Army examines telemedicine

Walter Reed officials said the system eliminates problems associated with sending and
reviewing medical images and data via desktop computers.


Previously, telemedicine systems offered limited clinical applications and had high
transmission costs, said Col. Edward Gomez, chief of vascular surgery at the Washington
Army hospital.


Using commercial software, Walter Reed doctors can transmit X-rays and patient medical
records during videoconferences that let doctors at different hospitals conduct
cost-effective diagnostic consultations. Walter Reed is testing the system in a controlled
clinical trial as part of a first-ever study of desktop telemedicine technology in a
neonatal acute care setting, Army officials said.


The experiment, which includes the pediatric surgery unit at Walter Reed and the
neonatal intensive care unit at the National Naval Medical Center in Bethesda, Md., began
in January and runs through the end of the summer.


It is a collaborative effort designed to avoid duplicative services at the two
hospitals. Although the experiment involves neonatology, it has applications for
cardiology, dermatology, dentistry and radiology, among others, Gomez said.


"We looked at new applications because traditional teleconferencing was too
expensive, too limited in scope and really wasn't addressing the needs of the health care
provider," Gomez said. "We needed more than just teleconferencing on a desktop.
We needed electronic medical records and a multitask, integrated solution."


Known as the Analog/Digital Project, the pilot lets doctors at Walter Reed and the
National Naval Medical Center conduct pediatric consultations using an Integrated Service
Digital Network link instead of analog telephone lines. ISDN lines provide 128-kilobit/sec
data transfer to send video and audio in real-time interactive and store-and-forward
formats.


The two hospitals are connected via the Internet and ISDN communications as an
alternative to the prohibitive costs of providing a direct T1 link.


"We got away from these expensive T1 solutions, so our workstations cost less than
$5,000, compared to $15,000," Gomez said.


Doctors are using Apple Power Macintosh 8100 machines with 17-inch monitors. The Macs
run the Apple videoconferencing program QuickTime, which taps an electronic medical
records database.


The software is built into the Mac's operating system and can send and receive document
images. It also supports a whiteboard function. Doctors use digital cameras from Fuji
Photo Film USA Inc. to capture images.


The beauty of the A/D project is that the technology solutions all came from one
vendor, Gomez said.


"We're working with Apple Computer because they had a desktop solution,"
Gomez said. "We looked at other systems but really didn't find anything that met our
requirements."


The Army also considered using hardware from Dell Computer Corp. and software from
PictureTel Corp. of Danvers, Mass. Ultimately, Walter Reed officials decided to avoid
integration difficulties by going with a single package, he said.


"We couldn't have a technician working with a physician full time, and some of
these other solutions required technical support just to do these kinds of
consultations," Gomez said.


"Everything needed to support this project was in the box," said Alan Grogan,
federal account manager for Apple Computer's federal group in Reston, Va. The company has
set its sights on a U.S. telemedicine market that is estimated to be worth $20 billion, he
said.


"Clearly for us the large opportunity is in the private sector," Grogan said.


"However, the military has always been the leader in adopting new telemedicine
technology."


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