If you have worked in government service or the military for any length of time, you know that the types of people you encounter are incredibly diverse; however, there is always that one individual. The one who can make anything happen. The one who has such a can-do attitude that no project is impossible when it's in their hands.
Chuck Lappan, a health systems specialist at Regional Health Command -- Central, is one of those rare individuals, and since 2002, he has been the driving force behind many successful regional telehealth programs.
Lappan has called this place home since 1999, when he still came to work in uniform as an Army lieutenant colonel in the operations branch. In the nearly 20 years since that time, he has been instrumental in the success and growth of various virtual healthcare programs throughout the region as well as the entire Army Medical Department.
When Lappan first began working on the tele-dermatology program in the early days of Operation Enduring Freedom and Operation Iraqi Freedom, the goal was to prevent unnecessary medical evacuations of Soldiers from theater operations. If there wasn't a dermatologist available for consultations, patients would have to be flown to a hospital with a dermatologist. So often, the issue was easily treatable, but it took anywhere from days to weeks of travel to and from their units. This lead to a substantial impact on unit readiness.
"He started his tele-heath experience working as the Tele-Dermatology Program Manager and grew that program to answer over 50K consultations. Based on the success of the Tele-Derm Program he was asked to lead the effort to establish a Dermatology email based consultation program to support deployed providers in Iraq," said Col. L.A. Cromer, Jr., assistant chief of staff for information management/G6 at Regional Health Command -- Central. "This need came from dermatology conditions being the number three reason for patient evacuation from theater in 2003," he continued.
The tele-dermatology program was an innovative way to use technology to get Soldiers the treatment they needed without all the dangerous travel through a war zone. Using Army Knowledge Online, doctors in theater would take photos of the affected skin, obtain a detailed medical history and then send it to the teledermatology email group where it was automatically routed to the on-call dermatologists, who would reply back to the group and the primary care provider with specific recommendations. All of the dermatologists who participated in the teleconsultation received those emails, and had the ability to chime in if they had experience with the specific health issue referenced.
"As a result of the successes of the Tele-Derm email consultation program, the scope was increased to support 19 clinical specialties," Cromer said.
The first decade of the 21st century saw the acceptance of a number of telehealth protocols including video teleconferencing and web-based systems that connected providers to patients hundreds of miles away for everything from behavioral health to ophthalmology. A number of regional programs connect Soldiers, who aren't near a needed medical specialty, to those providers throughout Army Medicine--without the added cost of traveling to and from treatment.
Sometimes, a specific medical discipline is a good candidate for virtual health because there is a national shortage of providers and an immediate need. According to Lappan, that is what happened in 2006 in the Army with rheumatology doctors. According to Dr. Daniel Battafarano, the Chief of the Rheumatology Fellowship Program at Brooke Army Medical Center, the number of civilian rheumatologists graduating from medical school is not keeping pace with demand especially as the older rheumatologists are nearing retirement. Not all rheumatology patients live in the same metro area as the doctor they need to see. The solution Lappan and Battafarano came up with was to take a detailed patient history and photos and send them via email. It was a low-tech solution, and a viable alternative for those providers who were deployed in an area without access to medical video teleconference capability.
Eleven years later, this program is still an indispensable tool when it comes to ensuring patients have access to the care and professionals best suited for their healthcare needs. Considering the ratio of providers to patients in this specialty, this low-tech and inexpensive solution is a viable tool for civilian rheumatologists as well as their military counterparts.
In 2016, Lappan and Battafarano, along with Dr. Ian Ward and Dr. Thomas Schmidt, co-authored a paper titled 'How Critical is Tele-Medicine to the Rheumatology Workforce?' that showed the tangible benefits of being able to assist patients remotely. Battafarano was invited to present this model of remote care to the American Academy of Rheumatology and participate in the panel afterwards.
Lappan recorded and submitted the statistical data for the paper. Most significant was the number of cases that required a rheumatologist versus the number of Soldiers who actually had to be evacuated. Of 200 electronic consultation program cases between May 2006 and May 2014, only 25 had to be transferred to a tertiary care center. This keeps Soldiers with their units and prevents major impacts on a unit's readiness while deployed. In addition, it has a positive impact on the individual patient's medical outcomes.
Ever since BAMC was designated the Army's first virtual medical center, Lappan has been planning with his counterparts at the hospital how to manage these programs at BAMC, with the long-range goal of getting the virtual rheumatology program out of RHC-Central and available throughout the Army Medical Department. This specialty is one of many virtual healthcare capabilities that make up the legacy program at RHC-Central--one of many.
"I think his contributions can best be summed up using the words of a deployed dermatology consultant in theater that use the telemedicine system, 'That Chuck is great!' is consistently heard all the time," said Cromer.
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