Vendors were recently selected to push forward military telemedicine experiments.
In supporting the Defense Department’s broad push to develop a secure 5G core environment, officials at Joint Base San Antonio are exploring next-generation wireless capabilities to accelerate enhanced health care for U.S. service members anywhere on Earth—and beyond it.
“My personal experiences with being out as a remote medic in a combat situation, or in a situation of need where I did not have adequate or reliable medical services, [5G] would have definitely come in handy at that time,” veteran and JBSA 5G Executive Telemedicine Investigator Dr. Paul Young told Nextgov on Jan. 12. “But now, as I envision what the future role of 5G will help with for the medical services, I see it as an exciting opportunity.”
Telemedicine is a modern practice that involves technology to connect patients or participants in different locations for health-supporting purposes. It will likely play a major role in military operations and medical care going forward—and it marks one element at the heart of the Texas military base’s pursuit.
In mid-2020, JBSA was among the experimentation sites the Office of the Undersecretary of Defense for Research and Engineering named as official testbeds to drive the department’s strategic 5G development. Since then, base officials have honed in on technological use cases to innovate medical treatments and training, helped form a new committee of vested partners from all DOD medical service components to boost coordination and more.
Multiple officials briefed Nextgov on the evolution of JBSA’s 5G-centered telemedicine activities and some of what’s to come in 2022.
“We want to make sure that the applications that we use [within] the 5G environment are appropriate, secure, reliable and fast,” Young explained.
Baby Steps and Big Leaps
Fifth-generation wireless technology refers to the latest iteration of cellular communications tools. In offering substantially more bandwidth than 4G and other components that will enable much faster connectivity speeds and links between heaps more devices, 5G is anticipated to provide transformational capabilities across many sectors—including national security and health care.
DOD has dedicated millions of dollars across more than 10 military bases over the last few years in a large-scale effort to test out and deploy 5G applications that support its mission. While other bases are embarking on projects associated with smart warehouses and spectrum-sharing, JBSA’s been tasked with producing prototypes and experiments concentrated on advanced training and telemedicine uses for future medical needs and to optimize DOD’s medical care.
JBSA 5G Executive for Data Analytics and Artificial Intelligence and Machine Learning Dr. Patti Geppert noted that such responsibilities were assigned to the base in part because of its close relationships with the Air Force and Army medical communities.
Among JBSA’s 5G explorations include projects using augmented reality or AR to boost medical training and expand coverage.
“Medical training is in limited supply and it can be hard to provide for the servicemembers before they deploy, or after they deploy for their medical service,” Geppert noted.
Augmented reality is an option in the emerging realm of extended reality technologies that offers users interactive experiences by superimposing computer-generated elements over what they see in the real world.
When the program first launched, JBSA was prioritizing various technical areas of focus—but since the program has come into fruition, those are now referred to as use cases. Through one medical training use case, officials are working with partners to prototype and demonstrate 5G-enabled and AR-guided enhanced lessons that are meant to improve readiness in situations that are “in-garrison,” on the actual post or “just-in-time,” right before deployment when military members must be taught.
With supporting AR headsets, the scenarios participants experience would educate them about amputating limbs and treating gunshot wounds in high-stress environments, how to recognize toxic exposures or deal with burn injuries and more.
Geppert, a neuropharmacologist with decades of experience across sectors, currently also serves as an executive for internet of medical things and augmented and virtual reality at JBSA—and runs the extended reality working group for OUSD R&E. She noted that the instruction-boosting technology, powered by 5G, can provide “a level of training that is similar to what participants would get in a face-to-face situation.” AR also allows for officials to increase class sizes and reduce the number of trainers that are required, which is particularly important considering how training is limited in supply.
Work on the base, Geppert noted, additionally involves a mobile medic focus, as well as applying AR to pave the way for remote telementoring for medical procedures.
“In this scenario, you would have, let's say, a [provider] that's working in a forward operating base that has to do a procedure that maybe they're not specifically trained to do. So, you might have a general surgeon that has to do a neurosurgical procedure [they've only done a few times],” she explained. “Instead of having to transport that patient back to a central location, they can do that surgery at the forward operating base under the guidance of a remote mentor. So, using low latency, high bandwidth augmented reality, you can actually take that remote expert and put them on the shoulder of the surgeon that is doing that procedure.”
She added that AR allows that expert to “actually put their hands into the operating field or the visual field so that they can point out aspects of the procedure that the remote surgeon needs to pay attention to,” and offers providers on-site digital access to medical records like CT scans.
While multiple federal entities are also exploring and deploying 5G for health-aligned and other needs, Young noted that JBSA’s work is unique in that the next-level capabilities it’s creating must be explicitly designed to operate in austere environments ranging from combat environments, jungles, and even in space.
He said the team is serious about ensuring that DOD beneficiaries in all domains are covered when 5G comes to fruition, and “that we do have capabilities based on not only if activities are taking place now, but also visualizing what could take place.”
“For all of this stuff, we are trying to use 5G to expand the capabilities of medical support, medical service and communications when we are in a situation where there is a lack of resources or availability of the certain types of specific care entities that we need for doing our interventions—whether they be either physically, clinically, or done for eye-, life-, or limb-saving techniques,” Young explained.
Drawing from his own experiences as a military flight surgeon, he said he feels that such solutions could “definitely save lives” down the line.
These experiments can be considered “ongoing,” according to Geppert. Following a solicitation, award letters were just recently sent to vendors that were selected to drive this telemedicine work forward. A three-year period of performance is set for the effort, and officials involved aim to make solutions that are ready to be fielded or transitioned to a program of record by the end of that period.
“We're anticipating at least in this quarter that there's going to be an announcement,” Geppert said.
It’s been an exciting journey so far—but not one without some adjustments. For instance, one of the original experiments JBSA was pursuing encompassed an end goal of using telerobotic surgery to its fullest capacity. Budget cuts, technical realizations and other facets resulted in the team now considering that application as part of their roadmap and less of an immediate priority.
“I think that in order to succeed, especially at the leading edge that we're at, you have to be really flexible and open to the possibilities,” Geppert noted.
She emphasized that the three-year program period is “not the end of the development of this technology,” but just the beginning, for the most part. In her view, a key part of this process is to get the military comfortable with using some of the technology to then build on its capabilities.
“So, especially when you talk about things like remote telementoring—that's just a baby step into a larger picture of medical technology development for the military,” Geppert explained. “If you can't develop a comfort level with something like remote telementoring, then you're never going to get to that step of actually being able to use telerobotic surgery to its fullest capacity. So it's baby steps—they're big leaps—but they're still baby steps in the development of really functional and capable medical technology for the military.”
Here to Stay
Less than 6 months after JBSA was selected as an official DOD 5G testbed, Young in October 2020 worked with colleagues to shape a Medical Steering Committee for 5G Telemedicine. He’d recently left what felt like “retirement mode” to support the Pentagon initiative that he thought could shape the future of how the military provides care.
Now, the crucial cadre is helping facilitate this weighty endeavor and functions to connect all of the medical components and major players together to discuss strategic plans, progress and other important features to support DOD’s medical services.
Young currently serves as the MSC’s chairperson.
“I think the major impact was just getting all of the bodies involved together to come under one forum and start speaking as one voice through review of all of our goals, and understanding the experiments that we in JBSA 5G with the [program management office] are doing for them,” he explained, noting that the efforts are ultimately about their benefits, not the PMO. “Everything that we do is focused on how can we improve and how can we augment military medical capabilities to support the DOD services?”
Since its standing, the committee has coordinated many deep discussions, guided research and the publication of trade and informational articles, provided feedback to relevant project managers and more.
According to its official charter, “the 5G MSC serves as the first level of strategic vetting for planning, programming, and facilitating medical aspects and issues to engage in emerging technology, which includes future applications for expeditionary medical operations.” Part of its intent is to help guarantee that the 5G prototypes concentrate on future medical needs and requirements for advanced telemedicine.
Dozens of officials who serve in or work with DOD attended the monthly MSC meeting that was held this week, which Nextgov joined. During the hour-long discussion participating doctors, military staff, contract officials and others discussed updates on 5G telemedicine projects, opportunities for cross-partner collaboration and plans for 2022.
These events also provide a channel for technology providers to showcase their products. In the meeting, an official from CSI-Health demonstrated a platform that supports capturing and relaying biometric and diagnostic information in real-time mobile environments and is expected to facilitate even more when enabled by 5G. The company is already working with an Air Force innovation component via a small business innovation grant, and JBSA officials see the potential for it in relation to the unfolding mobile medic experiments.
MSC’s next meeting will likely include a presentation on cyber vulnerabilities related to medical equipment.
Ensuring that all relevant entities are aware of the in-development 5G capabilities will be important going forward, Young told Nextgov after the meeting. With that top of mind this year, officials involved are preparing to conduct formal presentations at national and international conferences and symposiums, “depending on what COVID-19 allows” them to do.
For now, plans include potentially joining a NATO technical symposium, Military Health System medical meeting and medical vulnerabilities conference.
“Getting that face-to-face time and that contact to have that awareness is the first step for I think the medical support entities. So then, everybody on board knows that this is coming and that we will be utilizing or capitalizing on the services—because we have to be. 5G is here to stay,” Young said. “And as we move forward, we don't want to be lagging behind, which has happened in the past...”
Editor's note: This article was updated to clarify details regarding the Medical Steering Committee for 5G Telemedicine.