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Telemedicine: It's About Better Care (corrected copy)

By Douglas J. Gillert
American Forces Press Service

SAN DIEGO, June 15, 1999 – The young boy courteously answers his nurses' questions. Yes, he's taking his medicine. No, he's not over- exerting himself when he plays with his friends outside. Yes, he's been sleeping well. No, he hasn't had too much of a problem breathing.

He doesn't mind the questions because at least he doesn't have to go to the hospital, where all those sick people are. He isn't missing school, and he can be with his friends a lot quicker and for longer than if he had to go to the hospital.

It's kind of like watching television. Hey, not bad he can talk with the person on the TV. That's pretty cool. Asthma's a drag, you know, but yeah, he can deal with it.

The little dude's lucky, because he has parents in the military and they get their health care from Naval Medical Center San Diego. It has cool programs like "telehome care" for pediatric asthmatics. So here he is in his living room talking to his nurse back at the hospital. Just seeing her smile at him makes him feel pretty good. Like, he's going to be all right.

In 1997, the medical center received $750 thousand from DoD to develop telemedicine initiatives like this one. Air Force Dr. (Lt. Col.) Kerry Larson is the second head of the Telemedicine and Technology Assessment Office, a job that takes someone like him who gets excited about applying technology to health care, a physician who knows the difference between high and low bandwidths, who understands the limitations and exploits the strengths of telecommunications to treat patients. He's definitely enthused about the program.

"We're using telemedicine primarily for ear, nose and throat patients and neurology, and we're just starting up tele- psychiatry," he said. "Because many of the military treatment facilities in Southern California are in isolated locations, they have only limited access to civilian medical specialists. With telemedicine, we extend the reach of Naval Medical Center specialists and also save patients time away from their duties and homes."

Larson admits the primary business logic behind telemedicine is saving the government travel costs and time military people have to spend away from their units. In fact, TRICARE Southern California has conducted more than 400 telemedicine consultations, deferring $100,000 in travel costs and saving 5,000 hours in lost travel time. But there are even greater dividends for the physicians and patients, he said.

For example, an Army colonel at Fort Irwin, Calif., previously visited the Naval Medical Center for medical care but received his follow-up care at the fort rather than traveling the desert freeway to San Diego, an eight-hour round trip.

"Patients like telemedicine because it allows them to remain with their own doctors and close to home," Larson said. "We had to overcome some initial skepticism from the physicians, but once they experienced what it can offer, they got behind it. Now they offer us ideas for other ways we can use the technology."

Specialists at the Naval Medical Center use telemedicine consults not only to directly examine patients but to train general physicians in specialty care. Taking that concept a step further, the medical center now provides quarterly continuing medical education courses over the system. It even hosted an all-day trauma symposium, with 16 treatment facilities logged onto the system for eight hours. The symposium was open to anyone wanting to "attend" and even drew interest from outside Southern California when physicians at Nellis Air Force Base, Nev., tapped into the on-line training.

Each telemedicine consult usually lasts about 20 minutes, according to Cmdr. Bobbie Crann, telemedicine clinical coordinator for TRICARE Southern California region. The outlying hospitals and clinics using automated software schedule most of the consultations by medical center specialists. But there also have been some emergency cases.

"A couple of weeks ago, a patient at Port Hueneme [a naval installation about 60 miles north of Los Angeles] was bleeding excessively after surgery," Crann said. "A specialist here was able to examine the patient through a telemedicine hookup and help the physician there stop the bleeding, so the patient was treated faster and better and a trip to San Diego was unnecessary."

Telemedicine is really about access to care, according to TRICARE administrators here. It's about satisfying family members' medical needs and helping them avoid trips to the emergency room. It's about keeping soldiers close to their home posts and the training they need to be ready to deploy. And it's about helping doctors learn new skills and raise the quality of care they can give, no matter where they are based.

It's about good medicine.

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Click photo for screen-resolution imageA military spouse at Fort Irwin, Calif. (on screen) listens to an ear, nose and throat specialist at Naval Medical Center San Diego describe what he's found after examining her from hundreds of miles away. The Telemedicine and Technology Assessment Office for TRICARE Southern California uses telemedicine to connect patients and their physicians with specialists at the medical center. The electronic consultations save travel costs and patients' time away from work, home and families and help general physicians improve the quality of care they provide military beneficiaries. Douglas J. Gillert   
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