Patient Movement Panel Discussion Medical Director, TAO-Pacific Clinical Operations, TAO-Pacific Health Care Operations, USNH Okinawa Chief, Clinical Ops, TPMRC Flight Surgeon, TPMRC Chief Managed Care, TAMC

Patient Movement Main Issues Pacific Referral System – Juniper Commercial Air Evacuation Brief and Checklist Overflight Programs for NH Okinawa and TAMC TPMRC Funded Commercial Evacuation

Patient Movement Algorithm Patient Referral for Specialty Appointment NH Oki schedules appt. dates sends through Juniper CM/AE requests appointment using Juniper TAMC schedules appt. send dates through Juniper Pt accepts or declines CM/AE completes Comm Air Brief Pt travels for appt.

Patient Referrals - Juniper New system replaced Persona Feb/Mar 08 Pacific facilities must have remote access to TAMC’s system to input referrals Many MTFs have limited access Firewalls Local IT connections Lack of training and system knowledge

Patient Referrals - Juniper Referral workload now moved to TAMC and other MTFs to input Faxes and emails between MTFs Connected MTFs input into system Creating havoc in specialty care clinics No shows Cancellations Patient miscommunications

Comm Air Evac Brief & Checklist ISSUES Commercial AE lacked standardization throughout the Pacific Inadequate patient preparation for referral appointments Negative impact on specialty care availability at TAMC Increased TDY time/costs to parent command 12 Pacific Referring MTFs demonstrated disparity in the quality and comprehensiveness of preparatory briefings for Commercial AE. lacked any specific guidelines or standards to dictate patient preparation for the referral care process Lack of proper patient instruction/preparation on the Commercial AE Process was negatively impacting specialty referral care at Tripler, decreasing patient satisfaction, and adversely impacting the quality of patient care.

Comm Air Evac Brief & Checklist SOLUTION Process Action Team created to address issues - comprehensive representation of Pacific MTFs Created a standardized briefing for the Pacific approved by TAMC and JPLO Improved patient preparation for referral appointments Increased specialty care availability at TAMC Decreased TDY time/costs to parent command – SAVE $$$ The process action team was lead by the TAO-P and consisted of Tri-service Soldiers, Airmen, Sailors and civilian case managers, air evacuation clerks, service liaisons, and health care integrators from 5 countries in 3 time zones representing all MTFs in the Pacific. The brief is the mandatory minimum and should not be changed or updated without another PAT team to address changes but we encourage individual MTFs to add their own information to beef up their briefing ie lodging info, transportation info, restaurants, POC phone numbers for taxis, liaison, maps etc to assist the beneficiary while travelling away from home.

Commercial Air Evacuation Brief

Commercial Air Evacuation Checklist

Overflight Program NH Okinawa Purpose: Better use of existing services within WestPac AOR Applies to referrals from South Korea and Japan Overflight request required prior to referring patients to TAMC or CONUS for services that are available at USNHO See SAR on USNHO public website https://www.okimed.navy.mil Send request to USNHO overflight Approval email: NHOKI-OverflightApproval@med.navy.mil Negligible impact on TAMC’s GME program NO involvement of TAO-P New Customer Service Initiatives associated with program: Transportation for patients Coming soon: Additional billeting on Camp Lester Comprehensive Welcome Aboard package on public website Over flight of USNH Okinawa (USNHO). As of September 2008, over flight of USNH Okinawa from Pacific MTF patients requires approval of USNHO. USNHO will maintain an accurate and up-to-date Service Availability Report (SAR) on their website. All requests for over flight of USNHO are to be made through XXXXXXXXXXXXX. TAO-P is not part of this process. Attempt to provide training opportunities for TAMC’s GME program. If they have the capability then patients should go there. Can overfly for extenuating circumstances, social reasons, PCS, or service specific medical boards, or end of life care considered on a case by case basis. Must be approved by TAMC’s DCCS. Then on to TPMRC for final approval for commercial ticketing. Previously process involved TAO-P Medical director which was rate limiting step which was not value add to the process. Over flight of Tripler Army Medical Center (TAMC). Over flight of TAMC require direct approval of TAMC and coordination with TPMRC. This involves direct e-mail communication and submission of required over flight request form from the requesting MTF to TAMC. When approved by TAMC, the form will be forwarded to TPMRC for further approval for commercial ticketing. Prior to April 2007, TAO-P Medical Director was part of this process. TAO-P no longer has any involvement in TAMC over flight unless the requesting MTF asks for further review of a TAMC/TPMRC refusal of over flight request.

Overflight Program Tripler Army Medical Center Benefits TAMC GME program Email communication from originating MTF to TAMC DCCS – Approval then to TPRMC for commercial ticketing NO involvement of TAO-P Attempt to provide training opportunities for TAMC’s GME program. If they have the capability then patients should go there. Can overfly for extenuating circumstances, social reasons, PCS, or service specific medical boards, or end of life care considered on a case by case basis. Must be approved by TAMC’s DCCS. Then on to TPMRC for final approval for commercial ticketing. Previously process involved TAO-P Medical director which was rate limiting step which was not value add to the process. Over flight of Tripler Army Medical Center (TAMC). Over flight of TAMC require direct approval of TAMC and coordination with TPMRC. This involves direct e-mail communication and submission of required over flight request form from the requesting MTF to TAMC. When approved by TAMC, the form will be forwarded to TPMRC for further approval for commercial ticketing. Prior to April 2007, TAO-P Medical Director was part of this process. TAO-P no longer has any involvement in TAMC over flight unless the requesting MTF asks for further review of a TAMC/TPMRC refusal of over flight request.

TPMRC Funded Commercial Air PMR Issues Recommendations to MTFs for AE Remote EVAC support Today Future Military Helicopter Evacuation Capabilities Japan (Tokyo) for local emergency OB evac

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