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The Southern Regional Medical Command Teledermatology Program, has provided consultations since 2001. The Army Knowledge Online (AKO) Teleconsultation Program, meanwhile, has extended the reach of dermatology specialists, both on and off the battlefield.
Schissel said that, with the AKO, greater dermatology expertise has been extended into the war zones to help providers make a more accurate diagnosis. Military dermatologists from outside of theater are available for consultation through the program, which has participation from all service branches.
“Doctors can put in consults to our 24/7 manned dermatology consultation service and we can help guide the diagnosis and treatment from afar, which has helped a lot,” he said.
According to the Telemedicine and Advanced Technology Research Center website, the concept for the teledermatology program originated at a conference in 2003. Military dermatologists decided to create a formal, user-friendly teleconsultation program to support deployed military healthcare providers because they believed troops were being evacuated for medical conditions that could have been managed in theater with assistance from knowledgeable consultants. The program began formal operations in 2004.
In addition, an in-theater dermatology consultant was assigned to the theater to help with diagnoses, according to Schissel.
“If the telemedicine program could not assist enough, then this person would be transported to the major referral center in theater and evaluated by a dermatologist,” he said. “I think, then, 90% of the time they were treated appropriately and returned to duty. That other 10% that needed further care or further study were then evacuated, so that decreased the number of evacuations, as well.”
A 2010 study examined cost savings from the military teledermatology program in the deployed setting. The study, also published in the Archives of Dermatology, included 2,197 Army teledermatology consults between January 2005 and January 2009. 2
Deployed healthcare providers who needed a dermatology consult “took digital photographs and emailed them along with a brief history to a single email address at a monitored server. The emails were then distributed to the on-call consulting dermatologists,” the authors wrote.
The most prevalent diagnoses by the consultant dermatologists were eczema (13%), fungal infection (7%) and bacterial infection (7%). Forty of the 2,197 consults recommended evacuation back to the United States, which cost an estimated $562,380. Another 104 patients were referred for an in-person evaluation by the dermatologist in Iraq for a cost of approximately $416,000.
“A total of 2,157 patients could be managed in Iraq, which is an overall cost savings of approximately $30.4 million. One additional benefit of teledermatology in the combat setting is the incalculable savings of avoiding the risk of travel in a war zone,” the study authors wrote.
The authors added that the study “demonstrates the role and cost savings of teledermatology in the combat setting.”
“Dermatologic conditions remain a common complaint among deployed soldiers, and teledermatology can substantially reduce the number of patients who need to be evacuated for treatment, resulting in substantial cost savings,” they wrote.
1: McGraw TA, Norton SA. Military aeromedical evacuations from central and southwest Asia for ill-defined dermatologic diseases. Arch Dermatol. 2009 Feb;145(2):165-70. doi: 10.1001/archdermatol.2008.554. PubMed PMID: 19221261.
2. Henning JS, Wohltmann W, Hivnor C. Teledermatology from a combat zone. Arch Dermatol. 2010 Jun;146(6):676-7. doi: 10.1001/archdermatol.2010.110. PubMed PMID: 20566937.
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