1. 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 chuck.lappan@us.army.mil (210) 295-2512, Fort Sam Houston, Texas Revised 20 April 2010 The information in this PowerPoint may not be place in non – military websites

2. Teleconsultation Groups burntrauma.consult@us.army.mil (Burn-trauma) cards.consult@us.army.mil (Cardiology) derm.consult@us.army.mil (Dermatology) eye.consult@us.army.mil (Ophthalmology and Optometry) id.consult@us.army.mil (Infectious Diseases) infect.cntrl.consult@us.army.mil (Infection Control) im.consult@us.army.mil (Internal Medicine) microbiology.consult@us.army.mil (Laboratory Services) nephrology.consult@us.army.mil (Nephrology) neuron.consult@us.army.mil (Neurology) ortho.consult@us.army.mil (Orthopedics and Podiatry) picu.consult@us.army.mil (Pediatrics Intensive Care) pmom.consult@us.army.mil (Preventive Medicine) rheum.consult@us.army.mil (Rheumatology) sleep.e.consult@us.army.mil (Sleep Medicine) tbi.consult@us.army.mil (Traumatic Brain Injury) toxicology.consult@us.army.mil (Toxicology) urology.consult@us.army.mil (Urology) Specialties organized into email groups – send teleconsult to appropriate email For dental teleconsultations please see the special groups on the next page 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 chuck.lappan@us.army.mil

3. Dental dental.consult@us.army.mil (General dental questions) endodontic.consult@us.army.mil (Endodontic or root canal issues) oralpath.consult@us.army.mil (Pathology in or around oral cavity) oralsurgery.consult@us.army.mil (Removing teeth, infections or fractures involving the jaw) pedodontic.consult@us.army.mil (Dental questions involving children) perio.consult@us.army.mil (Periodontal conditions or questions involving the gums) protho.consult@us.army.mil (Implants, crowns, partial dentures, or complete dentures) Teleconsultation Groups Specialties organized into email groups – send teleconsult to appropriate email Vaccine Healthcare Centers Network SAMMCVHC@amedd.army.mil VHC Website http://www.vhcinfo.org US Army School of Aviation Medicine flightsurgeon@amedd.army.mil Joint Flight Surgeon Knowledge Center http://www.us.army.mil/suite/community/ 14881024 https://www.us.army.mil/suite/page/385506

4.  Other specialties “as requested” – send teleconsultation to chuck.lappan@us.army.mil 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 Teleconsultation Groups 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”

5. Business Practice Consultant retrieves and reviews teleconsultation Teleconsultation is routed to the appropriate specialty group Deployed Provider emails consultation Copy furnished to specialty group… confirms teleconsultation is answered and enables collaboration Teleconsultation emailed to Referral Manager Finds consultant with appropriate expertise Specialty with Contact Group Yes No Consultant emails recommendation to the deployed physician Provider sends f/u or questions/info to group Include chuck.lappan@us.army.mil in the “cc” address

6. 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 encrypt the email or the attachments Do not send radiographs in DICOM format  Requires special processing by radiology delaying by days our recommendations

7. 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.”

8. Potential Problems If you use your AKO email address in your teleconsultation and you did not inform your email administrator you were deploying replies to your AKO email address will be automatically be routed to your MTF email address  Add @mail after your email AKO email address: Example: chuck.lappan@mail.us.army.mil AKO blocks emails > 5 mB … some MTFs limit email sizes to 2 mB  Compress images in the camera before imaging or use Microsoft Picture Manager Large files overload Consultant’s email boxes causing their In-boxes to become full  Try to keep your entire consultation under 10 mB Compress images before or after taking them When in doubt send your consultation to chuck.lappan@us.army.mil  Will compress your entire consultation to > 500 kB and forward to the group Blurred images may be difficult to diagnose  Use the macro lens (flower icon) for all close-ups and use the focus-lock technique Additional information is found in the AKO website in the references on the next page or contact LTC (Ret) Chuck Lappan for specific information at chuck.lappan@us.army.mil  If you have questions on your camera please include the make and model of your camera

9. 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 chuck.lappan@us.army.mil for “Read Only” permission See the Telemedicine And Advanced Technology Research Center (TATRC) website http://www.tatrc.org/?p=projects/ako for additional links Medical Warfighter Forum: https://www.us.army.mil /suite/page/131414