Army Using Telemedicine For Healthcare DeliveryArmy Using Telemedicine For Healthcare Delivery

The U.S. Army is using mobile technology to transmit health tips, appointment reminders, and general announcements to the cell phones of more than 300 wounded soldiers. The mobile phone-based secure messaging system called mCare is one of several innovative wireless technology solutions that the Army is deploying to improve the health of its employees.

"Patients with mild traumatic brain injury are a target population for mCare," said Col. Ronald Poropatich, deputy director of the Telemedicine and Advanced Technology Research Center at the U.S. Army Medical Research and Materiel Command in Fort Detrick, Md.

Poropatich outlined the Army's use of wireless technology last week at a hearing of the House Committee on Veterans' Affairs subcommittee on health. He noted that since June 1, mCare has delivered 18,500 messages, with patients receiving a minimum of six messages per week.

The mCare system is HIPAA compliant, uses bi-directional messaging, and distributes information from a central website that uses a secure virtual private network through which healthcare providers can enter and control message content as well as review acknowledgements and delivery confirmations. The wounded soldiers using mCare are in the outpatient phase of their recovery and are recuperating at home.

mCare's initial group of targeted participants are warriors in transition assigned to Community Based Warrior in Transition Units (CBWTUs). Soldiers assigned to a CBWTU are typically National Guard or Army Reservists who receive outpatient care in their home community and are monitored remotely by a case manager or care team from a regional case management center.

"mCare is not intended to replace all face-to-face or telephone-based encounters from the CBWTU team, rather it is designed to complement these efforts with additional means of communication," Poropatich said.

The Army estimates that 63% of this message activity is related to appointment reminders, which are sent to the patient 24 hours and again 90 minutes prior to each scheduled clinical encounter. The system has demonstrated improvement in appointment attendance rates. Seventeen percent of the message activity is attributed to health and wellness tips, which are customized to the needs of each patient from a library of validated resources within the mCare application. Twelve percent of the message traffic is related to unit-specific announcements. The Army has embarked on other initiatives using telehealth technology, the committee learned. For example, Text4Baby (T4B) is a free mobile health information service that provides timely health information to women from early pregnancy through their babies' first year.

Women who sign up for the T4B service receive three free text messages each week timed to their due date or baby's date of birth. The messages focus on topics critical to the health of mothers and babies, including nutrition, seasonal flu prevention and treatment, mental health issues, risks of tobacco use, oral health, and immunization schedules.

"The Army Medical Department plans to introduce T4B to military mothers at Madigan Army Medical Center at Joint Base Lewis McChord in Washington, as part of a demonstration to formally evaluate the acceptability and utility of using text messaging to deliver information and encourage healthy behaviors as part of its overall maternal health outreach initiatives," Poropatich told the committee.

The third wireless application that the U.S. Army is investigating is the impact of a reminder system on glycemic control in patients with diabetes. "The reasons why more patients do not reach appropriate goals for glycemic control are multiple and complex, among them poor compliance with self monitoring of blood glucose and medication non-adherence," Poropatich said during the hearing.

The Army is conducting a study at the Walter Reed Army Medical Center that examines whether a cell phone video reminder system will improve self-care and glycemic control in patients with diabetes when compared to those who don't use the system. Preliminary results show that blood glucose levels improved more in those patients provided with video reminders compared with those who did not receive them. Overall, the viewership was about 50%, which exceeds that of most other e-Health studies.

"Among subjects who watched at least two-thirds of the daily cell phone-based video tips [and] reminders, the decline in [blood glucose] was greater than it was for subjects who used the technology less," Poropatich said.

Looking ahead, Poropatich told the committee that the U.S. Army Research, Development, and Engineering Command (RDECOM) is evaluating commercial handheld solutions such as iPad, iPhone, iPod, and other platforms and their applicability in a tactical setting. RDECOM has developed numerous handheld command and control solutions and is supporting the development and transition of MilSpace, a combined planning and social networking environment. The Telemedicine and Advanced Technology Research Center is working with RDECOM to leverage U.S. Army investments in mobile technology and apply them to healthcare in the United States and in deployed settings overseas.