G.R. Zaramba

Electronic Intensive Care Unit

Human Disease Diagnoses and Treatment

Advancing Health Treatment through Technology

G.R. Zaramba

Problem

• Need for military intensive

care services around the world

• Increased numbers of critical care patients in military facilities

• Limited number of Intensive Care Specialists in the active military

Solution

Electronic Intensive Care Units “eICU”

• How do they work?

• What are the benefits?

• What are the challenges?

• What are the successes?

How Does eICU Work?

• Physicians in military medical facilities in the US can examine, diagnose, and monitor patients in ICU’s across the globe.

• Through the use of high resolution cameras, stateside physicians can consult with local physicians at the patient’s bedside.

• Specialists can review the patient’s chart, lab work, and other data.

What are the Benefits?

• Through telemetry and ‘virtual exam’ of the patient, ICU specialists can make real time decisions in consultation with the attending physician.

• The patient’s chances of recovery are greatly improved.

• By bringing the specialist to the patient, there is a reduction in air evacuations and associated cost savings.$$$$$

What are the Challenges?

• High cost of technology• Cooperation between onsite physicians and

eICU specialists• “Big Brother” concerns, particularly among

young physicians with limited experience• Staff turnover at remote sites• Military “Red Tape”• Limits access to patients in ICU

What are Some of the Successes?

• Reduced mortality and morbidity

• Shortened stays in ICU

• Reduced cost of air evacuations

• Support and training to onsite physician staff

• Enhanced inter-service cooperation

• Potential new horizons: eICU on ships at sea and battlefield hospitals

MC4Electronic Medical Records

•Medical Communications for Combat Casualty Care.

• MC4 is several information-collection devices, software, databases, and servers for use on battlefields and in field hospitals.

•5 M Documents, 25K devices, 29K trained medical personnel

MC4 References

• https://www.mc4.army.mil/index.asp

• AHLTA-Mobile AHLTA-T  Enables medical professionals to record, store and transfer medical records to the DoD’s clinical data repository (CDR) by synchronizing the device with an MC4 laptop

• Displays medical history, physical exam and disposition in structured data terms – ICD-9,

• disease non-battle injury (DNBI) and MEDCIN

• Human body diagrams and forms enable users to capture data using a stylus

• DCAM (Defense Medical Logistics Standard System Customer Assistant Module)

• ePDHA (Electronic Post Deployment Health Assessment) 

• JMeWS (Joint Medical Workstation) 

• MEDIC (Medical Environmental Disease Intelligence & Countermeasures) 

• Micromedex 

• TC2 (Theater Medical Information Program Composite Health Care System Caché) 

• TMDS (Theater Medical Data Store)

VA Update• Obama Announces Vets e-Records System• April 09, 2009• Military.com|• by Bryant Jordan

• President Barack Obama today announced plans to provide service members with an electronic health records

• Defense Secretary Robert Gates and Secretary of Veterans Affairs Eric Shinseki, a former Army chief of staff. Also in attendance was Tammy Duckworth, an Army UH-60 Black Hawk helicopter pilot who lost both her legs when her helicopter was shot down in Iraq. Duckworth has been nominated to be assistant secretary of public and intergovernmental affairs at the VA.

• Obama said his 2010 budget includes $25 billion more for the Department of Veterans Affairs over the next five years. The money will also include funding for other new or expanding programs, among these efforts to treat veterans with mental health issues and those who suffer from brain injuries -- one of the signature injuries of the wars in Iraq and Afghanistan.

• "This budget approves services for cognitive injuries," he said, noting that many veterans "with these injuries have never been evaluated" by a doctor.

• Obama also cited the needs of thousands of veterans who suffer from post-traumatic stress disorder, the rising increase of suicides among veterans, and the problem of some 154,000 veterans who are homeless (not homelessness).

• In all, he said, some 500,000 veterans who previously have been denied health care will get it, including through the use of mobile clinics that will reach veterans in rural areas.

eICU

Questions

References• Tele-treatment: Monitoring from Afar; Liz Kowalczky,

The Boston Globe, November 19, 2007.

• Tripler’s Scenic View Includes Glimpse of Military Medicine’s Future; Kevin Downey, Tripler Army Medical Center Public Affairs; February 25, 2008.

• www.saintlukeshealthsystem.org/slhs/services/common/eicu/welcome.htm, 2006.

• http://www.hawaiitelehealth.net/documents/Telehealth%20Project%20Summaries/eICU.pdf, 2008.

• https://www.mc4.army.mil/mc4newsletter/2008_9/index.asp

• http://medicaldesign.com/electrical-components/managing_medical_data_0808/index.html

References• Tele-treatment: Monitoring from Afar; Liz Kowalczky,

The Boston Globe, November 19, 2007.

• Tripler’s Scenic View Includes Glimpse of Military Medicine’s Future; Kevin Downey, Tripler Army Medical Center Public Affairs; February 25, 2008.

• www.saintlukeshealthsystem.org/slhs/services/common/eicu/welcome.htm, 2006.

• http://www.hawaiitelehealth.net/documents/Telehealth%20Project%20Summaries/eICU.pdf, 2008.

• https://www.mc4.army.mil/mc4newsletter/2008_9/index.asp

• http://medicaldesign.com/electrical-components/managing_medical_data_0808/index.html