Tech in San Diego helps focus on health

SAN DIEGO — The Defense Department can use its electronic health care systems to not only provide better individual patient care but to manage the health of 9.6 million patients as a whole.

That's the view of Capt. Charles Davis, the pediatrician and neonatologist who serves as deputy commander of Naval Medical Center San Diego. Davis said he believes that the center's population health program can result in breakthrough changes to ensure healthier lives for its 120,000 patients.

At the same time, an emphasis on population health will reduce a strain on the center's physical and financial resources, he said. That is largely because a small pool of patients use a disproportionate amount of those resources.

These patients include 9,000 people who have diabetes. For those patients, even a marginal change in their behavior and diet can have an impact on the hospital's resources, Davis said.

The center has used the Composite Health Care System I and plans to use CHCS II, which the center started to install last month. CHCS II will help identify and manage diabetic patients and those with asthma, another group that uses many hospital resources.

Early identification of diabetes allows the medical center's clinicians to better manage patients' blood sugar levels, which in turn alleviates the need for additional treatment, Davis said. Collating data across the diabetic population also allows doctors to determine what kinds of treatments work best.

This doesn't necessitate new computer tools, Davis said. Instead, officials are hoping to tap existing systems. Those systems allow the medical center to identify diabetics or potential diabetics in the system and then manage their health, not their illness, he said.

Managing population health requires access to a structured element database, part of CHCS II but not CHCS I.

Cmdr. Emory Fry, a neonatologist who heads the application development department at the center, said the hospital built its own structured database. This allows clinicians to graphically map a patient's blood sugar levels, he said. Combined with other data-mining techniques, this enables clinicians to "actively manage and substantially improve the health" of those patients, he said.

Technology has also allowed the medical center to treat patients at remote clinics, providing quality care without having to go to the hospital.

Darrell Hunsaker, a retired Navy captain and the medical

center's ear, nose and throat specialists, said the hospital has tapped the power of videoconferencing systems to conduct ENT examinations at remote clinics in California, including the 29 Palms Marine Corps Base and Navy bases in Lemoore and Point Hueneme.

The videoconferencing connections allowed him and other ENT specialists to provide service to those bases, which don't have ENT doctors on staff, Hunsaker said. The clinicians use remote cameras to conduct throat examinations and electronic stethoscopes to listen to a patient's breathing.

This equipment allows him to make a diagnosis remotely that is as good as one he could make in person, saving a sailor or Marine an overnight trip to San Diego. Such remote treatment could cut $100,000 a year from travel budgets, Hunsaker said.

Besides supporting active and retired military personnel across a wide swath of California, the medical center also supports the staff of the USNS Mercy hospital ship, currently deployed in the Indian Ocean for post-tsunami relief operations.

Lt. Cmdr. Erik Threet, chief information officer for both the Mercy and the San Diego center, said the ship has close to the same capabilities as the hospital, including a CHCS system with hundreds of terminals, a teleradiology system, videoconferencing systems and a Cisco Systems voice-over-IP telephone system, which saves bandwidth when calls are routed through the ship's satellite communications systems.

Primary communications from the Mercy occur via a DOD Challenge Athena satellite link, which has a raw throughput of 1.54 megabits/sec, and two commercial satellite systems with a throughput of 64 kilobits. The systems allow the Mercy to function as just another node on the medical center's network, Threet said.