An Internet based consultation and referral network between Tripler Army Medical Center and hospitals in the Western Pacific

Since the initiation of the Pacific Island Health Care Project in 1989, over 2,500 patients from the US-associated Pacific islands have been cared for at Tripler Army Medical Center at no cost to the patient or island nation. In an attempt to contain Tripler costs, increase access and provide consultative and referral services to healthcare professionals in the Pacific Basin, a Web-based referral network was established in December 1997. Four sites were selected as beta-test sites: Weno, Chuuk State, FSM (Federated States of Micronesia); Kolonia, Pohnpei State, FSM; Koror, Republic of Palau and Majuro; and the Republic of the Marshall Islands. Each site was provided with a desktop computer, digital still camera, digital video camera, flatbed scanner and printer. A digital oto/ophthalmoscope was provided to Chuuk and Pohnpei. Local clinicians fill out consultations on the Internet, attach supporting imagery and submit the consultation package to Tripler. The multimedia consultations are inserted into a database, then dynamically posted on a secure Web page, where they are viewed and commented on by specialists. Cases are formatted to allow rapid consultant response, image review, consultant-provider interaction and presentation of the case for peer review. These cases provided unique graduate medical education and military-relevant experiences for students, residents and staff physicians at Tripler. Initial experience indicates that the Internet can be easily used as an inexpensive store-and-forward consultation format. There has been an overwhelming enthusiasm for this project by all participants