Posted: 10 Oct. 2018 8 min. read

Virtual health: Extending the Military Health System’s outreach and reach-back

By Dr. Bruce Green, Managing Director, Deloitte US

As the functional manager of the US Air Force Medical Service and the 20th Air Force Surgeon General, I saw first-hand how digital technologies can extend the outreach and reach-back of the Military Health System (MHS) to improve operating efficiency and the patient experience. One technology which is already demonstrating its value, and which holds even greater promise for the future, is virtual health—the use of teleconferencing, mobile apps, and other technologies that allow patients to connect with health care providers across vast distances.

The MHS has used virtual health in some capacity since the 1990s,1 in both direct care for active military personnel and purchased care for family members and retirees. Types of services include consultation via teleconference, secure messaging, mobile applications, and store-and-forward, which allows for the electronic transmission of medical information, such as photographs, diagnostic images, documents, and pre-recorded videos for diagnosis or evaluation. Such services are available between MHS providers (typically a generalist and a specialist) and between patients and providers.2

Today, we can see virtual health applications being used in MHS base hospitals, field hospitals, ambulances and air evac vehicles, and in battle. One exciting example is the Battlefield Airmen Trauma Distributed Observation Kit (BATDOK), a mobile application used by the Air Force that allows a front-line medic to monitor multiple patients with relative ease while on the battlefield. The software comes with FDA-approved sensors, which, when attached to a patient, send the patient’s vital signs back to the medic’s screen in real time. If, while examining Patient A, Patient B’s heart rate drops to a dangerous level, the medic will receive an alert so he or she can attend to Patient B immediately. The sensors also document the exact geographic location where a patient is located, which can aid in communication and identifying casualties. Patient data included in BATDOK is automatically integrated into his or her MHS electronic medical record. The software is interoperable with battlefield digital situation awareness maps, which helps identify the exact location of casualties. It also includes a medical library for providers to reference when needed.3

As is frequently the case when introducing a new technology, getting providers and consumers to adopt virtual health may take time. Deloitte recently surveyed more than 4,500 US adults to understand how consumers engage in the health care system. When asked about virtual care, more than three quarters (75 percent) said they have never tried a virtual visit.4 In addition, only 53 percent of consumers thought that the professional they saw during the virtual visit was as professional or knowledgeable as the professional they see during an in-person visit. Less than half (44 percent) of respondents said the wait time was shorter for a virtual visit. Also, only a third of respondents felt they received all of the information they needed from the virtual visit.

These findings suggest that the MHS should consider training its clinicians to conduct virtual visits. Prior research has shown that bedside manner is important to patient health.5 As more physician-patient interactions happen virtually, physicians and health systems might need to determine how to ensure an appropriate “webside manner.”6 This, I know from personal experience. When I was with the Air Force, I led an initiative to boost physician and patient acceptance rates for the RelayHealth secure messaging system (SMS) at Elmendorf Air Force Base in Anchorage, Alaska. By focusing on user adoption and gaining broader visibility for new technologies in general, we grew the SMS user acceptance rate four-fold: from the typical 15 percent to 60 percent. Today, SMS is a mainstay of the health care industry.

As Deloitte joins more than 500 organizations this week for the US National Health IT Week, I am reminded once again how each innovation applies to the needs of military members, dependents, retirees, and the professionals who provide their care, and how digital technologies can help the MHS achieve its clinical, operational, and financial goals.

P.S. We will be talking in depth about MHS use of virtual health and other exponential technologies in a new report, available October 30.


2 Office of the Under Secretary of Defense, “Report in Response to Section 718 of the National Defense Authorization Act for Fiscal Year 2017 (Public Law 114-328)
3 “
5 John M. Kelley et al., “The influence of the patient–clinician relationship on healthcare outcomes: A systematic review and meta-analysis of randomized controlled trials,” PLOS One, April 9, 2014.
6 Erica Tiechert, “Training docs on ‘webside manner’ for virtual visits,” Modern Healthcare, August 27, 2016. 

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Bruce Green, MD

Bruce Green, MD

Managing Director & Chief Medical Officer

Dr. Green is a managing director with Deloitte Consulting LLP, serving as chief medical officer for Deloitte’s Federal Health practice. Dr. Green is an advisor to Deloitte’s federal and commercial health clients and a thought leader in clinical public health leadership and preparedness. Dr. Green was the 20th Air Force Surgeon General and the functional manager of the U.S. Air Force Medical Service. He has a MD and a MPH from the Harvard School of Public Health and is board certified in Aerospace Medicine.