Telemedicine and Advanced Technology Research Center, Mobile Health Innovation Center, Fort Gordon, GA 10905, USA.
University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
Mil Med. 2021 Jan 25;186(Suppl 1):137-141. doi: 10.1093/milmed/usaa281.
The current model for treating behavioral health patients requires that providers and patients be in the same location for appointments. However, deploying warfighters present a challenge to this current model. Recent advances in technology make telehealth or virtual visits a viable option to replace the current model. This project leveraged mobile technology to see if performing tele-behavioral health visits presented a viable option to the current in-person model for future deployed warfighters. At the time of this publication, the authors note the current pandemic lends all the more urgency to the need for enhancing our video communication platforms for remote monitoring with the Military Health System.
The research team assessed existing Internet protocol-based desktop teleconferencing solutions, generically known as a Web Real-Time Communications (WebRTC) system, for establishing a secure connection to a Service Members personal mobile device outside of the Department of Defense (DoD) network. Of the five existing WebRTC systems evaluated, only the backbone component to the existing Defense Information Systems Agency Global Video Services (DISA GVS) known as Vidyo, was suitable to meet DoD security requirements and still connect with both major operating systems (OS) on mobile devices. An existing DoD program of record mobile application, mCare, was integrated with Vidyo desktop technologies to form what the research team called "Mobile Connect."
Deployment of the Mobile Connect product yielded distinct differences and high levels or variability between the .osd.mil and the army.mil network connections over time. These network differences impacted quality of service solution where Mobile Connect could not be used to provide care between the .mil and patient's personal mobile devices from a osd.mil domain connection. The current DoD WebRTC systems offer potential solutions but presently cannot connect with personal mobile devices in their current configurations. Additionally, any WebRTC system used by the DoD for future connections to personal mobile device must leverage commercial Single Socket Layer certificates (e.g., not DoD issued), or the communications with the mobile device will fail as a result of an authentication error.
It is technically feasible to provide desktop Video Tele-Conference capabilities from a .mil computer to a personal mobile device without compromising DoD security and information assurance requirements using future WebRTC systems. Approved ports, protocols, and system settings must be configured to accept both inbound and outbound, encrypted traffic to/from personal mobile devices to maintain consistent quality of service with all DoD networks. Of the current DoD WebRTC options, working with the DISA GVS Program Manager to expand services to support commercial mobile devices has the highest probability of future success.
目前治疗行为健康患者的模式要求提供者和患者在同一地点进行预约。然而，部署作战人员对当前模式提出了挑战。最近技术的进步使远程医疗或虚拟就诊成为替代当前模式的可行选择。本项目利用移动技术，研究通过远程医疗进行行为健康治疗是否为未来部署的作战人员提供了一种可行的选择。在本研究发表之时，作者指出，当前的大流行使得加强军事卫生系统的远程监控视频通信平台变得更加紧迫。
研究团队评估了现有的基于互联网协议的桌面视频会议解决方案，通常称为 Web 实时通信（WebRTC）系统，以建立与国防部（DoD）网络之外的服务成员个人移动设备的安全连接。在评估的五个现有的 WebRTC 系统中，只有国防信息系统局全球视频服务（DISA GVS）的骨干组件，即 Vidyo，适合满足 DoD 的安全要求，并仍然可以与移动设备上的两个主要操作系统（OS）连接。现有的 DoD 记录移动应用程序 mCare 与 Vidyo 桌面技术集成，形成了研究团队所谓的“Mobile Connect”。
Mobile Connect 产品的部署产生了明显的差异，并且随着时间的推移，.osd.mil 和 army.mil 网络连接之间的差异很大。这些网络差异影响了服务质量解决方案，Mobile Connect 无法在.osd.mil 域连接下在.mil 和患者个人移动设备之间提供护理。当前的 DoD WebRTC 系统提供了潜在的解决方案，但目前无法在当前配置下与个人移动设备连接。此外，DoD 用于未来与个人移动设备连接的任何 WebRTC 系统都必须利用商业性的单套接字层证书（例如，非 DoD 颁发的证书），否则与移动设备的通信将因身份验证错误而失败。
使用未来的 WebRTC 系统，从.mil 计算机向个人移动设备提供桌面视频会议功能，在不损害 DoD 安全和信息保障要求的情况下，在技术上是可行的。必须配置批准的端口、协议和系统设置，以接受来自个人移动设备的入站和出站加密流量，以保持与所有 DoD 网络的一致服务质量。在当前的 DoD WebRTC 选项中，与 DISA GVS 项目经理合作扩展服务以支持商业移动设备具有未来成功的最高可能性。
