title: Operation Joint Endeavor in Bosnia: telemedicine systems and case reports.
abstract: OBJECTIVE
  For the last several years the U.S. Department of Defense (DoD) has operated a telemedicine test bed at the U.S. Army Medical Research and Material Command's Medical Advanced Technology Management Office. The goal of this test bed is to reengineer the military health service system from the most forward deployed forces to tertiary care teaching medical centers within the United States by exploiting emerging telemedicine technologies.
  
  
  METHODS
  The test bed has conducted numerous proof-of-concept telemedicine demonstrations as part of military exercises and in support of real-world troop deployments. The most ambitious of those demonstrations is Primetime III, an ongoing effort to provide telemedicine and other advanced technology support to medical units supporting Operation Joint Endeavor in Bosnia.
  
  
  RESULTS
  Several of the first instances of the clinical use of the Primetime III systems are presented as case reports in this paper. These reports demonstrate capabilities and limitations of telemedicine.
  
  
  CONCLUSIONS
  The Primetime III system demonstrates the technical ability to provide current telecommunications capabilities to medical units stationed in the remote, austere, difficult-to-serve environment of Bosnia. Telemedicine capabilities cannot be used without adequate training, operations, and sustainment support. Video consultations have eliminated the need for some evacuations. The system has successfully augmented the clinical capability of physicians assigned to these medical units. Fullest clinical utilization of telemedicine technologies requires adjustment of conventional clinical practice patterns.
authors.affiliation: U.S. Army Medical Advanced Technologies Management Office (MATMO), Fort Detrick, Frederick, MD, USA.
authors.forename: D E
authors.initials: DE
authors.lastname: Calcagni
authors.forename: C A
authors.initials: CA
authors.lastname: Clyburn
authors.forename: G
authors.initials: G
authors.lastname: Tomkins
authors.forename: G R
authors.initials: GR
authors.lastname: Gilbert
authors.forename: T J
authors.initials: TJ
authors.lastname: Cramer
authors.forename: R K
authors.initials: RK
authors.lastname: Lea
authors.forename: S G
authors.initials: SG
authors.lastname: Ehnes
authors.forename: R
authors.initials: R
authors.lastname: Zajtchuk
mesh_terms: D000328:Adult; D000818:Animals; D017522:Bosnia and Herzegovina; D002522:Chlorocebus aethiops; D003937:Diagnosis, Differential; D004427:Ear Diseases / Q000175:diagnosis; D004814:Epidermal Cyst / Q000175:diagnosis; D006801:Humans; D008297:Male; D008887:Military Medicine / Q000379:methods*; D008889:Military Personnel; D019114:Remote Consultation / Q000379:methods; D016097:Simian Acquired Immunodeficiency Syndrome / Q000175:diagnosis; D015302:Simian Immunodeficiency Virus; D017216:Telemedicine; D013736:Testicular Neoplasms / Q000175:diagnosis; D014646:Varicocele / Q000175:diagnosis; D015047:Zoonoses