“Hacking” Military Health: An Interview with Dr. Steve Steffensen 

Now Chief of the Learning Health System for Dell Medical School,Dr. Steve Steffensen spent 20 years pioneering technological strategies to improve the well-being of our armed forces.

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By Katherine Corley
Population Health Scholar
University of Texas System
Dual Degree Master's Student in Journalism and Global Policy
UT Austin Moody College of Communication & UT Austin LBJ School of Public Affairs

 
 

Dr. Steve Steffensen began his career as a military neurologist a few months before 9/11. His experience as a computer programmer goes back much further, to the age of 10, when he began writing code on his own. As a young doctor stationed at Pensacola Naval Hospital, he reprogrammed an electronic medical record he didn’t like—a choice that sparked a new path in military health IT and innovation.  He eventually rose to lead health innovation efforts for all three branches of the military, separating from active duty in 2016. He is currently Chief of the Learning System for Dell Medical School, where he uses his expertise in health IT to improve population health for the state of Texas. We spoke to Dr. Steffensen, also an Associate Professor of Population Health and Associate Professor of Neurology at Dell Medical School, about his military service.



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Steffensen received his B.A. in Letters and his M.D. from the University of Oklahoma. He completed his neurology residency at the National Naval Medical Center in Bethesda, MD, and is board certified in neurology.



Texas Health Journal: What first interested you in military service?

Steve Steffensen: I am the first in my family to go to college, and I paid my way through college by working two and, during the summer, three jobs. When I started looking at medical school, I needed to find a way to help pay the cost of medical school, and I didn't want loans. One option that emerged was the military route. It was the last thing I thought I would actually do.To be honest, I had a lot of very negative stereotypes about the military, and I joined with a lot of misperceptions.  But upon entering my military service, the stereotypes started to fall away. I realized that the goal of the Military Health System was extremely genuine and was focused on a very noble mission of taking care of people. The patient was at the center of everything we did.

How did 9/11 impact your career in the military?

I graduated medical school in June of 2001, and entered my internship at Bethesda Naval Hospital later that month.I worked for the Military Health System, which cares for about 10 million patients, only about 15% of whom wear a uniform. The other 85% are military spouses, children, retirees, and retiree spouses. At the time, the world seemed relatively peaceful.  And then September 11 happened. Before 9/11, I might have treated a 77-year-old heart surgery patient, or someone battling an infection. After the war started, it was more often a 19-year-old service member. Most of the neurosurgeons get forward deployed to combat zones where they surgically stabilize injured soldiers, but neurologists like me were needed stateside to care for those who returned. So my residency started with 9/11, which fundamentally changed my career in terms of caring for injured soldiers, sailors and airmen. It was a profound way to start my career.

What made you shift from neurology into health IT?

I've been programming since I was about 10 years old, and actually started an electronic health record company during my fourth year of medical school, though I had to give it up when I entered the military.  After my residency, I was stationed at Pensacola Naval Hospital and the commanding officer of the hospital knew about the company I'd started. At the time, the military had a new electronic health record system, and I was asked to be the person in charge of deploying it to the hospital.  I wasn't very fond of it, but my background in IT and programming allowed me to modify the physician’s user interface to make some improvements. The joke became that I hacked the system—I prefer “backward engineered”—and that I would either be court martialed or promoted. The work I was doing slowly started to wind its way through the Military Health System, and I started to get a reputation in health IT within the military.

Can you describe some of your health IT projects?

After my time in Pensacola, I was asked if I would be interested in staying on in the military to lead the Health IT Innovation Center in Fort Detrick,MD. My response was yes, if you can find a way to get me to Austin, TX. They moved me and my family to Austin, TX on active duty, and I managed the largest health IT research portfolio in the military from Austin. I started to gain a wider reputation in health IT innovation. At the time, there was a nationwide effort going on to create an interconnected Nationwide Health Information Network. I led the effort to connect all our military health records across the country, so that patients could access their health records no matter where they were.  Other projects I worked on included natural language processing, enabling the computer to extract useful clinical information from a patient’s medical record. For instance, if a patient was diagnosed with multiple sclerosis, the computer would recommend a particular medication given the patient’s age and allergies. This was all part of the work I did to create a health IT framework that is still used in the Military Health System today.

How did you widen your focus from IT to population health?

I was invited to go on a tour of military trauma facilities in Baltimore with Lieutenant General Patricia Horoho, the military’s first female Surgeon General. She knew about the work I had done at Fort Detrick, and asked me to lead health innovation efforts for all of Army medicine, which was an offer that I couldn’t turn down.  

Lt. Gen. Horoho had a very different perspective on health and healthcare. She was focused on being proactive about wellness, instead of just reactive to disease. On average, each of us see a physician about five times a year for about 20 minutes.  That’s 100 minutes per year to influence your health—barely a blip, right? Lt. Gen. Horoho realized that health happens where you work, live, play, and pray—beyond the exam room of a doctor’s office. She said that our commissaries—our grocery stores—arguably have more of a role to play in the health and readiness of our active duty force than a physician does in a 20-minute appointment. So, we partnered with our commissaries. Likewise, she noted that our Chaplain Corps—our clergymen of the military—arguably do more for the wellness of our enlisted troops than doctors do, so we partnered with our Chaplain Corps.

We started measuring a different set of vital signs—asking a different set of questions—to really learn about the wellness of our population. In the military, we talk about something called readiness, the ability of an active duty person to be able to deploy at a moment’s notice.  Readiness, for us, is really health, which is more than just the absence of disease. It includes the health of your relationships, your mental health, etc.—all resources that enable a service member to withstand the challenges of deployment. We started a number of wellness campaigns that we spread throughout Army medicine, such as the Performance Triad, which focused on sleep, activity, and nutrition. We also created several programs centered on health and mindfulness, which was the first time across Army medicine where those kinds of concepts were introduced.

That message of continually focusing on health and readiness was a pivotal point for me.  Most of my career to that point had been focused on health IT, but now I was working from a larger strategic vision of how technology could play a role in the wellness of the community.  

Tell me about your work leading health innovation for the Army, Navy, and Air Force.

The then-Assistant Secretary of Defense for Health Affairs, Dr. Jonathan Woodson, asked me to come lead innovation efforts for the entire Military Health System. In that position, I was trying to do what I had done for Army medicine across all three branches of the military. I had the privilege of working for Vice Admiral Raquel Bono, the Director of the Defense Health Agency. In this role, I focused on three broad categories of health innovation. First, I focused on garrison-based health innovation with stateside clinics and hospitals.  The Military Health System also has a robust global health mission, sending hospital ships on humanitarian missions and partnering with Ministries of Health in various countries. And of course, we have the combat medicine mission—combat medics and hospitals that deploy during times of conflict.

Most of my time working for the Defense Health Agency was focused on the combat medic community. One of the problems the military faces is how to train people on Tactical Combat Casualty Care (TCCC), which are the protocols used by combat medics to stop bleeding, resuscitate, and stabilize a person for transport. How do combat medics maintain their skill sets in between conflicts?  One of my tasks was to create an educational platform for the combat medic community, an app called Deployed Medicine that anyone can download, to use to continually reinforce their training. It was an honor to work with these combat medics who have done truly heroic work in situations where they were being shot at while trying to save someone’s life. Each of the combat medics go into harm’s way, and they do it without question because they want to take care of the people in their unit. That kind of community and commitment to mission is truly inspiring.

What brought you to civilian life?

A friend of mine told me about this new position at Dell Medical School called Chief of the Learning Health System. The school was seeking someone committed to community wellness who also understood the technology necessary to create a model Healthy City in Austin. The job was such a beautiful marriage of all of my prior experience, recognizing that you need a medical and an IT perspective to apply technology to the mission of improving health.

The concept of a learning health system was popularized by the National Academy of Medicine in 2006. The idea is that, if you want to improve community health and wellness, you need to be able to measure the impact of your interventions to know if you’ve made a difference. Best practices in medicine are very hard to standardize, partially because we don’t have a feedback mechanism to track patient outcomes. For example, I think I’m pretty good at treating headaches, but I can’t point to any data to tell you how my headache patients have fared. The joke is that they must have done well because they didn’t come back, but the reality is that they could have gotten worse and gone somewhere else.  So, we want to create an IT-based learning health system where we record the outcomes of our patients, feed those outcomes back into our medical protocols to improve our clinical care, and report our findings.

How are you incorporating lessons from your military career into your current work?

One of my biggest surprises about working at The University of Texas was how similar the UT System is to the Military Health System. The Military Health System oversees the health and readiness of all its people, but it does that by collaborating with the Army, Navy, and Air Force, which each have their own hospitals, surgeons general, and service members. In the same way, Dr. Ray Greenberg, the UT System Executive Vice Chancellor for Health Affairs, must coordinate health activities across UT’s eight health and medical institutions, which each have their own executives, cultures, and communities.  Just as the Army, Navy, and Air Force must act together to improve military health, UT’s eight health and medical institutions need to unite to improve the health of Texas. Coordinating this is a tremendous challenge, but by using tools like technology and population health measures, we could increase the overall health of the state of Texas. I’m excited to facilitate communication between the UT System and the Military Health System, because I believe that there are a lot of lessons we can learn from each other.