MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. -- Sleep consults and pre-operative appointments, along with expanded pediatrics services, are now a part of the growing list of specialty care available to Madigan Army Medical Center patients through virtual health.Virtual appointments offer long-distance care supported by laptops, video conferencing and other tools so that patients can get their care at locations more convenient to them.Now patients who live south of Madigan can just opt to travel to the South Sound Community Medical Home in Lacey to take part in their pre-operative appointments with their anesthesia providers and nurse providers. These appointments educate patients on how to prepare for surgeries and assess underlying health conditions that might impact the surgeries or the anesthetics used, according to Col. (Dr.) Andrew Foster, chief of the Department of Anesthesia and Operative Services."There really are no limitations for the patient; it's the exact same anesthesia evaluation. The only thing that is different is where the patient is located, so it's just saving them time and is more convenient for the patient," said Jen Reinhardt, the clinical nurse officer in charge of Madigan's Surgical Services Center; she and Emery Collier, the center's assistant head nurse, set up the new virtual service.A telehealth nurse, Jo Montero, at the South Sound clinic takes patients' vitals in person (although providers on the other end can directly listen to the stethoscope via electronic transmissions), and sets up the video conference."In this day and age where people are very comfortable with Skype and FaceTime, especially our younger generation of folks who are quite comfortable using this technology and don't necessarily need or want to come to Madigan every time they need an appointment, having the ability to talk to a nurse via video-teleconference meets all of their needs," said Foster.Virtual health can also ensure patients can still access military medicine experts, no matter where they live. The Sleep Medicine Service's first virtual appointment offered a second opinion to a service member in Alaska on a debilitating sleep disorder diagnosis; while the Madigan doctor agreed with the network provider's diagnosis, being in military medicine meant he could also offer context of what the diagnosis could mean for a military career and what treatment options can look like for different career fields."We were able to do all of that without ever having the person step away from his parent duty station, and then he was profusely thanking me because he said, 'I just recently got back from a deployment. I went overseas for nine months; now every time I walk out the door to go to work my kids think that I'm never going back. You saved me a week of TDY where I didn't have to tell my kids I will be back,'" said Dr. Brian O'Reilly, Madigan's medical director for the Sleep Medicine Service.His clinic is taking medical care even closer to the patients by allowing patients to take part in home sleep apnea tests."So basically now instead of coming in and doing in-lab sleep studies, we can do these sleep tests at home and it's as simple as just putting a little probe on your finger," he said.The device is actually deceptively simple: with obstructive sleep apnea, the body's upper airway folds in on itself causing a heaving response; this in turn sends out a stress hormone that causes arteries to stiffen, which is the marker the probe measures."We want to say you can be wherever you are and we can come to you to do your sleep evaluation," said O'Reilly.Virtual health options are also expanding in pediatrics, which began more than 10 years ago offering real-time echocardiograms of infants who are suspected of having congenital heart disease.Madigan trains pediatricians from locations without sonographers to conduct live, supervised echocardiograms using virtual health technology, said Allegra Frank, a health systems specialist with the Madigan Department of Pediatrics. She added that this live reading can avoid a delay of care for babies who might need surgeries.Now, any Madigan pediatric specialist who wants to offer a consult via virtual health can do so. Frank said developmental behavioral pediatricians participate the most in virtual health offering follow-up appointments to patients at Bassett Army Community Hospital in Alaska.Earlier this spring, Madigan patients also got access to virtual health appointments with a pediatric nephrologist at the Walter Reed National Military Medical Center."We're both the providers of virtual health, and the consumers, which is exactly the intent. Wherever the need is unmet and the capacity is unused, we connect the two; that's just better efficiency for the entire enterprise," said Lt. Col. (Dr.) Christopher Colombo, Madigan's chief of the Department of Telehealth.