DEFENSE HEALTH HEADQUARTERS, FALLS CHURCH, Va. -- Today, virtual health -- it's also called telehealth or telemedicine -- works, and it's improving patient satisfaction, health outcomes, readiness, and access.
Tomorrow, however, virtual health will be helping medics save lives on the battlefield, and the concept of an entire virtual medical center is being explored.
From 26 to 28 July 2016, a team of about 30 senior leaders, regional chiefs, clinicians, and experts from a variety of fields held a symposium to discuss expanding the use of virtual health in Army Medicine.
In FY 2015, there were over 40,000 virtual health encounters in Army Medicine. About 80 percent of that number of was for behavioral health. Although behavioral health specialists have widely adopted the use of virtual appointments, virtual health can be applied to almost any specialized area of medicine. In fact, the number of virtual health appointments for other specialties and routine care is growing rapidly.
For example, virtual health encounters include video visits on smart phones and remote health monitoring at home for patients who are receiving ongoing care. A patient can have signs and symptoms checked without walking out the door, a significant time and cost savings.
An additional advantage for medical planners are that no-show rates for virtual health encounters at a patient's home are likely to be extremely low, Dr. Colleen Rye, Chief of Army Telehealth at the Office of the Army Surgeon General, said, which is important for efficient and effective scheduling of both practitioners' and patients' time.
Work remains to be done to continue adoption of virtual health by patients and practitioners. Rye pointed out to the symposium participants that a consistent medical experience with virtual health will lead to increased comfort levels for patients and wider use. Pilot studies, she said, are "yielding information that will help to eventually standardize" virtual health procedures and operations.
Standard operations for virtual health exams may involve a nurse or medic on site to assist with collecting data for the remote physician.
The telemedicine practitioner has special tools to support his or her ability to treat patients -- such as a "telemedicine cart" that has been developed for just this purpose.
Basic equipment on the telemedicine cart could include a digital stethoscope, an otoscope (like a magnifying glass with a light to examine ears and sinuses), an ophthalmoscope (to examine the eyes), and an exam camera. The cart also has a computer with monitor and software to store and transmit sounds and images, if needed, to the remote physician.
Virtual health also allows the remote physician to send patient information and receive diagnostic confirmation from specialists who could be in a third location, sometimes deployed.
Although virtual medicine has many uses for the Army family and other beneficiaries, development of applications for the battlefield is crucial.
Army Medicine faces a critical need in developing virtual health for combat. Battlefield care can save more limbs and lives if the medic has direct connection to the surgeon with the forward surgical team or at the medical center.
Maj. Gen. Robert Tenhet, Deputy Surgeon General, discussed virtual health on the battlefield as one of the top five issues of Army Medicine right now and a top priority of The Surgeon General, Lt. Gen. Nadja West.
"Taking care of beneficiaries is easy," Tenhet said, "if we can meet the needs on the battlefield."
One of West's goals is the virtual medical center. What exactly will comprise the virtual medical center is being discussed, but there is no higher medical priority for Army Medicine than continuing to improve battlefield medical care.
"We need to figure where we go from here," said Robert Goodman, Chief of Staff for the Army Medical Command, to the symposium.
Where we go with virtual health is being affected by an administrative issue. Physicians and other clinical personnel must accurately code for virtual health procedures in electronic health records. Although there is documentation of extensive use of virtual health in the electronic health databases, virtual health encounters are probably being undercounted because of incorrect coding.
Those who attended the symposium agreed that future planning and funding requests require accurate counting of virtual health procedures.
Other factors that are impeding utilization of virtual health are being identified and addressed. Concerns regarding legal issues, credentialing of clinical personnel, and admitting privileges at medical centers as they relate to virtual health are being discussed and resolved.
Even with issues to resolve, the use of virtual health is growing and providing benefits.
Physicians gain rapid access to specialists to help make decisions about care, increased clinical efficiency, and the potential for better patient outcomes.
Patients will be able to receive treatment in the home or close to home, immediate access to the most experienced physicians, and improved quality of care.
The virtual medical center is being developed; it's not a matter of if but when such a concept becomes fact, said Tenhet.
Virtual health has high potential to support the warfighter. On the battlefield, medical care, when it's needed, is always right now.
But that's the point. Virtual health allows us to be "everywhere we are needed," said Dr. Rye. Virtual health means immediate access to care anytime and from anywhere.
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