Virtual medicine extends specialist care to soldiers in remote places

Sgt. 1st Class Todd Hall, in charge of telehealth for Regional Health Command Europe, demonstrates the virtual eye exam on 1st Lt. Alexander Cho on May 31, 2016. Virtual health is the use of electronic information, imaging, and communication technologies to provide health care when distance separates the patient and the provider.


By JENNIFER H. SVAN | STARS AND STRIPES Published: December 13, 2016

LANDSTUHL REGIONAL MEDICAL CENTER, Germany — More Defense Department patients in Europe assigned to isolated or remote locations may be able to visit with a specialist at their local base clinic or in even in their home as the Army continues to broaden virtual health capabilities.

Over the last three years, an Army team under Regional Health Command Europe has ushered in a huge expansion of virtual medicine across the Continent.

The Army recently recognized the nine-member team — called the European Advancement for Regional Telehealth — for its work, including more than doubling the number of virtual health visits between patients and providers in the region since 2013.

The group received the Army Surgeon General and the Chief of Army Medical Department Civilian Corps’ annual Wolf Pack Award. The award recognizes exceptional teamwork by an integrated group of military and civilian team members in support of Army medicine, according to the Army.

Teams from Army medicine compete quarterly for the award, and an annual winner is chosen from among the four winning quarterly finalists, of which Europe’s telehealth team was one, official said.


The European group is credited with connecting more than 70 specialists at LRMC to 15 Army health clinics and about 100,000 beneficiaries through “real-time regional telehealth,” according to the award citation.

Up until early 2014, most virtual health visits involved only behavioral health and nutritional medicine, officials said. The program has since been expanded to include about 32 different specialties available at LRMC, from allergy and immunology to speech pathology.

About 1,250 virtual health visits through Regional Health Command Europe were conducted in 2014, an increase of 70 percent from the previous year, officials said. That number grew to 2,500 in 2015 — a figure surpassed in late summer this year.

The command’s virtual health team is also expanding virtual health into the home. Earlier this year, it completed the first “in-home” virtual health visit between a patient and a doctor, officials said. That interaction occurred between a pediatric gastroenterologist at LRMC and his teenage patient, who was able to speak from his home in Vilseck to his doctor about a chronic medical condition. The consultation saved an eight-hour, round-trip drive to LRMC for a checkup.

Army virtual health officials say allowing more patients to visit with doctors virtually cuts back on missed work and school days and reduces travel-related expenses for soldiers. That means less mileage traveled on the road and fewer dollars spent on temporary duty.

“What they’re doing is expandable to Army medicine across the world, not just here in Germany,” said Gregg Stevens, the deputy commanding general at the Army Medical Department Center and School at Fort Sam Houston, Texas.

“There’s a huge potential that’s still out there, as the technology gets better and we figure out better how to use it, I think it will continue to grow,” he said.

Stevens, who’s also the chief of the Army Medical Department Civilian Corps, was at the LRMC chapel on Thursday for the Wolfpack Award presentation. Army Surgeon General Lt. Gen. Nadja Y. West spoke at the ceremony through video teleconferencing, congratulating the team, which includes nursing, medical and information technology experts.

“This is the wave of the future. We are no longer an experiment, we are reality,” said Ron Keen, Regional Health Command Europe Virtual Health chief, summarizing some of West’s remarks.

Seven to eight years ago, when the concept of virtual health was just getting off the ground in Europe, Keen said, the idea was a harder sell.

“‘You’re going to talk to a doctor through Skype?,’” Keen said with a note of incredulity.

Nowadays, the virtual health program is more than just a doctor-patient conversation on Skype, Keen said.

The program operates with a secure web-based video link, ; a cart with various tools allows a nurse to examine the patient, taking vitals, or looking at the eyes or ears, as directed by the doctor, Keen said.

“A lot of opportunity in virtual health comes from the patient being able to go over their history with that specialty provider,” he said. “Sometimes it doesn’t need an exam, and the doctor will determine if they need to be seen or based upon their symptoms, what the next step should be.”

The most common medical specialty using the platform currently is sleep medicine, Keen said, mostly for patients with sleep apnea. Soldier readiness — ensuring periodic health assessments and medical profiles are up to date — is another popular use of virtual health, particularly with soldiers located in or deployed to remote areas in Europe, Africa and the Middle East.

The program does have limitations. In some locations, low bandwidth makes internet connection a challenge. And virtual health isn’t possible for surgery or some behavioral health issues, Keen said.

“Some things telehealth cannot replace,” he said, “especially if the doctor needs that hands-on touch with the patient and to physically see them. We offer virtual health as an alternative.”

Stevens said virtual health has much future potential, in combat especially.

“We’ve been very fortunate in the last 15 years, that we’ve been able to get patients moved out of theater and to Landstuhl to care very quickly,” he said. If the fight was in a congested city, “where the evacuation was much more tenuous,” a medic through telemedicine “might very well be able to keep that patient alive (on the battlefield) for a much longer period of time and allow us to get that patient to care.”



Lt. Col. Robert Cornfeld, pediatric gastroenterologist at Landstuhl Regional Medical Center, Germany, conducts the first in-home virtual health visit within Regional Health Command Europe earlier this year. In-home virtual health provides patients with the option to conduct a doctor?s visit without having to go into a clinic. Efforts are underway to expand virtual health opportunities for military members and their families in Europe.

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