Space-age technology makes it possible for Army health-care providers deployed overseas to have access to the technical knowledge of medical specialists within a few hours. E-mail teleconsultations make the best treatment available while avoiding unnecessary evacuations of patients for specialty care.

"The program gives deployed physicians a user-friendly reachback capability when communications systems are not robust and/or bandwidth is limited," said COL Ronald Poropatich, deputy director of the Telemedicine and Advanced Technology Research Center and medical informatics consultant to The Surgeon General. "An e-mail with JPEG image attachments works well for teleconsultations. Digital cameras are common in theater."

"The simplicity of use and minimal training needs has resulted in a self-sustaining program. Deployed physicians are able to make informed decisions to either care for the patients at their facilities or evacuate for more definitive care," he added.

Safer than travel

"It provides a rapid response when it will be safe for the patient. To transport a patient when there might be an (improvised explosive device) by the road could be dangerous," said Chuck Lappan, project manager for the OTSG Teleconsultation Program. Lappan also manages the teledermatology program for the Great Plains Regional Medical Command.

Providers needing a consultation can submit the e-mail to an AKO address for the specialty group, or to for a specialty with no organized group.

Contact groups are organized for burn trauma, cardiology, dermatology, ophthalmology, infectious diseases, internal medicine, nephrology, neurology, orthopedics and podiatry, pediatrics intensive care, preventive medicine, rheumatology, toxicology and urology. Specialty medical consultants supervise their respective teleconsultation service and ensure scheduling and availability of medical staff.

Consultations are available at any hour and any day. Lappan said he received an e-mail from a consultant on call on Thanksgiving Day, concerned the system might not be working because he had not received any consult requests over the holiday.

Most consult requests are answered within five hours.

Lappan advises providers to be sure to notify their information management support to disable their home-base Outlook e-mail account ( when they deploy, and to turn off the AKO automatic forwarding of e-mail. Otherwise, the consult may be routed unseen to the provider's home account at a MEDDAC or MEDCEN.

"I am usually able to get through, but it takes a lot more work to ensure we support the provider in the way they deserve. I really can't fault the deployed provider. When you receive a deployment order the last thing on your mind is adjusting your e-mail account," he said.

Another problem Lappan sees is too-large e-mail files. He said three to five photos are sufficient with patient history and exam information, and high-resolution images are not necessary.

Messages must not contain any patient identifying information to maintain privacy.

Providing information

Lappan briefs classes at the AMEDD Center and School about the program. He also has available pocket-sized cards explaining the procedures.

AMEDD telemedicine began in 1992 with deployed reachback teleconsultation from Somalia. The AKO teleconsultation program was established in 2004. Since then the system has received more than 3,000 consult requests from more than 900 health-care professionals.

More than 100 patients were evacuated on advice of the consultants, while more than 50 evacuations have been avoided.

Besides Iraq and Afghanistan, consult requests have been received from Belize, Bosnia, Chad, Diego Garcia, Djibouti, Ecuador, Egypt, Honduras, Kenya, Kuwait, Kyrgyzstan, Nepal, Okinawa, Pakistan, the Philippines, Qatar, Turkey, the United Arab Emirates and Navy ships at sea.

The service is available to deployed providers of all military services for any patients they treat. It can be used for humanitarian or civil-affairs missions as well as combat support.

"Even though it is an Army system, only about 55 percent of the patients are Army," said Poropatich.

The program is not open to hospitals in the U.S. or fixed facilities in Europe. However, regional medical commands operate teleconsultation programs in dermatology and cardiac echocardiography (Brooke Army Medical Center), radiology (Landstuhl RMC), pediatrics and intensive care (Tripler AMC) and psychiatry and neurosurgery (Walter Reed AMC).

"I must commend the selfless service of the consultants who support this effort. They are doing this on love time - literally answering the mail on off-duty time. They have made this program self-sustaining with nearly zero funding. This kind of selfless service is what makes this a special program," said Poropatich.