Reach-back to subject matter experts improves healthcare quality, influences the decision to evacuate and reduces costs: an observational study of the UK Defence Medical Services Deployed Telemedicine System

Introduction The UK Defence Medical Services (DMS) have used the medical instant messaging application Pando (Forward Clinical, London) since 2019. This application is used to deliver a deployed telemedicine system comprising a wide range of specialist advice teams. We report an 18-month evaluation of workload, user experience and military effect.Methods Server data pertaining to the 'Ask Advice' function from 1 January 2023 to 30 June 2024 were analysed retrospectively. During the same period, a voluntary online, anonymous survey was offered to all requestors of advice, evaluating the impact of advice on evacuation decision-making, estimations of costs saved and healthcare quality.Results There were 833 eligible advice conversations during the study period. The three most frequently consulted specialties were trauma and orthopaedics, hand surgery, and ear, nose and throat. There were 274 responses to the survey. 168/274 (61%) responses reported that telemedicine had changed the evacuation priority. 102/274 (37%) responses reported cost savings and 245/274 (89%) responses said that the quality of healthcare was improved.Conclusions The DMS Deployed Telemedicine System is used most days, and users report improvement in healthcare quality for patients. There has been a meaningful impact on the decision to evacuate service persons, with the likelihood of significant cost savings. Benefits may be realised during warfighting activity if assured bearers and bandwidth can be provisioned to military medical services.