Navy New PHA version coming out soon?

[flightdoc09]

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Anyone have the inside scoop on this? I feel like the current PHA is horrible and would love to provide some feedback to make it better. I know lots of PCMs/GMOs that feel the same way.

 

[pgg]

First thing you should keep squarely in mind is that the PHA is primarily an administrative encounter, not a medical one. It's intended to be useful to the service, not the member.

The truth is that the PHA process is "just fine" ... as a tool for tracking vague self-reported statistics of population health and readiness. You can provide all the feedback you want, that a primary care visit with an E4 armed with a checklist is a medical farce in 19 different ways, and more power to you. 🙂 But keep in mind that the people who created the PHA and use the data from it have different objectives than physicians whose chief concern is the health of the person in front of them.

The first sentence on health.mil's web page about PHAs says it in black and white:

The Periodic Health Assessment (PHA) is a screening tool used by the armed forces to evaluate the individual medical readiness of their Service members.

Any health benefits to completing the task are incidental. The best that can be said for PHAs from a medical perspective, is that they can help ensure immunizations are up to date, periodic screening labs are done, and sometimes they can prompt a member in need to make a medical appointment with a real PCM, nutritionist, smoking cessation program, etc.

It's true that all of these things could be done much better via an ordinary appointment with a PCM. But then an E4 couldn't do 4 of them per hour and the data wouldn't be collated for the service to measure medical readiness, so it wouldn't be a useful "PHA".

 

[flightdoc09]

First thing you should keep squarely in mind is that the PHA is primarily an administrative encounter, not a medical one. It's intended to be useful to the service, not the member.

As depressing as your post is, I know you're right...

But even if I set aside the ways to make it better from a preventative health/patients actually taking it seriously perspective, there's plenty of stuff that could be fixed in it to make it more streamlined and take less time to complete. It's just a very buggy system with pointless required fields. Why is there a check box for me to click "None" (the patient has no health concerns) and then a text box where I'm required to type something in for the same questions?!

Also, I love how patients can answer stuff like they get chest pain, or they have dizziness, are passing out, are off the charts depressed, and then when they meet with that E4 corpsman doing the records review they say "no, I don't have anything I'd like to speak with a doctor about." Then a few days/weeks later you go through the list to do your part, and all of a sudden you have to start tracking down these people trying to see if they really have syncope or if they just clicked it on accident trying to click through the PHA as quickly as possible.

I would actually be happier if the whole process just involved an E4 with a checklist, and didn't require the separate parts that seem to do nothing other than put liability on physicians.

But indeed, it is probably futile to enact real change.

 

[d2305]

PHAs become difficult if they check anything yes in the mental health section.

 

[flightdoc09]

Alright, I found the people at BUMED working to improve the system and they're open to feedback. I'm working with other docs and corpsmen at the moment to compile suggestions. If you would like to see everything so far, please shoot me a PM and I can share the google doc with you. If you just want to send me a suggestion, please post here or PM to me.

Preferred format is Topic, Problem description, Proposed solution. Please include screen shots if applicable.

Also, another common feedback I've gotten is that the Air Force's ASIMS is great. Way more user friendly, more streamlined, more succint, and incorporates readiness items that would be found in MRRS, as well as upchits/AERO type stuff, into one platform. A lot of people think we should just adopt their system rather than reinvent our own.

Thanks

 

[ArmyTiger]

Alright, I found the people at BUMED working to improve the system and they're open to feedback. I'm working with other docs and corpsmen at the moment to compile suggestions. If you would like to see everything so far, please shoot me a PM and I can share the google doc with you. If you just want to send me a suggestion, please post here or PM to me.

Preferred format is Topic, Problem description, Proposed solution. Please include screen shots if applicable.

Also, another common feedback I've gotten is that the Air Force's ASIMS is great. Way more user friendly, more streamlined, more succint, and incorporates readiness items that would be found in MRRS, as well as upchits/AERO type stuff, into one platform. A lot of people think we should just adopt their system rather than reinvent our own.

Thanks

Topic: A CMA could do this.

Problem description: None of this requires a physician to look at it. There are a few fields that should require a physician to review them, but those usually aren't selected, and a CMA can make that appointment if needed.

Proposed solution: Make this a CMA review, not an in person appointment.

Sent from my SM-G975U1 using Tapatalk

 

[flightdoc09]

Topic: A CMA could do this.

Problem description: None of this requires a physician to look at it. There are a few fields that should require a physician to review them, but those usually aren't selected, and a CMA can make that appointment if needed.

Proposed solution: Make this a CMA review, not an in person appointment.

Sent from my SM-G975U1 using Tapatalk

Very much agree with you. But I think the powers at be believe that a physician can get more out of asking someone if they have a gambling problem than a corpsman/CMA. Apparently they also think asking them if they have a gambling problem should be a required question, but asking them if they've thought about suicide shouldn't.

But, if we have to jump through these hoops, at least we should try to make them easier, faster, and more relevant hoops to jump through.

 

[pgg]

But I think the powers at be believe that a physician can get more out of asking someone if they have a gambling problem than a corpsman/CMA.

I wonder what the NNT is for that "intervention" ...

Or if anyone is even attempting to track it.

 

[flightdoc09]

I wonder what the NNT is for that "intervention" ...

Or if anyone is even attempting to track it.

If I had to guess, I'd say no one is tracking it as there's really no way of knowing what interventions are done because of the PHA. If someone says they're extremely depressed, or excessively drinking, a new set of options pops up asking me if I think they need referral or not. If not, I get to choose if it's because they're already under care, they have no significant impairment, or "other."

Beyond that, there's no way of tying in what information the PHA gives me with my interventions. There's no way of even tracking if they followed up and made an appointment even if I put in the referral. It's now up to me, as the provider, with a limited 5 minute picture of the situation, to ensure that this person who states they're super depressed, to go to appropriate counseling. Sometimes they fill out the PHA a month or even 3-4 prior, and then say "oh yeah, I'm good now."

There are a lot of good things in the PHA that would be great to track and ask service members on a regular basis. But the yield for what you get is way too low to justify the time suck, both for them, and for the medical team from corpsman to physician. And the format and horribleness of the website just make it worse.

And honestly, even if anything from the PHA was tracked, it would be horrible data. Service members just click through it to be done with it as fast as possible, providers pretty much do the same, or don't know how to fill out certain things. Like when a member puts down that they drink twice a week, 3 drinks max, but you've seen them pound a 12 pack in an evening, are you supposed to just ignore their responses?