Joshua L. Wick  |  Stripe Staff Writer

July 29, 2010

In a standard conference room on the 5th floor in Ward 58 of Heaton Pavilion, a dedicated team of neurosurgeons, nurses and other staff talk with patients, offering them a unique environment and service indicative of the innovation and adaptive use of technology of Army Medicine.

Access-to-care could be just another medical catch phrase if it wasn’t already in action here at Walter Reed Army Medical Center. For the last six years, the Northern Regional Medical Command (Provisional) has developed and implemented a tele-neurosurgery program that provides initial and follow-up neurosurgery patient screening using video teleconference (VTC) technology.

The program is designed to improve clinical outcomes, increase access-to-care, ensure continuity-of-care, recapture workload, and reduce outsourced neurosurgery costs within the region. In essence, it has established, “access-to-care they [patients] might not normally have,” said Dr. Samuel S. Lyness, director of the Tele-Neurosurgery program, at WRAMC.

“There’s nothing like being in the same room as a surgeon,” said Lyness, “but this is the next best thing. It’s vastly better than making them [the servicemember, beneficiary, and/or retiree] take a day to travel here only to be told that they really don’t have a surgical problem and can go back home and get physical therapy or medications.”

“This process has evolved from doing something like this once every two months to now where we do it every two weeks,” said Joe Smith Jr., director and clinical supervisor, Womack Army Medical Center, neurosurgical clinic, Fort Bragg, N.C.

Running more than two VTCs a week with Womack, Ireland Army Community Hospital at Fort Knox, Ky., and other clinics, NRMC’s regional virtual clinics see between 20 and 40 patients a week, Lyness said.

“The goal here of tele-neurosurgery is to maximize operative cases within our military system, ultimately it’s to keep the surgeon in the operating room and out of the clinic,’’ added Smith. “We [support staff] basically do all the clinical evaluations, workups and treatments until patients reach the point where they maximized their non-surgical options, or they are maybe already to a point to where they are at an immediate surgical option. We coordinate care on the spot for these patients.”

Having done everything possible to try to avoid surgery on his neck, Staff Sgt. Kort Wilson, a vehicle mechanic, assigned to Foxtrot Company, 2nd Battalion, 2nd Brigade Combat Team, 82nd Airborne Division, was referred to tele-neurosurgery at WAMC.

“Actually, it [the VTC]was pretty neat,” said Wilson. “It was nice to actually get to sit there with the actual surgeon himself and be able to ask him specific questions about what’s going to happen with me. It gave me a better understanding about the whole process.”

Having a cervical disc herniation, between 4th and 5th vertebras in his neck, the staff sergeant knew surgery was necessary.

“It’s only been a month,” Wilson said.

He met with Smith the first time after his MRI. They did the VTC, and originally scheduled him for surgery early August. The surgeon at the National Naval Medical Center, Bethesda, Md., had an earlier opening, and Wilson said, “Let’s do it.”

Had this been a few years ago, “I would have had to come up here to Walter Reed TDY [temporary duty assignment], then go back and wait a month or two or three or however long it would take to get into surgery. In this case, I didn’t have to leave my duty station. I just went over to the hospital, did the VTC with the doctor, and asked him every question that I had. It was easy because it was one trip up here,” said Wilson.

“This has endless amounts of benefits for the Army,” said Smith. “Money will continuously be saved at an unpredictable amount, and this is something that is blossoming with boundless potential. We have consistently saved money for the military and taxpayers, essentially paid for ourselves.”

As for the benefits, “if we weren’t doing this forum, they [patients] would be going to the civilian network and that’s a huge expense for the Department of Defense to pay,” said Navy Lt. Cmdr. Jonathan Gilhooly, a surgeon for the Integrated Department of Neurosurgery WRAMC and NNMC. “Here, the residents benefit because there are more cases; the staff benefits and the patients benefit. Most of these folks want to get seen in the military system anyway; the outside system is very foreign to them.”

All servicemembers, beneficiaries, and retirees are eligible for VTC care, and this application is ideal and certainly transferable, within the joint setting, added Smith.

Currently there plans to begin to expand the program.

“We’re already in the works and expected to open a connection between the veterans hospitals here in Washington D.C. shortly,” said Lyness.

In addition to linking up with the Veterans Administration, the program is planning to expand and establish a link between Alaska and Madigan Army Medical Center in Tacoma, Wash.

“There’s a gigantic endless need for neurosurgical management,” Smith said.

With the success of the program from patient access-to-care, the cost benefits and, “because this is a training center [WRAMC and NMMC], these cases also provide graduate education for the residents to observe, watch, and train on, so it’s a vital part of the training program,” said Lyness.

The tele-neurosurgery program here, added Lyness, will be the link between Bethesda and Fort Belvoir for neurosurgery and for Joint Task Force National Capital Region Medical.

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