In 2000, NATO created the Telemedicine Expert Team (TMED ET) when few nations had deployed telemedicine systems to support military field operations. This group and its successor has been encouraging the nations to deploy telemedicine (TMED) in support of their forces, and has been developing the doctrine and technical standards which will facilitate the use of TMED within NATO. This has been a highly successful effort, and TMED is increasingly being used within the military medical structures of some NATO and Partnership for Peace nations to provide medical care to deployed military personnel. This chapter describes a general overview of telemedicine evaluation measures and contrasts civilian measures with the outcome measures used to assess the effectiveness of military and NATO telemedicine programs in austere overseas locations. It provides important examples of the U.S. military telemedicine programs in Iraq and Afghanistan and their outcome measures many of which are shared in NATO telemedicine programs. The evaluation measures describe the unique military and NATO uses for telemedicine such as impact on medical evacuation and types of medical problems encountered in deployed settings critical for future military and NATO manpower planning and staffing. The chapter further describes a multinational telemedicine study conducted in 2005 called the Telemedicine Interoperability Study (TIOPS) that showed the usability and clinical comparability of diagnoses made by consultants from different nations. The TIOPS provides an important framework for future NATO telemedicine evaluations for demonstration projects that can establish long-term measures of effectiveness in NATO missions.
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