Operational Use of U.S. Army Telemedicine Information Systems in Iraq and Afghanistan - Considerations for NATO Operations.

摘要

An issue raised repeatedly with regards to teleconsultation, especially in disaster settings, is the effectiveness of such consultations across national boundaries. It has been postulated that technical, cultural, and training issues will be the major problems which can impede the successful use of multinational teleconsultation, in addition to language problems. The United States Army and NATO have established an agreement which allows deployed NATO forces in Afghanistan to make use of an already-deployed U.S. Army system for this purpose, and have clearly shown the successful utilization of such a system in a multinational setting. In this multinational setting, the system has thus been in use for over a year, and metrics on its success and acceptability have been collected, involving both patients and providers from multiple nations. The system involves U.S. consultants providing teleconsultation on individual patients to NATO practitioners in Afghanistan, and has been most successful in avoiding unnecessary evacuations, facilitation of needed evacuations, and return to duty of many patients. This article will discuss consult types, physician acceptance of the system, and some inherent problems in using such a system in a cross-cultural setting. Critical issues appear to be those of training of users, and ensuring that the training transfers to new practitioners upon personnel rotations. Quality of consultations and their acceptance have not been a problem. Drop-offs in usage noted in conjunction with routine personnel changes will be discussed, along with mechanisms implemented by NATO to ensure that this does not happen in the future. The acceptability and usability of the system have been such that one nation has requested the ability to use it in support of all its deployed forces, not only those in Afghanistan, thus clearly demonstrating the acceptance and desirability of the capability, in spite of the current lack of use. This effort clearly demonstrates teleconsultation can be effectively provided on a multinational basis, not only within one nation's forces, and this demonstration may provide a basis for extension of such a concept to other military or to disaster response situations.