Health Care Without the Commute

Almost 30 percent of the U.S. Veteran population resides in rural areas. This percentage is even higher for Veterans in VA Nebraska-Western Iowa Health Care System's coverage area with a total of 52 percent living outside of the cities.

With so many Veterans in rural areas, delivering health care closer to home, through telehealth, has become a growing practice. VA NWIHCS led the nation for clinical video telehealth appointments in 2012; VA NWIHCS had 16,621 encounters with patients through telehealth services. Clinical video telehealth, home telehealth, and store and forward are all used to provide health care for Veterans who can benefit from the features.

Clinical Video Telehealth

Clinical video telehealth is done in outpatient clinics throughout VA NWIHCS. A patient, with nursing assistance, can be seen through a video conference by doctors located hundreds of miles away. Before the capabilities of CVT, if a patient had a scheduled surgery at the Omaha VA Medical Center, he or she would need to travel to the Omaha VAMC two or three times prior to the surgery date for consultations and exams. Now these patients can avoid the hassles and be seen at clinics closer to their home for presurgery appointments. This not only saves the Veterans' cost for travel, it saves the VA on travel reimbursement.

Tia Bieber, a licensed practical nurse, has worked in telehealth at the Grand Island Community Based Outpatient Clinic for a year and a half and knows what it means for Veterans. "It saves a lot of travel time. Vets love it, and that is the goal," she said.

"Providing health care to those who wouldn't have access or would have to travel to get it, it's efficient and just as effective as face-to-face," Bieber said.

Home Telehealth

Home telehealth provides Veterans with equipment for home use. Portable systems send data from the Veteran to be monitored and recorded by health care providers. This helps providers track conditions of patients, and allows them to make educated health care decisions without the Veteran leaving home.

Prescriptions can be changed, activity can be monitored and patients can recover at home.

"We have a lot of patients in Kansas and beyond North Platte. This allows our Veterans to not have to make so many clinical visits," said Elizabeth French, registered nurse and lead care coordinator in home telehealth at the Grand Island CBOC. "We are changing meds with providers' recommendations, and they are staying home."

VA NWIHCS is one of several VA facilities piloting a new program for home telehealth called American Well. The web-based program allows patients to be more involved with their health care by bringing it into Veterans' homes through the internet. The software allows patients and health care providers to have immediate, live and clinically meaningful visits through video, secure text and phone conversations.

Store and Forward

Diabetic Veterans are able to have retinopathy testing done in Omaha and evaluated at the Minneapolis VA Medical Center. Patients have images taken of their eyes at the Omaha VAMC. Those images can then be transmitted to an ophthalmologist in Minneapolis for review. The results are sent back to physicians in Omaha and reported back to patients.

Dr. Ahsan Naseem, the Midwest Health Care Network Telehealth physician lead, wrote the proposal for the telehealth program in 2009. Since then the program has grown significantly. In 2012, there were four times the amount of overall encounters as there were in 2009. He said he sees a great future for telehealth in the VA health care system.

"The technology is evolving," Naseem said. "It started out with simple video conversations. Now, we can use stethoscopes. We envision the technology to continue to grow."

To learn more about telehealth at VA, visit www.telehealth.va.gov.

By Kate O'Dell

NWIHCS Telehealth