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The Honolulu Advertiser
Posted on: Monday, August 18, 2003

Link expands hospital's reach

By William Cole
Advertiser Military Writer

From a distance of more than 3,000 miles, doctors at Tripler Army Medical Center are using telemedicine technology to peer over the shoulders of colleagues in Guam to help treat critically ill patients.

Col. (Dr.) Benjamin Berg, residency director of internal medicine at Tripler Army Medical Center, operates the $1.45 million telemedicine system. Tripler is the first military hospital to use the high-tech product for long-distance care of critically ill patients.

Richard Ambo • The Honolulu Advertiser

Using high-resolution remote-controlled cameras and real-time transmissions, Tripler specialists can examine intensive-care unit patients, talk to them, and monitor heart rate, blood pressure and other vital signs on a bank of computer monitors to assist with treatment overseas.

The cameras are so good, "we can read a bar code across the room," said Maj. (Dr.) Eric Crawley, a pulmonary critical-care specialist at Tripler. "I think the amazing thing to me is you can almost do a pupil exam from Hawai'i."

In use since mid-June at the U.S. Naval Hospital, Guam, the pilot eICU program has resulted in one documented saved life out of 25 patients examined so far, officials said.

Tripler is the first military medical center to use the telemedicine product for long-distance ICU care. Others are expected to follow as part of a move to improve treatment and reduce emergency evacuation costs.

Doctors using the technology say it could have applications down the road to bring the level of medical expertise at hospitals like Tripler aboard a ship or to a field hospital.

"I think it's exceeded all of our expectations," said Col. (Dr.) Benjamin Berg, Tripler's medical director of the eICU program. "If we can clearly document we've saved a life through the use of this system with our partners in Guam over the first month of operations, I think that's a very clear success."

The $1.45 million eICU may be expanded throughout the Pacific to include all of the smaller healthcare facilities with intensive-care units in the Tripler system, including centers in Okinawa, part of northern Japan and South Korea. Tripler is the specialty-level care provider for Asia and the Pacific.

"We have the expertise and the capacity to participate in the care of those patients, and I think this system is a great way of projecting that expertise to those smaller facilities," Berg said.

The eICU, a commercial product offered by Baltimore-based Visicu Inc., is part of a research project financed and managed by the Pacific Telehealth & Technology Hui, a joint partnership of Tripler and the Veterans Affairs Pacific Islands Health Care System — Spark M. Matsunaga Medical Center.

Guam, a territory of the United States, does not have any intensive-care unit specialists or "intensivists," Army officials said.

There is a nationwide shortage of intensivists, and as is the case at other smaller medical centers, the Naval hospital in Guam can't justify having the experts on staff for so few patients.

A Navy doctor in Guam consulting on a critical-care case on Wednesday with Tripler was a family practitioner. Berg previously assisted an internist in performing a heart catheterization.

As with other hospitals, the use of telemedicine technology is increasing, and the Senate Appropriations Committee last month approved $24 million for ongoing Tripler telemedicine research.

For the past two years Tripler has been electronically receiving echocardiograms from Guam — a process that previously took six weeks and involved recording the heart ultrasounds on videotape for delivery.

Berg said there is no other system that is "as robustly developed" for critical-care purposes as the eICU product. Walter Reed Army Medical Center in Washington, D.C., and about a half-dozen other hospitals have the system, but only Tripler has used it to reach as far as Guam.

The fiber-optic eICU is expected to result in significant cost-savings by stabilizing some patients who might otherwise need emergency air-evacuation at a cost of more than $100,000. Instead, those patients can be transported on a regularly scheduled medical flight mission when they are in better condition to fly, Berg said.

Reach William Cole at wcole@honoluluadvertiser.com or 525-5459.


Correction: Col. Benjamin Berg is the residency director of internal medicine at Tripler Army Medical Center, as well as the medical director of the ICU program at the hospital. Berg's title was incorrect in the photo caption in a previous version of this story.