Army telemedicine programs going mobile

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The Army's wide use of telemedicine is evolving from fixed-based access sites to highly mobile programs using cell phones, according to a report in Telemedicine and e-Health.

The Army has been using telemedicine since 1992. Its Medical Department Telehealth Network spans 50 countries and territories from America Samoa to Afghanistan, across 19 time zones. It has 22 service lines available, with behavioral health consults making up 55 percent of telemedicine services, followed by cardiology, teledermatology, infectious diseases, neurosurgery, pain management, and orthopedic surgery. Radiology, which is completely digital in the Army, is not counted among uses of the service lines, according to the report.

Limited resources and austerity of the environment are among the challenges the Army faces in providing telemedicine in the field.

A store-and-forward email service with an image attachment system called the ''E-mail Teleconsultation Program'' has been used since 2004. For example, photos sent for consultation of a fleshy mass on the neck of a 50-year-old man with a history of substantial sun exposure reveal it to be a malignant melanoma. Over the past eight years, this capability has prevented unnecessary medical evacuation from the battlefield at least 131 times. However, the service generally provides for timely and appropriate evacuation, the article states. In this example, waiting out a six- to 12-month deployment for treatment could have disastrous results.

The Army has 13 teleradiology sites in Iraq and 22 in Afghanistan. Landstuhl Regional Medical Center in Germany archives the Army's images and forwards them on as patients are returned to the United States.

Behavioral health is the largest application of telemedicine, with clinical programs covering traumatic brain injury, psychiatric, psychology and neuropsychologic care. Using simple equipment in "whisper rooms" for privacy, patients in remote locations can consult over a secure connection with providers, overcoming the challenges of travel, weather and other constraints. There are 78 sites in Afghanistan, with 28 more planned. Surveys have found that more than 70 percent of the behavioral health encounters would not have occurred if telebehavioral health were not available.

Back home, the focus is on using cell phones to help returning service men and women manage their medical care though patient-centered medical home in an accountable-care-like organization. Along with medical services such as pain management and behavioral health consultation, this model will offer services such as e-prescribing/refills and e-scheduling, health tips and the ability to store healthcare information. This is expected to improve contact between recovering soldiers and their geographically remote case managers through a web portal.

The paper calls for improved integration between mhealth and electronic records and for wearable physiological sensors or "smart bandages" that integrate with the smartphone.

"The smartphone has opened up the potential for improving health outcomes, empowering the patient,providing the clinician or researcher with mobile education and research, and assisting in biosurveillance and disease management," the article states.

The departments of Veterans Affairs and Defense have been aggressively expanding their use of telemedicine, especially to veterans in remote areas of the United States in need of behavioral health services. A high numbers of veterans are returning from Iraq and Afghanistan with traumatic brain injury and post-traumatic brain injury. Though an array of clinical programs address those problems, an Institute of Medicine report criticized the two agencies for failing to adequately track whether the PTSD programs work.

Meanwhile, a recent study by the University of Miami's Lehman Injury Research Center, Division of Trauma and Surgical Care found the remote presence of a trauma surgeon could be helpful in mass casualty or disaster scenarios.

To learn more:
- read the paper in Telemedicine and e-Health

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