Comfort seeks an upgrade

By Peter Buxbaum
01:41 PM

The United States Navy's Fourth Fleet plies the waters of the Caribbean and the South Atlantic, securing international trade lanes and looking out for potential security threats.

But the Fourth Fleet also heads up an ongoing series of medical missions known as Continuing Promise. The next chapter in that saga begins early this year when the hospital ship USNS Comfort begins calling on Central and South American port cities, providing services to locals ranging from vaccinations and dental care to nutritional advice and plastic surgery. Goals of the mission include building host nation capabilities and relationships with local medical infrastructures.

The mission is committed to bringing First Worldmedical care to these developing countries, said Capt. James Terbush, the Fourth Fleet's Command Surgeon. But Continuing Promise has found it difficult to get outfitted with the latest Department of Defense patient tracking and electronic record technologies. Past naval medical missions have also been criticized for failing to exploit the possibilities of telemedicine.

Individual data has been recorded on "old-school" Scantron forms, such as those used for standardized scholastic tests, on which circles are darkened with pencils to record vital signs and symptoms.

"Those are fed into a Scantron reader so that we can look at the data and work with it," said Terbush. Summary and individual medical data are provided by the missions to host countries.

Terbush is pushing to correct these shortcomings. "In the past missions have used pen and paper" to record medical encounters and to accumulate data, said Terbush, "but some new technologies could be incorporated" in the upcoming mission.

Terbush is considering running the Joint Patient Tracking Application (JPTA) on Continuing Promise 2010. JPTA is a Web-based system originally developed by the U.S. Northern Command for tracking evacuees. It has since been supplanted in theater by the Theater Medical Information Program (TMIP), a suite of software tools fielded by the Army's Medical Communications for Combat Casualty Care (MC4) program that supports battlefield clinical documentation and health surveillance, as well as tools to track patients, supplies and equipment.

Terbush is also considering broadening its international outreach through the more dedicated use of telemedicine technologies.

Past Navy medical missions "have not taken full advantage of telemedicine," said Dr. S. Ward Casscells, former assistant secretary of defense for health affairs who is affiliated with the Universityof Texas. "I pushed them hard when I was assistant secretary and I'm still prodding them" to do more.

"That is where we are headed," said Terbush.

In one case, the Fourth Fleet is working with the Foundation for the Advancement of Children's Esthetics (FACE), a Jacksonville, Fla.-based nongovernmental organization that provides fellowships to Salvadoran surgeons for training on reconstructive facial surgical techniques.

"The concept is to build a telemedicine network between FACE headquarters and facilities in Latin Americato provide real-time consultations, supervision, and oversight for facial plastic surgery procedures," said Terbush.

Terbush has applied to the Army's Telemedicine and Advanced Technology Research Center (TATRC) for financial support of such a project, but to date, TATRC has been non-committal. "We are in preliminary discussions," said Col. Ron Poropatich, TATRC's deputy director, "but have not committed to supporting this project yet."

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