1. 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

2. 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

3. 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.

4. 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

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

6. 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.

7. 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.

8. Commercial Air Evacuation Brief

9. Commercial Air Evacuation Checklist

10. 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
Send request to USNHO overflight Approval
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 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.

11. Overflight Program Tripler Army Medical Center
Benefits TAMC GME program
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 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.

12. 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

13. QUESTIONS?