Photo By Miguel Alvarez | 170823-N-KR394-002 SAN DIEGO, Calif. (Aug. 23, 2017) Cdr. Joseph Carney (left),...... read more read more
SAN DIEGO – Cdr. Joe Carney, division head for the Naval Medical Center San Diego (NMCSD) Complex Surgical Sports Team, sat in his small office as he examined his patient, a 29-year-old Army officer suffering from a Femoral Acetabular Impingement (FAI).
An FAI is a painful condition affecting a person’s hip joint that can sometimes be remedied by arthroscopic surgery — a minimally invasive surgical procedure where someone like Carney would access the joint using an arthroscope inserted through a small incision.
Carney’s goal was to determine whether the young Soldier would be a viable candidate for such a procedure. “Point to where you feel pain most,” said Carney as he began to evaluate his patient. “Right here,” said the patient pointing to his left hip.
Carney is an orthopedic sports surgeon who specializes in young adult hip arthroscopic surgery. In fact, he’s one of only two of the Navy’s such specialists on the U.S. West Coast helping young service members in need of his rare expertise throughout the Western United States and Pacific region.
While Carney performs about three to four of these types of consults per month, today’s particular encounter was unique, because his patient was 6,000 miles away on the small Pacific island of Guam at U.S. Naval Hospital Guam (NHG).
This was made possible by telecommunications technology and support from the Defense Health Agency’s (DHA) communications network, according to the virtual health program manager at Navy Medicine West (NMW). NMW is the command that oversees the U.S. Navy’s healthcare system in the Western U.S. and Western Pacific, caring for over 675,000 beneficiaries.
The interface is comprised of a small cylindrical camera atop a computer monitor through which Carney and the patient could view and talk to each other in real time similar to how one would interact through Skype, but via more secure channels guaranteeing patient privacy, and with the ability to display X-rays, MRIs, and other information visible to patients and medical providers at both locations.
It was the first tele-orthopedic consult ever performed in the Navy. “You’re a first for us. You’re ‘patient zero’ for VTC (Video Teleconferencing), so thank you for doing this,” said Carney.
Accompanying the patient in Guam was Lt. Cdr. Bennett Shapiro, an orthopedic surgeon who once served under the tutelage of Carney during his residency at NMCSD. Throughout the encounter, Shapiro helped the patient perform motion exercises directed by Carney and offered recommendations as the three collaborated. “I’m going to flex your hip up, and I want you to verbalize for us if it’s hurting,” said Shapiro, guiding the patient through the troubleshooting motions. The patient winced.
The tele-orthopedic concept was sparked during a phone call between Carney and his clinical coordinator, Deborah Vance-King. “I have this idea,” said Vance-King, quoting Carney as she cheerfully recounted the conversation, which took place in the spring of 2017.
Carney says the seemingly simple endeavor took about four months from idea to fruition and took buy-in, much collaboration and coordination among a cadre of information technology, administrative and medical experts at NHG, NMCSD and NMW to bring it all together.
Currently the ability to conduct tele-orthopedic consultations exists only between NHG and NMCSD, but the team envisions expanding the capability to other Navy medical facilities, such as Naval Hospital Okinawa, Japan, and Naval Hospital Yokosuka, Japan.
In addition to being a first for the Navy, the consultation served as the harbinger of a new paradigm of improved access, convenience, cost savings, and less travel for patients stationed in Japan, Guam, Korea and other distant locations, according to staff here.
“There’s a clear benefit to this,” said Carney. “The way the system is set up, we can’t just bring someone out, evaluate them and then do surgery the same day or the next day, because some of them don’t need surgery and some really need more time to consider the surgery, because there are risks, benefits, outcomes and so forth that need to be considered. So it’s really not appropriate to bring somebody in, have this specialist evaluate him and say, ‘okay let’s do surgery this afternoon or tomorrow.’”
With NMCSD being the only Navy medical facility in the region where young adult hip arthroscopy surgeries are performed, and only two specialists being available, a patient stationed in Guam usually makes a 12,000 mile roundtrip for a consultation at NMCSD, costing the U.S. Government at least $4,000 in travel and incidental expenses. After the consultation, if surgery were an option and the patient decided to undergo surgery, he would then have to repeat the roundtrip — 6,000 miles to NMCSD, undergo the surgery then undergo three weeks of post-surgery recovery in San Diego. The patient would then fly another 6,000 miles back to Guam for follow-on care, again costing at least another $4,000 of travel and incidental expenses on taxpayer dime.
As for today’s patient? It turns out he is a viable candidate for arthroscopic surgery, and fortunately he’ll only have to make one roundtrip if he decides to undergo it. A great return on investment, says Carney. “This will save a lot of time, a lot of money, so I think this is a good thing.”
| Date Taken: | 08.23.2017 |
| Date Posted: | 08.30.2017 12:15 |
| Story ID: | 246552 |
| Location: | SAN DIEGO, CA, US |
| Web Views: | 748 |
| Downloads: | 0 |
This work, A Virtual First for Orthopedics in Navy Medicine, by Miguel Alvarez, identified by DVIDS, must comply with the restrictions shown on https://www.dvidshub.net/about/copyright.
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