Sunday, April 17, 2011

Reaching Out to Rural Vets

According to Mary Beth Skupien, M.D, Director of the Veterans Health Administration’s Office of Rural Health (ORH), rural veterans have difficulty obtaining access to quality healthcare. This is due to the fact that many veterans may have to travel long distances to healthcare facilities, they can lack health insurance, and in general, there is a lack of specialty care providers working in rural areas. Added to these facts, rural veterans suffer from unique health complications associated with exposure to combat such as PTSD, depression, and TBI.

ORH has invested over $95 million dollars in telehealth equipment and is continually building up telehealth capabilities particularly home-based telehealth. Reports show that by the end of September 2010, over 71,000 veterans were enrolled in the VA Care Coordination Home Telehealth program.

It has been announced that the VA just awarded new contracts to keep up with changing telehealth solutions. On April 11, Authentidate announced that it was one of six companies to be selected by the VA to be awarded a home telehealth contract. VA facilities will now be able to use the company’s Electronic House Call™ and its Interactive Voice Response (IVR) system to remotely monitor patients.

The Office of Rural Health Newsletter “The Rural Connection” reports in their April issue on several new telehealth programs to address health problems in rural areas. For instance, the VA Stars & Stripes Healthcare Network (Region 4) is using the E-Consult program. Once the patient gives approval, their primary care provider in a rural clinic and a specialty provider located in a VA hospital are able to communicate about their care by using secure email along with electronic records.

Researchers from the VA’s Center for Health Equity Research and Promotion based at the Pittsburgh VA Medical Center evaluated the E-Consult program based on satisfaction, quality, time, access, safety, expectations, confidence, and intent to continue to use E-Consult. Overall, veterans and primary care physicians are significantly satisfied with the program and there are plans in 2011 to expand.

Rural health challenges are not new to the VA Rocky Mountain Network (Region 19) which includes Montana, Utah, most of Wyoming, Colorado, and parts of Idaho and Nevada. Region 19 is now able to provide tertiary specialty care in critical care. This has really been a problem, since it is particularly difficult to treat veterans in this low population region due to the lack of available medical and surgical specialists in the region.

To help in this situation, critical care is delivered virtually by what is referred to as vICU which happens to be the first of its kind to be used in the VA system. Unlike other virtual ICU models, this program is unique because it is nurse driven. Modeled after a traditional Rapid Response Team (RRT) approach, a critical care certified nurse manages the vICU system 24/7 from a VA facility in Denver and provides consultations and support. The nurse also coordinates the point-to-point video communication between hospital physicians at the rural sites and specialty physicians in Denver.

Telehealth is valuable within the VA Salt Lake City Health Care System and they have embarked on an aggressive telehealth program to help the 10 to 38 percent of veterans that are 65 years old and older that live in isolated areas within the region.

Last February, the Salt Lake Health Care System opened a second primary care telehealth outreach clinic in Idaho. In the past, veterans in the area would have to travel one hour for primary care service and over three hours for specialty care services that are now provided though telehealth technology. Future primary care telehealth outreach clinics are due to open soon in Nevada and Idaho.

Unfortunately, cancer treatments are not available at all VA facilities so to address these limitations, the Michael E. DeBakey VA Medical Center (MEDVAMC) in Houston supported by the VA’s ORH, has implemented a Virtual Tumor Board (VTB) between different institutions located in the South Central VA Health Care Network.

The VTB project was designed to enable physicians at smaller distant clinics to present complex cancer cases during the MEDVAMC tumor board conference using telemedicine technology. High tech communication enables the physicians to review the cancer patient’s case and to discuss and develop a consensus for a treatment plan. The DeBakey Cancer Center is now working to implement this project on a wider scale with the goal to provide this service throughout Region 16 and across the country.

Go to to view the Rural Connection Newsletter.