Operation Just Cause... ...for as long as it takes
By Douglas J. Gillert
SAN DIEGO -- The young boy courteously answers his nurses'
questions. Yes, he's taking his medicine. No, he's not over-
exerting himself when he plays with his friends outside. Yes,
he's been sleeping well. No, he hasn't had too much of a problem
breathing.
He doesn't mind the questions because at least he doesn't have
to go to the hospital, where all those sick people are. He isn't
missing school, and he can be with his friends a lot quicker and
for longer than if he had to go to the hospital.
It's kind of like watching television. Hey, not bad … he can
talk with the person on the TV. That's pretty cool. Asthma's a
drag, you know, but yeah, he can deal with it.
The little dude's lucky, because he has parents in the military
and they get their health care from Naval Medical Center San
Diego. It has cool programs like "telehome care" for pediatric
asthmatics. So here he is in his living room talking to his
nurse back at the hospital. Just seeing her smile at him makes
him feel pretty good. Like, he's going to be all right.
In 1997, the medical center received $750 million from DoD to
develop telemedicine initiatives like this one. Air Force Dr.
(Lt. Col.) Kerry Larson is the second head of the Telemedicine
and Technology Assessment Office, a job that takes someone like
him who gets excited about applying technology to health care, a
physician who knows the difference between high and low
bandwidths, who understands the limitations and exploits the
strengths of telecommunications to treat patients. He's
definitely enthused about the program.
"We're using telemedicine primarily for ear, nose and throat
patients and neurology, and we're just starting up tele-
psychiatry," he said. "Because many of the military treatment
facilities in Southern California are in isolated locations,
they have only limited access to civilian medical specialists.
With telemedicine, we extend the reach of Naval Medical Center
specialists and also save patients time away from their duties
and homes."
Larson admits the primary business logic behind telemedicine is
saving the government travel costs and time military people have
to spend away from their units. In fact, TRICARE Southern
California has conducted more than 400 telemedicine
consultations, deferring $100,000 in travel costs and saving
5,000 hours in lost travel time. But there are even greater
dividends for the physicians and patients, he said.
For example, an Army colonel at Fort Irwin, Calif., previously
visited the Naval Medical Center for medical care but received
his follow-up care at the fort rather than traveling the desert
freeway to San Diego, an eight-hour round trip.
"Patients like telemedicine because it allows them to remain
with their own doctors and close to home," Larson said. "We had
to overcome some initial skepticism from the physicians, but
once they experienced what it can offer, they got behind it. Now
they offer us ideas for other ways we can use the technology."
Specialists at the Naval Medical Center use telemedicine
consults not only to directly examine patients but to train
general physicians in specialty care. Taking that concept a step
further, the medical center now provides quarterly continuing
medical education courses over the system. It even hosted an
all-day trauma symposium, with 16 treatment facilities logged
onto the system for eight hours. The symposium was open to
anyone wanting to "attend" and even drew interest from outside
Southern California when physicians at Nellis Air Force Base,
Nev., tapped into the on-line training.
Each telemedicine consult usually lasts about 20 minutes,
according to Cmdr. Bobbie Crann, telemedicine clinical
coordinator for TRICARE Southern California region. The outlying
hospitals and clinics using automated software schedule most of
the consultations by medical center specialists. But there also
have been some emergency cases.
"A couple of weeks ago, a patient at Port Hueneme [a naval
installation about 60 miles north of Los Angeles] was bleeding
excessively after surgery," Crann said. "A specialist here was
able to examine the patient through a telemedicine hookup and
help the physician there stop the bleeding, so the patient was
treated faster and better and a trip to San Diego was
unnecessary."
Telemedicine is really about access to care, according to
TRICARE administrators here. It's about satisfying family
members' medical needs and helping them avoid trips to the
emergency room. It's about keeping soldiers close to their home
posts and the training they need to be ready to deploy. And it's
about helping doctors learn new skills and raise the quality of
care they can give, no matter where they are based.
It's about good medicine.
Sent in by Veterans News and Information Services
American Forces Press Service
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