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Home/Magazine Archive/March 2000 (Vol. 43, No. 3)/On Site: Using Telemedicine in the Department of Defense/Full Text
Communications of the ACM
On Site: Using Telemedicine in the Department of Defense
In order to meet increasing global crises, the U.S. military must find ways to more effectively manage manpower and time. Joint Medical Operations—Telemedicine (JMO-T) was developed by the Department of Defense to collect and transmit near-real-time, far-forward medical data and has been successful in resolving uncertain organizational and technological military deficiencies, improving medical communications and information management. Deployable, mobile telemedicine teams are the centerpiece of JMO-T. These teams have the capability of inserting essential networking and communications elements into austere theaters, establishing an immediate means for enhancing health protection, collaborative planning, situational awareness, and strategic decision-making.
JMO-T technology initiatives utilize these dedicated, small mobile teams with a sophisticated IT infrastructure to provide telemedicine capabilities where needed in the medical battlespace. This IT infrastructure includes medical equipment sets that use digital capture devices such as digital cameras, digital scopes, digital blood and urine laboratories, physiological monitors, advanced digital radiography, and digital ultrasound. JMO-T software, such as the Pacific Virtual Health Care System, offers electronic medical record archiving capability, enables automated, standardized teleconsultation by forward medics to higher-echelon physicians.
A suite of software, databases, and architecture standards were adapted to provide deployable medical information management. The Theater Medical Core Service is a database that stores data locally and is capable of sending encrypted email to several redundant database servers via store-and-forward. The database servers aggregate information and store it in databases for distribution. Web servers supply data to medical personnel as customized encrypted reports.
The Medical Workstation (MeWS) is a network-based workstation equipped with portable medical devices, clinical support capabilities, medical information support, and a graphical user interface. The MeWS supports multipatient monitoring, patient record interfacing, and provides access to a searchable database. It also provides a personal information carrier (PIC) with read-and-write implementation. The MeWS collects, stores, and forwards medical device data and images. By utilizing the Global Positioning System, the MeWS has the capability to enter patients' geographical locations. Various software components of the MeWS help facilitate clinical data entry, acquisition and retrieval. The MeWS enable the generation of medical facility status reports, the monitoring of disease surveillance, the updating of supplies, and tracking of evacuation requirements.
The Field Medical Surveillance System (FMSS) is an expert system that systematically detects and monitors epidemiological trends and profiles patient populations. FMSS integrates patient information to the Global Infectious Disease and Epidemiology Network (GIDEON) knowledge base. Demographic and symptomatic information is used to arrive at a presumptive diagnosis or classify the patient using discriminate analysis. FMSS is also capable of providing incidence and prevalence trends for infectious diseases.
The Libretto, a commercial off-the-shelf handheld computer, has the capability to automate field medic PIC card software by reading service member's demographic information from the PIC into the software. It can also write GPS medical encounter information to the PIC and store the information as a preformatted message for transmission.
Telemedicine teams have the capability of inserting essential networking and communications elements into austere theaters, establishing an immediate means for strategic decision-making.
Tactical medical communications require updating the existing IT infrastructure. JMO-T hardware, software, and interfaces were implemented in order to enable this change and facilitate the transmission of medical-unique information over the existing communications hardware and command, control, communication, computers, intelligence, surveillance, and reconnaissance networks. However, telecommunications from the operational area of responsibility to the medical sustaining base is through the existing Defense Information Systems Network.
JMO-T technologies have been assembled into an exportable capability specifically tailored to meet the medical information management and IT needs of the unit it is supporting. This assemblage of technologies is referred to as the "capability package." The capability package must work in concert with the unit's infrastructure, communications, tactical situation, and logistical constraints if the military is to realize its full potential in meeting today's global crises.
In summary, telemedicine effectively reduces the amount of people and equipment necessary during times of war in combat areas by utilizing distributed computing power, human expertise, and connectivity to provide medical care throughout the world. During peacetime, telemedicine is critical in maintaining the health and readiness of the U.S. military forces, so they can provide real-time responses to disasters. Telemedicine is helping the joint armed forces meet global crises at the speed of thought.
Figures
Figure. Left: A soldier using the JMO-T end-user terminal with a WaveLan card. Right: A closer view of the Libretto 110C2 handheld computer.
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