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Tech for Deployment Health with Col Teyhen, WRAIR (Next Generation Behavioral Health Podcast)

Tech for Deployment Health with Col Teyhen, WRAIR (Next Generation Behavioral Health Podcast)

[Dr. Christina Armstrong] Hello and welcome
to “Next Generation Behavioral Health”. [Dr. Julie Kinn] Ten Minute Tips for Modernizing
Patient Care. [Armstrong] [music] I’m Dr. Christina Armstrong. [Kinn] And I’m Dr. Julie Kinn. [Armstrong] Today we’re joined by [Army] Col.
Deydre Teyhen, who has helped the Military Health System implement technology in several
innovative ways. [Army Col. Teyhen] Hello. [Armstrong] Thank you so much for joining
us. We’re so excited to hear about the work you’re
doing. [Teyhen] Well, thank you. [Armstrong] Could you tell us about your current
work with Walter Reed Army Institute of Research (WRAIR)? [Teyhen] Right now I am the commander of the
Walter Reed Army Institute of Research, and we really are responsible for protecting the
most important six microns to six inches on the battlefield. What I mean by that is that we protect our
soldiers from the diseases of the countries in which the Army and the military send them,
from infectious diseases like malaria or dengue, and that’s the six microns, and then the brain
health research is the six inches. General Brown always says, the most important
six inches on the battlefield are the six inches between our ears. At WRAIR we have that amazing opportunity
to protect the six microns to six inches. [Kinn] Oh, that’s fantastic. [Armstrong] Col. Teyhen, I was so impressed
by the passion and dedication you have for championing the excellent health and medical
readiness in our nation’s war fighters, not just out on Schofield Barracks, but all across
the Military Health System. Can you tell a little about the important
work you’ve been doing to improve the health and readiness in our service members? [Teyhen] Well, thank you. Yes. So before I went to Schofield Barracks, I
had the amazing opportunity working for the Surgeon General. And with the Surgeon General, we unrolled
multiple programs to focus on the holistic health needs of our community, not just the
soldiers but their family members and our retirees. As part of that, we rolled out the “Performance
Triad” which is the importance of sleep, activity, and nutrition. And then in addition to that, we rolled out
a program called “Move to Health” which is, when patients come into our clinics, how
do we train providers to better understand the needs of our patients from a holistic
perspective? At this point in time, what’s really important
is that we understand that we as military medicine need to meet our patients where they
need to be met at to improve their health where they live, love, and labor. And so instead of focusing on pills, potions,
and procedures, we really have to figure out ways to reach them, and technology like apps
is a great way to do that. [Kinn] What are some specific ways that you’ve
seen technology being used to– I forget, what did you say? Potions– I forget the other two Ps. [Teyhen] Pills, potions, and procedures. Yes. [Kinn] I love it. OK, got to write that down. What are some ways you’ve seen technology
used in place of pills, potions, and procedures? [Teyhen] Well, the one thing that I’d like
to echo is Dr. Eric Topol is a leading expert in the field in this area, and he, at this
point, always likes to say that he prescribes more apps than medications. And that’s really what we wanted to try to
teach the team at Schofield Barracks, is that most health conditions are chronic lifestyle
changes that are required to get over the condition. And it really is about small changes that
make a big difference. We don’t need people to make huge changes
to have actually a large effect in their health. It’s actually the small things we do every
day. And a lot of times, technology, specifically
apps, can help us get there. So we really need to bring the exam room to
where the patients are, and apps allowed us to do that. [Teyhen] And so the example I would like to
use it an easy one. So we know the health benefits of mindfulness
training. And with mindfulness training, there’s two
apps that just teach people really the initial part of that, which is really the breathing
piece. We have the “Tactical Breather” app and
we have “Breathe2Relax.” And what we have found is that with a soldier,
sometimes using the “Tactical Breather” app kind of gets their foot in the door to
understanding the power of their breath and how much they can change how they deal with
the daily stresses, how aware they are in the moment, through just using something as
simple as “Tactical Breather.” Some require a little bit more mood setting,
which is what I love about “Breathe2Relax” because it can either add the music, it has
the visual, and both of them get after it. But apps allow to not just meet their need
and meet them where they need to be met, but it gives them something they have in their
hand so that they can practice it and have reminders set on their phone so that if we
want them to do breathing exercises a few times a day, not only do they have the app
but we have the phone set alarms to kind of remind them when they want to apply that. And that allows us to reach outside of the
brick and mortar, of the health care facility back to where our patients are living. [Armstrong] Col. Teyhen, you’ve been in the
military health system for a long time. How have you seen technology change in military
health over those years? [Teyhen] The most important change that’s
occurring is the adoption of the technology, and specifically the adoption, not only of
the health care providers but of the patients and the willingness to bring technology in
as part of the health care solution. And it requires both sides to really be wanting
to engage in it, and so it is about the providers feeling comfortable that the technology can
actually assist them in reaching their clinical goals, while also having the patients be very
comfortable with leveraging technology and sharing that technology with their providers,
and understanding how that works. And I actually have a kind of a personal story
in this realm. And so there was a period of time where I
had a very unexplained weight loss, and for those that know, unexplained weight loss is
usually a trigger for people to be concerned about cancer. And so there was no reason for me to have
this weight loss. And I had a scale in my bathroom that was
giving me a daily weight, and I had that for months and months. And I went in and my provider didn’t know
what to do with all that data and just sent me back with saying, “Well, why don’t you
keep measuring it for three to four more weeks and see how it turns out.” And I was just like, “No. This is months of data.” I’m like, this is showing a real change. [Teyhen] And so it really is about both the
patient wanting to share that data and the provider being willing to receive that data
and know what to do with all this additional data points that can come in. The other thing that I think has been pretty
amazing is some of how they’ve been able to integrate some of this with our wounded warriors. And so some of the test technology out there
allows our wounded warriors to answer a few questions each day about how well they’re
doing, and then the social workers that are actually caring for these wounded warriors,
when they come in they have a dashboard, so they know who to call first thing in the morning. [Kinn] Back to the idea of adoption, what
would you say to teams or clinics who are nervous about integrating technology into
care? [Teyhen] So I think they have to see some
of the benefits. And so when they start to see the benefits
in understanding what it can do, I think that’s where you get the buy-in. The one example I would say, or the two examples
I would say, is the “Mindfulness Coach” and “CBT-i Coach.” And the “Mindfulness Coach,” it really
allows the lesson plan to continue outside of the appointment. So you can spend your time in the appointment
talking about what you want them to do, you can really show them the tools and the resource,
and then when they go home and practice they can actually review it. Because a lot of times there is a white-coat
syndrome out there where our patients are a little nervous when they’re in with us. They might not fully understand. They might not be willing to ask us to repeat
it. But when they go home and the information
is already in the app, they have the ability to review it at their own pace and practice. [Teyhen] And so specifically with “Mindfulness
Coach,” what we’ve seen is that as the providers that teach mindfulness see that their patients
are more compliant when they use the app, then the buy-in comes in. And then when you get a clinical champion
that says, “Hey, listen, this is really making an impact in how I’m practicing medicine,”
then it really spreads a lot easier once that success has happened. And “CBT- Coach” is very similar with
helping people who are struggling with sleep, specifically from insomnia. It’s really allowing that conversation to
occur in the clinical setting, and the patient knows when they leave, they have all the information
right in their phone. And then they can read it again, they can
practice it, and they have that ability to focus a little bit better on that patient
appointment on asking the questions they want, and then have that tool to reinforce the treatment
when they get home. [Kinn] And just for our listeners who might
not be familiar with that app, “CBT-i Coach” is Cognitive Behavioral Therapy for Insomnia,
and of course, as always, we’ll have links to all these resources in the show notes. [Teyhen] You know, it’s not just about the
clinician and the provider as much as it is also about the community. And so one of the things that we try to do
at Schofield Barracks is ensure that we educated the broader community on this. And the one that I would like to highlight
is the “Sesame Street Big Moving Adventure,” which I think is phenomenal for how our families
move. So when we rolled that out, we ensured that
we shared that information at the community information exchanges, we shared it at the
senior leader forums across the installation, and we really decided to pick an app a month
and really make that the theme across the whole installation. And so it wasn’t just about trying to get
the health care providers to think about apps, but as the community-wide to kind of think
of it in a preclinical setting, right? So maybe there’s some things you want to kind
of get smart on, or you learned about mindfulness, or you want to learn about breathing to relax,
or if you want to talk to your kids about the upcoming move, we time those across the
year based on what would be naturally happening. So in May, we really pushed really hard to
push out the “Big Moving Adventure” for the families that were going to PCS [permanent
change of station] in the summer. And I really think that helped. We got a lot of positive feedback of not just
making these health care apps available from a clinical setting but also taking them out
to the community beyond our brick and mortar where people live, love, and labor. And that goes back to our need to really bring
the exam room to where our patients are. [Kinn] It sounds like it’s more than just
the patient and the provider. It’s the system as a whole that really needs
to look at how can we leverage this technology to be helping. [Teyhen] Absolutely. [Armstrong] What resources can you recommend
for service members before going downrange? [Teyhen] I think the best app out there right
now for service members before they deploy is the “Virtual Hope Box.” And what that allows is it allows all of our
service members to collect audio clips, video clips, pictures, their favorite sayings, songs,
and put it in one app. And so when they’re downrange, even if they
don’t have connectivity, they can still use the app on their phone to listen to their
child sing “Happy Birthday.” Or they can do it in reverse where they can
actually use the “Virtual Hope Box” and leave messages for their family members to
play. So if you know that your child’s birthday’s
going to be going on while you’re deployed, on the “Virtual Hope Box” you leave for
your children, you could actually sing “Happy Birthday” and that could be played if you
were going to be without technology on that day. Or you could have those videos up there. So the “Virtual Hope Box” allows you to
really create a technical support network for your families while you’re downrange. And although we normally think of the “Virtual
Hope Box” for the person going downrange, we also encourage them to do it in reverse
and have the children and the spouse also create their “Virtual Hope Box” so that
when you’re feeling down and it’s your anniversary and you’re not with your loved ones on your
anniversary, you already have a place to go where you know, without thinking twice, that
all of your favorite things are in that app. And I think that’s a phenomenal tool for as
much as we have to deploy and go downrange and go on missions and miss a lot of what
happens in normal life. This app really helps us with that. [Armstrong] Oh, what a great idea. [Kinn] Thank you so much, Col. Teyhen, for
joining us today. [Teyhen] Thank you. [Armstrong] Well, listeners, it finally happened. We went over our 10-minute limit. But we hope you found this conversation valuable. [Kinn] If you’d like to hear more about Col.
Teyhen’s work and the great things that WRAIR does, please check out the links in the show
notes. And of course, you can get in touch with all
of us on Twitter and Facebook @militaryhealth. [Armstrong] [music] Thank you for sharing
“Next Generation Behavioral Health” on social media and subscribing and rating wherever
you get your podcasts. [Kinn] “Next Generation Behavioral Health”
is produced by the Defense Health Agency.

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