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Top Military Health Care Leader Looks to the Future of Medicine

Image of Navy Lt. Cmdr. Kathryn Lipscomb, the urology department head at U.S. Naval Hospital Rota in Spain, waves to staff in USNH Naples, Italy during the first virtual cystoscopy between both hospitals in Jan 2021. (Photo: Navy Cmdr. Ryan Nations). Navy Lt. Cmdr. Kathryn Lipscomb, the urology department head at U.S. Naval Hospital Rota in Spain, waves to staff in USNH Naples, Italy during the first virtual cystoscopy between both hospitals in Jan 2021. (Photo: Navy Cmdr. Ryan Nations)

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Years ago, surgeons removed patients' gall bladders by making a large incision and cutting through abdominal muscles. If the procedure went well, the patient went home about 10 days later.

Fortunately, those days are over. Thanks to new medical technology, today most gall bladder patients can go home the same day of their surgery. Typically they're eating and back to their daily routine in three to five days.

Health care has come a long way in recent years, thanks to technology, innovation and unexpected challenges like the COVID-19 pandemic. Dr. Brian Lein, the Defense Health Agency's assistant director of healthcare administration, cited the gall bladder example and pointed to an array of advancements in surgical techniques when he spoke at a recent presentation on the role of military hospitals and clinics in the next decade.

"Facing almost three years of a global pandemic has completely reshaped how it is that we do medicine," he said. Lein spoke at a virtual event hosted by AMSUS, the Society of Federal Health Officials, on Feb. 23.

The explosion of capabilities includes robots in the operating room, the expansion of virtual health care and virtual encounters, remote patient monitoring and artificial intelligence, he said.

At the same time, the COVID-19 pandemic has made the entire Military Health System more flexible and agile, more receptive to change and innovation.

For example, "we know patients recover better at home," he said. "You're sleeping in your own bed. You're eating your own food. You're not tripping over stuff going to your bathroom because you've walked to that bathroom for the last 30 years. And you have one nurse taking care of you, so there's no concern about different kinds of medications or medication errors."

Lein's role at DHA involves planning and managing health care facilities as well as implementing changes that affect health care delivery and administration. He foresees a "huge increase in a mixture between what used to be purely inpatient care to what is now often outpatient care."

For example, he explained "we are at the very infancy of artificial intelligence and machine learning." Those technologies are never going to replace physicians. But they are going to augment physicians' abilities to do their job, he said.

"They're going to help make decisions for me. They're going to advise me on the best recommendations that are out there based upon gathering of millions upon millions of data points that I may not even be aware of as the provider taking care of a patient," he said.

"Now, that doesn't mean that we should ever take away the face-to-face encounters with our patients," Lein said. "As a provider, I can tell you, I pick up on a lot of things when I have patients in the office, so we can never take that away."

But for most visits that only require medication refills and routine checks, he said, increasing the use of virtual encounters might be better for everyone involved.

Recalling his experience as a surgeon, Lein said he would operate on someone and send them home, but need to see them again soon afterward to make sure they were progressing as expected.

"Often their spouse had to put them in the car. They were uncomfortable riding in the backseat of the car because the seatbelt hurts. And then they get in to see me and all I do is look at them and say: 'Hey, you're good to go. Come back and see me in a couple of weeks.'"

Doctors don't need to do that anymore, he said. "We've learned over the course of COVID that a lot of the consultations that we need don't necessarily need to be face-to-face."

However, "what will never change in the military [hospitals and clinics] is our responsibility for readiness, the readiness of the soldiers, sailors, airmen, Marines and guardians on the installations that we support, and the readiness of the medical force that works in those military [hospitals and clinics]," he said. "That's been a hallmark of military [hospitals and clinics] since they were first established."

As he looks toward the future, Lein said the Military Health System will make sure that the core functions of the military hospitals prioritize the readiness of individuals.

"What we considered ready versus non-ready 10 years ago has markedly changed based upon health care delivery, health care options, and innovations," he said.

"We've got to change with the times."

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