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Save Billions in Healthcare Continued from home page I have been AAFP (American Academy of Family Practice) board certified since 1982 and after practicing Emergency Medicine for 10 years, attained in ABEM (American Board of Emergency Medicine) from 1992 to 2002. I worked a variety of places, including Tripler Army Medical Center, Waianae Coast comprehensive health center ER, Kahuku hospital and KVMH (Kauai Veterans Memorial hospital) in Waimea on Kauai. I was intensively involved in all aspects of emergency, ICU, medical-surgical floor, obstetrical care. In the small community hospital (KVMH) where I did most of my work, I also frequently assisted in surgery and delivered many babies. I was familiar with the recovery room, Xray department, Laboratory and physical therapy. In other words, I was intimately involved in all aspects of hospital care. As a surfing afficiano, I was motivated to put to use the latest available wireless communication gear available from the very start, around 1983, prior to the cell phone revolution. During the 24 hour emergency call for KVMH (Kauai Veterans Memorial Hospital), our 50 bed community hospital serving around 20,000 people of rural west Kauai, ER doctors carried 2 radios and a pager during the day while they were driving or at their clinic. One radio was MedCom (the radio that ambulances used to call the hospital ER or emergency physician) and the other radio was Local Government (the radio that police dispatch used to call the poice, fire department and ambulance to respond to emergencies). The fire trucks would frequently respond to medical emergency 5-15 minutes before the ambulance because their stations were closer and areas of responsibity smaller than the EMS (emergency medical service) units. I was not always hospital based while on call in that my office was 6-8 minutes fast drive to the ER. The police all knew my jeep and when they heard a call on the same radio, knew that I was tearing down the highway for a legitmate reason. On the Westside, there was no need for lights and siren, a few flashes of my brights and people would think: "There goes Dr Spear." When I arrived 6-10 minutes before the MICT (medical emergency care technitions who are like ICU/ER nurses that can work in the field) and EMTs (emergency medical technicians), invariably the firemen where greatly relieved when a medically sophisticated professional was there to take over the patient(s). Since 2003 I have added tele-medicine to my practice by bringing the communicaiton directly to the patient, not just other medical paraprofessionals. To my knowlege, am a pioneer in this technique. I also have had some legal consequences of being on that forefront of tele-medical pain practice which I can address in another correspondence at your request. I have also had a great deal of experience with musculoskeletal pain and addiction management, areas that are know to be the highest utilizers of outpatient primary care visits, by some estimates up to 30% of outpatient visits. implementing my remote tele-medical methodology in this large population alone can manifest enormous savings immediately.

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