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 (210) , San Antonio, Texas Revised 25 November 2009 The information in this PowerPoint may not be place in non – military websites

Teleconsultation Groups (Burn-trauma) (Cardiology) (Dermatology) (Ophthalmology and Optometry) (Infectious Diseases) (Infection Control) (Internal Medicine) (Laboratory Services) (Nephrology) (Neurology) (Orthopedics and Podiatry) (Pediatrics Intensive Care) (Preventive Medicine) (Rheumatology) (Sleep Medicine) (Traumatic Brain Injury) (Toxicology) (Urology) Specialties organized into groups – send teleconsult to appropriate 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 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

Dental (General dental questions) (Endodontic or root canal issues) (Pathology in or around oral cavity) (Removing teeth, infections or fractures involving the jaw (Dental questions involving children) (Periodontal conditions or questions involving the gums (Implants, crowns, partial dentures, or complete dentures) Teleconsultation Groups Specialties organized into groups – send teleconsult to appropriate Vaccine Healthcare Centers Network VHC Website

 Other specialties “as requested” – send teleconsultation to 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”

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

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 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 A: OnyxLite.exe In accordance with NETCOM guidance A, 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 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 -  Case Studies -  Reference Materials - Access limited to Healthcare professionals with MC, MS, SP, AN, and Enlisted Medical All others please contact for “Read Only” permissions See the Telemedicine And Advanced Technology Research Center (TATRC) website for additional links