Online doctor visits prove valuable at some Europe bases

GRAFENWÖHR, Germany — The U.S. Army is testing telemedicine as a way to give patients at remote posts in Europe better access to American specialists.

In recent years, as the military footprint in Europe has shrunk and U.S. hospitals in places such as Würzburg have closed, servicemembers and family members increasingly have been sent to foreign medical facilities for treatment. Telemedicine — which enables doctors to do remote consultations over the Internet — is a way to bring those patients back into the U.S. medical system, according to Col. Steven Brewster, commander of U.S. Army Medical Activity Bavaria.

A telemedicine system is being tested at two on-post clinics in Vilseck, allowing doctors at Landstuhl Regional Medical Center to perform examinations and determine if more extensive care, such as surgery, might be needed.

Telemedicine will help the Army tighten oversight of soldiers’ medical treatment and provide the best long-term results, he said.

“We want them to see an orthotic surgeon we have confidence in,” Brewster said. “We are getting that on the economy but I’m going to feel better if they consult with a surgeon in a military treatment facility.”

One advantage for soldiers seen by U.S. military doctors is that get the same standard of care they’d get in the States, he said.

In the past, soldiers with sports injuries, such as a torn knee ligament, had the option of driving to Landstuhl to see a surgeon for several pre- and post-operative appointments. But Landstuhl is a three- or four-hour drive from some bases.

Telemedicine allows the patient to consult the specialist without leaving their home base.

David Melaas, an orthopedic physician’s assistant from Landstuhl Regional Medical Center, is at Vilseck this month helping surgeons examine patients using the system.

The telemedicine program began Jan. 22 and runs until April 16, he said. As of last week, nearly 40 patients have used the program, which currently is open to active-duty personnel with sports injuries and family members with small fractures that don’t require surgery.

The Army was unable to provide a patient who has used telemedicine to be interviewed by Stars and Stripes.

If the program is successful and increases access for patients, telemedicine will be opened up to family members with more chronic musculoskeletal problems, he said.

The program aims to identify patients who need surgery — people with anterior cruciate ligament or Achilles tendon ruptures, meniscal tears, unstable ankles or rotator cuff tears, he said.

If Melaas thinks a patient might need surgery, he schedules a telemedicine appointment with a surgeon.

“I can perform some of the physical maneuvers and the surgeon can ask them questions and review an MRI scan through a link,” he said. “He can make a decision, offer the patient surgery if it is indicated and give them a date.”

After surgery, patients can do post-operative telemedicine appointments with their surgeon, Melaas said.

In addition to sports injuries, the command plans to use telemedicine at a newly opened Vilseck Mild Traumatic Brain Injury Clinic to gain access to specialists at Landstuhl. Telemedicine can even be used to give soldiers access to U.S.-based specialists such as oncologists, Brewster said.

“We have had soldiers diagnosed with cancer,” he said. “It sure would have been nice if they could have talked to the doctor who is going to receive them at Walter Reed.”

Brewster said he could see the system being expanded to other communities in Europe.

In Vicenza, Italy, for instance, patients sometimes talk to surgeons on the telephone but they must fly to Landstuhl or go to Italian medical facilities for appointments, he said.

“I could see this working in other large military communities where there is remote access to medical care such as Schweinfurt, Bamberg and Stuttgart,” he said.

Telemedicine has already gained a foothold in the U.S. health care system.

Late last year, the U.S. Department of Agriculture announced $34.9 million in grants for 35 states to increase health care services in rural areas. The funding will be provided through USDA’s Rural Development’s Distance Learning and Telemedicine Program, according to an article on the Federal Telemedicine News Web site.

Additionally, the Veterans Affairs Department is already a step ahead of the rest of the federal government in promoting telemedicine, according to a Feb. 17 article in Federal Computer Week.

The VA’s program cares for 35,000 patients, the article states, and is the largest of its kind in the world. According to the department’s plans, it would grow to $163 million in fiscal 2011, more than twice the $72 million spent in fiscal 2009.