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The Defense Health Agency (DHA)provides care “Anytime, Anywhere, Always.” For the first time ever, patients at Naval Hospital (NH) Jacksonville can receive care from a pediatric endocrinologist in the pediatric clinic of the hospital. Capt. William Scouten from Naval Medical Center Portsmouth (NMCP), Virginia, makes quarterly visits to see local patients often within a week, when wait times for a consultation were previously four to six months.
“The most common endocrine problems that I am asked to consult on can be managed by first understanding the problem from thorough review of medical records followed by discussion with the parents over the phone,” Scouten said. “Starting with a 30-minute telehealth appointment, I can make a plan with the family, order diagnostic studies, and then meet and examine the patient when I travel down to NH Jacksonville for clinic. Because I already have results of diagnostic studies, I am able to make a diagnosis and provide education at the same appointment.”
Scouten further explains that after creating a Pediatric Subspeciality Division about 20 years ago at NMCP, he saw success when specialists traveled between facilities.
“Before the DHA, each hospital’s operating budget was based on their own productivity, so it did not make a lot of business sense to provide outreach. Now, with an enterprise-level look at finances and consideration of how-to best care for our military population, it makes total sense to use specialists where we need them. And as a result, we are providing care quicker and more efficiently, improving communication by keeping care within the military system, and NH Jacksonville is saving (not avoiding) at least $75,000 each year by this service,” he explained.
Scouten began his naval career in 1990 and has had numerous deployments on the U.S. Navy Mercy-class hospital ship USNS Comfort( T-AH 20), providing care after disasters including an earthquake in Haiti in 2010. He also completed a command tour at NH Rota, Spain. In addition to his current duties at NMCP, he serves as an assistant professor of pediatrics at the Uniformed Services University of Health Sciences.
Scouten reinforces the important role of the Primary Care Provider (PCP) as he consults. He emphasizes a team approach, involving the PCP in initial evaluation and the management plan. He encourages “curbside consultation” using the message function of MHS GENESIS, the Military Health System’s modern electronic medical record that provides a single health record for service members, veterans and their families. He also works with the medical staff to create referral guidelines which improve the quality of clinical consultation.
“One thing that we can do now that we weren’t able to do before is that we can securely receive questions in MHS GENESIS about a patient’s condition from the PCP, review the patient’s records, including older records in the Joint Legacy Viewer and shared records from civilian partners, and give recommendations for immediate care. Previous wait times are eliminated,” Scouten said. “That is powerful and it enables the best care delivery.”
Military families also benefit from continuity of care when one military subspecialist turns care over to another as families move from one duty station to another. In this hybrid telemedicine/itinerate care model, the same subspecialty teams have managed some patients for years through multiple moves to new duty stations.
“The Pediatric Endocrine team receives 20-60 new consultations per month, whereas NH Jacksonville generates about 150 consults per year,” he said. “After taking a month to set up the program, I saw 18 patients on my first visit in January.”
In an ever-evolving medical environment, some could find keeping up with the demand challenging. The leadership at NH Jacksonville sees the changes as nothing but a benefit for the community.
“When this idea was in its infancy, I saw this as nothing but a win for our local families and patients,” said NH Jacksonville Director Capt. Craig Malloy. “Any time we can add services to our facility and provide more to the families of our warfighters, I’ll take that challenge.”
Due to the success of the program, Scouten will soon begin seeing patients at Naval Medical Center Camp Lejeune, North Carolina.
“My value to the enterprise has increased, and I think we need to be using more providers this way,” Scouten said.
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