Back to Top Skip to main content Skip to sub-navigation

Tele-critical care will play increased COVID-19 response role in 2021

Infographic that says "202 tele-critical care successes will help 2021 COVID19 response" The COVID-19 pandemic, the deadliest global health threat in more than a century, galvanized the Military Health System in 2020. Navy Capt. Konrad Davis is director of DHA Tele-Critical Care (Photo by: Savannah Blackstock).

Recommended Content:

Coronavirus | Military Health System Transformation

The Military Health System's success in adapting and expanding tele-critical care programs for critically ill patients in 2020 during the COVID-19 pandemic will play an essential role in bringing the virus under control in 2021.

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 number of COVID-19 cases continues to underscore the need for proactive virtual health planning and implementation," said U.S. Navy Capt. (Dr.) Konrad Davis, MHS director of tele-critical care. “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."

Tele-critical care and other virtual health programs help sustain care while keeping beneficiaries and health care teams at a safe distance, said Jamie L. Adler, lead of the Virtual Health Clinical Integration Office at the Defense Health Agency Connected Health Branch.

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, he said.

Joint Tele-Critical Care Network

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, Davis said.

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.

In response to the COVID-19 pandemic, the JTCCN added seven new spoke site hospitals during calendar year 2020, nearly doubling the number of participating locations. In all of 2020, the JTCCN provided over 2,200 days of ICU coverage to 432 unique patients in 109 ICU beds spread across 15 spoke site hospitals. The JTCCN plans to add one additional spoke site hospital in calendar year 2021.

National Emergency Tele-Critical Care Network

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, Davis said.

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.

Partnerships Key to Success

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, said Dr. Simon Pincus, chief of the DHA Connected Health Branch. 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, Davis said.

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.

You also may be interested in...

DHA-PI 6205.01: Medical Logistics Guidance for the DoD Coronavirus Disease 2019 (COVID-19) Vaccination Program

Policy

This Defense Health Agency-Procedural Instruction (DHA-PI), based on the authority of References (a) and (b), and in accordance with the guidance of References (c) through (n), establishes the Defense Health Agency's (DHA's) procedures for ordering, receiving, and managing COVID-19 Vaccines inventory and ancillary kits.

DHA-IPM 20-004: Department of Defense (DoD) Coronavirus Disease 2019 (COVID-19) Vaccination Program Implementation

Policy

This Defense Health Agency (DHA) Interim Procedures Memorandum (IPM), based on the authority of References (a) through (d), and in accordance with the guidance cited in References (e) through (aa), establishes the DHA’s procedures to implement instructions, assign responsibilities, and prescribe procedures for the COVID-19 Vaccination Program. This DHA-IPM applies to DHA, DHA Components (activities under the authority direction, and control of the DHA), Military Departments (MILDEP), and the United States Coast Guard (CG). This DHA-IPM cancels and replaces DHA-IPM 20-004, “Department of Defense (DoD) Coronavirus Disease 2019 (COVID-19) Vaccination Program Implementation,” December 13, 2020.

TAB A MEO COVID19 Medical Coding Policy

Policy

Memorandum for DHA Staff - Military Medical Treatment Facilities to Implement Updated DHA COVID-19 Medical Coding Policy

  • Identification #: N/A
  • Date: 3/25/2021
  • Type: Memorandums
  • Topics: Coronavirus

DHA COVID19 Medical Coding PolicyV5 1v

Policy

Establishes the DHA procedures to standardize the coding for Coronavirus 2019 (COVID-19) within military medical treatment facilities (MTFs). This memorandum replaces DHA-Policy Memorandum 20-003 of July 1, 2020. Attachment 1 was updated to include the 2021 procedure and diagnosis codes for COVID-19, including the new vaccination and treatment codes.

  • Identification #: 20-003
  • Date: 3/25/2021
  • Type: Memorandums
  • Topics: Coronavirus

Supplemental Guidance for Providing DoD Coronavirus Disease 2019 Vaccines to DoD Contractor Employees and Select Foreign Nationals

Policy

This memorandum provides supplemental guidance on the provision of coronavirus disease 2019 (COVID-19) vaccines, in accordance with reference (a). The Defense Health Agency (DHA) is the lead coordinating DoD Component for executing this guidance, in coordination with the Military Departments and other DoD Components as appropriate.

HA Guidance for Coronavirus Disease 2019 (COVID-19) Laboratory Pre-Testing Questionnaire

Policy

This memorandum provides guidance for a COVID-19 laboratory pre-testing questionnaire that will be mandatory for all Active Duty Service members and encouraged for all other DoD beneficiaries treated at military medical treatment facilities.

Executive Order on Ensuring Access to United States Government COVID-19 Vaccines

Policy

This EO outlines who should receive priority access to COVID-19 vaccines developed in the United States or procured by the United States Government (“United States Government COVID-19 Vaccines”).

Coronavirus Disease 2019 Vaccine Guidance

Policy

This memorandum provides guidance on the provision of coronavirus disease 2019 (COVID-19) vaccines. The Defense Health Agency (DHA) is the lead coordinating DoD Component for executing this guidance, in coordination with the Military Departments and other DoD Components.

DHA-AI 3020-01: Return to the Workplace Staffing Plan in the Coronavirus Disease 2019 Environment

Policy

This Defense Health Agency-Administrative Instruction (DHA-AI), based on the authority of References (a) through (b) and in accordance with the guidance of References (c) through (z3), establishes the Defense Health Agency's (DHA) plan to return to full operations and support the whole-of-government response, during the Coronavirus Disease 2019 (COVID-19) pandemic. This DHA-AI also provides a preventive plan to monitor and assess for the appearance of new cases and implement those processes that will prevent them from impacting the workforce. The processes describe herein are intended to offer an actionable plan for the workforce to re-enter DHA Administrative Offices. See Appendix 1 for a summary of the DHA Administrative Office Reopening Plan. The plan uses the Force Health Protection Guidance and Health Protection Conditions (HPCON), in accordance with Reference (d), to ensure protection for the workforce, including the most vulnerable-to-serious complications from the virus while enabling DHA Administrative Offices to continue its mission. See Appendix 2 for the conceptual HPCON framework.

  • Identification #: 3020-01
  • Date: 11/3/2020
  • Type: Administrative Instructions
  • Topics: Coronavirus

DHA AI 3020.01: Return to the Workplace Staffing Plan in the Coronavirus Disease 2019 (COVID-19) Environment

Policy

This Defense Health Agency-Administrative Instruction (DHA-AI), establishes the Defense Health Agency’s (DHA) plan to return to full operations and support the whole-of-government response, during the Coronavirus Disease 2019 (COVID-19) pandemic and in preparation for regression or resurgence in COVID-19 cases that could impact the workforce.

  • Identification #: DHA AI 3020.01
  • Date: 6/12/2020
  • Type: Administrative Instructions
  • Topics: Coronavirus

Continuing Implementation of the Reform of the Military Health System

Policy

This memorandum directs the continued implementation of the Military Health System (MHS) organizational reform required by 10 U.S.C. § 1073c, and sections 71 land 712 of the John S. McCain National Defense Authorization Act (NDAA) for Fiscal Year (FY) 2019. The DoD policy for this reform is guided by the goals of improved readiness, better health, better care, and lower cost. The Department will advance these objectives through specific organizational reforms directed by Congress and the continued direction of the Secretary of Defense·anct the National Defense Strategy.

Showing results 1 - 11 Page 1 of 1

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.