Military Telemedicine Military Telemedicine & Medical Advanced Technology & Medical Advanced Technology Spanish American War; 1899 Spanish American War; 1899 Haiti; 1995 Haiti; 1995 Medical Advanced Technology Medical Advanced Technology Management Office Management Office Command Briefing Command Briefing Reengineering Health Care Delivery Reengineering Health Care Delivery Meditag Meditag
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Military Telemedicine & Medical Advanced Technology & Medical Advanced Technology Military Telemedicine & Medical Advanced Technology & Medical Advanced.
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Military TelemedicineMilitary Telemedicine
& Medical Advanced Technology& Medical Advanced Technology
Military TelemedicineMilitary Telemedicine
& Medical Advanced Technology& Medical Advanced Technology
Spanish American War; 1899Spanish American War; 1899
Haiti; 1995Haiti; 1995
Medical Advanced TechnologyMedical Advanced Technology
Management OfficeManagement Office
Command BriefingCommand Briefing
Medical Advanced TechnologyMedical Advanced Technology
Management OfficeManagement Office
Command BriefingCommand Briefing
Reengineering Health Care DeliveryReengineering Health Care Delivery
MeditagMeditag
Croatia
Bosnia
Serbia
Macedonia
and Herzegovina
Montenegro
Vojvodina
SloveniaZagreb
Skopje
Sarajevo
QuickTime™ and aPhoto - JPEG decompressor
are needed to see this picture
Medical Telepresence . . .. . . Projecting Specialty Care Support in Far-Forward, Difficult-to-Serve Areas.
Medical Telepresence . . .. . . Projecting Specialty Care Support in Far-Forward, Difficult-to-Serve Areas.
Information in “Technology Savvy” Organizations has evolved . . .
Information in “Technology Savvy” Organizations has evolved . . .
Ad HocraticAd HocraticAd HocraticAd Hocratic
The basis for our strategy . . .The basis for our strategy . . .
Military TelemedicineMilitary Telemedicine
HierarchicalHierarchicalHierarchicalHierarchical
TofflersTofflersParadigm Paradigm ShiftShift
TofflersTofflersParadigm Paradigm ShiftShift
Spokes:Spokes:
Hubs:Hubs:
a “grid-based” matrix . . .
People who needPeople who needHealth CareHealth CarePeople who needPeople who needHealth CareHealth Care
People who can provide Health CarePeople who can provide Health Care
S x H
Difficult to ServeDifficult to Serve
Expensive-to-serveExpensive-to-serve
UnderservedUnderserved
Difficult to ServeDifficult to Serve
Expensive-to-serveExpensive-to-serve
UnderservedUnderserved
S1
S2
S3
S4
S5
H'H2 H3 H4 H5 H6
Ad-hocratic organizations can be task-organized into . . .
"Bob, what do you think about this ankle ?
Should we evachim or not ?”
. . . facilitates time and distance independentmedical decisions
Multimedia Informatiuon
Realtime Tele-Imaging . . .
Telemedicine Test Bed Vision:
Telemedicine projects world-class health care to patients and providers, anywhere, anytime.
“I want to take the very best of Army Medicine to the front!”
General Max Thurman
DoD Telemedicine Overview DoD Telemedicine Test Bed MATMO Projects/Funding MC4 Medical Communications for Combat
Casualty Care Accomplishments and Future Vision
Telemedicine Test Bed Strategic Principles
Readiness Orientation Patient Focus Rapid Prototyping and Process Re-engineering Outcome-based Metrics Open and Integrated System Architecture Leveraged Development Sound Business Practices
Telemed-PMTelemed-PMUsers GroupUsers Group
AF Centers of ExcellenceAF Centers of Excellence
Navy Centers of ExcellenceNavy Centers of Excellence
Army Centers of ExcellenceArmy Centers of Excellence
AF & Navy, Academia, AF & Navy, Academia, IndustryIndustry
CG, MRMCCG, MRMCChief Op OffChief Op Off
Army TSGExec Agent
T-Med StakeholdersT-Med Stakeholders
LAM / Battle Labs /ARPALAM / Battle Labs /ARPA
AMEDD AMEDD C&SC&S
AF & Navy SG’s
Army Digitization OfficeArmy Digitization Office. . .Test-Bed Operations
Test-Bed Oversight . . .DOD (HA)DISA, DDRE
Tri Service T-Med Test-Bed Structure . . .
Medical Advanced Technology Management Office (MATMO)
Testbed Management and Administration at USAMRMC
Coordinates testing, integration, and prototype deployment of telemedicine technologies
DoD telemedicine project clearinghouse
Physicians
Medical Physicist
BiomedicalEngineer
Systems &Telecom
Health Care Admin/Log
Imaging Tech
Army
Air Force
Navy/Marine Corps
DoD Civilians
Academia
Contractors
Joint Telemedicine Project TeamWhen you play baseball you don’t pick 9 shortstops ...
The T-Med ProgramThe T-Med Program
Mobile Medical Mentoring(M3) VehiclesMobile Medical Mentoring(M3) Vehicles
6 Program Thrust Areas . . .6 Program Thrust Areas . . .
Worldwide Telemedicine Rapid DeploymentsWorldwide Telemedicine Rapid Deployments in the past in the past
Croatia
Bosnia
Serbia
Macedonia
and Herzegovina
Montenegro
Vojvodina
SloveniaZagreb
Skopje
Sarajevo
Primetime III . . .Primetime III . . .Telemedicine Augmentationto Task Force EagleMedical Units in Support ofOperation Joint Endeavorin Hungary and Bosnia
. . .. . .
. . . the action spot today
Croatia
Bosnia
Serbia
Macedonia
and Herzegovina
Montenegro
Vojvodina
SloveniaZagreb
Skopje
Sarajevo
Croatia
Bosnia
Serbia
Macedonia
and Herzegovina
Montenegro
Vojvodina
SloveniaZagreb
Skopje
Sarajevo
Primetime III T-Med Support Task Force
Med Adv Tech Mgmt Office - Support Task Force Chairman
Landstuhl / European HSSA
30th Med Brigade
AF MEDSITE
MEDCOM, DCS IM, NOD
HCSSA
Army DMIS
AMEDD C&S & Test Board
PASBA
ARPA
TRANSCOM
DoD (HA) DMIM
Navy Med Inf Mgmt Ctr
USUHS
DISA-USA
DISA-Europe
5th Signal
22th Signal
V Corps
EUCOM
USAFE
ASDC3I
USAMMCE
Coordinations to date:
Aid Stations
Clinics
MASH
Combat Spt Hospital
StatesideHospitals
USSGeorge
Washington
Quick Overview of Operation . . .
Up to 170 beds, 400 sick call/clinic visits per day200 X-Ray Exams, Up to 25 CT studies per day
Landstuhl
Hungary
Bosnia
ATHCroatia
Croatia
Bosnia
Serbia
Macedonia
and Herzegovina
Montenegro
Vojvodina
SloveniaZagreb
Skopje
Sarajevo
Croatia
Bosnia
Serbia
Macedonia
and Herzegovina
Montenegro
Vojvodina
SloveniaZagreb
Skopje
Sarajevo
Five Major Task Force Eagle Customer Requirements
Patient Accountability
Minimize Evacuations
Specialty Medical Consultation
Rapid Trauma Response
Medical Situational Awareness
1
2
3
4
5
Video T-Med Imagery
Filmless Teleradiology
Digital CT Scanner /Ultrasound
Tele-Surgical Mentoring
Lab & Radiology Results (CHCS)
CHCS/TAMMIS/PARRTS/DMRIS
Croatia
Bosnia
Serbia
Macedonia
and Herzegovina
Montenegro
Vojvodina
SloveniaZagreb
Skopje
Sarajevo
Croatia
Bosnia
Serbia
Macedonia
and Herzegovina
Montenegro
Vojvodina
SloveniaZagreb
Skopje
Sarajevo
Capabilities to Meet Requirements
FOB/BOB
15-16x
MASH
CSH
Landstuhl
IDNXCloud
WurzbergHeidelberg
Ft Sam Video Bridge
CONUS Med CensOverview:Primetime IIIT-Med Solution
Norfolk
USSGW
POP
FOB/BOB
4-5x
(Germany)
(Hungary)
(Bosnia)
An Army Aviator was unable to fly due to a cyst in his external ear...the flight surgeon needed a teleconsult...
...she established a link to an ENT specialist in Landstuhl and successfully removed the cyst...the Aviator was returned to duty... NO EVACUATION NEEDED!
67th CSH -- Tazar, Hungary
QuickTime™ and aPhoto - JPEG decompressor
are needed to see this picture.
67th CSH
Landstuhl Regional Medical Center
FOBBOB
MASH
CSH
LandstuhlCONUS Med Cens
CONUS Med CensPrimetime IIIPhase 4
Norfolk
USSGW
Transmittable and TransportableClinically Relevant Patient Record: “BOSMEDNET”, MARC--MEDITAG
EVALUATION STRATEGY
OBJECTIVES
Clinical ,Technical, and
Operational Effectiveness
COLLABORATIVE but INDEPENDENT
•Telemedicine Evalutation Working Group (TEWG)* - Clinical Effectiveness
Integration of Advanced Technology into Clinical Practices
“Make it Programmatic” (GEN Sullivan)Transition to Standards-based ArchitectureEvaluation and Outcomes AssessmentLegal Implications
Medical Communications for Combat Casualty Care (Army MC4 Program)
Far-Forward Telemedicine Digital Field Medical Treatment Facility Expert Tertiary Care Host Telemedicine Sustainment Integration of Emerging Technologies
Army Force XXI - 5 TMED Thrusts
MC4 Challenges
Flexibility - Shared Bandwidth Interoperability - With other systems, with other
Services: Army Digitization Office (ADO), Theater Medical Information Program (TMIP)
Technology Cycle (18 - 24 months) Transition from R&D Prototyping to Full
Deployment
Concept Exploration
AdvancedDevelopment
Fielding &Sustainment
Hard Transition
Hard Transition
OP & OM FundingR & D Funding
Rqmt/Doctrine
Traditional R&D
Concept Exploration
Advanced Development
Fielding & Sustainment
SoftTransitions
OP & OM Funding
R & D Funding
Rqmt/Doctrine
Rapid Prototyping R&D
“We must change the way we change ”
Emerging Evolutionary Principles . . .
DARPAAdvanced R&D
6.1. - 6/3
MC4Concept, Acquisition
Development & Deployment
6.5 -6/6
Devel
opm
ent
Tech
nolo
gies
MATMOCOTS Technologies
Prototyping and Integration
6.3 - 6.4
Coordination with DARPA
AWE Battle Labs
TMIPNAVY
AIR FORCE
MDIS Filmless Medical ImagingMDIS Filmless Medical Imaging
Large Storage CapacityLarge Storage CapacityRapid Transfer RatesRapid Transfer RatesSecureSecureSimpleSimple
Allow data capture and delivery of a wide Allow data capture and delivery of a wide array of data types: X-rays, MRIs, EKGs, array of data types: X-rays, MRIs, EKGs, Sound, or up to 40,000 pages of text.Sound, or up to 40,000 pages of text.
Meeting the Meeting the NeedsNeeds
20-21 megabytes of LossLess Compressed Data 20-21 megabytes of LossLess Compressed Data
Ruggedized: 100% Weather Proof, Withstands 500 G forcesRuggedized: 100% Weather Proof, Withstands 500 G forces
Compatible with all types of Computer hardware Compatible with all types of Computer hardware
Securely Stores Text, Voice, Video and any form of Digital Data Securely Stores Text, Voice, Video and any form of Digital Data
Memory cells DO NOT require batteriesMemory cells DO NOT require batteries
Extensible: System will Evolve with TechnologyExtensible: System will Evolve with Technology
Project ProMedProject ProMed
•Developing uses for Handheld Devices
•Wireless Distributing Computing Networks
•Intuitive Interface Design
•Making Access to Information more Efficient.
•Developing uses for Handheld Devices
•Wireless Distributing Computing Networks
•Intuitive Interface Design
•Making Access to Information more Efficient.
Digital Mammography Mobile Digital Mammography Mobile LaboratoryLaboratory
• Intelligence Imaging Technology TransferIntelligence Imaging Technology Transfer
• High Capacity CommunicationsHigh Capacity Communications
• DoD, HHS, NIH, CIADoD, HHS, NIH, CIA
Consortium on TelepsychiatryConsortium on Telepsychiatry...Promoting Mental Health into the 21st Century...Promoting Mental Health into the 21st Century
• Consortium between the United States Consortium between the United States Department of Defense Telemedicine Test Bed Department of Defense Telemedicine Test Bed and Academic, Governmental, and Industrial and Academic, Governmental, and Industrial Partners.Partners.
• Further the practice of mental health care Further the practice of mental health care through the intelligent and programmatic through the intelligent and programmatic application of advanced technology.application of advanced technology.
Med College of Georgia
Med College of Georgia
Tertiary Care Telemedicine Georgia Triad--Military & AcademiaTertiary Care Telemedicine Georgia Triad--Military & Academia
Ga TechGa TechEisenhowerEisenhower
Rural TelemedNodes in GeorgiaRural TelemedNodes in Georgia
McPherson&
OtherArmy Signal School
McPherson&
OtherArmy Signal School
“Home house call”
“Home house call”
AugustaAugusta AtlantaAtlanta
CATV Broadband Topology
Headend
Distribution amp
70-mile radius
San Antonio “Medical ATM T-Med Grid”San Antonio “Medical ATM T-Med Grid”
4 Major Components4 Major Components
CHCS “Mothership”CHCS “Mothership”
Filmless MDIS System
Brooke T-Med Kiosk Host
USAA Towers
ATM Link to Wilford Hall
Filmless MDIS System
Brooke T-Med Kiosk Host
USAA Towers
ATM Link to Wilford Hall
Wilford Hall MDIS
new Brooke MDIS
The DoD Telemedicine Test Bed The DoD Telemedicine Test Bed World Wide Web PageWorld Wide Web Page
•Using the Internet for Using the Internet for Information ExchangeInformation Exchange