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Teleconsultation Program • Available to all deployed providers and to Independent Duty Medical Technicians working under the authority of a provider • Consultations are answered 7 days a week • Recommendations submitted within 24 hours • Uses Army portal with participation by all branches of the military • Consultants are from all branches of the military (Army, Navy, Air Force) • POC is LTC (Retired) Chuck Lappan [email protected] (210) 295-2512, San Antonio, Texas Revised 25 November 2009 The information in this PowerPoint may not be place in non – military websites Teleconsultation Groups Specialties organized into email groups – send teleconsult to appropriate email • • • • • • • • • • • • • • • • • • [email protected] (Burn-trauma) [email protected] (Cardiology) [email protected] (Dermatology) [email protected] (Ophthalmology and Optometry) [email protected] (Infectious Diseases) [email protected] (Infection Control) [email protected] (Internal Medicine) [email protected] (Laboratory Services) [email protected] (Nephrology) [email protected] (Neurology) [email protected] (Orthopedics and Podiatry) [email protected] (Pediatrics Intensive Care) [email protected] (Preventive Medicine) [email protected] (Rheumatology) [email protected] (Sleep Medicine) [email protected] (Traumatic Brain Injury) [email protected] (Toxicology) [email protected] (Urology) Note There are many consultant’s in each of these groups. It is common for you to receive an “Out of Office” or a “Full E-mail In-box” notification. If your receive an undeliverable message back from one or two consultant’s do not be concerned. When in doubt please contact LTC (Ret) Lappan [email protected] For dental teleconsultations please see the special groups on the next page Teleconsultation Groups Specialties organized into email groups – send teleconsult to appropriate email Dental [email protected] (General dental questions) [email protected] (Endodontic or root canal issues) [email protected] (Pathology in or around oral cavity) [email protected] (Removing teeth, infections or fractures involving the jaw [email protected] (Dental questions involving children) [email protected] (Periodontal conditions or questions involving the gums [email protected] (Implants, crowns, partial dentures, or complete dentures) Vaccine Healthcare Centers Network [email protected] http://www.vhcinfo.org VHC Website Teleconsultation Groups Other specialties “as requested” – send teleconsultation to [email protected] The following are examples of the “Other Specialties” have assisted with teleconsultations This list is not all inclusive and may change without notice • • • • • • • Allergy Endocrinology ENT Flight Medicine Gastroenterology General Surgery Hematology • • • • • • • Legal Neurosurgery Nutrition OB-GYN Oncology Pharmacy Plastic Surgery • • • • • Pulmonary Diseases Psychiatry Radiology Speech Pathology Vascular Surgery Cell-phone Cameras Unless your cell-phone camera has good optics the image may not be acceptable Image taken with a cell phone camera with poor optics “Image inadequate for diagnosis” Business Practice Provider sends f/u or questions/info to group Deployed Provider emails consultation Specialty with Contact Group Yes No Include [email protected] in the “cc” address Consultant emails recommendation to the deployed physician Consultant retrieves and reviews teleconsultation Teleconsultation is routed to the appropriate specialty group Teleconsultation emailed to Referral Manager Finds consultant with appropriate expertise Copy furnished to specialty group… confirms teleconsultation is answered and enables collaboration How To Send A Consult • Patient History When did it start? Days? Weeks? Months? Years? Patient symptoms now? Chronicity: Getting better? Worse? Staying the same? Spreading? What was used to previously treat the patient? Effectiveness of previous treatments? Laboratory and Test results if any? Your Diagnosis and/or Differential Diagnosis Limitations you have in treating the patient such as medications, procedures, lab tests? • Include Patient Demographics: branch of service, age, and gender. If not U.S. military state their nationality. Identify if contractor, detainee, foreign military, etc • Include digital images if appropriate Use the jpeg format for images Check images before transmitting to ensure they are in focus and accurately portray the problem as you see it Usually 3 to 5 images is all we need When in doubt, overload us with images • Other attachments: PDFs of EKGs JPEGs of radiographs Copies of laboratory and pathology reports • Do not include any patient identifying information Do not include the patient’s name or SSN • Try to limit one patient per teleconsultation • Do not send radiographs in DICOM format Requires special processing by radiology delaying by days our recommendations How To Send A Consult • If you send a consult and later need additional assistance send the teleconsultation to the generic email address of the specialty and not to the consultant who answered your consult Most consultants are on a call-roster and look for consults during the period they are on-call Most delete the consult after they have answered it Project Manager makes an MSWord file for each consult When a reconsult is sent, the Project Manager transmits the file to the on-call consultant • Do not include “archive” attachments Certain file types such files are automatically blocked “The sender of the message sent the following files that are not allowed by NETCOM guidance 2004-11A: OnyxLite.exe In accordance with NETCOM guidance 2004-11A, AKO has begun stripping files with the following extensions: .ace, .ad, .ade, .adp, .asp, .b64, .bas, .bat, .bhx, .ceo, .ce0, .chm, .cpl, .crt, .dbx, .dll, .dot, .eml, .exe, .hlp, .hqx, .hta, .inf, .ins, .js, .jse, .lnk, .mdb, .mde, .mim, .msi, .msp, .nch, .ocx, .pi, .pif, .rar, .scr, .sct, .shb, .shs, .upx, .uue, .uu, .vbe, .vbs, .vss, .vst, .vsw, .wmi, .ws, .wsc, .wsf, .wsh, .xxe, and .zip. Since this is an Army policy, AKO will not be able to grant exceptions. You may view the NETCOM guidance at https://www.us.army.mil/suite/doc/7190255 The guidance includes instructions on how the sender should send the files that are restricted.” AKO Website • Detailed information on Program is found in the Army Knowledge Website Deployed Providers Briefing https://www.us.army.mil/suite/files/19174202 Case Studies https://www.us.army.mil/suite/files/19174257 Reference Materials https://www.us.army.mil/suite/files/19174300 • Access limited to Healthcare professionals with MC, MS, SP, AN, and Enlisted Medical • All others please contact [email protected] for “Read Only” permissions • See the Telemedicine And Advanced Technology Research Center (TATRC) website http://www.tatrc.org/?p=projects/ako for additional links