Establishing an Army Medical Department’s Regional Medical Command’s TeleTBI Network

Military Relevance

Recent wars have generated many patients who have incurred a Traumatic Brain Injury to such an extant that it is now become known as the wars’ signature injury. Once the military patients return to their duty stations, medical treatment facilities or homes the challenge becomes gaining access to care and to the appropriate specialists as soon and as often as necessary. Many of these patients reside great distances from the medical facilities that have the necessary specialists and equipment to treat their TBI conditions and are often not in condition to drive themselves. One way to meet these challenges is to establish an infrastructure of tele-medicine equipment and personnel in locations where the patients reside and within the distant medical facilities where the appropriate medical specialists are located. Following the establishment of this Army-wide personnel and equipment infrastructure it is anticipated that we will have quicker access to care, reduced patient travel time to and from medical facilities, as well as reduced medical specialists travel time to remote areas, decreased referrals outside the local medical facilities, and greater patient satisfaction.

Background and History

A U. S. Army-wide telemedicine network has been enlarged to meet the evolving clinical needs of a geographically dispersed military population. Five regional medical commands spanning 14 time zones – from American Samoa to Germany – were identified and personnel and equipment needs procured based on clinical needs. In phase 1, a centrally managed regional Management Teams (thirteen people in total) consisting of a tele-TBI program manager, clinical and technical advisors were put in place at the five Regional Medical Commands to help build their programs and develop policies and procedures. Site surveys, clinical, technical and administrative assessments were conducted for all five Regional Medical Commands. Over sites have been equipped with VTC equipment and it is estimated that this number will increase to over eighty in the coming months. Over fifteen different medical disciplines conducted telehealth encounters. As of September 2009, greater than 17,000 behavioral telehealth and tele-neurosurgery encounters were conducted in fiscal year 2009. It is anticipated that we will see a dramatic increase in telehealth encounters in 2010 for other clinical disciplines as we augment the current medical treatment facilities (phase 2) with sixty-three additional clinical, administrative and technical personnel. Tele-consultation clinical models such as behavioral health, neurosurgery, headache evaluation, neuropsychology, speech and language pathology were established and others such as, orthopedics and neurology are being developed. The neurosurgery tele-consultation program return on investment alone was over two million dollars in 2009. Telemedicine increased access to care, reduced patient and specialist travel, decreased lost work times, returned money to the medical command by avoiding clinical referrals to the civilian sector and was widely accepted among the patient population. We have initiated the documentation of metrics such as, the number, type and location of telehealth encounters; cost avoidance by conducting a telehealth visit verses a face to face visit, as well as solicited qualitative metrics. As with any new initiative we have witnessed early successes and challenges in terms of acceptance and establishing these programs from scratch in most regional medical commands. We are committed to share lessons identified across the Army Medical Department with all regional medical commands and to continue to work closely with the Army Surgeon General’s Post Traumatic Stress and Traumatic Brain Injury Behavioral Health Integration (PTBI) team.