Houston Briefing

1
Telemedicine Advanced Technology Research
Center (TATRC) Brief Presented To American
Institute for Medical Biological Engineering
Annual Meeting 28 February 2007
COL Ron K. Poropatich, M.D. Deputy Director,
TATRC Fort Detrick, Maryland
COL Karl E. Friedl, Ph.D. Director, TATRC Fort
Detrick, Maryland
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Operational View OV-1

• Describe how the capability will be employed

3
Theater Combat Casualty Care Challenges and
Capabilities
Reduce the Number of Deaths from Combat rFVIIa
Freeze Dried Plasma Damage Control
Resuscitation Enhanced Resuscitation
Fluids Platelet Derived Hemostatic Agent
Meet Demands On First
Responders Warrior Medic Diagnostic
System Warfighter Physiological Status
Monitoring Impedance Threshold Device
Improve En Route Care Oxygen conservation Closed
loop algorithms Conserve IV fluids Lightweight
diagnostic therapeutic modules
Improve Medic Training Untethered
Mannequins Intervention based consequences
Restore Full Function Regenerative
Medicine Infection Control
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The Casualty Care Challenge for the Future Force
Time is of the Essence
Future Force will require significant
enhancement of initial treatment capability to
offset dispersion of troops restricted footprint
Technology must be an enabler of new paradigms
for emergency treatment stabilization of
casualties prior to during evacuation
EXTEND

0
10
30
60
Time (minutes)

• Reduced forward medical logistics
• footprint, dispersion, and mobility of
• battlefield
• Displaced casualties from medics
• and definitive care facilities

Distances are a Barrier
Technology and enablers should fill this gap and
provide solutions over time
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USArmy Medical Research Materiel Command Core
ST Programs
Med Chem Defense 15
Military Infectious Diseases 27

• Military Infectious Diseases
• Medical readiness
• Vaccines
• Biotechnology
• Prophylaxis/treatment drugs
• Diagnostics/prognostics
• Vector control
• HIV countermeasures

Combat Casualty Care 10
Med Bio Defense 31
Military Operational Medicine 17

• Medical Chemical Defense
• Medical management ofCW casualties
• Medical readiness
• Drug prophylaxes/pretreatments
• Diagnostics/therapeutics

• Combat Casualty Care
• Lightweight medical equipment
• Trauma care
• Health monitoring diagnostic technology

• Medical Biological Defense
• Vaccines/therapies
• Field-portable diagnosticsystems
• Medical readiness
• Biotechnology

• Military Operational Medicine
• Soldier selection sustainment
• Soldier performance
• Warrior system modeling
• Health hazards protection
• Diagnostics/prognostics
• Health monitoring

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Congressional Special Interest Programs
Management

• Congressionally Directed Medical Research
  Programs (CDMRP)
• Breast cancer
• Prostate cancer
• Ovarian cancer
• Neurofibromatosis
• Other diseases

TATRC 27
CDMRP 43
RADs 20
Adv Dev 10

• Research Area Directorates (RADs)
• Research projects that enhance core programs

Telemedicine and Advanced Technologies Research
Center (TATRC)

• Medical information technologies
• Advanced medical technologies

• Acquisition Directorate
• CSI products in advanced development

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Direct Reporting Agency toU.S. Army Medical
Research and Materiel Command

• Mission
• Execute a congressional special interest program
  of medical science and technology research that
  maximizes benefits to military medicine
• Vision
• Be the model of government enablement of
  technology transfer to use

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Evolution of TATRC

Courtesy of Dr. Seong K. Mun, ISIS Center,
Georgetown Univ.
First Decade
DIN/PACS and Teleradiology Filmless
Hospital Skunk Works - ad hoc funding
Second Decade
Telemedicine and e-health Seamless Flow of
Information Innovation in Funding
Present

• Innovation in Managing Technology
• Timely and Flexible Response
• Ability to Harness
• Academic innovation
• Congressional interests
• Industrial investment
• Serving Army Medical Research
• Facilitate Innovations for the Command

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DEPARTMENT OF THE ARMY Telemedicine and Advanced
Technology Research Center (TATRC) U.S. Army
Medical Research and Materiel Command Fort
Detrick, Maryland 21702-5012 COMMERCIAL TELEPHONE
[phone] DSN 343-2413 FAX [phone]
WEBSITE www.tatrc.org
Senior Consultants Senior Scientist
TATRC Director
Deputy Director
Chief of Staff
Outlying Functions
External Subject Matter Experts
TATRC-Hui Hawaii TATRC-South Ft.
Gordon TATRC-West Los Angeles Europe
liaison D. Lam (Univ of Maryland) SOCOM
liaison R. Clayton (Geneva Found.)
B. Boedeker, Univ of Nebraska T. Broderick, Univ
of Cincinnati J. Collman, Georgetown Univ W.
Grundfest, UCLA M. Kratz, Univ of Michigan E.
Krupinski, Univ of Arizona
K. Montgomery, Stanford Univ C. Pugh,
Northwestern Univ A. Reisner, Mass Gen Hosp J.
Rosser, Beth Isr Med Ctr B. Wiederhold, Int.
Media Inst J. Wilson, Georgetown Univ
Assistant Director forResearch Programs Chief
Scientist
Assistant Directorfor Administration
Resources Management
Information Technology


Research Review Division

Research Support Division



Communications External Affairs

Project Officers
Proposal Review Board

Logistics

ResearchPortfolios
RAD1, RAD2, RAD3, proj ofc
Security, Plans, Operations Training
AMEDD Adv Med Tech Initiative
DARPA proj mgmt
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Current Congressional Special InterestPrograms
Partners

• Hawaii Federal Health Care Network (Pacific
  Telemed Tech Hui)
• Military Molecular Medical Initiative (M3I)
• Center for Integration of Medical Innovative
  Technology (CIMIT)
• Pain and Neuroscience Center Research (Conemaugh)
  
• Texas Training and Technology for Trauma and
  Terrorism (T5)
• Proton Beam Treatment/Synchron
• Military Amputee Research Program (MARP)
• National Functional Genomics Center
• Metroplex Comprehensive Imaging Center
• Center for Advanced Surgical Interventional
  Technology (CASIT)
• Military Veteran Complementary Med (MIL-CAM,
  VET-HEAL)
• Center for Excellence for Remote and Medically
  Under-Served Areas (CERMUSA)
• Gynecological Disease Program
• Joslin Vision Network
• Ultrahigh Speed MEMS Electromagnetic Cell Sorter
• Brain, Biology and Behavior
• Center for Military Biomaterials Research (CeMBR)
  
• Military Low Vision Research Program/Schepens Eye
  Research Inst.
• Minimally Invasive Approaches to Surgery

As of 8 January 2007
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Research Portfolios
Key Product Lines
Medical Robotics
Health Information Technologies
Medical Imaging Technologies
Advanced Prosthetics and Human Performance
Computational Biology
Mobile Computing and Remote Monitoring
Simulation and Training Technology
BHSAI BIC
New Initiatives Basic Science
Neuroscience
Regenerative Medicine
Nano-Medicine and Biomaterials
Medical Logistics
Chronic Disease Management
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Center for Military Biomaterials Research (CeMBR)

• CSI awarded to Rutgers University
• Tissue engineered knee joint meniscus
• Hemostatic Polymeric Wound Dressings
  Incorporating Concatameric Cationic Peptides
• Multifunctional Biomaterial Conjugates as
  Next-generation Antimalarial Drugs
• Bioactive Peripheral Nerve Grafts

Note Partial listing
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What is the Comprehensive Diabetes Management
Program (CDMP)?

• Congressionally-funded 4-partner consortium
• DoD WRAMC and Tripler/Univ. Hawaii
• VA Boston
• Indian Health Service
• Joslin Diabetes Center
• Web-based diabetes case management tool
• Developed by a consortium of physicians and
  educators specializing in diabetes and its
  management

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CDMP Features

• Patient-centered
• Care Team-based
• User configurable
• Built on available technologies and tools
• Uses familiar red, yellow, green risk
• (screenshots available at the end of this brief)
• Interoperable or Links with EMRs
• Weighs behavioral data with clinical data for
  a whole patient picture

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Point-of-care CDMP capabilities completely
withinAHLTAWorkflow
CDR
Point-of-care
CDM/W
Non point-of-care case management
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Care Provider Home Page scheduled
patients, new alerts and reminders
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Patient Home Page Alerts,
Reminders, Care Plan, Risk Profile, etc.
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Patient Clinical Behavioral Alerts

• View individual Alerts view data that
  triggered the alert
• Closing Alerts requires a follow-up action

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Patient Snapshot CDMP Patient Status,
Clinical Behavioral Overview
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Behavior Nutrition Surveys

• Scored Behavior Assessment
• Physical Wellness, Psycho-Social,
  Self-Management
• Auto-generated Alerts based on replies
• Simple Advanced Nutrition Assessments

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Education Assessment

• Patient Education Assessment
• Pre Post Assessment
• Built on ADA Education Guidelines
• Customizable Assessment Areas

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Care Plan

• Physical Wellness - Readiness to Change
• Patient Education - Self-Management
• Action Items

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Image Catalog

• Images are a big part of patient records. CDMP
  can import a wide variety of images.
• Patients can upload standard JPG or GIF photos
• Integrated with Eye exam
• DICOM images
• Radiology
• EEG/EKG

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Retinal image display
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Eye Care Summary Report
Access to Diabetic Retinopathy diagnosis,
treatment and follow up details
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Key TATRC Product Lines
Advanced Prosthetics Human Performance
Medical Imaging Technologies
Medical Robotics
Health Information Technologies
Simulation and Training Technology
Mobile Computing Remote Monitoring
Computational Biology
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Key TATRC Product Lines
Advanced Prosthetics Human Performance
Medical Imaging Technologies
Medical Robotics
Health Information Technologies

• KEY INITIATIVES
• Hospital of the Future (HFPA)
• Gaming Simulations for Medic Training
  (AMEDD CS PEO-STRI)
• Electronic Health Record (TMA)
• Medical Robotic Extraction Care of Combat
  Casualties (ARL PEO-Soldier DARPA)
• Biosurveillance Early Detection Systems and
  AHLTA-Mobile Decision Support Tools
  (TMA(FHP))
• Neurocognitive Assessment Models and Systems
  (PEO-Soldier DARPA)
• Military Amputee Reset and Return to Duty
  (WRAMC)

Simulation and Training Technology
Mobile Computing Remote Monitoring
Computational Biology
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Reporting and Review

• External Peer Review Panels
• Proposal Review Board (PRB)
• Integrated Product Reviews
• Product Line Reviews (PLR)
• National Conferences (ATA, MMVR, RSNA, AMIA,
  ATACCC, AIMBE)

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• AIMBE TATRC Collaborative Opportunities

• Subject Matter Experts at TATRC Product Line
  Reviews
• AIMBE hosted Topical Meetings
• Health Grid
• Computational Biology
• Regenerative Medicine
• Proposal submission to the Broad Agency
  Announcement
• www.usamraa.army.mil/pages/BAA_paa/BAAproposal.htm
  

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What is the Soldier Institute of Regenerative
Medicine?

• A new institute founded to develop advanced
  regenerative techniques for the treatment of
  military trauma.
• Integrate regenerative therapies across the
  spectrum of treatment from battlefield to
  hospital to longer-term care.
• Focused on the major tissue reconstruction and
  salvage problems confronting military surgeons
• Compartment syndrome
• Limb and digit salvage and reconstruction
• Regenerating large osseous defects
• Nerve repair
• Regrowing muscles and tendons
• Healing without scarring
• Facial reconstruction
• Burn repair

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Soldier Institute of Regenerative Medicine

• Structure
• Funded with a Cooperative Research Agreement for
  a five-year period with the possibility of
  renewal if the institute is productive and there
  is available funding.
• A virtual organization with one university acting
  as a prime contractor and other universities and
  individuals acting as subcontractors.
• It will have to have a strong management cell
  that ensures that all projects are focused on
  solutions to military problems and their eventual
  translation to the clinic.
•  
• Timeline
• February 2007 Publish Request for Information
• May 2007 Release Broad Agency Announcement
  (BAA)
• September 2007-Announce Winning Proposal
• October 2007- Begin work

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Soldier Institute of Regenerative Medicine

• Funding
• The Army will contribute 5 million per year for
  this effort.
• A minimum of 10 million per year is needed to
  ensure that these technologies can be translated
  to clinical practice.
• The US Army Medical Research and Materiel Command
  is seeking cosponsors for this effort.
• It is expected that potential bidders will be
  able to generate significant levels of matching
  funds.
•  

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Soldier Institute of Regenerative Medicine Goals
Long-Term

• Cell Therapy
• Restore tissue and organ function
• Develop new precursor cell systems to stimulate
  tissue and organ regeneration
• Tissue Engineering
• Skin, muscle and tissues for trauma burn
  patients
• Limbs and digits for amputees
• Skeletal muscle, nerve, bone and vessels to
  repair/replace major injuries in the arm and leg
• Organ Regeneration
• Engineer/repair hollow organs (trachea,
  esophagus, bladder)
• Repair or replace damaged solid organs (liver,
  kidney)

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ContactsCOL Ron Poropatich, MD301-619-7967poro
patich_at_tatrc.orgDr. Ken Curley, MD Chief
Scientistcurley_at_tatrc.orgDr. Eva Lai, PhD
Acting Chief Scientistlai_at_tatrc.orgMr. John
Winston BAA submissionswinston_at_tatrc.orgwww.t
atrc.org