Telemedical tests to begin with `electronic dog tags`
By John Rhea
VIENNA, Va. - U.S. Army leaders are to begin field testing a telemedical system this month in which soldiers carry their medical records in "electronic dog tags" that can be read by a PCMCIA reader attached to a ruggedized personal computer.
The system is called Medi-Tag, and the critical issues to be resolved include adequate data storage capacity, security of the medical records, and the ability to integrate a number of medical conditions in order to give a clear picture of a soldier`s status during deployment conditions, says Brig. Gen. Russ Zajtchuk, commander of the Army Medical Research and Materiel Command (MRMC) at Fort Detrick, Md.
Zajtchuk and speakers on related topics made their comments at the Global Forum on Telemedicine last month sponsored by the Association of the U.S. Army (AUSA).
Capt. Paul Zimnik, also at MRMC, is the program manager, and he says the system will use a commercial communications infrastructure - the World Wide Web - for interoperability with other services and, eventually, dual-use applications with civil health programs. Medi-Tag will use ruggedized commercial off-the-shelf (COTS) equipment.
Ten prototype Medi-Tag readers and 100 prototype tags have been delivered to Fort Detrick, says Thomas Clark, chairman and CEO of Data-Disk Technology Inc. of Sterling, Va., which is developing the system. The tests, "in the mud" to determine their performance in the most severe environments, are scheduled for Fort Gordon, Ga., Brooks AFB, Texas, and Wright-Patterson Air Force Base, Ohio, he says.
The most ambitious test of telemedicine to date was in Bosnia, Zajtchuk says; Army officials are still evaluating that experiment.
In Bosnia, medical technicians gathered data on soldiers` conditions by conventional means, yet they linked the information via satellite to specialists in military medical centers in the U.S. for diagnoses. Zajtchuk estimates the cost of that test at $50 million, and claims one "first" for it: no in-country radiologist was necessary to support 20,000 troops.
Dr. Jay Sanders, president of the American Telemedicine Association in McLean, Va., lauds the Internet approach. "All telemedicine is the use of off-the-shelf telecommunications and expert information: audio, text, real-time video, and store-and- forward video," he says.
The most important of these is the store-and-forward capability, he adds, to gather diverse information on patients` conditions and enable medical personnel for the first time to bring medical services to the patient, rather than the other way around. Primary care physicians can call in specialists as needed.
"The smart card is the beginning of an electronic medical record that travels with the patient," Sanders says. He envisions its evolution into a "voice-activated, branched logic tree computer based on patient responses."
The main technological problem for Medi-Tag is storage capacity, and Clark estimates an operational system for the military will require at least 20 megabytes in each tag. The prototypes have only 2 megabytes, but data compression techniques enhance that by a factor of 5-1 for text and 10-1 for images.
Zajtchuk says he is looking for at least 6 megabytes within a year to accommodate the DD 1380 standard medical form, EKGs, and other information.
Cost is another critical consideration, and Zimnik says evaluation and modeling efforts will determine whether the technology is sufficiently mature to be fielded.
Clark estimates the current prototype tags, which have gone through a series of refinements to arrive at a 20-pin configuration, run about $75 each and should drop to $50 in quantities of thousands, and $25 in ten thousands.
The heart of each tag is a COTS NAND flash ROM from Samsung, Toshiba, and other commercial vendors.
The readers, from AMP Inc. of Harrisburg, Pa., now run around $500 apiece, and Clark sees this number eventually dropping to below $200. AMP is geared up to produce 5,000 a month, he says.
Data-Disk has introduced a developer`s tool kit that includes the PCMCIA reader, six tags, and installation software at $2,500. Developers can write their own application software. Data-Disk officials are evaluating whether to contract out the manufacturing of the tags or to do it in-house.
Zajtchuk also says Army officials will begin demonstrating their advanced liter for critically wounded personnel, known as the Aztec, by the end of the year.
Aztec is essentially a mobile intensive care unit. The 4,000-pound, helicopter-deliverable unit provides oxygen and other medical supplies and has a digital wireless link to medical facilities.
This program is being coordinated with the other services, and Zajtchuk says the Marine Corps officials are particularly interested. The unit is being given a chemical and biological warfare capability and is also being evaluated for humanitarian assistance applications.
