When the HELP telemedicine system went live in 2014, the program's administrators knew it would take time for word to spread about the availability of a consult with a Naval Medical Center Portsmouth specialist at the click of a mouse.

The telemedicine initiative, called Health Experts onLine at Portsmouth, gives health care providers access to specialists at NMCP when they need to consult about a difficult medical case that is not an emergency. These providers can be independent-duty corpsmen on small ships, general medical officers on aircraft carriers, or doctors at military hospitals and clinics who don't have access to specific specialties within their facility.

The goal of the consult system is to reduce unnecessary medical evacuations from ships at sea and overseas, as well as to reduce patient referral to the civilian health care network.

In its first year, from mid-2014 to mid-2015, HELP saved the Navy about $575,000 in prevented medevacs, expedited evacuations and recaptured care, offering assistance in about 600 cases and preventing 39 medevacs. When considering all of 2015, cost avoidance was $1.2 million for the year.

The newly reviewed data for 2016 revealed the program provided assistance in 2,300 cases, prevented 94 medevacs and recaptured care in 321 cases, all at a cost avoidance of $1.5 million.

"The biggest benefit is to be able to deliver specialist-type care at the front line," said Cmdr. Michael Johnston, HELP's medical director. "Many of these doctors have had one year of training after medical school, which is an internship and most have not had a residency. And then there are independent-duty corpsmen who have not gone to medical school. We are able to deliver to them fast advice, which is really cool."

The system offers asynchronous telehealth, which means the communication is doctor-to-doctor. On the medical center side, the doctor does not interact with the patient.

"The doctor on the other end is providing all of the care and assuming all of the responsibility for the patient," Johnston said. "They can choose whether or not to follow the advice of the specialist. What is new is that we have converted some of our encounters into synchronous cases. Primarily this is linking our geneticists with patients in Europe so they don't have to be flown back to the States for counseling. They can receive genetic counseling over the phone."

From a clinical standpoint, the types of cases that can be worked through HELP have remained the same since the system was unveiled nearly three year ago. The top three consults continue to relate to orthopedics, dermatology and psychiatry. Psychiatry primarily uses the system to track patient movement, rather than an asynchronous consult, because NMCP is a major hub for patients being medically evacuated.

"Around the first part of 2015, we opened up the patient movement aspect, so now we can track patients as they come back from CENTCOM (U.S. Central Command) and Europe, and we can have a back-and-forth dialogue between clinicians during that process," Johnston said. "Previously, the patient might show up with their records and we might not have known they were coming. Now we have the ability to make the appropriate plans for treatment before they arrive."

The patient tracking aspect means when a patient's need for medical evacuation is placed into the system, immediate coordination for transport can begin. In one case, a patient was transported from Camp Lejeune, North Carolina, to NMCP right after diagnosis; and within a couple of hours, the patient was in the operating room. Another case resulted in a patient being flown immediately from Guantanamo Bay, Cuba, to NMCP for cancer treatment.

In 2016, NMCP began assisting the Coast Guard, as well as the State Department. The State Department has frontline providers in remote locations such as Africa. In at least two cases, Johnston said, "We were able to advise an immediate medical evacuation back to the States instead of recommending treatment by an orthopedist in Africa."

Johnston said feedback from the fleet shows the program is well received.

"We are able to get them an answer within an hour 20 percent of the time, our median response time is five hours, and we are able to answer 80 percent of the questions within 24 hours," Johnston added. "NMCP's physicians understand what it's like to be deployed and not have access to assets. Ultimately, HELP has magnified the amount of medical resources that are available."

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