Say telemedicine and you could imagine two-way or perhaps tactile video sensors and augmented reality, features that need wide bandwidth. But field studies of a successful telemedicine network built by military doctors show that low-bandwidth chat and text features are often all that is needed. The real barriers to a wider adoption of telemedicine are bureaucracy and misperceptions.
Army Lt. Col. Chris Colombo, director of virtual health and telecritical care at Washington’s Madigan Army Medical Center, is one of the brains behind the national emergency telecommunications care network. It is an experimental effort to connect doctors and other experts with nurses, field doctors, and other caregivers who need additional instructions on how to care for a patient. As described by Colombo and his fellow authors in the July issue of Critical Care Medicine, the network is simply a way to connect people who care for patients with doctors through mobile applications and elastic cloud computing.
“Our teams have experienced numerous successes,” Colombo writes. They include: “1) the treatment of tension pneumothorax, while local experts managed a cardiac arrest in a different location; 2) stabilize respiratory failure, while the local tele-ICU system suffered a communications failure; 3) avoid hospitalizations through remote home control and home delivery of oxygen therapy; and 4) supporting end-of-life care in a small hospital and in a home with a family, both of whom are not accustomed to this experience. “
Neither these results nor battlefield medicine usually require video transmissions or other functions that require a lot of information. “Most medication needs in the field can be easily managed using asynchronous and synchronous voice data. So ‘Hey, take a picture of the wound you’re wondering or the rash you’re wondering about,’ ”he said in an interview.“ You can send a pretty decent high-resolution photo and compress the file size with a very limited bandwidth, certainly enough to support voice with current technology. “
Colombo said that for most battlefield medical emergencies that require the attention of a remote expert, voice communication is sufficient. “We made them document vital signs for several hours of care and then we took a picture of them [chart] and send it. Then the [doctor] or the surgeon at the other end may have the feeling, “Oh, your patient is tending this way. This happened, at this hour; you have given these medications.” Now they are up to date with almost no bandwidth. ”
This matters at the same time as the military struggles to spread and connect more things to the battlefield networks and opponents improve in electronic warfare.
But, Colombo said, people who organize exercises and writing requirements generally don’t understand the little bandwidth needed to improve medical care in the field. Since the assumption is that telemedicine will require many round-trip videos, the inclination is to give none more than enough. “The perception is that we will play high definition video 24/7,” he said.
This is one of the problems. Another is that in order to prove that telemedicine has value, more exercises need to be done, and finally military doctrine and requirements. But in order to do so, they must prove that they have value.
“The problem is that military doctrine does not require telemedicine because we know that doctrine evolves much more slowly than reality. There was also no doctrine for cutting down hedges in France during World War II, ”he said.
He recounted experiences in which he would talk to the organizers of large-scale field exercises, exercises in which commanders wanted to test concepts of telemedicine, but then he would encounter a Kafkaesque situation:
“If I keep saying,‘ We have to do this, ’and everyone says,‘ Well, where’s the requirement? “I say,‘ Well, I can’t generate any requirements until I prove it has value. I can’t prove it worthwhile until you’re willing to do it. But you are not willing to do it unless it is necessary. And it’s an ice cream cone that licks itself.
To solve the problem, Colombo and his team have contributed their own internet capability to exercises just to show how easy it was to expand telemedicine services. “What we really need to do is go out into the countryside with people and if we have to bring our own internet, so be it, and show them the value, we will walk the distinguished guests [and ask] “What’s going on here?” Oh, they send text messages back and forth so the doctor knows how to properly mix this dose of medicine. ” And then people see that this has value even with low bandwidth. “
Ideally, Colombo said, the doctrine and requirements will be updated to allow for at least low-bandwidth telemedicine. And that, he said, will be much better than usual today.