3 min read February 2024 — In an interview with Invest:, Jeffrey Tiede, Director of the Center for the Intrepid at Brooke Army Medical Center, discussed the center’s recent achievements, its unique healthcare approach, funding strategies and future priorities for San Antonio’s healthcare landscape, including its connection to the Advanced Research Projects Agency for Health (ARPA-H), headquartered in Texas.
How has the past year been in terms of product development and research at the Center for the Intrepid and how does that reflect the state of the industry?
Our main research focus has shifted from prosthetic to operational medicine research, specifically focusing on using exoskeletons for military operational needs. We’ve collaborated with the Extremity Trauma and Amputation Center of Excellence (EACE), obtaining grants in operational medicine and partnering with academic and civilian colleagues for ongoing research.
What specific differences highlight your healthcare approach compared to the private sector in Greater San Antonio?
Our mission is to care for patients with severe extremity trauma. We work closely with Brooke Army Medical Center, which is a Level 1 trauma center, and collaborate with civilian providers. We offer care to patients who have experienced devastating injuries and our relationship with them is well established and ongoing. Additionally, we receive service members from around the world who are transferred to the San Antonio region for continued rehabilitation and care.
What opportunities is the center pursuing in the San Antonio healthcare landscape and how are you ensuring continued value and mission fulfillment?
We have significant opportunities in the San Antonio region to partner with academic medical centers and civilians for expanding research in extremity trauma. We are engaged in various projects with UTHSCSA and collaborate regularly with the Office of Military Medicine. Additionally, we work closely with UT Health San Antonio’s Military Health Institute on numerous ongoing projects. Furthermore, we have collaborations in the civilian sector, particularly with the Southwest Research Institute, where we jointly pursue grant opportunities and involve them as co-investigators.
What specific funding opportunities or grants are you actively seeking to capitalize on to support your work, considering the available resources?
The majority of our funding comes from the CDRP (Congressionally Directed Research Programs) and there are various subsectors within that. Each subsector has its own program and, historically, our focus was on rehabilitation. However, it has now shifted more toward operational medicine. In addition to CDRP funding, we have been able to secure funding from other sources, such as the Institute of Surgical Research here at Brooke Army Medical Center, where we have ongoing projects. We’ve also obtained funding from a broad agency announcement grant and other federal grants that we can utilize.
How is the center collaborating with higher education to maintain a sustainable talent pipeline amid challenges in talent retention within the healthcare industry?
Our primary mechanism for recruiting scientists is the ORISE program. We sponsor ORISE fellows at CFI through EACE, and some of those scientists have become senior scientists. The EACE allows us to bring in postdoctoral fellows to study here, with the hope that they’ll pursue long-term careers in the Defense Health Agency (DHA). We also collaborate with UT Health Science Center at San Antonio (UTHSCSA) to train fellows in physical medicine and rehabilitation, aiming to attract physicians to the military health system. Additionally, we partner with the Army school (Baylor) and several civilian schools to train physical therapists and occupational therapists. The goal is to retain these therapists after they complete their active-duty service requirement.
What are the prevalent challenges the military healthcare system is facing and how is the center focusing on navigating or mitigating them?
In discussing the economic impact of healthcare at the Department of Defense (DoD), I acknowledge that it’s a complex issue beyond my level. However, it’s important to note that the DHA operates within resource constraints, like other government entities. At Brooke Army Medical Center, our leadership places a high priority on delivering efficient healthcare, which allows us, as providers, to focus on patient treatment rather than economic concerns. The military health system as a whole operates in a unique ecosystem where we have flexibility in providing services without daily constraints from third-party payers. Additionally, our superiors are doing an excellent job of staffing and supplying our providers within the boundaries of the resource constraints inherent in the federal government.
How does technological innovation and disruption in the healthcare space from a military healthcare perspective mirror the work you are doing?
In the context of research and biotechnology development for the military, we focus on solving specific problems rather than commercialization. One project we’re working on is the Intrepid Battlefield Exoskeleton (IBEX), which aims to enable Soldiers with open tibial fractures to ambulate on the battlefield nearly immediately after injury. In the past, air superiority allowed our warfighters to airlift injured Soldiers quickly out of harm’s way. Future conflicts, we may not have that luxury. Therefore, we need a way to stabilize patients for up to three days without definitive healthcare. Dr. Lee Childers leads the development of the IBEX exoskeleton, which must be lightweight, fit 90% of service members, and be adaptable for different environments including Arctic conditions. This technology is crucial for military operations, though it may not have broad commercial applications. Additionally, we’re working on exoskeletons to help trainees with tibial stress fractures continue their training. In addition to facilitating training for the individual service member, this will also provide a large cost-saving measure for taxpayers.
Another product in development under the guidance of LTC Carrie Hoppes involves utilizing virtual reality technology to treat vestibular conditions seen post-concussion. Military-specific virtual reality environments are built which maximizes service member engagement and compliance. A pilot study is testing feasibility with hopes to expand further clinical research lines of effort.
Finally, we partner with a civilian firm who is developing a robotic arm to facilitate activities of daily living for patients with spinal cord injury. The product in development utilizes machine learning to identify an object, such as a soda can, grasp the object, and deliver the object to the patient via a robot arm attached to a wheelchair. Such a product would be game changing for a paraplegic patient.
What are the center’s priorities for the next few years and how does this affect the San Antonio healthcare landscape?
The outlook for the center is promising as we’ve successfully leveraged relationships with entities in the DoD and academic partners to expand our presence. Currently, we have no issues with research funding, but we’re actively seeking new relationships to grow further. For instance, we’re collaborating with the Military Health Institute and the Southwest Research Institute on human performance and musculoskeletal injury projects. This highlights our expansion from classical rehabilitation research into the human performance space. Our occupational and physical therapists are also training therapists for the holistic health and fitness initiative (H2F) in the DoD and Army. Our reach has extended widely, and we remain open to new civilian and military partnerships. We aim to utilize emerging technology to benefit service members. That’s our bottom line. We have expertise in navigating biomedical research in the DHA and can overcome nearly any hurdle in the process.
What is the primary purpose of ARPA-H and why is it headquartered in Texas?
ARPA-H stands for Advanced Research Projects Agency for Health. It focuses on advancing high-potential, high-impact biomedical and health research that can’t be easily achieved through traditional research or commercial means. It’s an executive branch initiative aimed at accelerating products that may not be commercially viable or aren’t created through the usual venture capital process. Recently, Dr. Childers from EACE was involved in recruiting for ARPA-H, which will be headquartered in Texas. This presents an opportunity for access to substantial funding and infrastructure.
For more information, please visit:
