Army's Iraq mental telehealth pilot slow to ramp up

By Peter Buxbaum
11:22 AM

A pilot program the United States Army has introduced to the Iraq theater to allow soldiers to consult remotely with psychiatrists, a key component in a comprehensive behavioral health care campaign, is taking time in getting off the ground.

The video teleconferencing system has not as yet received widespread acceptance by clinicians. But one Army reservist who has tried it, Virginia psychiatrist Lt. Col. Rafael Semidei, said it allows him to see more patients and reduces the danger and time involved traveling to and from remote locations.

"Not many providers have jumped at the chance to test the new system," said Semidei. "Providers are typically hesitant to implement new systems or processes. We like proven solutions."

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The pilot is part of the Army's Tele-behavioral Health Initiative, started in 2010, which is focused on improving access by widely dispersed warfighters to scarce behavioral health personnel in theater. The Army hopes tele-health will optimize the ability of behavioral specialists provide services and allow the Army to work with a smaller footprint of behavioral health personnel on the ground.

Semidei, who has previously participated in stateside video teleconferencing, has found that the system extends his reach as a physician.

Warfighters "from remote locations require days to travel to and from appointments," he said. "Travel time depends upon convoys and the ability to secure air transportation. This is a significant loss of man-hours. I now see more patients and spend less time traveling to and from locations."

While the learning curve to use the system is not great, it does take some getting used to, according to Semidei.

"Providers need to exude a little more effort to develop a relationship and bond with a patient," said Semidei. "They also should exaggerate body motions on camera to affirm a patient's comments, such as nodding more or repeating statements."

The system is also slowed by audio and video transmission delays.

"The dialogue isn't as natural as it would be with in-person consults," said Semidei. "You have to wait a little longer to make sure patients finish their thoughts."

Most health care providers Semidei has spoken to would rather see patients face-to-face.

"Remote consultations may not be appropriate for every medical discipline," he said, "but it is a tool to offer services to service members at remote locations where providers do not have a permanent presence."

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