“War fighters are our first priority for the laser correction vision program that will be available in late fall,” said Dr. Richard Dohoda, Commander of Medical Corps at Naval Station Bremerton. “The hospital is the fifth site to be implemented in the navy’s program.”

“The Laser Correction War Fighters’ Program will enhance and correct aviators’ and special warfare combatants’ eyesight,” Dohoda said. “Our men and women enter the navy with 20/20 eyesight. However, when they age over 40, nearsighted is common. We want to correct their vision to 20/20, so they can see in a distance, enhancing their operating capabilities. We have been losing aviators due to eyesight loss — and losing the money spent on years of training.”

Active navy and army aviators and warfare combatant personnel stationed in Washington, Oregon, Idaho and Alaska have had to travel to San Diego for laser correction. Laser correction of nearsightedness, farsightedness and astigmatisms will become available to them at Naval Hospital Bremerton.

In 1994, Capt. Steve Schallhorn, a naval ophthalmologist and cornea specialist stationed in San Diego, asked that nearsighted, active duty navy and marine personnel mail him letters if they were having on-the-job problems with their glasses or contact lenses. The letters helped to assess the need, value and demand of laser correction.

Members of Sea, Air and Land (S.E.A.L.) who had to wear prescription, underwater facemasks, initially paid out-of-pocket for laser correction. Gasmasks also required prescriptions.

“Captain Christine Hunter, current commanding officer of Naval Hospital Bremerton, and Vice Admiral Richard Nelson, retired surgeon general of the navy, worked hand-in-hand to implement the Laser Correction War Fighter’s Program,” Dohoda said. “Hunter served under Nelson as executive assistant to the navy surgeon general.”

VISX, Inc., will provide the laser vision-correction system, paid for by Bureau of Navy Medicine Funding.

“Bremerton is one of the first military medical facilities nationwide to be linked to TRICAREOnline.com,” said Patrick Flaherty, chief information officer at Naval Hospital Bremerton. “We are just now registering patients. We’ve been online for a little over a month.”

The Department of Defense created the website to improve healthcare access and wellness education for 8.4 million beneficiaries. It provides secure, interactive customer services, including medical advice and health information. Patients enrolled with TRICARE Prime and Bremerton Plus at Naval Hospital Bremerton — or any branch medical clinics — use the website to book routine and follow-up primary care appointments.

The website also personalizes healthcare. Patients create an online, personal health journal, recording current treatment, immunizations, prescribed medications and past medical procedures. By using a secure password, they retrieve personal health care information online from any location, when moving, traveling or away from home on temporary assignment.

TRICAREOnline is available seven days a week, 24 hours a day.
As a compliment to TRICARE Online the hospital has recently installed a online pharmacy refill system that is available through their home page. “They type in their prescription number and choose if they want to pick up their prescription at Naval Hospital Bremerton, Smoky Point Pharmacy in Everett or branch clinics at Sub Base Bangor and Puget Sound Naval Shipyard,” Flaherty said.
Most-wired status

Naval Hospital was awarded as one of the nation’s 100 most-wired healthcare facilities in 1999, 2000 and 2001.

Hospitals & Health Networks, a monthly magazine, presented the award. The award is based on an annual survey, polling military and civilian healthcare systems throughout the nation. About 300 hospitals and health systems responded to the survey in 2001. The survey examined the use of Internet technologies that connect hospitals with patients, physicians, nurses, health plans and employees.

“This year there is emphasis on the PDA,” Flaherty said. “We are looking to start a pilot program this summer.

PDA stands for personal digital assistant. The hand-held device has the ability to provide wireless access to the Internet, store and retrieve appointments and telephone numbers. A PDA can exchange or synchronize information with a full-sized computer.

“We are looking at using PDAs in the gradate medical education residency,” Flaherty said. “Out of our desire to maintain state-of-the-art medical education, we want to see how hand-held devices fit in.”
Robotics
   OB WAN, the robot, moved quickly through the vertical prescription isles within the glass-front case that held 185 oral medications. OB WAN helps to process 1,500 prescriptions a day at the Naval Hospital Bremerton pharmacy. So do R2D2 and Pinky and the Brain.

“We’ve given them names, so we know which of the three robotic stations we are talking about,” said Chad McKenzie, lieutenant, in charge of Inpatient Pharmacy Services at Naval Hospital Bremerton. “At this time, we are the first of three sites in the nation to use the robotic system.”

The ScriptPro system interfaces with pharmacy computers to fill and label vials at 100 prescriptions per hour. Two hundred cells handle tablets and capsules of all shapes and sizes. Drug cross-contamination is eliminated, because robots fill vials directly from the dispensing cells. Robots print and apply prescription labels with bar codes to assure accuracy and quality control. They deliver uncapped vials to a tray for manual inspection and on-screen drug image verification. In case of an electrical emergency, robots are linked to an uninterruptible electrical source.

The pharmacy fills more prescriptions per day than any other pharmacy in Kitsap County.

McKenzie helped to implement the system.
Teledermatology

Teledermatology allows Cmdr. Robert Butler of Naval Hospital Bremerton to diagnosis skin lesions of personnel on board the USS Carl Vinson within 24 hours.

“I’m the only naval dermatologist in the Pacific Northwest,” he said. “We are regionalizing military medicine to serve ships and deployed troops.”

The teledermatology system loads and transmits digital pictures of skin, hair and nail disease and their medical history from outlying military clinics to a server. Doctors access and diagnose the pictures and medical history at military hospitals.

“I get a visual feel, recognize, diagnose and advise treatment,” Butler said.

“The teledermatology website is secure and requires a password for patient information,” Butler said. “I see 15-20 cases a month. Skin lesions and rashes are common. If skin problems looks cancerous, I ask technicians at the clinics to perform biopsies.”

Active naval personnel living in Oak Harbor and Everett especially make use of teledermatology. It saves them a full working day traveling to and from Naval Hospital Bremerton for diagnoses. Teledermatology is also offered to dependents and retirees.

Patients’ medical history is stored on the server. The server was relocated from Walter Reed Army Medical Center, Washington, D.C., to Madigan Army Medical Center in Tacoma, on May 16. The navy and army are collaborating to regionalize medicine.
Telepsychiatry

“Telepsychiatry is like an emergency room,” said Eric Richards, HM3 hospital coreman third class of the Mental Health Clinic. “If a medical provider at an outlying clinic in Oak Harbor or Everett thinks a patient is suicidal or homicidal, the patient can talk to and be observed by a doctor at Naval Hospital Bremerton by computer.”

Telepsychiatry is an arm of regionalized medicine, a collaboration of the army and navy. The videoconference server is located at Madigan Army Medical Center, Tacoma.

Richards demonstrated the system. On the desktop, he clicked on telepsychiatry software, gave his password and chose a closed circuit with secure access to an outlying clinic in Everett. The screen offered a virtual visit between patient and doctor. Half of the divided screen showed an empty chair in the clinic, where a patient would have sat. It also showed a smaller picture of the chair where the in-house doctor would have sat.

“Before the visit, I adjust the light at our end,” Richards said. “If it’s too bright, I close the drapes. The same is done at the outlying clinic. A camera is operated from both ends. At this end, I adjust the camera so the doctor can clearly see the patient’s body movement and positioning. At the clinic’s end, the camera is adjusted so the patient can clearly see the doctor.”

The other half of the screen allowed input of patient information, including diagnosis and history. The doctor keys information after video conferencing.
“Most of the time patients want a professional to listen, to help work out problems,” Richards said. “Patient needs reassurance. If patients are suicidal, we don’t want them to harm themselves.”

Naval Hospital Bremerton offers no inpatient service. Patients are watched until hospitalized. Harrison Hospital handles dependent cases and Madigan Army Medical Center handles active military cases. Retirees can be sent to either hospital.

Naval Hospital Bremerton has offered telepsychiatry for almost a year. The Apollo Encounter System is linked to Madigan Army Medical Center, Naval Station Everett, Fairchild Air Force Base in Spokane and Naval Air Station, Whidbey Island.
Integrated Clinical Database

“ICDB is an offshoot of CHCS,” said Flaherty. “Doctors love ICDB, because it is more user-friendly, having a web-based front-end.”

ICDB stands for Integrated Clinical Database. CHCS stands for the 15-year-old character-based Composite Healthcare System.

ICDB differs from CHCS, because it integrates text, regarding pharmacy, laboratory and patient information, with color and graphics. A mouse enhances maneuverability.

“We still use CHCS,” Flaherty said. “It is truly an integrated clinical database, but it lacks a user-friendly interface.”.