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Telehealth offers hopes for better access to specialists, lower costs

Navy Lt. Commander James Prahl, an ER doctor at U.S. Naval Hospital Guam, turns on a video monitoring feed that connects his patients in Guam with doctors at Tripler Army Medical Center in Hawaii. The teleheatlh suite gives patients on the remote U.S. island territory more options when they need specialty care.

Technological advances in telemedicine could soon allow military doctors to reach more patients, helping active-duty troops with everything from routine medical checkups to mental health counseling.

In this burgeoning field, doctors might be able to connect via video conference with a depressed NCO sitting at home. Or a medic at a remote field hospital could use a smart phone to consult with doctors while trying to save a badly injured servicemember. In a more futuristic scenario, a surgeon could potentially operate on a patient remotely using highly sensitive robots and cameras.

Both the military and civilian medical communities in the United States are embracing the concept of telemedicine, experts say.

The aim is to treat growing patient populations cheaper and faster than ever. Instead of waiting weeks for an appointment with a specialist, more active-duty patients are being offered consultations with such experts via video teleconference.

“One of the universal findings of studies of teleheath is that patients love it,” said Dr. Jaime Adler, chief of the Clinical Telehealth Division of the military’s National Center for Telehealth and Technology at Joint Base Lewis-McChord. “They value the convenience and don’t feel like it’s cold or impersonal.”

The Defense Department is in the process of implementing the Servicemember Telemedicine eHealth Portability Act (STEP), which will make it easier for servicemembers to get more virtual medical care, particularly mental health counseling. The act cuts through legal red tape and allows DOD-contracted healthcare providers to treat patients in other states and countries where they are not licensed. Those directly employed by the DOD already get worldwide privileges at military treatment facilities with only one state medical license.

“It says that within DOD we should be able to use our providers to reach out to patients no matter where they are or where the provider is,” said Suzie Martin, Pacific Regional Medical Command Director of Telehealth at Tripler Army Medical Center in Hawaii, which is connected with hospitals in Guam, Korea and Japan, where specialists are in limited supply. “It’s going to drastically improve access.”

It’s also going to save money.

A highly secure and stable video-teleconferencing system goes for roughly $200,000 — about the same as the cost to medevac a patient to the U.S., said Col. Eric Crawley, chief of pulmonary critical care at Tripler. “If we can avert one transfer, it essentially pays for itself.”

Rep. Glenn Thompson, R-Pa., father of an Army staff sergeant deployed in Afghanistan, sponsored the bill after his son relayed stories of multiple soldiers from his unit committing suicide while deployed or upon returning from Iraq after his last tour a few years ago.

“I think it’s going to save lives,” said Thompson, who worked for nearly 30 years in healthcare administration before getting elected to Congress in 2009.

The STEP Act will increase the number of doctors and counselors available to active-duty servicemembers, when the military’s dense medical manual is changed to reflect the new law.

“Once these guidelines come, a provider who’s interested in working with DOD would be able to start,” Thompson said.

Pentagon officials could not specify when implementation would occur but said it would be “soon.”

While the law is a response to the hallmark injuries of today’s conflicts — post-traumatic stress disorder and traumatic brain injury — the applications of telehealth are practically limitless, according to health officials.

For example, telemedicine can connect a cardiologist in Hawaii with a heart patient in Guam. Sophisticated cameras can aid diagnosis by zooming in on parts of the body.

“I think a lot of people are excited about it and are excited about the possibilities of it,” said Lt. Cmdr. James Prahl, a pulmonary intensivist ER doctor at U.S. Naval Hospital Guam and the only sub-specialist on staff there.

Prahl and other doctors in Guam who use the system are present when the off-site provider “meets” with a patient to discuss diagnosis and treatment possibilities. Patients are never forced to go the telehealth route and can instead get a referral to an off-base provider, Prahl said.

The telehealth option actually seems to ease the stress of ailing patients on Guam, who understand the hospital’s limited resources and feel more comfortable when they can consult with a specialist, even if not in person, he said.

There are drawbacks.

Healthcare providers on both ends of a telehealth case must trust each other, Crawley said.

“That can be challenging when you cross services,” he said.

Ensuring strict federal health privacy laws are maintained through the Internet-based teleconferencing is another challenge, experts said.

And what about bedside manner? While some fear telemedicine makes for a cold experience, doctors practicing telemedicine contend that is not the case.

“It’s quite easy to make it appropriately personal,” said Adler, from T2.

“Shaking somebody’s hand is not the only factor in establishing a clinical relationship. Eye contact in the video is sometimes better.

reed.charlie@stripes.com

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