Military telemedicine extends its reach

Army, Mar 1997 by F Clifton Berry Jr

The applications of military telemedicine are proliferating. Once an exclusive preserve of advanced researchers, military telemedicine has become more widespread in scope and more accepted in practice. In 1997, the uses of telemedicine reach beyond video teleconferences and exchanging X-rays. Telemedicine applications range from clinical consultations to interactive distance learning, electronic patient records and professional medical education. The scope is broad and expanding daily.

To Surgeon General of the Army Lt. Gen. Ronald R. Blanck, telemedicine is a "force multiplier" for Army medical professionals. Gen. Blanck said that "telemedicine is really moving information" of all sorts, whether digitizing images of computed topography scans or X-rays, conducting video teleconferences or conveying professional education to remote sites. It combines the applications of digital technologies, computing power and communications to improve health care.

Gen. Blanck observes that the ability to move information anywhere at anytime enables something profound to occur-the patient and the specialist caregiver do not need to be in the same place for superb care to be given. He pointed out that telemedicine is a part of the massive informatics revolution sweeping society.

Gen. Blanck's deputy surgeon general, Maj. Gen. John J. Cuddy, said, "The tactical use of telemedicine offers us the potential of extending the reach of a vast array of medical specialists much farther forward than anything we have ever imagined in the past."

Gen. Cuddy told Congress in 1996, "We are proud that we have many entrepreneurs throughout the Army Medical Department who are working diligently to develop innovative uses of telemedicine within their own resourcing structure. They are encouraged to combine smart business practices and modern technology to solve local problems."

The tactical uses of telemedicine have been expanded over the past year, most intensively with the U.S. forces serving in Operation Joint Endeavor in Bosnia. The telemedicine component of that peacekeeping operation is named Operation PrimeTime III. The telemedicine capabilities of PrimeTime III mean that medical professionals caring for American men and women in the field in Bosnia have 24-hour access to medical specialists.

Dr. Stephen C. Joseph, assistant secretary of defense (health affairs), told Congress, "What telemedicine means in Bosnia is that real-time, very specialized health care, in the form of diagnoses and consultation, can be projected forward to the patient. It means very high-quality, sophisticated care for the patient, often without having to transport the patient hundreds, even thousands of miles from his or her unit."

Major Army medical units involved in PrimeTime III include the 212th Mobile Army Surgical Hospital (MASH) in Tuzla, Bosnia; the 67th Combat Support Hospital in Taszar, Hungary; and the Landstuhl Regional Medical Center in Germany. The 30th Medical Brigade is medical command and control headquarters in the theater. The U.S. Navy's USS George Washington, also linked into the PrimeTime III telemedicine network, is the first aircraft carrier to deploy with full telemedicine capabilities.

Included in the Bosnia telemedicine capabilities are electronic patient records and a protocol for evaluation of telemedicine actions-two features that reflect lessons learned from tactical medical care and telemedicine experiments. The electronic patient records are created when soldiers first enter the health care chain. They are an innovation that carries much future promise. Their use means that the patient can be located at all times, which was not always the case in the past. Also, the patient record is accessible to caregivers at all times, with appropriate safeguards for privacy The evaluation protocols ensure that data are collected rigorously and that evaluations of costs, benefits and other variables can be made.

Continuing medical education (CME) and professional updates are also provided to the medical staff in Bosnia and Hungary. The Center for Total Access at Dwight D. Eisenhower Army Medical Center, Fort Gordon, Ga., began a twice-weekly CME program to Bosnia and Hungary in 1996. These classes have been well received and beneficial. For example, a two-part burn treatment program was conducted, and the day after it was completed the 212th MASH in Bosnia had five burn victims to treat. The MASH staff said that the refresher course resulted in better and more timely care to the patients.

Creating and deploying the PrimeTime III telemedicine network was handled by the Medical Advanced Technology Management Office (MATMO) at Fort Detrick, Md. Col. Gary Gilbert directed MATMO during much of 1996 and into 1997. MATMO is an operating activ- sE ity of the DoD Telemedicine Test Bed operated by Brig. Gen. Russ Zajtchuk. It has a multiservice staff of medical, informatics, logistics and telecommunications experts.

One concern of Operation Joint Endeavor health care planners was holding down the number of medical personnel while maintaining the highest quality of medical care. Gen. Blanck called that "reducing the footprint" in the field. he telemedicine technologies deployed in PrimeTime III included computed topography scanners and 3-D ultrasound and diagnostic teleradiology support. Since these capabilities enabled medical professionals with the troops to consult with top radiologists in Germany and the United States at any time, radiologists were not deployed to Bosnia. Gen. Zajtchuk said that as of the end of 1996, more than 8,000 successful radiology consultations had been conducted from Bosnia, validating the decision to omit radiologists from the forward medical forces there.