Key Takeaways from DHITS

In today's special episode of the Fed to Fed podcast, we take a deep dive into the future of military healthcare, exploring how digital innovation is essential to advancing readiness by building mission-ready systems that are more resilient, agile, and user-centered. 

We are joined by Maximus’ Dr. Jennifer Garrison, Vice President Federal Health and Alex Dixon, Senior Director, Military & Veterans Health Technology.They bring decades of experience and are fresh off insights shared at the Defense Health Information Technology Symposium (DHITS), where this year’s theme was “Empowering Care, Enhancing Readiness: Harnessing Health IT Innovation.”

This podcast is part of the Innovation that Modernizes Healthcare digital hub brought to you in collaboration with Maximus. To learn more about government healthcare modernization, visit: https://www.govtechconnects.com/innovation-modernizing-healthcare/

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Transcript

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X. Welcome to a Driving Healthcare Effectiveness and Efficiency episode of the Fed to Fed podcast by GovTech connects. This special series, brought to you in collaboration with Maximus, focuses on best practices for meeting evolving health needs and improving citizen experience by combining advanced technology and human centered design principles. We'll explore how emerging technologies can drive transformation in a way that effectively and efficiently delivers health services and programs and systems with flexibility. Security, scan and human connection. in this episode, we take a deep dive into the future of military health care, exploring how digital innovation is essential to advancing readiness by building systems that are more resilient, agile and centered around the patient. Drawing from decades of experience and fresh off sites shared at the Defense Health Information Technology Symposium, DHITS, theme Empowering Care Enhancing Readiness Harnessing Health, I.T innovation, we examine how breakthroughs in data, artificial intelligence, interoperability, and digital infrastructure are revolutionizing care delivery across the military health ecosystem. Featuring diverse voices and perspectives, this episode highlights how emerging technologies are reshaping both the patient experience and mission readiness to deliver a future for military health that is digital, personalized, secure and remains mission ready, especially with a constrained budget and personnel shortages. Welcome, doctor Jennifer Garrison and Mister Alex Dixon. Well, thank you both. So much for joining us today, Doctor Garrison. Alex, we're thrilled to hear more about diving into the future of military health care and exploring how digital innovation is essential to advancing readiness by building systems that are more resilient, agile, and centered around the patient. So, Doctor Garrison, let's go ahead and start with you. How are digital innovations helping to create military health information systems that are more resilient and agile in supporting mission readiness? So, Susan, that's a really great question. As as a prior operational medicine director at DHA, I can tell you that that topic is extremely important. So the integration of digital health truly offers opportunities to increase our operational readiness, improves our clinical outcomes, it enhances our quality and safety, it reduces risks, and of course, fortifies that resiliency, that the total force and all of Department of War beneficiaries are looking forward to. So transforming the DHEA into a digital health force multiplier is really not an option, but it's just really necessary to ensure mission success across the Department of War. We understand that failing to embrace digital transformation will hinder DG's ability to effectively support the national defense strategy as we know it, deliver the joint capabilities that our warfighters are looking forward to that are needed specifically by our armed services and our combatant commands that provide that quality care to the total force in the Department of War beneficiaries. We understand that at digits this year, it was definitely eye opening for us because that roadmap for our government contractors are preparing to support that, de mission. So, I would say the key takeaways that Maximus are are one. And no particular order was the reverse industry day. It really highlighted for us the direct opportunities to bring forward those solutions that can shape the DHS acquisition strategy. We understand that it addresses the capability requirements for system performance to evolve during the life cycle because, as you know, as evolving technology threat or interoperability needs are to reduce the program cost or schedule and enable that technology refresh operational medicine modernization. Viejo, mass. I work with Joe Mas directly for a couple of years to to create that demand that we need for an inoperable, secure and deployable IT infrastructure, modernizing those solutions and prioritizing those, to make sure that we have the data backbone that are aligned, combat commanders need and also to provide that critical data transport and that management capabilities that are key to the Joe Mesh operational medicine modernization activities. I would be remiss if we didn't talk about the joint federal electronic health record because, as you know, that rollout means years of integration, customization and cybersecurity work ahead. And working with us, at TI Maximus, playing that vital role and ensuring that seamless adoption. We understand that working with multiple efforts, that will be the Department of War, the Department of Veterans Affairs, Department of Homeland Security's, the US Coast Guard, the commercial National Oceanic and Atmospheric Administration. Those are just a few to name that we can help support this, this level of effort. That's fantastic. Thank you so much to Dr. Kerrison. So, Alex, how are emerging technologies balancing the need for personalized care with the imperative of maintaining security and privacy in military health? I think that is one of the biggest questions that we have right now. Right. I think moving toward the personalized care approach, whether you call it precision medicine, whatever you decide to call it, right, that necessitates data interoperability, data sharing, the coordination across IT systems. Well, that opens a slew of other issues with that security of that data, the privacy of that data. You need to ensure patient trust in your system, that that patient data is not leaking, whether it's inadvertent by accident or whether there is some sort of cyber security thread attack, or other data breach. So, I mean, we really need to ensure that we're not just talking about data in an electronic health record cloud. Maybe that's protected by the cloud defenses. We have a lot of data in transit. So we need to make sure those APIs are secure, that any type of data in transit is secure when we're talking to encryption, for sure. I mean, at Maximus, we're already again looking at the post quantum cryptography, right? As computers advance, as we move to a quantum computing world, the better capabilities maybe of adversaries, maybe the cybersecurity bad actors, right? We need to make sure that data is protected not only in an electronic health record cloud, but also as it moves along. I think key elements when it comes to the military health system, it's not just a standard health care system. The data that is within there has operational impact, right? Any breach or leak of military health health care data could impact an operation. It could be used by our adversaries to know and geo locate where our forces are. It is an extremely important element in the military health system is taking this as a paramount concern, regardless of the emerging technology. What benefit does it offer? Can it help personalized medicine to get to a precision medicine space? That's the reward. But they have to look at the risk and they have a robust risk management framework, that they are not just going to accept, or take that reward, that capability on face value. They have to run through their processes. And some contractors, some companies, oh, this takes too long. It takes takes forever to get an authorization to operate within the the Da or MSS, network. That's for a reason, right? They are weighing the risks. It's not a no, it's not an outright no until they've gone through their risk management framework and they've understood, okay, what is the risk to the network if we introduce this new emerging technology. So a it's we actually heard a lot from the DIT leadership. The CSO, CIO talking about the zero trust journey where they are. I think that the data, the images on a whole is very advanced. And there's zero trust journey because they designed and engineered their Medco network, they did it with HIPAA in mind and protecting that health information already. So before zero trust was really a buzzword, they were already thinking about engineering to protect their data in certain manners. And separating a little bit from the standard DoD doted network, the nipper net, and having their own protected network to help secure that data. It's a journey. Zero. Trust is a journey. DHS is well on their way to the FY 27. I think they're they're going for the zero trust target level by the end of FY 27. I think they're getting there right. They are definitely knocking out the actions that need to be done to protect the network, to also move again from that perimeter based defense to an identity based defense. So I think they've made great strides. Emerging technologies are always looking to balance and strike that balance between the capability and the security. And I think Doe has done an outstanding job of analyzing that. And making sure they're not introducing risk to their networks. I love that perspective, Alex, and your work and Doctor Garrison, your work for years aligned with the warfighter, aligned with operational medicine, align with the G6 and the importance of all of that. As experts looking ahead, what are the biggest opportunities and challenges and mission ready, digitally enabled military health care system faces? I'll jump in on that. And doctor, yes, please, please chime in as you feel appropriate. Right. I'm just gonna say, I mean, regardless of the military health care system, right, there are specific needs and opportunities and challenges on that face. All healthcare systems within the United States are seeking to strike that balance. How do we leverage this new technology to enhance care, to, frankly, enhance the health of our beneficiaries, all while providing that privacy and security of that data, and also enabling autonomy for that patient to have control over their health care journey through the system and through multiple systems. Right? I mean, when you start out, your first job, whether you're you're enlisted in the military health care system or enlisted in the military or whether you're working for a private company, right, that's not always going to be your health care plan or your health care provider, through retirement, through senior citizen age. Right? So maintaining that ability to interoperate, that data across the span is a key challenge for all health care systems. So, I mean, when it comes to the NHS, I do see numerous opportunities in the future, but I'm really going to focus on a few who, frankly, we try to do yet. I mean, the first is leveraging artificial intelligence capability to help enhance delivery. So we heard a lot about Ask Sage at digits. This is one of the first forays for the data and the images into the artificial intelligence space. And they are analyzing ask Sage. Sage is a large language model capability. Uniquely. It kind of pulls in different models that already exist, and they're trying to authenticate and authorize the utilization of Sage on their network. If that AI is authenticated, authorized, and has access to the protected health information, then you unlock doors to precision medicine and personalized medicine, efficiencies. And your administration and clinical teams. Eventually, maybe getting to that point where the provider can utilize that tool to really drive into precision medicine for that patient. Right. That's an interesting opportunity there. Again, mid-flight and getting that and analyzing how that can be utilized under system. Another thing we've heard hit in has been something that might be near and dear to. Doctor Garrison's heart is a unified readiness system. So we have our different services within the military. They do have some unique readiness health elements. Certainly somebody in submarines is going to be so many different in flies and F-16 or F-35, right. However, there's a lot in common with our military to make sure they are ready, health ready to be deployed to to be out there. So we need to work and day and the Army just need to work toward what can we have as a common level for a unified system. So we don't have these legacy systems still hanging out there that are accumulating technical debt, and you can get the efficiencies. So there's not somebody in the Army, Air Force and Navy having a worry about the system, that it can be controlled an enterprise level by the day within the NHS, with the customization for each service as needed. I think that's that's on the horizon. And finally, I'd be remiss in not mentioning a true longitudinal electronic health record, right. That goes from enlistment to deployment in theater to garrison at home, to retirement or transition to veteran status, to Medicare eligible data that follows that individual, that patient through their entire experience. We're getting closer. We've been talking about the electronic health record, modernization and everything within the podiums on that side where they mesh Genesis. They are working in the Joe Esteem doctor care. Some mentioned they are working toward that theater electronic health record, electronic medical record, that health care data from the field and making sure that follows the patient the entire way. That's an absolute opportunity that they have to kind of seize on. They are moving in that direction. It takes time. It takes resources. It's not an easy fix. We've been talking about this for quite some time. But it's something that I think they have an opportunity to really seize on. And moving toward the challenges that they face are not unlike any other health care system, in my opinion. But I don't see them necessarily as technological challenges. And it might sound cliche, but I see them as resource challenges. Do they have enough money to do what they need to do? Do they have enough people to do what they need to do? There have been constrained or stagnant budgets from the health I.T perspective for for multiple years. That's impacted what they've been able to do to kind of erase some of that technical debt, implement new technologies, innovate. I think there's always a challenge on that front. You always have enough resources to do what you want to do. Yeah. But how do you select what you want to do given your constrained budget? And for it, leadership specifically has all the steps and processes in place, but they have to be highly selective and prioritize where they're going to put their money. So things like ask sage the AI tools, they're going to ideally have a large reward, large return on investment. At the end of the day, they're going to put their money there, right? Some other ideas, some other tools. Maybe they don't make the cut. So they're going to have to be highly selective. I also have to mention the people, the images. They have outstanding people. And 525 has been a very interesting year across the entire federal government landscape. And unfortunately, the do it team, they've lost quite a lot of great leaders over this year, whether to, deferred retirement or resignation program or whatever might be. It can take decades to build up the level of knowledge and experience and leadership experience that the Da has lost. They have great people waiting in the wings. They've got great people stepping into those roles, but it's going to take time for them to really develop their leadership skills and mastery of everything that's going on within the IT ecosystem. And I think that's one of the goals that they have, right? They need to identify and get those personnel as quickly as possible. The resource issue, the financial issue does play a factor in that hiring new personnel to join the team. If you have constrained resources, again, you got to be highly selective and move forward as quickly as possible on that front. So I think those are the key challenges. Again, they're not technological by nature. It's more managerial. But I'd love and Doctor Garrison, if you have thoughts on opportunities or challenges. Yeah. Alex I think you're spot on because when I was a part of operational medicine, as the director there at DHEA, we had the operational Medicine Information Technology Steering Committee to do exactly what you talked about. We had summits, bringing all the services together collaboratively, to talk about what is good look like, how are we going to modernize that digital space, making sure from a Rogue One all the way to a role for how do we bring that patient back in safely and having that critical information at the fingertips, at that provider's hands so they can make those critical decisions? Because we all know in flight, your priority can change. So what is it that we need to have to make sure that I understand there's connectivity issues. There is latency issues. But with the technology that we have using AI and predictive analytics and the great team that we have it working with the services, we can we can collaborate with our, our, our government and contractors and say, how can we best move this forward? I know we have the, the power to do so. It's just making sure we all prioritize because we can't boil the ocean overnight. So, do that timeline. March that out. Working together to, to make sure we can execute the mission appropriately. Doctor garrison and, Alex, is there anything else that you'd like to share? Okay. If you're okay, Alex. I so I thought the hits this year was really eye opening, like Alex talked about, because if you look at the theme, it's called empowering care Enhancing Readiness Harnessing Health I.T innovation. This goes back to your question, is operational medicine in it together? Yes. Because the DHS made it very clear at this hit that the Da is both massive and scale. It's ambitious and it's innovative. So for government contractors like Alex and I this is a call to action bringing in the smart people. What are some opportunities that will flow for those who can bring in those solutions that scale, integrate seamlessly, and will direct and prove those mission outcomes? I will say the mass military health system and I have been working on an AI mission and vision strategy that that they have constantly finding ways to incorporate AI machine learning into specific areas of the military health, keeping in mind that it must be done in a reasonable, ethical and trustworthy way. That goes back to what Alex was saying. And for those reasons and and have taken their time to analyze these AI tools to launch on their network. So, so I get, digits, like Alex just said, we're launching our sage, a large language model AI that's uniquely close, to and it offers multimodal capabilities. The DA's goal is to enable this and make sure we implement using Microsoft Copilot, a generative AI assistant within its miter 65 application platform, to empower efficiency and effectiveness on daily tasks. And that's that's awesome because Copilot is being tested before implementation across the enterprise. So when they roll it out, it's done correctly. Health affairs is working to identify those actions that are needed, that is needed to enable that advances. And adoption of artificial intelligence and machine learning across US military medicine, and ensuring those robust safeguards that's critical to make sure that they are in place. And I would be remiss if I didn't say that the office of the Assistant Secretary for Health Affairs has identified those five key areas for promoting trustworthy AI and machine learning, and we understand. And when we develop our capabilities, it's making sure we maintain an AI and machine learning inventory and that guidance that's responsible for that. I provide guidance for a trustworthy generative AI, promote and enable AI digital workforce, because we know that's critical, and we also promote and coordinate with our other DoD and federal agencies. So we're in lockstep with them. So as we execute the mission, it's enabling the warfighter to do what they need to do. Awesome. Alex, last word. Just to piggyback on what Doctor Garrison said and kind of bring another item to the table when we talk about AI, it's only as good as the data. And we heard a lot of hits. And we've heard in multiple conferences in the military health system, the move toward data literacy across the agency, the move toward understanding where all the data is, what applications are in existence today, and the new CDO at GA is driving forward with initiatives to understand the data landscape and implement an integrated data ecosystem. So you have the AI tools are outstanding. Does it connect to the right data sets? Do we have the right source data? Is that data clean? Is that data need to be in a common data model? Right. Like are we using the same terminology. So we heard that it hits quite a bit. It is a key push. Everything that we talked already talked about with the privacy and security of that data is paramount. And the data it teams will handle those pieces. But I think we'd be remiss in the digital space not mentioning the data modernization journey that they are on. However, starting with the understanding of what data is out there, like what do we have? What do we already have in place for data analytics? What applications are there, and making sure that they are driving lockstep with what is going to impact the services? What is going to help the readiness mission? What helps with that readiness of our clinical teams and health care providers and get there. I think they're getting after it. And I think the hits really hit that home that they are implementing. Even with those constrained budgets I talked about, they're implementing smart, innovative moves to get to the goal that they want to reach. That's wonderful. It's certainly an exciting time over data and makes, to protect our warfighters and to provide them the best care that's available. Thank you both so much for joining us. That was such an incredible discussion. I look forward to additional conversations in the future. Thank you so much, Susan. Thank you Susan. Thank you for joining us today to find out more about digital innovation for federal health optimization and resilience, visit the Driving Healthcare Effectiveness and Efficiency landing page on GovTech connect.com. Don't forget to subscribe to our podcast channel to stay up to date on the latest episodes.