Telemedicine: Revolutionizing health care for soldiers and veterans

Telemedicine – the exchange of medical information via electronic communications – has vastly changed the way deployed soldiers receive access to health care. And now, this new communication system promises to offer better access to care for veterans in the future as well.

When Dr. Ronald Poropatich first joined the military 30 years ago, the digital cameras and web cams required for the use of telemedicine barely existed. Yet, during his career as the deputy director of the Telemedicine and Advanced Technology Research Center in the United States Army, Poropatich helped revolutionize health care for soldiers by bringing telemedicine technology to army bases and field hospitals around the world including in Somalia, Iraq and Afghanistan.

Today, soldiers in Iraq or Afghanistan can get second opinions on tricky medical situations from doctors located halfway around the world. They can receive diagnoses from medical specialists – even when none are stationed at their base. And they can access psychiatric care via Skype-like technology when stationed in remote locations.

Utilizing technology to diagnose and treat
Though he was trained as a pulmonary critical care physician, Poropatich eventually became involved in telemedicine as a way of improving access to care for people in the military.When he was first deployed in 1993, to set up telemedicine capabilities in Somalia, the technology available to him was expensive and rudimentary.

“I took a 1.5 megapixel $25,000 digital camera made by Kodak (to Somalia),” Poropatich told “Now you have a 10 or 15 megapixel camera on your cell phone.”

Thirty years later, telemedicine has advanced greatly, allowing soldiers to email photos of electrocardiograms (EKGs) or skin rashes back to physicians back in the U.S., and receive feedback within approximately five hours, according to Poropatich. Soldiers can even use Skype-like technology to speak with specialists in real time over secure networks.

“A soldier has a microphone, an earphone, and sits in front of a laptop with a webcam over a secure network that’s HIPAA-compliant,” Poropatich said. “It meets military standards and medical standards, and it’s a private conversation.”

This technology has allowed the military to spot medical conditions that would have otherwise been missed or quickly garner second opinions on cases that have the potential to warrant costly evacuations. They can also utilize the technology to spot false alarms, like in the case of one pilot that Poropatich treated who had an abnormal EKG reading.

“If there are unusual findings on an EKG, and if there’s no cardiologist around, then we have to ground that pilot,” Poropatich said. “But the beauty is I can now send it to a cardiologist and in this particular case we got a turnaround in 40 minutes saying this is normal, this guy can go back out today and fly.”

Treating behavioral health issues
Telemedicine has also provided a way to treat soldiers for conditions like post-traumatic stress disorder, or depression, while preserving their privacy.

“A lot of guys don’t want to seek behavioral health care because they don’t want to sit in a clinic with a bunch of other guy saying, ‘I know why you’re here.’ There’s a stigma,” Poropatich said. “These guys are warriors, they don’t want to show weakness, and we trained them that way.”

The military has experimented with various ways to utilize telemedicine to treat behavioral health issues, via the use of webcam technologies, or even cellphones. In one study, Poropatich and his colleagues enrolled soldiers in a program that allowed them to track their mood via text messages.

“We’d send a secure message, a text that’s HIPAA-compliant, which means the message is encrypted and sits on the dedicated server. So if you lost your phone, there’s no evidence you’re talking to a psychiatrist,” Poropatich said. “(Then), case managers can send patients a text saying, ‘Overall how is your mood today?’ and I’d trend that over time, and it shows if (their) mood is getting better or worse.”

Based on the results, care givers could provide soldiers with wellness tips, educational information or advice on how to cope with conditions associated with post-traumatic stress disorder or depression – such as sleep disturbance. Overall, Poropatich said many of the soldiers enrolled responded positively to the program.

“If they know they can talk to somebody and there’s not going to be anyone knowing about it and it’s going to be confidential and secure, then we believe…that you’re going to have a better outcome if servicemen have this available,” Poropatich said.

Though Poropatich was only deployed outside of the United States for short periods of time, he understands the repercussions that deployments can have on a soldier’s mental health.

“You have to maintain a certain composure and awareness. You have to keep your head in the game, and you can’t become lackadaisical…You can’t assume the Coke can on the ground isn’t a bomb,” Poropatich said. “You don’t get as much sleep …You may miss the birthday of your child, your anniversary, the passing of your parents. Just imagine that there are guys who have deployed a year at a time, three, four or five times, imagine all the stress on their marriage, their rapport with their spouse and children.”

Providing a lifeline to veterans
Poropatich, 58, who retired from the military in August and is now the executive director of the Center for Military Medicine Research, Health Sciences at the University of Pittsburgh, hopes to bring telemedicine to veterans back in the states as well.

“Right now, the survival rate, if you can get to a combat support hospital level 3 facility in Afghanistan, you have a 90 percent chance of survival,” Poropatich said. “That’s an amazing statistic; we never had that level of survival before. But what that means is a lot of guys are surviving horrific wounds so that adds a tail to health care delivery."

Poropatich believes that by allowing veterans to communicate with health care providers outside of in-office visits, for example through the use of a cellphone or webcam, they’ll be more likely to stick with rehabilitation programs and outpatient treatment, ultimately ensuring better mental and physical health outcomes in the long term.

“When we tell people to go home and do rehab, cognitive training to improve memory, or to take care of blurred vision from (traumatic brain injuries), more and more we can give them these technologies on a portable device and monitor to see if they’re actually doing it,” Poropatich said. “We give them this lifeline back to the medical center using telemedicine in a peacetime U.S. environment.”