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In the Pacific Theater, Telemedicine is "Akamai"

By Douglas J. Gillert
American Forces Press Service

TRIPLER ARMY MEDICAL CENTER, Hawaii, June 26, 1996 – Clever; smart; best at something. That's a rough translation of the Hawaiian word "akamai" and why planners chose the word as the title for a major telemedicine project in the Pacific theater.

Akamai is one of a roughly halfdozen telemedicine projects Tripler and other components of the U.S. Pacific Command are testing for the assistant secretary of defense for health affairs. Air Force Lt. Col. Tony Gelish, project director, said the primary goal of Akamai is "customer service, whether they are health care providers or the patients" in areas of the theater where health care is limited.

"Tripler is reaching out and asking the question, 'How can we improve our customer support?'" Gelish said. "'Telepresence' is a great way, because it's less expensive than moving patients or assigning additional [health care] providers."

Three objectives guide the project:
- Conduct telemedicine and digital imaging throughout the Pacific, including ships at sea;
- Evaluate telemedicine's impact on patients and health care providers and on military readiness;
- Investigate applications of emerging telemedicine products, technologies and services.

Currently, Akamai fields two basic services. The first is teleconsultation. This uses fullmotion, realtime video and allows doctors to consult with other medical personnel in remote areas. It is being used primarily on Kwajelein Island. The second is a concept called "store and forward."

The latter allows health care providers at distant locations to store information by modem to a computer file, using the Digital Satellite Network. Specialists at Tripler can then retrieve the information and evaluate it, Gelish explained. They, in turn, store the results of their evaluations and treatment recommendations for later retrieval by the attending provider. The concept eliminates barriers created by the Pacific Ocean's 10 time zones.

"Over 24 months, we performed more than 300 telemedicine consults," Gelish said. "About 95 percent of those could be done by 'store and forward.'"

The concept impacts military readiness, Gelish said. "For example, with telemedicine we may be able to treat a sick crew chief at Kunsan [Air Base, Korea] instead of evacuating him. That means a lot to the commander trying to launch [fighter aircraft] sorties.

"Usually, all that doctors [at understaffed locations] need is 'telementoring,' and their level of confidence goes up." With Akamai's store and forward capability, he said, "an experienced subspecialist is looking over your shoulder 24 hours a day."

As a result, Gelish said, medical evacuations decrease, and physicians can make smarter, earlier decisions about the level of care their patients need. In this way, he said, the services and the individuals both benefit.

The ongoing telemedicine project supports operations in Micronesia; Coast Guard ships at sea; Hickam Air Force Base, Hawaii; and Madigan Army Medical Center, Wash., the next nearest major DoD medical center. The project includes a deployable telemedicine unit at Hickam, and technicians now are installing a medical diagnostic imaging support system to provide picture archiving and communications to support digital radiology at Tripler and remote sites.

The 15th Medical Group, Hickam, is using the first deployable teleradiology unit in the world, said thengroup commander Col. Horace Carson. Teleradiology, Carson explained, reduces the cost of obtaining Xrays by replacing expensive film with basically free digital images. The process also saves time.

"Before, couriers had to handcarry film Xrays to Tripler Army Medical Center (about a 30minute drive from Hickam), where radiologists could read them and provide evaluations," Carson said. "Now, we have T1 [telecommunication lines] directly to Tripler and can transmit the images immediately."

Master Sgt. James North, noncommissioned officer in charge of radiology at Hickam, said the deployable telemedicine unit can endure any field conditions. "Temperatures aren't a factor because we don't have film to protect," he noted. Besides sending digital images back to Tripler, he said, medics in the field can print the image on normal bond paper.

Akamai is in the fourth year of a fiveyear contract set to expire in fiscal 1997. Three contractors are demonstrating their equipment, Gelish said, and evaluators will determine which products best suit the delivery of telemedicine in the Pacific region. Since the contract began, he added, more than 300 consults have occurred.

Early on, providers in the field resisted "outside advice," Gelish said. "But after using it awhile, they like it a lot."

The project will expand to Okinawa and Guam this summer, and then to Korea, he said. The main islands of Japan, which already have a robust medical system, don't need Akamai, he said.

With the Western Pacific lined up, Akamai is now also pointing back toward North America. A new hospital currently under construction at Elmendorf Air Force Base, Alaska, will be completely digital, Gelish said. Akamai, he said, will help make this next building block in military medicine "clever, smart and best."

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