Telemedicine Interview : The Pacific Telehealth &
Technology Hui (psychology and mental health)

An interview with Leigh W. Jerome, Ph,D
Director of Extramural Research at the Pacific Telehealth and Technology Hui

By: Bob Pyke, Jr. RN, CPNP
Assistant Editor & Roving Reporter TelehealthNet News

Dr. Jerome, Aloha

Aloha, Bob.

Can you tell me how you became involved with Telemedicine and how you became involved with the Pacific Telehealth & Technology Hui?

Hawaii is composed of a string of non-contiguous islands in the Pacific. Hawaii has only one state psychiatric hospital, located on Oahu. In the early 90's, I was Chief of the Psychology Department at this facility. Psychiatric patients who were scheduled to appear for court hearings on other islands had to endure an arduous transportation process with a complex custody chain. In addition to the expense, inconvenience, and potential threats to public safety, the process represented a stressful event, especially for individuals with already compromised mental status. I began to investigate the feasibility of utilizing a state teleconferencing facility to mitigate this onerous procedure. The efforts were very successful and well accepted. It was at that point that I experienced a kind of epiphany regarding technology and the significance of imminent changes in health care. I started to envision research opportunities and new solutions for technology, telecommunications and health care. Then I launched into these telehealth efforts with a passion. When the original AKAMAI project started up, the predecessor to the Pacific Telehealth and Technology Hui, I was asked to come be a part of one of the projects. Later, I became involved in the central coordinating effort.

Can you tell me the history of the Pacific Telehealth & Technology Hui

On 1 July 2001, the Pacific e-Health Innovations Center (P-eIC) was re-designated as the Pacific Telehealth and Technology Hui under a memorandum of agreement between the Pacific Regional Medical Command the Veteran Affairs Medical Regional Office Center in Honolulu. The Hui is jointly governed by the VA and DoD as a healthcare research and development organization. The Hui's mission is to create partnerships for developing and providing research services, education and training and to apply innovative technologies to all aspects of its endeavors. The Hui conducts research, develops prototypes, demonstrates, tests, evaluates, validates, and then institutionalizes telehealth applications in support of the health and medical needs of beneficiaries in the Pacific. The Hui then works to make these technologies and systems available to other federal, and private organizations through its emerging technology transfer program. Currently the Hui has 42 projects in development involving a broad range of technologies, including clinical informatics, biomedical applications, clinical telehealth practices, data-warehousing and joint venture interoperability between DoD and VA clinical information systems.

Tell me about the training that you offer at the Pacific Telehealth & Technology Hui.

We do not have a formal training component at this time, although it is easy to see this developing in the near future. We have quite an array of novel and forward looking projects that would both benefit from and be leveraged by students interested in telehealth and technology applications for health care.

Tell me what new projects are going on with your program these days?

Projects span a range of demonstration and research efforts including clinical informatics; biomedical applications; clinical telehealth practices such as behavioral telehealth; data-warehousing; and, joint venture interoperability between DoD and VA clinical information systems.

What projects are you involved in?

My primary responsibility, as Director of Extramural Research, is in putting together viable extramural research partnerships toward building new synergies with the University, industry and the community of Hawaii. We are very interested in behavioral health technologies and biomedical applications and are exploring the development of healthcare and gaming, new biosensors developments, persuasive technologies, expert systems, presence and virtual reality, to name only a few.

What excites you the most about these projects? Do you have a favorite?

I am actually so excited about these projects that I sometimes can't even sleep for thinking about them. This enthusiasm is generated on two levels. To begin with we are eager to create a network that leverages the resources in our small Pacific community to do some creative transdisciplinary work. More specifically, several of the projects themselves are quite exciting. It is hard to pick a favorite but moreover, I am very interested in the construct of presence. By understanding how to build presence for avatars, games and VR applications, I think we will be able to develop insights into psychological processes that may help us understand how to enhance and teach optimal presence in therapeutic environments. This could lead us to an understanding of how to build and teach empathy and other positive social constructs. Further, I am interested in the development of games and avatars for healthcare and behavioral health applications. We hope to work with information generated from biosensors to achieve insights for promoting healthy lifestyle choices, enriching mind-body awareness and facilitating strong relationships.

What about research?

We hope to become a premier research facility with expertise in healthcare, health promotion, technology and telehealth. Even our demonstration projects require the gathering of outcome data in order to determine efficacy. Too often, when programs implement telehealth solutions, they overlook the critical importance of gathering empirical evidence. Anecdotal success stories are interesting but they don't provide the data needed to establish clinical efficacy, generalizability and to encourage reimbursement for telehealth interventions.

What do you want to do, and in what direction would you like to see your program go in the future?

We are working to build our base expertise and expand professional involvement that will leverage relationships and technology resources. By working together, we can expand into new areas of understanding in bioinformatics, behavioral health, multi-media and expert systems. The potential would then open up to the capturing of emerging technological advances for healthcare applications.

A lot of our readers are psychologists and counselors. What are you doing in this area, and what do you see developing?

I think prevention and early intervention opportunities are critical areas for involvement. We are interested in identifying ways that behaviors and attitudes can be assessed and how people and systems can be impacted. For example, biosensors and expert systems offer new tools for promoting healthier lifestyles, better decision-making processes and more satisfying relationships. We are eager to identify interventions that provide these opportunities naturally, within daily routines, which may utilize games, computers and other technologies that people have already embraced.

Prevention and early intervention may be with individuals and whole communities.

Looking ahead 1, 5, and 10 years from now, where and what do you see in telemedicine?

Technology applications will continue to evolve rapidly and will become more integrated and ubiquitous. There will be convergences in healthcare, technology, telecommunications and applied science that we can only begin to imagine. Science will allow dramatic advances in our understanding of the brain and behavior related to genetics, biomedical connections, new aspects of consciousness and the efficacy of mind-body approaches in preventing and treating specific diseases and disorders. We will begin to explore not only our pathology, but also our potential. Certainly, there is no way to accurately predict the future. We can, however, prepare for change and envision the changes we would like to create.

What can we do to continue to promote Telemedicine in the U.S.? and in your case the Pacific rim and basin?

I don't think that telemedicine really requires much promotion – technology will continue to evolve and so will the application of new technologies to healthcare environments and procedures. What is really needed is the application of strict empirical investigation for the authentication of techniques and the identification of critical variables; to document successful applications and processes; to make meaningful distinctions regarding individual differences and culturally specific indices; and, to leverage national and global data into evidence-based standards of care.

David Balch from Eastern Carolina said that Telemedicine, as we know it will disappear, meaning it would be commonplace and web based. What do you see happening?

Yes, it is true; the distinction of telemedicine will disappear by virtue of its pervasiveness. This is already happening. I think that progress will be very strongly impacted by wireless and broadband innovations. These changes promote portability and the seamless integration of technology into daily life.

So, in time, telemedicine applications will even evolve beyond Internet based opportunities. They will become wearable, wireless, portable and eventually, cellular. I can foresee a future where the individual becomes his/her own medical record. Where the body reports health information, in real-time, whenever and wherever it is needed, generating required laboratory levels, “living” images and perpetual test results able to be transmitted immediately and continuously via nanotechnology, biosensors and implants. In this vision of the future, documentation would occur at a cellular level, recording queries, augmentations, modifications and adjustments. Alerts are spontaneously initiated with a simultaneous response, either internally or by speeding external responsivity. Diagnosis automatically launches and integrates information on new medical innovations, best practices and the current status of global empirical knowledge. Treatment is self-correcting whenever possible. Otherwise, minimal invasiveness is the gold standard. But of course, this is a very long-term vision.

What do you want to say or add to your colleagues out there? And what words of advice can you offer?

I think it is very important to understand how quickly technological and scientific changes are occurring. People tend to overestimate what will happen in one year but underestimate what will happen in five to ten years. In the near future, we will likely enjoy an explosion of creativity from expanded human capabilities and collaborative science – but, rapid technological changes can also threaten social structures, stability and spiritual meaning. We need to start thinking about desired social outcomes and prepare for changes that the convergence of healthcare, technology and telecommunication will certainly bring. We need to develop a vision of the future that is tempered by a global understanding of our interrelatedness and work to advance the future as we know it should be.

Leigh W. Jerome is Director of Extramural Research at the Pacific Telehealth and Technology Hui at the Pacific Telehealth & Technology Hui - it is a joint DoD/VA project. We are located at Tripler Army Medical Center in Hawaii.   The web page can be accessed at : www.pacifichui.org

Disclaimer to include:

“The views I am expressing are mine and mine alone and do not reflect official policy or position of the Department of the Army, Department of Defense, the Pacific Telehealth & Technology Hui or the U.S. Government.”