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'Telemental Health' of Growing Interest to DoD Medics

By Douglas J. Gillert
American Forces Press Service

BETHESDA, Md., Feb. 26, 1998 – Although telemedicine has been highly touted as a revolutionary means of extending the reach of health care providers, only a handful of specialties routinely use the technology for patient treatment.

Today, most DoD medical centers operate telemedicine clinics, and nearly all radiology laboratories have gone digital. Increasingly, mental health clinics are finding videoteleconferencing conducive to evaluating patients at distant locations.

About one-fourth of all requests for telemedicine consultation the National Naval Medical Center here receives are related to mental health. Dr. (Cmdr.) Nancy Bakalar, a staff psychiatrist and clinical consultant to DoD health affairs, said the system adapts well for psychiatric evaluations. Psychiatrists have to be able to observe their patients and talk to them, both of which are readily accomplished through videoteleconferencing, or telemental health, Bakalar said.

Defense health care is probably ahead of its civilian peers, because it has access to DoD's vast technological resources, said Dr. (Cmdr.) Richard Bakalar. Nancy's husband and the center's chief of telemedicine, Bakalar said the country is dotted with pockets of telemedicine expertise, based on medical specialties. But only the American College of Radiology has published guidelines for telemedicine, he said.

The other professional groups haven't defined their standards," he said. "We really need to do this on a large scale -- develop professional guidelines that establish how everyone practices telemedicine in the future."

As the mental health consultant, Nancy Bakalar wants to establish telemental health standards for DoD, but also envisions a defense plan for all telemedicine procedures. "Eventually, DoD will want policies on how we manage not only mental health and the privacy and confidentiality issues, but telemedicine in general," she said. "We probably won't get too specific about it, but we would certainly want to set some general guidelines."

She also sees a need for a cost-benefit analysis that measure's DoD's return on investment in telemedicine. "When do you send a psychologist to a ship versus when do you use telemental health? How do you use your specialists to give fleet support or support to an operation like the one in Bosnia? After we get a little more information on using these technologies, we'll have to do an analysis and decide where to go from there."

In the meantime, the Telemedicine and Advanced Technologies Research Command at Fort Detrick, Md.; and the National Naval Medical Center and Walter Reed Army Medical Center in nearby Washington have contracted with the Menninger Clinic of Topeka, Kansas, to gather information about telemental needs within DoD. Menninger representatives will contact several TRICARE regions to obtain data on common diagnostic categories and rates, said health affairs officials.

Menninger will seek to determine bandwidth requirements, the necessity of videoteleconferencing for different mental health procedures, qualifications for consultants and infrastructure requirements for implementing telemental health defense-wide.The report is due this summer.

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