Telemedicine in the Battlefield - October 25, 2011 - ISC 310 - 801 - 2

Telemedicine in the Battlefield: 

Telemedicine in the Battlefield The History, Present and Future of Telemedicine in the Battlefield By : Mary Boyd November 16, 2011

“A Brief History of Telemedicine”: 

“A Brief History of Telemedicine” “1964: Under a grant from the U.S. National Institute for Mental Health (NMH), the Nebraska Psychiatric Institute began using a two-way closed-circuit TV link between the Institute itself and Norfolk State Hospital about 112 miles away. “ “1967: A medical station was established at Boston's Logan International Airport and linked to Massachusetts General Hospital (MGH), miles away within the city of Boston.” “1971: The U.S. National Library of Medicine's Lister Hill National Center for Biomedical Communication chose 26 sites in Alaska to verify the reliability of telemedicine via satellite communications. “ “1972: NASA began trial runs of its Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC) program for telemedical help for people living in remote locations with little or no medical services, like Arizona's Papago Indian Reservation. The program lasted until 1975.”

“A Brief History of Telemedicine” (Cont.): 

“A Brief History of Telemedicine” (Cont.) “1972: The Health Care Technology Division of the U.S. Department of Health, Education and Welfare (HEW) funded seven telemedicine research and demonstration projects: the Illinois Mental Health Institutes in Chicago, Ohio's Case Western Reserve University in Cleveland, Massachusetts' Cambridge Hospital, Illinois' Bethany/Garfield Medical Center in Chicago, Minnesota's Lakeview Clininc in Waconia, Dartmouth Medical School's INTERACT in Hanover, N.H., and the Mount Sinai School of Medicine in New York City. The next year, the U.S. National Science Foundation (NSF) funded two more telemedicine projects: the Boston Nursing Home project for geriatric patients, and the Miami-Dade project between Florida's Dade County and Miami's Jackson Memorial Hospital. “ “1977: Canada's Memorial University of Newfoundland participated in a Canadian Space Program for distance education and medical care, using the joint Canadian/U.S. Hermes satellite.”

“A Brief History of Telemedicine” (cont.) : 

“A Brief History of Telemedicine” (cont.) “1984: The North-West Telemedicine project was set up in Australia to pilot test the Australia government's Q-Network satellite communications network.” “1989: After a massive earthquake hit the Soviet Republic of Armenia, the U.S. offered the Soviet Union, under the auspices of the U.S./U.S.S.R. Joint Working Group on Space Biology, use of a one-way international telemedicine network for consultations between Yerevan, Armenia, and four medical centers in the U.S. The Space Bridge program was later extended to Ufa, Russia.” “A Brief History Of Telemedicine”: Roger Allan June 29, 2006” (Roger Allan is a 42-year electronics journalism veteran, and served as Electronic Design's Executive Editor for 15 of those years. He is also a Life Senior Member of the IEEE and holds a BSEE from New York University's School of Engineering and Science. His specialties include MEMS and nanoelectronics technologies.) http://electronicdesign.com/article/components/a-brief-history-of-telemedicine12859.aspx

“Battlefield Telemedicine” : 

“Battlefield Telemedicine” Link to a video that gives a brief description of the use of telemedicine in the battlefield. http://www.youtube.com/watch?v=-arf4VjToDA Retrieved Nov. 15, 2011 Uploaded by UNMCEDU on Sep 16, 2011

: 

Joint Theater Trauma Registry (JTTR) “Joint Theater Trauma Registry (JTTR) is a data repository that collects and hosts all DoD trauma-related data. JTTR is used to document and provide timely information on care and outcomes of military and civilian trauma patients at follow-on medical facilities.” “Key Capabilities Creates a research strategy that supports reduction of morbidity and mortality in military and civilian trauma patients Establishes and maintains a trauma-outcomes database to analyze and evaluate clinical decision-making and measures subsequent outcomes for improving treatment modalities Provides activities of each service with full and complete access to data in the DoD Trauma Registry Features a store and forward component that can function in low/no communications environments” Battlefield medicine and the urgency to save Soldiers April 26, 2011 By Paul Boyce (Paul Boyce works for U.S. Army Forces Command Public Affairs). MHS Military Health System - U. S. Department of Defense – Defense Health Information Management System http://www.army.mil/article/55508/battlefield-medicine-and-the-urgency-to-save-soldiers/

“Implementing the Theater Medical Information Program During Operation Iraqi Freedom”: 

“Implementing the Theater Medical Information Program During Operation Iraqi Freedom” “1999, Congress mandated that the Department of Defense (DOD) develop a system for collecting, storing, and tabulating medical data for all service personnel in an electronic health record (EHR). In response, DOD created the Composite Health Care System II (CHCS2) (recently renamed the Armed Forces Health Longitudinal Technology Application [AHLTA]). In 2003, a version of that system, the CHCS2–T (Theater), was introduced on the battlefields of Operation Enduring Freedom and Operation Iraqi Freedom. The goal of CHCS2–T is to provide commanders the medical surveillance and monitoring capabilities they need to evaluate force health protection needs. The use of CHCS2–T on the battlefield provides a comprehensive, historical, durable medical record for each warfighter encompassing all of his medical encounters.” by Lieutenant Colonel Mark L. Higdon Army Logistician – Professional Bulletin of United States Army Logistics http://www.almc.army.mil/alog/issues/JanFeb07/medinfo_oif.html

TMIP is the military’s answer to the need for a fully computerized medical health record for all Soldiers that is comprehensive and easily transferable from peacetime to combat operations. “Implementing the Theater Medical Information Program During Operation Iraqi Freedom” by Lieutenant Colonel Mark L. Higdon http://www.almc.army.mil/alog/issues/JanFeb07/medinfo_oif.html : 

TMIP is the military’s answer to the need for a fully computerized medical health record for all Soldiers that is comprehensive and easily transferable from peacetime to combat operations. “Implementing the Theater Medical Information Program During Operation Iraqi Freedom” by Lieutenant Colonel Mark L. Higdon http://www.almc.army.mil/alog/issues/JanFeb07/medinfo_oif.html

“This chart shows four TMIP data systems and the echelons of care for which each is used.” by Lieutenant Colonel Mark L. Higdon Army Logistician – Professional Bulletin of United States Army Logistics http://www.almc.army.mil/alog/issues/JanFeb07/medinfo_oif.html : 

“ This chart shows four TMIP data systems and the echelons of care for which each is used.” by Lieutenant Colonel Mark L. Higdon Army Logistician – Professional Bulletin of United States Army Logistics http://www.almc.army.mil/alog/issues/JanFeb07/medinfo_oif.html

Battlefield Medical Information System – T : 

Battlefield Medical Information System – T “Two significant problems arose from this initial proposal: 1. BMIS-T software was not complete enough to allow for the creation of the full documentation required for the description of the resuscitation phase of trauma care. 2. The BMIS-T application design was directed to medics in the battlefield” The C.A.R.E. system creates detailed physician and nurse documentation and generates data for billing, administrative and research purposes. Nearly 70% of the data elements entered into the trauma registry are captured through the C.A.R.E. documentation processes at the point-of-care. After it was determined that BMIS-T would not meet the documentation demands required in resuscitation, efforts began to develop a system that integrated the mobility of the BMIS-T system with the documentation flexibility offered by the C.A.R.E. system. This required BMIS-T to reach a level of application development and software architecture so that members of the Ryder Trauma Center information systems development team could integrate the application. Availability of software at that level occurred in May 2005. Since that time, Ryder personnel have been studying the BMIS-T application for integration purposes“ “Field Testing of the Battlefield Medical Information System –Telemedicine” 01-12-2005 by: Jeffrey S. Augenstein, M.D., Ph.D., F.A.C.S.

Present: 

Present I contacted Dr. Augenstein for an interview if possible and he responded. When asked about the results of the testing of the BMIS-T for use in the battlefield, he stated, “That actually was the starting point for a number of things that the military did, it never really went anywhere, and so we’ve kind of replaced what we missed was with our own software that we call Mobile C.A.R.E. ” “And Mobile C.A.R.E. is, you know, this integrated approach; you can use it through your cell phone, like iPhone or ipad and it literally has all the pieces on it; the education, the documentation, it alerts you when you have something you need to know about one of your patients; and it can be a… telemedicine connection.” “…in the military there’s been a lot of push back because, you know, it’s just too tough to do what you need to do, so we kind of built a front-end to the medical record that’s a little easier to use, and it sends the information into the, you know, record and gets information, and it makes it a whole lot easier.” Telephone interview: (Nov. 15, 2011 – 2:18 pm) Field Testing of the Battlefield Medical Information System –Telemedicine ( 2005) by; Jeffrey S. Augenstein, M.D., Ph.D., F.A.C.S. Professor of Surgery; Director, William Lehman Injury Research Center; Director, Medical Computer Systems Laboratory; Medical Director, Trauma Intensive Care Unit Ryder Trauma Center | 1800 N.W. 10 th Avenue, Ste. T235 | Miami, FL 33136

Latest News: 

Latest News Recently Dr. Jeffery Augenstein, among others, was mentioned in a newsletter on Veteran’s Day November 11, 2011 from University of Miami Miller School of medicine, and it states, “In marking the 10th anniversary of the Army Trauma Training Center at UM/Jackson’s Ryder Trauma Center, the only Army training center in the nation for our armed forces care providers, which has trained more than 90 surgical teams heading to Iraq and Afghanistan, the U.S. Army last month recognized the contributions of our faculty. Kenneth G. Proctor, Ph.D., professor of surgery, anesthesiology and biomedical engineering, and Jeffrey Augenstein, M.D., Ph.D., professor of surgery and director of the William Lehman Injury Research Center, received Commander’s Public Service Awards for improving medical outcomes for soldiers and others wounded in war zones.” Message from the Dean: Veterans Day Date: Friday, November 11, 2011 8:26:07 AM

From the University of Miami Miller School of Medicine: 

From the University of Miami Miller School of Medicine “LTC George D. Garcia, M.D., assistant professor of surgery and director of the ATTC, presented Proctor and Augenstein with the Commander’s Public Service Award for providing important trauma research to the U.S. Department of Defense and for helping to establish the curriculum for the Forward Surgical Teams that train at Ryder before deploying to Iraq and Afghanistan. Proctor was recognized in particular for developing a “premiere mass casualty training exercise” that has greatly enhanced the life-saving capabilities of the surgical teams, and Augenstein for being “instrumental” to the overall success of the ATTC.” ““It is no exaggeration that each and every one of you has had a direct impact on an incalculable number of wounded warriors over the last ten years. There are no words to express the depth of gratitude and appreciation for the part you have played.’’” Stated LTC George D. Garcia - Army Trauma Training Center Marks a Decade by Thanking Miller School Life-Savers 10-11-2011 http://sz0024.ev.mail.comcast.net/service/home/~/Army%20Trauma%20Training%20Center%20Marks%20a%20Decade%20by%20Thanking%20Miller%20School%20Life-Sa.pdf?auth=co&loc=en_US&id=170860&part=4

Future ?: 

Future ? What is in the future for telemedicine in the battlefield? Military Dog Tags have changed since first implemented “Future: With the advent of microchip technology , the Army is testing an identification tag that contains a chip with most of a soldier's personal information programmed into it. These tags could then be scanned to obtain the information.” By Marshall Moore http://www.ehow.com/facts_6927006_purpose-military-identification-tags.html Will the military make implantable medical ID chips mandatory for our troops, possibly. Would this help medical teams, yes. Will it be considered an invasion of privacy, also possible. Will civilians be next? Only time will tell. Implantable Medical ID Approved By FDA By Rob Stein Washington Post Staff Writer Thursday, October 14, 2004; Page A01 “A microchip that can be implanted under the skin to give doctors instant access to a patient's records yesterday won government approval, a step that could transform medical care but is raising alarm among privacy advocates. The tiny electronic capsule, the first such device to receive Food and Drug Administration approval, transmits a unique code to a scanner that allows doctors to confirm a patient's identity and obtain detailed medical information from an accompanying database.” http://www.washingtonpost.com/ac2/wp-dyn/A29954-2004Oct13?language=printer

References: 

References Army Trauma Training Center Marks a Decade by Thanking Miller School Life-Savers - LTC George D. Garcia – 10-11-2011 http://sz0024.ev.mail.comcast.net/service/home/~/Army%20Trauma%20Training%20Center%20Marks%20a%20Decade%20by%20Thanking%20Miller%20School%20Life-Sa.pdf?auth=co&loc=en_US&id=170860&part=4 Retrieved Nov. 15, 2011 Battlefield medicine and the urgency to save Soldiers April 26, 2011 By Paul Boyce MHS Military Health System - U. S. Department of Defense – Defense Health Information Management System http://www.army.mil/article/55508/battlefield-medicine-and-the-urgency-to-save-soldiers Retrieved Nov. 14, 2011 Battlefield Telemedicine Uploaded by UNMCEDU on Sep 16, 2011 http://www.youtube.com/watch?v=-arf4VjToDA Retrieved Nov. 15, 2011 A Brief History Of Telemedicine : Roger Allan June 29, 2006” http://electronicdesign.com/article/components/a-brief-history-of-telemedicine12859.aspx Retrieved Nov. 15, 2011 Field Testing of the Battlefield Medical Information System –Telemedicine by; Jeffrey S. Augenstein, M.D., Ph.D., F.A.C.S. Jan. 12, 2005 http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA449980&Location=U2&doc=GetTRDoc.pdf Retrieved Oct. 3, 2011. Telephone conference call – Nov. 15, 2011 2:18 pm Implementing the Theater Medical Information Program During Operation Iraqi Freedom by Lieutenant Colonel Mark L. Higdon, JanFeb 2007 Army Logistician – Professional Bulletin of United States Army Logistics http://www.almc.army.mil/alog/issues/JanFeb07/medinfo_oif.html Retrieved Nov. 15, 2011