A single veterans hospital in rural Oregon saved more than $88,000 in travel expenses during fiscal year 2011 by shifting 3,224 patient encounters from in-person visits to telehealth services, according to a nursing executive there. The entire U.S. Department of Veterans Affairs' (VA) Northwest Health Network, also known as Veterans Integrated Service Network (VISN) 20, was able to trim upwards of $742,000 from its budget during the same period by facilitating 23,580 remote consultations.
"In the VA, we actually pay for miles," Tracy Weistreich, associate director for patient care services at the VA Roseburg Healthcare System, noted at the annual Telehealth Alliance of Oregon meeting in Portland last week. Roseburg is a small town off Interstate Highway 5 in southwestern Oregon, about halfway between Medford and Eugene, and the medical center there, like so many VA installations, has been dealing with an influx of wounded warriors from the Iraq and Afghanistan wars.
Roseburg's rural location makes employee recruitment and retention difficult, Weistreich said, and the patient population is scattered across a wide geographic area. Those conditions present a ripe opportunity for telehealth to extend scarce resources, allowing physicians and advanced-practice nurses to handle more patients and other clinical staff to provide whatever aspects of care they are legally allowed to practice.
"Providers need to work to their licenses," said Joseph Ronzio, Vancouver, Wash.-based telehealth coordinator for the VA Northwest Health Network. "The technology just supports their work."
The VA is well known for its embrace of telehealth, but Ronzio said that VISN 20 might be the largest telemedicine implementation in the world. The system serves sparsely populated Alaska, as well as Oregon, Washington State, and remote sections of California and Montana.
Roseburg, like the entire VA organization, offers multiple forms of telehealth. Clinical videoconferencing facilitates group and individual mental health, group education, management of implantable cardiac defibrillators, endocrinology, and chaplain services, and assists the amputation clinic, Weistreich said. For home telehealth, the VA offers interactive voice response, which Weistreich said many patients like when phoning in information, as well as support for Viterion TeleHealthcare monitoring devices.
The health system also offers teledermatology and retinal imaging services via store-and-forward technology.
Weistreich, a registered nurse with a doctoral degree, told the story of "Joe," a typical Roseburg VA telehealth patient who lost both legs to an explosive device in Iraq and suffers from post-traumatic stress disorder (PTSD). Joe's anger-management problems cost him his home and job, too.
The VA found him housing more than 40 miles from the Roseburg campus, and Joe no longer drives, so he has to rely on family and friends for transportation. Chronic fatigue and pain also make it difficult for him to travel.
His part-time work schedule was sporadic, and it was difficult for him to take time off, plus he has been reluctant to come to the VA for treatment, in part because he has felt a stigma about his PTSD diagnosis, Weistreich said.
Instead of trying to get Joe to travel to Roseburg, the VA arranged for him to "see" his doctors, therapists, and counselors while sitting in front of a telehealth cart at a clinic much closer to home. He has been participating in a PTSD therapy group and receiving individual mental health counseling, wound care, and spiritual ministry remotely, Weistreich reported. His wounds are healing and he only has had to visit Roseburg once in the past three months.
VA clinicians in Roseburg interact with Joe over a secure online video connection, while a technician or licensed practical nurse on the patient's end helps with the exam. Doctors, nurses, and therapists at the VA can document each encounter in the organization's electronic health record in real time, according to Weistreich. Some mental health services can be provided in the patient's home.
The VA technically classifies home telemental health as a pilot program; otherwise the government would have to pay for each patient's broadband Internet connection. But other telehealth services are part of regular care. "Telehealth is absolutely not a pilot in the VA. It is an established program," Weistreich declared.
The technology merely bridges the distant between patient and caregiver. "Telehealth changes the location where healthcare services are routinely provided and supports veterans' preferences to live in the least restrictive settings possible," Weistreich said, echoing the VA's telehealth philosophy.