Telemedicine Offers Great Promise for Soldiers Needing Health Care
By Dialogo August 19, 2011
In the days following Haiti’s January 2010 earthquake, doctors from the University of Miami set up a tent hospital in Port-au-Prince as well as a telecommunications link to the university’s trauma center.
That enabled them to consult in real time with their colleagues in Florida and make sure each quake victim got the best care possible — using nothing more than two devices about the size of a laptop, a satellite phone, a video camera and Internet access.
In Argentina, the country’s best children’s health-care provider — the Dr. Juan P. Garrahan Pediatric Hospital in Buenos Aires — uses that same technology to deliver remote support for diagnosis to more than 70 smaller hospitals throughout the country. That alleviates the need for patients to travel across Argentina to receive care.
And in the isolated, impoverished Ucayali region of Peru, a new telemedicine program will connect the region’s 23 villages with the main hospital in Pucallpa, 400 kilometers away.
What works for quake victims in Haiti and indigenous children in Peru already is working for U.S. soldiers in the field. No need to miss an appointment with the dermatologist because a soldier is deployed in the Iraqi desert or the Amazon jungle — as long as a cell phone is available.
That’s the promise and reality of telemedicine.
“In a remote location, in war or in peace, access to care can be very difficult, and a treatable rash may become a severe problem,” said Col. Ronald Poropatich, deputy director of the Army’s Telemedicine & Advanced Technology Research Center (TATRC), in Fort Detrick, Md. “Telemedicine bridges the gap.”
Last March, Poropatich visited the Central Military Hospital of Peru, accompanied by personnel from the Naval Medical Research Unit (NAMRU-6). The trip was to help assess the feasibility of implementing a national system of telemedicine for Peru’s armed forces.
In Peru telemedicine holds great promise for regional hospitals lacking specialists and in remote locations because the system would have its own bandwidth and would be effective in disaster situations.
“The potential is great, but we also have to be mindful of the cost,” Poropatich said. “I always recommend starting with small steps, for instance, sharing emails with image attachments, which requires no learning curve.”
Starting small and with ingenuity Given the absence of a central system, a group of dermatologists in Latin America decided to put together a Facebook page where they can share images and information.
Poropatich points out this allows for consultations without the patient having to move, providing care for the patient and a learning environment for the doctors. Because real-time teleconferencing can be expensive, he recommends countries develop low-cost solutions like this one.
In-theater in Iraq and Afghanistan, a dermatological telemedicine consultation prevents unnecessary evacuations. “Each time a soldier gets evacuated to Germany for an outpatient service, there is a three-week turnaround time with the resulting loss of duty,” said Poropatich, who is also chairman of the NATO Telemedicine Expert Team.
The remote medical technology addresses the three pillars of health care: cost, quality and access. It also conserves fighting strength and saves time and money for the Pentagon and soldiers themselves.
What is telemedicine?
Telemedicine is the use of electronic communications to exchange medical information to improve patient care, diagnosis and treatment. It extends the reach of quality medical care to both rural populations and soldiers deployed in battle. Internet access — now commonplace throughout much of the world — has brought an abundance of possibilities few could have imagined only a decade ago.
In most of the developing world, and even in the United States, specialty care, second opinions and continuity of care have been luxuries available only to those who live in cities or can afford to travel. The U.S. Department of Defense deals with 10 million healthcare beneficiaries in at least 21 time zones and more than 50 countries. Telemedicine is the answer to many longstanding problems.
For centuries, militaries around the world have been burdened by the expense and difficulty of caring for soldiers injured in battle by a bullet or a sudden skin condition. Time is of the essence, but the wrong treatment could mean death. An image emailed thousands of miles away can bring the right diagnosis instantaneously.
Two types of telemedicine
Telemedicine applications fall basically into two categories: store and forward, and real-time video teleconferencing. As a primary care physician in a small-town clinic, “I send the image of your cardiac ultrasound to a cardiologist and get his diagnosis and recommendations. That’s store and forward,” Poropatich said.
At that same clinic, a veteran may need a behavioral health consultation with a specialist, and, just as importantly, he may need regular follow ups. Real-time interactive video teleconferencing can greatly expand the clinic’s services.
The use of telemedicine applications is not limited just to provider-to-provider communications and consultations. Also important are the possibilities of patient-to- provider communications as well as the potential to improve patient self-care and compliance with treatment, he said.
In the patient-centered care arena, mobile phones hold the key to the next big transformation in telemedicine. Privacy and security concerns As in the civilian realm, the military is concerned with the privacy and security of those records, and the whole system is compliant with the Health Insurance Portability and Accountability (HIPPA) Act of 1996.
Encryption guarantees that even if a phone call or text message gets intercepted, the data cannot be deciphered. This requires a dedicated network sending messages to another dedicated network.
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