The document discusses how the US Air Force has developed and implemented a telemedicine program over the past 3 years to provide medical care to service members and their families remotely. The program uses technologies like video conferencing, digital imaging, and store-and-forward capabilities to connect medical providers at military bases across the US and overseas with specialists. Examples are provided of how telemedicine has helped diagnose and treat patients in remote locations like Alaska and the Middle East.
Calypso Medical's Prostate Cancer Treatment: Imaging Technology NewsCalypso Medical
A thorough explanation of image guided radiation therapy for prostate cancer, prostate cancer side effects associated with prostate radiation treatment, and how Calypso GPS for the Body technology greatly reduces the risk of side effects.
TransCode Therapeutics Inc is an RNA oncology company. It is created to defeat the cancer through the intelligent design and effective delivery of RNA therapeutics. The company's lead therapeutic candidate, TTX-MC138, is focused on treating metastatic cancer, which has the potential to produce regression without recurrence in a range of cancers, including breast, pancreatic, ovarian and colon cancer, glioblastomas and others.
Breast cancer research in animal models has long been hindered by the lack of a fast, portable,
high resolution, research and animal focused imaging system that can visualize 2D tumor size, 3D
tumor volume, neoangiogenesis and blood perfusion in vivo, in real-time and most importantly,
non-invasively.
In order to ameliorate this problem, VisualSonics has introduced a revolutionary micro-ultrasound
system that allows researchers to collect a plethora of important data over the lifespan of animals,
thereby significantly reducing the number of animals needed.
Nuclear medicine is a medical specialty that uses radiopharmaceuticals to diagnose, treat and monitor diseases. Nuclear medicine and molecular imaging procedures have a long history of use.
Field of oncology has evolved since many decades! This presentation will demonstrate how oncology had evolved. Special focus is on current radiation oncology and surgical oncology practices along with principles of oncology.
Calypso Medical's Prostate Cancer Treatment: Imaging Technology NewsCalypso Medical
A thorough explanation of image guided radiation therapy for prostate cancer, prostate cancer side effects associated with prostate radiation treatment, and how Calypso GPS for the Body technology greatly reduces the risk of side effects.
TransCode Therapeutics Inc is an RNA oncology company. It is created to defeat the cancer through the intelligent design and effective delivery of RNA therapeutics. The company's lead therapeutic candidate, TTX-MC138, is focused on treating metastatic cancer, which has the potential to produce regression without recurrence in a range of cancers, including breast, pancreatic, ovarian and colon cancer, glioblastomas and others.
Breast cancer research in animal models has long been hindered by the lack of a fast, portable,
high resolution, research and animal focused imaging system that can visualize 2D tumor size, 3D
tumor volume, neoangiogenesis and blood perfusion in vivo, in real-time and most importantly,
non-invasively.
In order to ameliorate this problem, VisualSonics has introduced a revolutionary micro-ultrasound
system that allows researchers to collect a plethora of important data over the lifespan of animals,
thereby significantly reducing the number of animals needed.
Nuclear medicine is a medical specialty that uses radiopharmaceuticals to diagnose, treat and monitor diseases. Nuclear medicine and molecular imaging procedures have a long history of use.
Field of oncology has evolved since many decades! This presentation will demonstrate how oncology had evolved. Special focus is on current radiation oncology and surgical oncology practices along with principles of oncology.
The Primer: Solutions in Social Media for HRDawn Yankeelov
These slides were prepared to address the Kentucky SHRM meeting in September 2009 by Founder Dawn Marie Yankeelov of Aspectx in Louisville. She speaks internationally on topics related to technology, marketing, and research.
Social Media: Podcasting, Blogging and Social NetworkingDawn Yankeelov
This is an overview talk regarding the state of social media on Aug. 19, 2009 by Aspectx, delivered to guests of One Southern Indiana, and Indiana Small Business Development Centers.
Teleradiology is a branch of telemedicine in which telecommunication systems are used to transmit radiological images from one location to another. Interpretation of all noninvasive imaging studies, such as digitized x-rays, CT, MRI, ultrasound, and nuclear medicine studies, can be carried out in such a manner.
The first steps in teleradiology date back to 1929 when a medical image was transmitted via telegraph to a distant location
To understand the definition of telemedicine
Knowing the history of telemedicine
To understand the advantages of telemedicine
Telemedicine during COVID 19
Future of telemedicine
Benefits of telemedicine
Dr Gupta spoke at the Indo-French dialogue on Telemedicine in Healthcare — with Christophe Saint Martin, Dr K Ganapathy, Vijay Agarwal and Shobha Mishra Ghosh.
http://www.ambafrance-in.org/Indo-French-dialogue-on
The challenges and opportunities in telemedicine during COVID 19 pandemic
Project supervisors: Dr. Rosalind Silverman and Dr. Lorelei Silverman
Background A multidisciplinary team consisting of premedical and predental students, internationally trained doctors, and IT professionals will showcase the present and future of telemedicine post COVID 19 era.
Methodology Our team researched literature and surveyed telemedicine clinics in Canada to identify the usage of telemedicine, devices, advantages and disadvantages of telemedicine in 18 medical disciplines.
Results We will present new technologies and best practice in telemedicine and tele dentistry as well as the practical use in clinics across Canada, USA, and internationally. We will also demonstrate the further role of telemedicine in expanding the field, and challenges and opportunities during COVID19. In addition, we will share our survey of application of telemedicine to telepsychiatry, teleradiology, telepathology, telecardiology, tele respirology, pediatrics, women health, ophthalmology, ENT, emergency response, physiatry, gastroenterology, infertility, dermatology, oncology, palliative care, allergology, rheumatology, and plastic surgery. The advantages of telemedicine such as fast access to care, reduced cost, cutting down on commuting, travelling in bad weather, taking time off from work, need for childcare, immobile patients, remote areas, cultural taboos are also assessed. The disadvantages of telemedicine are mainly present in older population that has less exposure to technology and the concern over data security.
Conclusion In sum, using virtual health care tools and telemedicine we can shorten wait times to see a provider, reduce the risk of community infection, improve training, and expand the range of access to specialists who live further away or need to be consulted for a second opinion
WAL_HUMN1020_03_A_EN-CC.mp4Chapter 8 Telehealth and Applicat.docxcelenarouzie
WAL_HUMN1020_03_A_EN-CC.mp4
Chapter 8 Telehealth and Applications for Delivering Care at a Distance
Loretta Schlachta-Fairchild
Mitra Rocca
Vicky Elfrink Cordi
Andrea Haught
Diane Castelli
Kathleen MacMahon
Dianna Vice-Pasch
Daniel A. Nagel
Antonia Arnaert
Growth in telehealth could result in a future where access to healthcare is not limited by geographic region, time, or availability of skilled healthcare professionals.
Objectives
At the completion of this chapter the reader will be prepared to:
1.Discuss the historical milestones and leading organizations in the development of telehealth
2.Explain the two overarching types of telehealth technology interactions and provide examples of telehealth technologies for each type
3.Describe the clinical practice considerations for telehealth-delivered care for health professionals
4.Analyze operational and organizational success factors and barriers for telehealth within healthcare organizations
5.Discuss practice and policy considerations for health professionals, including competency, licensure and interstate practice, malpractice, and reimbursement for telehealth
6.Describe the use of telehealth to enable self-care in consumer informatics
7.Discuss future trends in telehealth
Key Terms
Digital literacy, 141
Telehealth, 125
Telehealth competency, 131
Telemedicine, 126
Telenursing, 126
uHealth, 141
Abstract
Rapid advances in technology development and telehealth adoption are opening new opportunities for healthcare providers to leverage these technologies in achieving improved patient outcomes. Telehealth provides access to care and the ability to export clinical expertise to those patients who require care, regardless of the patients' geographic location. This chapter presents telehealth technologies and programs as well as telehealth practice considerations such as licensure and malpractice challenges. As telehealth advances, healthcare providers will require competencies and knowledge to incorporate safe and effective clinical practice using telehealth technologies into their daily workflow.
Introduction
Rapid advances in technology development and telehealth adoption are opening new opportunities for healthcare providers to leverage these technologies in achieving improved patient outcomes. Before we discuss these technologies and outcomes, it is important to explore the definitions of telehealth-related terminology.
Telehealth encompasses a broad definition of telecommunications and information technology–enabled healthcare services and technologies. Often used interchangeably with the terms telemedicine, ehealth, or mhealth (mobile health), telehealth is “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration.”1 Telehealth is being used in this text to encompass all of these other terms. Telemedicine is .
Telemedicine is a upcoming topic of interest, especially in pandemic times where remote places cannot be assesed telemedicine is a great oppurtunity in such circumstances.
anesthesia through telemedicine is possible.
Heavily based on a presentation I gave for the CMS 2020 National Quality Forum. Emphasis is on dialysis (particularly home dialysis). Discusses regulatory framework, medical devices used to render the services and outcomes of studies performed to day
This public policy session on the activities of the Technology Association of Louisville Kentucky (TALK) was presented in June 2022 at the TALK Cyber Security Summit in Louisville, KY.
A Look At Evolving Cybersecurity Policy for Financial Institutions 2021Dawn Yankeelov
Dawn Yankeelov, a cyber policy leader in Kentucky, speaks to the changing landscape for banking cybersecurity policy for a SecuretheVillage workgroup in the Summer of 2021.
A conversation on guidance and liabilities regarding reopening KY with Frost Brown Todd Attorney Victor Beckman and the Technology Association of Louisville KY's Executive Director Dawn Yankeelov.
DHS Cybersecurity Services for Building Cyber ResilienceDawn Yankeelov
DHS Cybersecurity Analyst details the US Department of Homeland Security Services for all businesses to build cyber resilience at the Technology Association of Louisville's CyberSecurity Summit on June 14, 2019.
Cyber Security Threats Facing Small Businesses--June 2019Dawn Yankeelov
This presentation was made by Cloudnexus Founder Jay Rollins at the Technology Association of Louisville Kentucky's Cybersecurity Summit on June 14, 2019.
This presentation was given by Security Analyst Josh Chou from Cybereason on June 14, 2019 at the Technology Association of Louisville Kentucky's Cybersecurity Summit.
Cyber Security Resilience from Metro Louisville Govt. Dawn Yankeelov
Metro Louisville's Chief Security Officer James Meece spoke at the Technology Association of Louisville Kentucky's CyberSecurity Summit 2019 in June on Cyber Resilience.
"How You Can Participate in TALK's KY Cybersecurity Enclave for Regional and National Attack Views & Reporting," Phil Bond, CEO of CyberUSA, with Q&A, including Dawn Yankeelov, Executive Director, TALK.
Understanding Cyber Industrial Controls in the Manufacturing and Utilities En...Dawn Yankeelov
"Understanding Cyber Industrial Controls in the Manufacturing and Utilities Environment," By Dr. John Naber, Co-Founder & Partner in True Secure SCADA, which is KY-based and holds 2 key patents in this area. This was given at the TALK Cybersecurity Summit 2018 in Louisville, KY.
Kentucky's Cyber Engineering Pathway for Teens By Scott U'SellisDawn Yankeelov
These slides by Scott U'Sellis of the Kentucky Department of Education, Office of Career and Technical Education, were presented at Techfest Louisville 2017 hosted by the Technology Association of Louisville Kentucky.
This presentation was made on PSST's approach to building the company at Techfest Louisville 2017, hosted by the Technology Association of Louisville Kentucky.
Entrepreneur John Wiliamson presented RCM Brain: AI Bots in Healthcare at Techfest Louisville 2017 hosted by TALK, the Technology Association of Louisville Kentucky.
Cybersecurity Trends & Startups by Gula Tech AdventuresDawn Yankeelov
This presentation was made by Cybersecurity Expert and Investor Ron Gula at Techfest Louisville 2017, hosted by TALK, the Technology Association of Louisville Kentucky.
Derek Rush of LBMC Information Security presented at Techfest Louisville 2017 which was hosted by the Technology Association of Louisville Kentucky (TALK.)
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
2. AIR FORCES REAL
TIME MEDICINE
By Dawn M. Yankeelov
During the past three years, the Air Force has developed a telemedicine capability.
Today, service personnel and their families from Alaska to Bosnia
are benefiting—and the process is just beginning.
A
fter a heavy air attack in a remote telemedicine. A “Star Trek” future of capabilities can be instituted to talk to
overseas location, military ser- medical care delivery, which has arrived specialists on the other side of the ocean.
vicemen are waiting for immedi- on U.S. Air Force bases and other For a modest five figure investment, add a
ate hospitalization. One is experiencing Department of Defense divisions, is put to video camera and high bandwidth with
internal hemorrhaging, another has use. High-tech telecommunications for supporting robotics controls to create real-
crushed bone fragments causing excruci- data transfer and combat control, which time interactive patient management.
ating pain, and still others are experienc- have led the way for high-tech medical This reality-based approach to
ing nausea from unknown chemical solutions, become lifesavers. medicine has not yet actually seen a
warfare. The nearest hospital is more than With a basic PC, a phone line, battlefield situation. However, it has
1,500 miles away.Enter the world of and a modem, simple store and forward entered the lives of thousands of
3. servicemen stationed on Air Force readiness, according to Dr.Benge.On bases
bases in the United StatesTelemedicine everywhere in the U.S., military physicians
training also began in October 1996 in will move to eliminate the need for sub-
Bosnia and Saudi Arabia to serve troops specialists in every location. “This will
already there. downsize the number of people and
The Department of Defense equipment required, avoid costly travel for
first cataloged success with telemedi- patients to the large medical centers, and
cine in 1993 when a serviceman’s save space ultimately,” Dr. Benge said.
severe skin rash wasdiagnosed from For example, digital radiology
Somalia. Doctors were baffled and used eliminates the need for expensive X-ray
telepathology to transmit a mic- film to be stored. Dr. Benge explained,
roscopic image of the rash to a derm- “Tons and tons of equipment, chemicals
atologist at the Walter Reed Army and water could be eliminated for this
Medical Hospital in Washington, D.C. specialty. The space needed to store X-ray
A microscope in Somalia was operated film could be reallocated.”
via computer tomake diagnosis and The environment benefits directly
treatment possible. just in the use of telemedicine in radiology
“Air Force medical services alone,because the U.S. Air Force can
have been involved for the last 3 1/2 eliminate the requirements to reclaim
years in Department of Defense dem- silver ions from water after developing
onstrations, trying t o prove or deter- film. It’s a near instantaneous payoff, Dr.
mine how best to utilize communica- Benge added.
tions for better patient management,” Telemedicine in the Air Force
Dr. Michael James Benge, Director of generally uses an interactive video system
Strategic Man- agement in the U.S. Air integrated with biomedical telemetry,
Force Surgeon General’s Office and except in areas where high bandwidth is
overseer of Air Force medical oper- cost prohibitive. Store and forward
ations,said. “It’s so dependent on image systems, that use “snapshots” instead of
capture. And in the early analysis, it’s real-time television, work as well. They
very profitable for all involved. allow a physician at a specialty medical
Through 2001, telemedicine complex or teaching hospital to examine
training will be completed for combat and treat patients at multiple
4. S POTLIGHTS
satellite locations, such as rural hospitals specialist can review any type of X-ray
and clinics. examination, including an MRI, CAT scan
Integrated into the video system, or ultrasound. Investments in equipment
and based on the requirements of the setup range from $15,000 for storage and
remote medical facility, are a number of forward to $200,000 per site for probes
diagnostic devices. The remotely con- and live television feeds.
trolled examination camera has a power- Telemedicine was unveiled for
ful zoom-focus capability that allows a broad military use in June 1995, when the
dermatologist to examine small details of Pentagon conducted a tri-service exhibit
a patient’s skin. An electronic stethoscope featuring live demonstrations of
permits a cardiologist to do a complete telemedicine in support of day-to-day
cardiological examination. Specific operations. At that time, then Secretary of
camera adapters and resolution capabili- Defense William J. Perry told the Air
ties enhanced by remote controlled optics Force News Service, “Telemedicine is
provides an ophthalmologist a clear view not just a new use of old technologies. It
of the retina at the referring site. A combines cutting-edge telecommunica-
Telemedicine’s enormous potential in the battlefield is demonstrated by this exhibition, in which an
attending physician assists a distant surgeon who uses electro-mechanical manipulators, lights and
television cameras to view the patient, communicate with the on-site physician and actually perform
some of the surgical procedures.
5. A corpsman examines battlefield casualties and prepares to administer first aid in this telemedicine simulation.
His helmet-mounted television camera and voice communications link allow him to transmit real-time images of
the wounds, plus his comments and questions, to a doctor located in a Mobile Medical Mentoring Vehicle, located
several miles from the battle area. Thus, the corpsman does not have to make difficult medical decisions alone.
tions systems with specialized medical equip- services to approximately 1 million people.
ment to project medical care in real-time Capt. Linda Eaton, now in charge of
anywhere in the world.” the fully operational program that began
During one international demonstra- several years ago, outlined the following
tion, doctors at the exhibit consulted via program goals:
satellite with doctors at the Air Force’s 60th • To improve access and quality care
Medical Group Hospital at Zagreb, Croatia, a rural bases;
about previous cases. Doctors also held live • To increase beneficiary and
teleconsultations with medical units in Haiti and provider satisfaction with health care
I Macedonia by satellite. delivery;
• To prepare providers for support of
TRICARE Southwest: An International deployed forces via teleconsulting;
Telemedicine Network • To improve and facilitate cross-
The first successful wide-scale service referrals;and
program implemented in the Air Force was • To be cost-effective or cost-
directed by Capt. Ken Bonner, now of MATMO neutral.
(Medical Advanced Technology Management “A paradigm shift must occur
Office). His success led to his current involve- through telemedicine training. Physicians are
ment with the efforts to set up telemedicine in not up to speed on their thinking about its
Riyadh, Saudi Arabia, where about 7,000 U.S. benefits, but through education the message
troops reside. “The Air Force realizes that you is getting out that this type of support is an
have to move information, not people. The important tool,” Capt. Eaton said.
delivery of quality health care is verbal, textual The plan is to have a telemedicine
and image-based,” Capt. Bonner said. network organized to function as a compre-
The TRICARE Southwest hensive system for the whole region, creating
Telemedicine Pilot Project is an approved a “virtual health care delivery system.” The
Department of Defense, Health Affairs (MHSS newly embraced technologies include digital
Proponent Committee), proof-of-concept compression, store and forward, automated
project initiated in Region VI. The region medical records, video e-mail and computer
covers Oklahoma, Arkansas and major portions networks. OC-3, DS3, and T1 bandwidth on
of Eastern Texas and Western Louisiana. The demand technology, coupled with the
Department of Defense medical plan in this DICOM standard for medical information
region is centered around two military medical interchange, supports the multimedia mix
centers-Wilford Hall Medical Center and necessary for gathering and analyzing
Brooke Army Medical Center. They provide information.
6. For example, doctor-to-doctor added. “The only difference is that you Dr. Reed oversees a pilot project
contact includes the transmission of can’t actually touch the patient.” between Offutt AFB in Nebraska and
medical records, transmission of medical The teleradiology and the Whiteman AFB in Knonoster, Mo. “We
images, video consultations and rules- telepathology system were the most are trying to help smaller facilities, like
based messaging. Doctor-to-patient supported at the program’s outset. At Whiteman, with low bandwidth to
contact includes remote patient monitor- Wilford Hall, eight telemedicine stations examine snapshots and answer ques-
ing, delivery of health information and have been established. Brooke Army tions,” Dr. Reed said. “You can’t make the
video consultations. Medical Center has a central suite and physician transmit. We haven’t gotten
Military treatment facilities telemedicine sites in cardiology, dermatol- over that speed bump. Physicians are not
involved with the TRICARE implementa- ogy, ophthalmology, surgery and pediat- used to using the technology. Our energy
tion include Corpus Christi Naval Hospital rics. Other specialists who have conducted of activation needs to be here to achieve
in Corpus Christi, Tex., Goodfellow Clinic telemedicine consultations from Wilford total success. The next generation of
in San Angelo, Tex., Dyess Hospital in Hall represented endocrinology, gastroen- doctors will be ready.”
Abilene, Tex., Ft. Polk Hospital in terology, ophthalmology, rheumatology The program’s first four months
Leesville, La., and Laughlin Hospital in and urology. When expanded to all the involved fewer than 50 patients but
Del Rio, Tex. Between 50-100 patients per region’s military installations, the proved the system’s premises. Total
month stand to be served by telemedicine TRICARE project could become the savings can climb well into five-figure
at each facility. Full program implementa- largest telemedicine network sums per specialty, according to military
tion is to occur in late 1997. “The patients models for Offutt AFB and Whiteman
seem to accept the technology. In most Air Force Surgeon General’s Office, AFB.
cases, they see a specialist on the screen Air Combat Command, Langley, VA Dr. Reed notes that telemedicine is
talking with them and the attending “Everyone thinks that the particularly useful for dermatologists and
physician,” Capt. Eaton said. “Downtime standard “Star Trek” real -TV transmis- ophthalmologists—an important point with
and costly travel is avoided. A typical sion approach is the only way to go, but the emphasis on eyesight for Air Force
specialist may be booked two to four we are using email and digital cameras to pilots, and the ongoing threat of chemical
weeks in advance. This changes the time do telemedicine. With essential ISDN and biological weapons in the Middle East.
frame in favor of the patient.” connections, we use store and forward “You don’t need video of retinas or ear
“All patients I’ve worked with capabilities to get the job done,” Lt. Col. drums or skin rashes. Photos work. Listen-
think it’s a great idea, “ Lt. Col. Dr. Gary Dr. Hadley Reed of Air Combat Com- ing to a heartbeat can also be had by email.
Gronseth, a Wilford Hall neurologist, mand said. An audio clip, for example,” he said.
7. TELEMEDICINE ... video teleconferencing suites at the five
Mental health patients can also primary medical sites in Alaska, even
be evaluated through telemedicine. “In the long-distance physical therapy manipula-
past, as much as three days would be lost tion and teledentistry were introduced.
to travel to see if a patient would require Real-world use included an oral surgeon
hospitalization through a psychiatric wanting the advice of an orthodontist
evaluation,” Dr. Reed said. before operating, a preoperative evalua-
Dr. Reed sees widespread tion for wisdom teeth extraction and a
implementation of telemedicine in the periodontic evaluation for gum disease
U.S. Air Force within 5-10 years. “People and treatment. “Over the first nine
do not realize that disease and non-battle months, 31 dental consults were per-
injuries are more of a concern in warfare. formed, saving more than 190 days and
Telemedicine can give near instantaneous $40,000 in travel expenses,” Col. Fred
tracking of the health of a force, if used Nolan, Jr. said.
efficiently.” Equipment choices supported the
use of low bandwidth, since high band-
3rd Medical Group, Elmendorf Air width circuits at 1.54 mbps and ISDN
Force Base, Anchorage, Alaska were not available. A pair of switched 56
In Alaska, telemedicine may Kbps data circuits was installed at each
serve approximately 40 percent of the location. The CLI Eclipse 8100 Model
population in the near future, since the was selected for video teleconferencing at
Department of Defense administers the 15 frames per second with full duplex
health care of active military, retired audio. The need for store and forward
military and dependents through an became apparent early in 1996, so
intricate partnership. Capt. Greg D. software and hardware under the name
Carson, clinical systems engineer for MD/TV was selected. An object camera
telemedicine in Alaska, claims tremen- was also available at all locations.
dous program success. “The reduced Col. Nolan reports that emer-
patient travel to Elmendorf from four gency orthopedic care has worked out, as
other program nodes is particularly in the case of a patient who had fallen on
welcomed based on the weather the duty, fracturing his little finger. There was
military faces here, in addition to the a question handled via telemedicine as to
distances between medical clinics,” he whether surgery would be required. “The
pointed out. human response to telemedicine in Alaska
The other Alaska sites involved has been very positive. Providers do
are Adak Clinic at Adak Naval Station, describe the need to reach out and touch
Kodiak Clinic at the U.S. Coast Guard the patient, but go on to state they put
Station in Kodiak, Eielson Clinic at their hands in their pockets. The initial
Eielson AFB, and Bassett Army Hospital shyness disappears quickly and the face-
at Ft. Wainwright. Involved with the DoD to-face relationships become a strong
healthcare initiative in the winter wonder- point,” he said.
land are Veterans Affairs and the Indian
Health Service. Overseas and Beyond
Air evacuations, particularly in Well into 1997, telemedicine will
Alaska, often may be risky, delaying become an integral part of the military
access to critical care or preventing it presence overseas, starting in Saudi
altogether. The state comprises 25 percent Arabia. Next, up to nine clinics will be
of all U.S. Iand acreage and covers the outfitted in nearby Kuwait, Oman and
same north-south distance as the entire Bahrain, at a cost of $50,000 per installa-
lower 48 states. It presents a challenge to tion.
provide specialty medical professionals INMAR-SAT-based systems,
from the 3rd Medical Group to Adak which can be set up anywhere, will
Clinic, at the Adak Naval Station some represent Phase II for DoD supporting the
1,500 miles away. Located in the Aleutian U.S. efforts in Bosnia. “People have not
Islands, Adaks NAS is the most remote put telemedicine into enough peacetime
site in the network. Meanwhile, the Coast care yet. We need to get our people into
Guard clinic on Kodiak Island is an air using this on a daytoday basis,” Dr.
flight from Anchorage, subject to extreme Benge, who oversees the ongoing
weather conditions, and is a free-standing telemedicine launch in the U.S. Air Force,
family practice clinic. said. “Telemedicine is very glamorous,but
With dedicated data circuits (56 it is still a concept trying to size itself and
Kbps), store and forward technology, and find itself, in terms of applications.”