By Mr. Wesley P Elliott (Army Medicine)February 25, 2016
FORT GORDON, Ga. -- Imagine having the choice to schedule an appointment with your doctor or instantly see a doctor anywhere in the world using your smart phone or tablet. This is how Col. Michael Weber, Eisenhower Army Medical Center (EAMC) Commander, envisions health care in the future.
The first steps have already begun at EAMC with a pilot program where emergency room patients at Fort Campbell, Ky., are being seen by doctors hundreds of miles away at Fort Gordon, Ga., and nurses in Puerto Rico are assisting patients and endocrinologists at EAMC as if they were physically in Georgia.
The pilot program was initiated by a request from the Chief of Staff of the Army who believes tele-health can be useful on the battlefield by providing health care at remote bases. To receive health care in remote locations, Soldiers must face possibly dangerous movement to a site that has physician and tele-health could reduce the risks to Soldiers in need of routine health care.
To meet the Army's needs, EAMC recently created a tele-health department to expand the tele-health services offered by the medical center. The new department is headed by Dr. Joseph Wood, an endocrinologist and Chief Medical Information Officer, who is developing tele-health programs to support medical clinics in the region that lack EAMC's specialties.
Wood states that "the department began the pilot program Jan. 31, where primary care physicians at EAMC provide tele-health support to non-urgent patients in the Blanchfield Army Community Hospital's (BACH) emergency department. The program is intended to allow BACH's ED to focus on urgent care patients and test the concept of non-urgent primary care via tele-health."
The providers at EAMC are supported by nurses and medics at BACH who assist the provider by documenting the visit, and ordering tests and medication as they would in a normal face-to-face visit.
The department is also testing the ability of nurses in one facility to assist a health care provider in another facilities' specialty clinic. Nurses in Puerto Rico are seeing patients in the EAMC Endocrinology clinic and assisting EAMC endocrinologists in documenting the consultation notes and ordering tests.
Wood explained that the next phase of the pilot will test how well tele-health works when the patient, provider, and nurse are all in different locations. If successful, this could open new possibilities for creating a tele-health workforce to support regional needs.
"When patients at smaller facilities can see EAMC specialists through tele-health, the patients typically have to wait less time and it eliminates costly travel to see the specialist," said Wood.
A patient needing specialty care or inpatient care could complete the entire consultation process by video and only travel to the regional medical center for the actual procedure.
Additionally, the U.S. Army operates the most effective medical air evacuation systems in the world and Wood theorizes that the system could be used to transport patients to the regional hubs for procedures after the initial consultations via tele-health.
"This practice would allow a wartime skill to be continually practiced so that MEDEVAC expertise is not lost between conflicts."
"EAMC is focused on being a benefit to the health care facilities in the region and is looking for ways to be a true regional hub and leader through tele-health," said Weber.
Other specialties being considered include infectious disease, rheumatology, and surgery pre-op and post-op follow-ups.
Weber explained that for several years, EAMC has provided tele-behavioral health consultations across the Army including Special Forces operators in Miami who are able to communicate with a behavior health provider, with the appropriate clearance level, at EAMC using soundproof booths for privacy.
"Tele-health allows operators to have access to a provider despite the sensitivity of their work."
In the future, as tele-health services are put into practice, the various students, interns, and residents training at EAMC will have the opportunity to rotate through these tele-health clinics and the practice will become more common across Army Medicine, said Wood.