[Congressional Record Volume 145, Number 103 (Tuesday, July 20, 1999)]
[Senate]
[Pages S8893-S8894]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                               TELEHEALTH

 Mr. INOUYE. Mr. President, this past month, Major General 
Nancy Adams, Commander of the Tripler Army Medical Center, Honolulu, HI 
participated in the Congressional Ad Hoc Steering Committee on 
Telehealth Demonstration and Briefing. I have been pleased to work 
closely with General Adams for a number of years, including during her 
earlier tenure as Chief, United States Army Nurse Corps.
  I am extraordinarily pleased to have her selected to command Tripler. 
She is the first female commander of our facility and the first two-
star nurse in the history of the United States Army.
  Mr. President, I ask that her opening remarks be printed in the 
Record.
  The remarks follow:

      Remarks of MG Nancy R. Adams, Department of Defense at the 
Congressional Ad Hoc Steering Committee on Telehealth Demonstration and 
  Briefing on ``Information Technologies for Healthcare: Government, 
         Industry and Academia Working Together'', 23 June 1999

       Good Morning and aloha from Hawaii. I am Major General 
     Nancy Adams. I am privileged to offer the opening remarks on 
     the accomplishments and challenges the Department of Defense 
     (DOD) is addressing in information technologies for 
     healthcare.

[[Page S8894]]

       In my current assignment as the Commanding General, Tripler 
     Army Medical Center, Hawaii, and the United States Army 
     Pacific Command Surgeon, I am somewhat in awe at being 
     designated as the DOD spokesman. However, I am very pleased 
     to have the opportunity because telemedicine and telehealth 
     initiatives are vital to the mission of my medical center. To 
     say that I am the DOD spokesperson does exaggerate my 
     accountability with the Department. So to be safe, I should 
     at this point go with the standard disclaimer, which says my 
     information does not necessarily reflect the views of the 
     Department or the Secretary of Defense.
       I am most pleased to be participating in the congressional 
     Ad Hoc Committee on Telehealth forum. This event acknowledges 
     the vision and support congressional representatives have 
     offered to enhance the applications of information technology 
     to healthcare in general with special emphasis on clinical 
     practice.
       Within the Department of Defense, and most particularly in 
     the Pacific, there are significant distances, time zone 
     disparities, and geographic boundaries that present 
     challenges to the delivery of patient care. In the Pacific, a 
     variety of both public and private sector agencies are 
     involved in health care services, with the overall goal to 
     transcend time, distance, and structural barriers to provide 
     quality healthcare to Department of Defense beneficiaries. 
     Because of our global role, it is incumbent that the 
     Department of Defense work collaboratively to afford 
     responsive health care services, and this challenge can only 
     be addressed with innovative technology and telecommunication 
     solutions. Hence, I would like to illustrate a few examples 
     from my Hawaii experience, on how the linkage between 
     information, knowledge, and technologies have enhanced access 
     to health care services and improved the quality of care 
     rendered.
       Tripler Army Medical Center is the only Department of 
     Defense tertiary care medical treatment facility in the 
     Pacific. Tripler serves the health care needs of more than 
     750,000 active-duty military, their families, military 
     retirees, retiree families and other Pacific island 
     beneficiaries. Using the systems developed through Department 
     of Defense, such as the Composite Health Care System II, or 
     CHCSII, Corporate Executive Information System or CEIS, 
     AKAMAI, and the Pacific Medical Network or PACMEDNET, have 
     enabled us to improve the quality of care and access to 
     health services for our beneficiaries.
       Healthcare information systems and telehealth applications 
     within the Department of Defense strive to accomplish the 
     following 5 goals: Keep Active Duty forces on the job; Reduce 
     the Military Health System skill mix and size in staffing 
     model; Increase productivity of the direct care component; 
     Enhance and measure health and fitness of beneficiaries, and 
     lastly, Promote and measure customer satisfaction with 
     Information Technology.
       The healthcare information management initiatives within 
     the Department of Defense focus on research and the value of 
     information and telehealth applications along with 
     implementation of automation support to enhance patient care 
     delivery. I can attest that information management support 
     provided by systems such as the CHCSII, CEIS, and the 
     telehealth support from Akamai and PACMEDNET, have provided 
     significant readiness and humanitarian implications for 
     regional care in the Pacific. Being responsible for delivery 
     of healthcare to a region as big as the Pacific--which 
     encompasses 70 countries and 14 time zones--requires me to 
     use and support the development of technology tools. These 
     technology tools and clinical capability offer tremendous 
     opportunities for reuse by other federal agencies, as well as 
     transferability to private sector agencies.
       As stated earlier, healthcare information technologies are 
     an essential element of health care services within the 
     Department of Defense because of the need to overcome the 
     dispersion of beneficiaries over great distances. The 
     telehealth possibilities are highly opportunistic and provide 
     a window on the future. Our technology is a means of 
     demonstrating US engagement in other nations by providing a 
     telepresence in other than US military medical treatment 
     facilities. Specific benefits healthcare technology has 
     offered Tripler Army Medical Center and the Pacific include:
       Ability to provide a health profile for a person that will 
     facilitate decision making by a provider who doesn't have 
     access to a complete medical record.
       We can integrate patient administrative and clinical data 
     between multiple and diverse healthcare systems.
       The same network and technology that provides information 
     for diagnosing and treating patients can also be utilized for 
     teaching via distance learning techniques.
       Use of the Internet and web-enabled solutions has fostered 
     a sense of community amongst clinicians and consumers by 
     enabling information sharing, education, and collegial 
     relationships.
       From my perspective as a military medical center commander 
     and the Command Surgeon, healthcare information technologies 
     contribute to the readiness and health care delivery mission. 
     I mention this as a single mission because the role of 
     military medicine is to stay trained and ready for 
     contingency operations that directly support the US 
     military. The business of health care in and of itself is 
     not our focus. It is the link between readiness and health 
     care delivery that makes military medicine vital to our 
     nation. The linkage between readiness and health care is 
     good business for the military.
       Through the application of information systems and 
     telehealth technologies, the quality of care and utilization 
     of scarce medical resources are positively effected thereby 
     improving both military readiness and health care delivery. 
     Utilization of information systems and telehealth 
     applications provides immediate access even when specialists 
     are not on site. For example, Tripler will be interpreting 
     echocardiograms from Yokoto, Japan and Guam. This can be life 
     saving information if you are talking about the patient's 
     need for surgery or the functioning of the heart after a 
     heart attack. These technologies also project medical 
     specialty expertise without deploying them from the medical 
     center. This saves significant dollars by not taking the 
     medical specialist away for a minimum of two days travel to 
     do a day's work. In addition, for those clinicians who are 
     forward deployed, this access to specialists decreases their 
     professional isolation and improves their decision-making 
     ability. In some cases there is the added benefit of 
     eliminating the need to air-evac patients for definitive care 
     and continuity of care is maintained at their home station.
       Healthcare information technologies are good new stories 
     for the Department of Defense but the potential is in its 
     infancy. Only by working with our partners in other 
     government agencies, industry, and academia, will we be able 
     to maximize the investment in technology by increasing its 
     utility and clinical efficacy. In closing, my goals for 
     attending the congressional Ad Hoc Steering Committee on 
     Telehealth Demonstration and Briefing are twofold:
       To communicate the reality of the technological solutions 
     currently available within the Department of Defense to 
     provide quality health care and improve access;
       And second, to encourage networking among the congressional 
     supporters, speakers, attendees, and exhibit presenters to 
     further maximize our capabilities. As we share information 
     and establish relationships with one anther I am sure our 
     collective efforts will produce more and better applications 
     of the technology than what is already here. Ideas for future 
     integration and information management technologies should be 
     the most valuable outcome of today's activities. I hope most 
     of you will be staying through the day and spending time in 
     the exhibit area. Many of the leading edge health care 
     technology companies have displays, as well as Department of 
     Defense, Veterans Administration, and Indian Health Service 
     enterprises. Individually as well as together we are all 
     involved in re-engineering health care processes to 
     incorporate emerging technologies!
       I am very pleased to be sharing the podium with 
     distinguished leaders from Congress, the military, government 
     service, and industry. Those of us in the military know that 
     it is only through the vision and support of Congressional 
     representatives that the Department of Defense has progressed 
     to our current level of sophistication in healthcare 
     information technologies and telehealth. Ladies and 
     Gentlemen, I challenge you to continue to exploit the 
     capabilities in healthcare information technologies; to 
     capitalize on the improvements it can offer the business 
     practice of patient care, and to nurture the positive and 
     sustained impact of technology on enterprise value. I 
     encourage you to take advantage of the sense of community the 
     Internet enables by sharing your ideas and solutions with 
     fellow government, industry and academic colleagues.

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