“This is all relatively new. The original operations order was sent out in 2009, saying we would go toward transitioning our clinics to the medical home model concept outside the civilian sector, where the concept already had been shown to work well. There also is a Navy patient center version and an Air Force medical home structure.”
That is among a number of new tools and initiatives from MEDCOM in the past couple of years.
Telemedicine, a term used interchangeably with telehealth in Army medicine, is a growing component in military health care, for both active duty and veterans. It employs interactive audio/video technology to provide clinical consultations and office visits when appropriate and medically necessary. Most recently, that includes a U.S. network of telemental health care originating sites for beneficiaries and networks of offsite providers who can evaluate and treat patients by video. This TRICARE benefit covers all aspects of behavioral health services, including psychotherapy and medication management.
“For example, the Army Medicine Secure Messaging Service, part of our Relay Health Initiative, allows patients to contact their primary care nurses and providers for medical refills; if the doctor is comfortable with that, it can be refilled without an appointment. Or the patient can ask questions that don’t really require an appointment, giving better access to medical information,” he said.
“There is another initiative, still in its infancy, called telemedicine, where instead of an office visit, a remote patient can set up a video conference with a provider, ask questions, and set up a treatment plan. We’re in the initial phase of testing its applicability to our patient population,” Nguyen said, adding it also is seen as helping with the long wait for care issues.
Charlene Roberson, a nurse in the Carl R. Darnall Army Medical Center, Fort Hood, Emergency Room checks in Keirsten Hall and son, Kostner Chaffin, for their visit. U.S. Army photo by Patricia Deal
Telemedicine, a term used interchangeably with telehealth in Army medicine, is a growing component in military health care, for both active duty and veterans. It employs interactive audio/video technology to provide clinical consultations and office visits when appropriate and medically necessary. Most recently, that includes a U.S. network of telemental health care originating sites for beneficiaries and networks of offsite providers who can evaluate and treat patients by video. This TRICARE benefit covers all aspects of behavioral health services, including psychotherapy and medication management.
Telemedicine also is used to deal with emergency situations involving the military. One such instance was the 2009 shootings at Fort Hood, Texas, in which 13 unarmed soldiers were killed and 30 wounded by Maj. Nidal Malik Hasan, an Army psychiatrist.
“When the Fort Hood shootings happened, we were there with telebehavioral, piping in psychiatric workers from all over the world, which enabled health assets on the ground to take care of the most critical needs,” Colleen Rye, Ph.D., chief of the OTSG’s Telehealth Service Line, recalled. “We’re very much down the [telehealth] road and have a rich history reaching back at least 20 years; much of the telemedicine you see in the world today originated in MEDCOM.
“We have about 45,000 provider-to-patient and provider-to-provider consultations around the world, strategically located to cover deployed needs. About 88 percent of those in FY 14 were telebehavioral health, of which 10 percent are teleconsultations – specialty providers helping each other. For example, if you have clinicians at Kwajalein [Atoll in the western Pacific] facing something with which they are not up-to-date, they can upload the information and a specialist anywhere in the world can look at photos or X-rays or other information and provide the best Army medicine has to offer.”
The Telehealth Service Line also is partnered with the Integrated Disability Evaluation System, enabling the use of telehealth to help service members deal with a lot of the requirements involved in transitioning from military health care to the VA without the need to travel as much.
Army telehealth officials talk regularly with the VA, which has been heavily involved with telemedicine for many years. Rye’s office also meets weekly with their partners in the combatant commands to exchange lessons learned and with the Air Force and Navy chiefs of telemedicine.
“We have an effort to meet at least once a week to talk about joint issues. The Army already reaches out to other services, especially for our teleconsultation system, which is used by all the services, and we have agreements for telemedicine of various types. It’s a very collaborative environment,” Rye explained.
“Our current system also is still facility oriented, although we are working toward moving to the home, but we have some restrictions to deal with first. If someone lives near a small facility that does not have the specialists they may need, they can connect with a specialist using their facility’s telehealth system. We operate across 18 time zones, so there is a likelihood there are teleservices going on 24 hours a day.”
Most patient contact is done by psychiatrists and clinical psychologists for telebehavior, while others are more of a mixed bag, she added.
“We have future plans that anticipate greater inclusion of nurses and technicians, especially as we get more into telehealth monitoring. We are planning for remote home monitoring in the future, which would include sensors taking vital signs, blood sugar levels, etc., that will allow us to keep an eye on our patients and keep them healthier. That all ties into the Surgeon General’s focus on what she calls the ‘life space,’” Rye said.