Q&A: Telemedicine in the Theater of War

By Tom Sullivan
04:26 PM

Imagine your marching orders are to link networking and telepresence across a wide array of hardware platforms and software applications to enable telemedicine with both voice and visual capabilities as far forward as possible into the remotest battlefield regions in Iraq and Afghanistan. 

Well, that’s only part of what LTC William Geesey and The U.S. Army’s Medical Communications for Combat Casualty Care (MC4) unit are doing. The pieces already include telesurgery and telebehavioral health services. Geesey spoke with Government Health IT Editor Tom Sullivan about what MC4 has accomplished to date, and what it is looking to achieve in the near future.

Q: In what ways has telesurgery been successful thus far?

A: We have a telesurgery pilot by LTC Dr. Sloane Guy in which he performed a very complex surgery for a rare malady. He was unfamiliar with how to perform that surgery, so he actually received live consultation from Brooke Army Medical Center. He performed live surgery and in that case was able to save the patient’s life.

Q: What technologies make that possible?

A: Telesurgery is a complex setup that has a high-resolution camera over the operating table to allow the remote physician to look down into the surgery field. It also provided a TV screen capability where the image of the surgery field was projected on the television and the remote physician was able to draw with a marker pen and say, “You see this point right here?” And the local physician was able to say, “Yes, I see that.” “Okay, cut here,” or do this. We have (a lot of) equipment, high-bandwidth requirements to move sharp, crisp images of the surgical field.

Q: Is that telemedicine suite completed?

A: It’s in development. We have not fielded it Army-wide. What we’ve done is actually sent that particular setup after it was used for telesurgery to a physician that wanted to be able to reach out on burns. With IEDs (Improvised Explosive Devices), a lot of soldiers are burned very badly so they want to be able to reach out to the burn center back at Brooke Army Medical Center, the Institute of Surgical Research to talk with burn specialists there to better manage burns in theater. It’s sort of been an ad hoc capability; what we’re looking to do is make it a permanent capability so any time a combat support hospital deploys in theater they will have the capability already up in the operating room or maybe in some clinic areas to support whatever it is that they want to do.

Q: MC4 has also had success with telebehavioral services?

A: The initiative that we’re doing in Iraq and Afghanistan now, in which a mental health expert is able to reach out to a soldier at a remote site who otherwise wouldn’t be able to see a behavioral health specialist without traveling on the roads, which is very dangerous, or flying which can be very dangerous. They can reach out and do a medication consultation or a behavioral health consultation. Of the several hundred telebehavioral consults that we’ve done, over 70 percent of them would not have been conducted without the capabilities. So that means 70 of every 100 patients probably would not have been seen by a mental health provider. We’ve been able to extend that physician’s reach out to the most forward parts of the battlefield.

Q: I’ve read a little bit about the Army using commercial technologies, such as smarthpones, tablets, and a hands-free EHR. How do those fit into the telemedicine strategy?

A: Where we are today is we have a device out there, it’s pretty large, about the size of a brick. It really adds to the load of the soldier. So we’re looking at smaller, lighter-weight devices and commercial devices like the Droids and iPhones to leverage existing commercial technologies. Rather than I as a program manager going out and fielding a device, and another program manager going out and fielding a device that has mapping on it, and another PM fielding a handle with language interpreters where I’m speaking in English and it comes out in the other person’s language on the other side, what the Army is looking at – and of course it makes sense in light of the current budget situation and the taxpayer – is to identify a singular handheld mobile device that will become the Army’s platform that they will issue to soldiers, and our goal is to then put our capability onto whatever that device is.

Right now, mostly squad leaders have a radio and then they have some sort of microphone. What we then envision is using noise-canceling technologies and speech-to-text technology to leverage the radio on the soldier. When combat medics go through EMT training and when they’re tested for an EMT license, they physically put their hands on a patient and talk through what they’re doing. “Okay, I’m now checking to see if the patient has a pulse.” Or “I’m checking to see if the patient is bleeding.” Basically, the way that they’ve been trained as a combat medic they continue to speak out what they’re doing, so if you translate that speech to text, you can insert it into patient medical records. And the electronic medical record that’s documented at the point of injury through all of the care in theater is to become part of the soldier’s EHR that is supposed to follow them throughout their career.