MDG. I won't publicize it here--you'll just have to wait the 3-6 months for it to publish.

AFI 48-149 will be re-written in 6-9 months. Nothing definite yet.

One Chief who shall not be named said "losing 4F broke Flight Med, but 4F wasn't perfect." He stated the the 4F concept needed a major overhaul (should have been more clinical), despite the step backwards in eliminating it. Essentially further justification for the 4NF.

One Colonel who shall not be named repeatedly called the Medical Standards Management Element (MSME) the "mimzy" despite everbody else's long held pronunciation of "miss-me" or "miz-me." May not seem like something big, but when an O-6 consistently mis-pronounces a well-known phrase, my confidence in him greatly diminishes.

Multiple leaders stated there will be no prioritized 4E to 4NF cross-training. With the updated Non-vol lists, it looks like 4E isn't hurting to lose bodies any more anyway, so this concept is dead before it ever took off.

General hope that the current Flight and Operational Medicine Clinic (FOMC) model will eventually morph into two clinics (assuming the installation/MDG is large enough to support it). The will be Flight Med PCM (FM) and Occ Health/Physical Exam and Standards (OH/PES). If this does happen, it'll be around 2017+, as there may need to be major physical structural changes requiring centralized funding.

More resources and direction will be shifted out of AFI's to the Air Force Medical Service Knowledge Exchange (AFMS Kx). This creates more perceived secrecy and reduced access, but it allows the AFMS to re-write regulation much more quickly without the need to submit an AFI Guidance Memorandum/re-write.

When you roll the whole thing together, in consideration of the Force Management Programs, IEHR on the horizon of 2017, and major DOD budget re-assessment and likely BRAC in 2016, the Military Health System is on the verge of enormous upheaval. I’m reminded of the lamentation from the line side, when things were easier in the heat of 2002-2004 and the wars allowed everyone to write their own blank checks. If you are in any medical position, strap in, it’s going to be a bumpy ride for the next 5 years.

[deaddebate]

https://www.appropriations.senate.gov/sites/default/files/hearings/032515 DHMS Miller Statement - SAC-D.pdf

Statement by Mr. Christopher A. Miller / Program Executive Officer, Defense Healthcare Management Systems / Before the Senate Appropriations Committee / Subcommittee on Defense

March 25, 2015

From 2010 to 2013, DoD and VA executed a joint program called the integrated Electronic Health Record (iEHR) in an attempt to create a single next-generation EHR system, led by the DoD/VA Interagency Program Office (IPO). [...] DoD is on track to award a contract by the end of FY2015. [...] Initial Operational Capability is planned for the end of 2016 at eight sites, representing all three Services, in the Puget Sound area of Washington State. Full Operational Capability, currently estimated for FY2022, will include deployment to medical and dental services of fixed facilities worldwide, including 55 hospitals, 352 clinics, and 282 dental clinics. Deployment will occur by region (three in the continental U.S. and two overseas) through a total of 24 waves. Each wave will include an average of three hospitals and 15 physical locations, and last approximately one year.

[deaddebate]

https://www.gao.gov/assets/680/673363.pdf

[VA and DOD] acknowledged that they do not expect to complete a number of key activities related to their electronic health record system efforts until sometime after the December 31, 2016, statutory deadline for deploying modernized electronic health record software with interoperability. Specifically, deployment of VA’s modernized VistA system at all locations and for all users is not planned until 2018. Meanwhile, DOD has yet to define all the additional work that will be necessary beyond 2016 to fully deploy the DHMSM system, and full operational capability is not planned to occur until the end of fiscal year 2022. Thus, for the departments, establishing modernized and fully interoperable health record systems is still years away.

Wow.  Even with my already low expectations of the VA, that is astounding.