WEST HAVEN, CONN. — Over the last few years, telemedicine has partially redefined how health care is delivered to patients, especially those who do not live near medical centers. For the most part, it has been a one-to-one exchange. One patient communicates with one physician, or one physician communicates with a specialist at another facility.
VA’s SCAN program, which began rolling out last month, looks to change that ratio, using telehealth technology to create the medical equivalent of a force multiplier.
SCAN will connect subspecialists with whole groups of physicians online, providing expertise that will not only help a single patient but will help improve the ability of primary-care physicians to treat an entire disease state.
Telemedicine Force Multiplier
SCAN is based on a program out of the University of New Mexico called Project ECHO (Extension for Community Healthcare Options). ECHO, which began in 2004, linked urban healthcare specialists with primary-care providers in rural settings, giving those providers access to the expertise needed to better treat their patients. Instead of teleconferencing a specialist with the patient, ECHO put a specialist online with a group of primary-care physicians to act as a mentor and educator.
At the same time ECHO was starting up, VA was beginning its own telemedicine initiative based on a more traditional model. Eventually VA became aware of the work ECHO was doing and initiated a national grant program to emulate it.
“This really originated with President Obama’s mandate to transform VA into a 21st century healthcare organization,” explains Jerry Grass, MD, director of the VA SCAN program for Region 1, which covers the Northeast and Mid-Atlantic areas. “What we’d like is for every veteran to have access to health care, especially subspecialty service, when they need it and where they need it.”
The grants for VA SCAN were awarded April 5 and cover all seven VA regions. “We realize that you can’t have a subspecialty physician in every facility in every VISN and CBOC,” Grass says. “Our job is to bring telemedicine capability to the desktop of every primary care provider in this region so that they can access specialists at specified times, present patients, and have discussions about treatment options.”Telemedicine Program Gives Patients Benefit of Team Approach to Their Care Cont.
Here’s an example: A physician at a CBOC in rural Maine is treating a veteran recently back from Iraq who is struggling with severe back pain. Different treatment options have been tried and failed; different medications have been prescribed, with each failing to relieve the patient’s pain. The physician wants advice on where to go next but has no access to a pain-management specialist, and the patient lives far from the nearest VAMC.
With SCAN, that physician could go online and request a consultation with a pain-management specialist. The physician would supply the patient’s history, along with what treatments have been tried. SCAN’s administrators would arrange a group of specialists to get together to review the case, as well as other cases that have been referred to them. Then a teleconference would be arranged between the specialists and all of the physicians seeking help with pain management. A notice would also go out to other physicians inviting them to listen in.
“The specialists will be able to discuss their approach to the case, as well as giving the physician education on that specialty,” Grass says. “We’ll be able to help treat that patient and all the other patients in this panel. We don’t just want that doctor on the line. We want 10 or 15 physicians listening in.”
SCAN will begin by providing expertise in three specialty areas: pain management, diabetes, and hepatitis C. If the program is successful with those, they will begin to add more specialties.
“And if the physician doesn’t have the equipment — a videocamera and microphone — we’ll provide it,” Grass says. “And everything will operate seamlessly over VA’s secure Enterprise Network.”
Grass wants to have the first teleconference clinic sometime this month. “We’re trying to move ahead as quickly as we can,” he said. “We want primary-care providers to feel comfortable using this, and not just have it be one more thing to do.”
A facility-specific survey found that 138 of 140 VA facilities reported shortages of medical officers, with psychiatry and primary care positions being the most frequently listed.
When Terrence O’Neil, MD, retired as chief of nephrology at the James H. Quillen VAMC in Johnson City in December 2016, he left in his wake decades of work treating kidney disease—nearly 35 years in the Air Force and DoD, plus 11 more at VA.