For Telemedicine & Advanced Technology Research Center
Advanced Medical Technology Initiative at TATRC
The concept that military work environments are complex adaptive systems is not a new phenomenon. Utilization of this framework is applied to various military operational work environments. This is also true of medical operating environments. Defining medical environments through the lens of complexity has been occurring for the past 30 years. The ability to quantify the increased complexity combined with the ability for computing large quantities of data also continues to expand yet limited literature applies the concepts complexity specifically to the military medicine work environment.
The Telemedicine and Advance Technology Research Center (TATRC) is a subordinate organization to the Medical Research and Development Command at Ft. Detrick, MD. The organization began in the early 1990s to develop research and technology to support the medical warfighter. TATRC has four research divisions that incorporate a user (soldier) centered design model for pragmatic research with feedback from end users (study participants) for the development and recommendations of technologies and acquisitions requirements for fielding technologies in the future (Kimmons, 2020). Army Futures Command adopted the soldier-centered design to elicit feedback during technology development stages so that fielded technologies meet the needs of end users.
An ongoing program at TATRC, the Advanced Medical Technology Initiative (AMTI), supports translational research throughout military medicine by facilitating scientific inquiry at the level of the clinical provider to inform acquisition level decision-making for the whole enterprise. Through the research efforts of the four divisions and the AMTI program, TATRC conducts early research efforts with medical technologies incorporating soldier-centered design.
“Nurse scientist a valued asset.”
TATRC recently identified a nursing science position as a valued asset for the organization moving forward. In May of 2021, LTC Patricia Schmidt became the first nurse scientist staff member at TATRC. Utilizing principles from complexity theory to shape the methodology of the research, LTC Schmidt and fellow researchers provide a data driven lab space to improve care for Service members, make recommendations for future acquisitions, and integrate human-machine teaming into military medicine. As the nurse scientist, LTC Schmidt is a resource to the entire organization working with the division chiefs to develop methodologies for designing studies to answer research questions and identify cases in need of technology to improve patient care.
LTC Schmidt primarily works with the TATRC Medical Modeling, Simulation, Informatics, and Visualization division which runs the Nexus human performance lab, where simulation exercises are used to explore research questions related to the delivery of care. The Nexus brings transdisciplinary research teams together to understand the impact of humans and technology on delivering patient care and how the resulting data may be leveraged for decision making beyond immediate clinical care.
Healthcare technologies should be developed with the intent to complete tasks or skills in a way that frees up the clinician to complete more complex work that machines are incapable of performing.
LTC Schmidt facilitated a comparative effectiveness study in preparation for the Project Convergence exercises in which telemedicine technologies were assessed in a simulated prolonged field care scenario. At the end of the study, each of the technologies were scored on functionality, usability, and technical ability to meet the criteria of the proposed use case. Qualified technologies have been recommended for inclusion in Army modernization exercises.
“Understanding how technology informs care.”
Future comparative effectiveness studies are designed to understand how the use of a technology informs care. Currently, LTC Schmidt and her team are recruiting for a study to investigate the ability of a technology to facilitate hemorrhage detection in patients and determine if the technology changes the participants prioritization of patients to receive blood or the amount of time it takes for participants to decide to treat patients for a hemorrhage.
TATRC envisions an interconnected health system that seamlessly communicates and follows Service members from the “healthy” space through illness or injury in garrison or deployed environments, through recovery. This interconnected data vision provides technology throughout the system to include the service member, their direct leaders, clinicians, and decision makers at echelon.
National emergency Telecritical Care Network (NETCCN)
One of the projects LTC Schmidt supports is the National Emergency Telecritical Care Network (NETCCN), a COVID-19 funded project to provide telehealth resources for communities in need of support across the U.S. LTC Schmidt is the leader for the data analytics and research team. The project utilizes HIPPA-compliant telehealth platforms and electronic health records to provide clinical support and resources to participating facilities. The proof-of-concept program successfully assisted 59 hospitals across the nation. Importantly, this resource can be transitioned to expand medical capability and capacity for military medicine in future large scale combat operations. The NETCCN concept is technology agnostic, meaning it is compatible with a range of smart devices and can potentially be a resource for monitoring of health of Service members such as conducting sick call, monitoring changes in status of units on a holistic level for public health purposes, providing expert support or consultation across the enterprise, and streamlining access to healthcare. Information from the NETCCN concept supports unified decision making for autonomous functions like facility resupply based on anticipated needs of the patients within the system, and development of decision support tools for transportation or evacuation planning integrated with echelon decision making tools. This holistic approach to data supports the development of dashboards and other decision-making tools that scale based on a person’s role and responsibilities.
TATRC research teams continue to propose and conduct research to support development of an integrated health system in which data used for the direct care of patients is informative not only for the healthcare professionals but is also utilized on an operational and strategic level for informed decision-making across operations. This integrated health system incorporates useful technology tools to facilitate care and decrease cognitive burden.
Over 100 nurses, licensed independent practitioners, and other healthcare providers from Tripler, Queens Medical Center, the Spark M. Matsunaga Veterans Affairs Hospital, the University of Hawaii, and other facilities throughout the island attended. Instructors traveled from Louisiana State University.
Dr. Todd Tartavoulle, DNS, APRN, CNS-BC and Mitchell Handrich, FNP presented their program titled “Delivering Culturally Sensitive Care to LGBTQ+ Patients: An Advocacy Program Train-The-Trainer©.” Each class began with an interactive exercise to improve understanding of terms related to the LGBTQ+ population, from “cisgender” and “pansexual” to “transgender” and “queer.” The instructors facilitated a conversation on the unique healthcare needs and concerns of this population, and how best to phrase certain questions to obtain a thorough health history and address the major health concerns facing this population. Class participants reviewed and discussed various scenarios involving LGBTQ+ individuals in order to identify unintentional biases and assumptions commonly made when caring for this population.