By Patsy Green
Telehealth? Peter Baumann (Laramie Boomerang, 11-15-12) notes: "A Telehealth program ... uses communication technology to facilitate health care over long distances."
So, what does this mean to VA Illiana Health Care System veterans?
VA is trailblazing Telehealth technology across the United States. At the VA Illiana Health Care System in Danville, a variety of Telehealth programs are offered to veterans.
Home Telehealth: This program focuses on patients with chronic diseases who need education regarding disease self-management skills and assistance using the skills they learn to improve their health. Each patient is issued a "Telehealth monitor" or given telephone access so he can participate in the program. The patient enters information about his chronic disease, answers program questions, and completes an educational session on a daily basis. His case manager (registered nurse, dietitian, social worker) reviews the information every day and contacts him when changes are needed in his treatment plan. The patient receives the care he needs at home and at the time it is needed. Patients who are experiencing difficulty managing diabetes mellitus, hypertension, heart failure, chronic obstructive pulmonary disease, obesity, depression and PTSD are all eligible for enrollment in a Home Telehealth program.
Store Forward Telehealth: This program "stores" images or other data and then "forwards" those images/data to a provider at another site who "reads" the images/data. The provider who reads the images/data then sends a consultation note back to the provider who ordered the service.
VA Illiana Health Care System has two Store Forward Telehealth programs. Through the Teledermatology program, a patient at the Danville VA or their outpatient clinics in Peoria, Springfield, Decatur and Mattoon and West Lafayette, Ind., can have images taken of a skin condition. The images are forwarded to the dermatologist at VA Indianapolis. Once the dermatologist has "read" the images, he writes a consultation note for the patient's provider. The patient's provider is able to use the consultation note and order appropriate therapy for the patient. Through the Teleretinal Imaging program, patients with diabetes are "screened" for diabetic retinopathy and other conditions using the store and forward process.
Clinical Video Telehealth: This program allows a patient at one physical location to see a provider at another physical location using video conferencing equipment. While some care must be provided with the patient and the provider at the same location, it's truly amazing the type of care that can be provided using this program. VA Illiana Health Care System has over 40 Clinical Video Telehealth clinics through which we provide patient care.
The Surgical Department at Danville uses TeleSurgery clinics to see patients at Peoria, Springfield, Decatur, Mattoon or West Lafayette. An appointment is made for the patient at his location of choice and an appointment is also made for the surgical provider at Danville VA. At the time of his appointment, the patient meets with the Telehealth Clinical Technician (TCT) and is prepared for the visit with the surgeon (patient interviewed, vital signs taken, surgical site exposed). The equipment in use on the patient side is a Global Med Primary Care cart. These carts have an otoscope (ear, nose, throat examination), sending stethoscope (sends heart sounds, lung sounds, bowel sounds), and a total exam camera (skin/surgical site examination). The equipment in use on the surgeon's side is a desktop unit with a receiving stethoscope (allows the surgeon to hear heart sounds, lung sounds, and bowel sounds.) Once the TCT places a call between the Global Med Primary Care cart and the surgeon's desktop unit, the visit begins. The patient consents to Clinical Video Telehealth care and he is identified according to procedure. Once the visit is complete, the TCT completes the surgeon's orders and reviews the surgeon's instructions with the patient. Typically, pre-operative and post-operative visits can be completed using Clinical Video Telehealth.
Other specialties where Clinical Video Telehealth is used include: speech, mental health, orthopedics, pulmonary, cardiology, geriatrics, pain evaluation, pain care school, diabetes education, insulin pump, substance use disorder, Polytrauma, infectious disease, anticoagulation, psychology, nutrition and podiatry. Specialty care between VA Indianapolis and VAIHCS includes: hematology, oncology, surgery, pre-operative anesthesia, vascular surgery, orthopedics and gynecology.
So ... how do veterans benefit?
Veterans are able to go to the location of their choice for their care.
Veterans do not have to drive hours to receive necessary care if it is available through the Telehealth program. Transportation costs are reduced and time is saved.
Veterans feel better when their chronic diseases are well-controlled.
Veterans may see fewer emergency visits, primary care appointments and hospitalizations.
Veterans feel empowered as active participants in their VA care.
Patsy Green, BSN, RN-BC, CDE, is the facility Telehalth coordinator at the VA Illiana Health Care System in Danville. She can be reached at 217-554-5266