William S. Middleton Memorial Veterans Hospital

Telehealth at the William S. Middleton Memorial Veterans Hospital

By Joe Aussem

Telehealth – health care and information delivered via telecommunications technologies.

• Use of video conferencing technology, secure messaging, wireless phones and other applications often combined with remote computer access.
  
• Real-time interaction between a health care provider at a central location with a patient and/or nurse or health technician at a remote clinic or patient residence.
  
• Use of specialized peripheral medical devices to ensure quality diagnostic imagery and confidential transfer of real-time clinical information.

As healthcare continues to transition in the coming years, the private and public sector are looking to emerging technologies to reach patients who require a wide range of medical services.  Telehealth has shown promising results particularly in providing a cost efficient model of care, meeting growing patient demands, and improving access to health care particularly in underserved and/or rural regions of the country.

Telehealth has been used in both the private and public sector in areas such as audiology, dermatology, cardiology, pulmonology, and mental health. The William S. Middleton Memorial Veterans Hospital has demonstrated excellence in the provision of telehealth throughout the Great Lakes region. Currently, the Madison VA provides telehealth services in the following areas:

• Telemental Health
• Teleaudiology
• Tele Pain Coping Group
• TeleSCI (spinal cord injury)
• TeleMove!
• Telespecialty
  • Rheumatology
  • Infectious Disease
  • Thoracic Surgery

Telemental health

The Madison VA has been a leader in telehealth services for many years particularly in the field of mental health. As one of the pioneering departments to utilize telehealth services, the Mental Health Department has been caring for veterans since the early 2000’s with services initially being provided between Madison, WI and Rockford, IL.  Since that time telemental health has expanded throughout southern Wisconsin and Northern Illinois with over 100 providers offering a range of services to patients.

Teleaudiology 

The audiology department at the Madison VA has also successfully integrated teleaudiology as a vital form of patient care. Acting as a lead facility for teleaudiology pilot sites, the Madison VA has been tracking and implementing state-of-the-art technologies which enable audiology procedures to be conducted at a distance.  Currently, teleaudiology services such as hearing aid fittings and follow-up appointments are provided at local VA clinics in Beaver Dam and Baraboo, WI. Future plans are to extend teleaudiology services to Janesville, WI as well as assisting with appointments in Rhinelander, WI and Iron Mountain, MI. 

Tele Pain Coping Group

The Madison VA offers the ”Resilient Coping with Chronic Pain” Skills Group both in person and via telehealth for veterans suffering from chronic pain. The telehealth videoconference link with local VA clinics in Janesville, WI, Rockford and Freeport, IL allows veterans who are dealing with chronic pain issues to attend group sessions and receive education and support.  Patients learn practical techniques for improving their ability to cope with pain on a daily basis as well as how to manage pain flares. The telehealth link makes this resource accessible to veterans so that they can take charge of their own pain management and learn the tools to optimize their own health outcomes.

Spinal Cord Injury Telehealth

The first SCI Telehealth visit in VISN 12 occurred on 9/8/2011 and linked a Veteran at the Madison VA with a Specialist at the Milwaukee VA Spinal Cord Injury (SCI) Center.    Members of the Madison Spinal Cord Injury/Disorders Primary Care team serve as the Telepresenters for the visits which originate from the Madison VA SCI/D exam room. Using state of the art technologies, Veterans with spinal cord injuries have improved access to specialty medical consultations that may include, but are not limited to, pressure ulcers, urological, or bowel management issues.   They may also receive consultations by physical and occupational therapists, post-operative follow-up, care coordination for complex psychosocial concerns and discharge planning.  SCI Telehealth is an exciting way for qualified Veterans with general medical concerns to access their specialists without traveling to where the specialists are located. 

TeleMOVE!

MOVE! is a national weight management program designed by the VA National Center for Health Promotion and Disease Prevention (NCP), a part of the Office of Patient Care Services to help veterans lose weight, keep it off, and improve their health.   In 2009, the Nutrition and Food Department in Madison, WI expanded  MOVE! to include outreach programs via Telehealth to the Baraboo WI, Beaver Dam WI, Janesville WI, and Freeport IL CBOCs.  On average 85-100 patients are seen per month from these locations.

Telespecialty:

Tele-rheumatology

Offering veterans a more accessible means for rheumatic care, the Madison VA Rheumatology department has expanded selective care to telehealth appointments. Rheumatology currently will see patients at the Madison location for an initial evaluation and in collaboration with the patient a decision can be made for a telehealth follow up appointment.  Madison providers see patients in Tomah, WI and Iron Mountain, MI using video conferencing technology without either party having to travel far to their local VA.  

Infectious disease

Infectious disease telehealth appointments are currently scheduled only as follow-up visits for Veterans with tuberculosis, HIV, suppression antibiotic therapy and some vets who have finished IV antibiotics.  In addition, various conditions such as osteo infections, complications from diabetes, post transplant, and post surgical are addressed through telehealth follow-up visits.  The first telehealth visit for infectious disease occurred on April 28, 2011with plans to expand in the near future.

Thoracic Surgery

The Department of Thoracic Surgery has been providing virtual consultation to both patients and providers since 2009.  Primary care providers are able to request virtual consultation for review of abnormal chest imaging.  This improves access to specialty care in a timely fashion.   Telethoracic surgery has been used for initial surgical consultation as well as post operative visits for patients throughout Wisconsin.  The Thoracic Surgery Department has also utilized telehealth to speak with patients remotely across VISN lines regarding lung transplantation or Lung Volume Reduction Surgery prior to bringing them to Madison for formal evaluation. 

 “New technologies such as telehealth help improve health care services in both rural and urban areas. However, for technology to be effective it must work for the people it is meant to help - patients and the professionals providing care. Telehealth in VA helps ensure veteran patients get the right care in the right place at the right time and aims to make the home or local VA clinic into the preferred place of care, whenever possible. Telehealth changes the location where health care services are routinely provided. The value VA derives from telehealth is not in implementing telehealth technologies alone, but how VA uses health informatics, disease management and telehealth technologies to target care/case management thereby facilitating access to care and improving the health of veterans.”

– from the VHA Office of Telehealth Services