JOINT BASE SAN ANTONIO, Texas –
The following article is a first-person account by Army Lt. Col. (Dr.) Gary Legault, director of the Virtual Medical Center at Brooke Army Medical Center at Joint Base San Antonio-Fort Sam Houston, Texas.
As Military Health System providers, part of putting patients at the center of everything we do is ensuring patients can quickly access high-quality care – particularly specialty care – wherever they happen to be. Virtual health is central to increasing timely access to care, which is why the MHS has Telemedicine Privilege by Proxy: a fast, efficient process that enables providers to file one application and get permission to virtually treat patients anywhere in the MHS.
Telemedicine Privilege by Proxy plays a crucial role in meeting one of the MHS’s biggest clinical needs: expanding access to limited specialty-care resources across the enterprise, especially to small, remote locations. The single, centralized process has also made it up to 30 times faster for providers to get permission to deliver care virtually at military hospitals and clinics. It only takes three to five days, down from 90 days or more.
The MHS’s Telemedicine Privilege by Proxy is a force multiplier that saves time, improves processes, and removes barriers to care for those we serve. By facilitating virtual health across state and federal jurisdictions, the process is an invaluable tool to increase military readiness, improve access, improve outcomes, and lower costs.
Telemedicine Privilege by Proxy offers providers opportunities to improve all virtual and in-person care. The process enables providers to deliver virtual care when appropriate and focus more effectively on patients that need in-person treatment. It reinforces the continuity of care by enabling providers to maintain relationships with in-person patients when the patients, providers, or both do a permanent change of station. It also enables providers to share their expertise outside their home facilities to help patients around the world.
Easing the Burden
The MHS Virtual Medical Center coordinates Telemedicine Privilege by Proxy as part of helping execute virtual health care across the MHS. The process decreases administrative burdens on military hospitals and clinics by handling two key tasks:
1. It confirms providers’ credentials and privileges at their primary facilities.
2. It then facilitates providers getting the same privileges for virtual care at other facilities, enabling quick access to patients at different locations as needed.
This fact sheet explains the process in more detail.
As part of Telemedicine Privilege by Proxy providers upload their information to the Department of Defense Joint Centralized Credentials Quality Assurance System, or JCCQAS, which helps ensure the VMC’s evaluation of provider qualifications meets DOD quality standards. The VMC also helps providers use JCCQAS as a resource to access the MHS electronic health record, lab results, and other clinical information.
Telemedicine Privilege by Proxy is for virtual health visits only – it does not authorize a provider to physically practice at a patient’s facility. That restriction does not impede providers’ ability to deliver high-quality care, however, as the MHS has many evidence-based virtual health options that Telemedicine Privilege by Proxy-privileged providers can use.
The new standard, synchronous method to meet with patients in real-time is MHS Video Connect. Rolling out across the enterprise, this new virtual health platform allows patients to meet with their Telemedicine Privilege by Proxy-privileged military health provider virtually through secure, live video on any internet-connected device.
But telemedicine doesn't always require video – in fact, most MHS virtual health is done by phone. For emergency cases, the VMC’s Advanced Virtual Support for Operational Forces hotline, or ADVISOR, connects service members or providers anywhere in the world 24/7 to specialty providers on call. These specialty providers – all privileged through Telemedicine Privilege by Proxy – can help with real-time virtual care when and where it's needed most.
Providers with telemedicine privileges can also do asynchronous virtual care when live interaction isn’t needed. For non-urgent requests, the VMC’s Global Teleconsultation Portal enables providers to refer cases to an appropriate Telemedicine Privilege by Proxy-privileged specialist, who generally responds within 24 to 72 hours.
You can learn more about these programs, Telemedicine Privilege by Proxy, and other VMC virtual health capabilities by visiting the VMC SharePoint.
Meeting the Demand
The COVID-19 pandemic forced the MHS to rapidly expand the reach and capabilities of its virtual health offerings to ensure continuity of care while keeping providers and patients safe. Now that virtual health has become a permanent, growing part of MHS care delivery, many providers – and their patients – want to continue using virtual care.
Telemedicine Privilege by Proxy plays an essential role in meeting that demand. By expediting the review and approval of providers to work virtually at other sites, the process enables providers and facilities to focus on delivering care more effectively – whether that care is in-person or virtual. Telemedicine Privilege by Proxy has been a huge win for the MHS and will continue to help ensure service members, retirees, and their families get the care they deserve.