1. North Florida/South Georgia Veterans Health System
Telehealth Increases Access to Care for Veterans with Physical Limitations and Chronic Disease Processes
Lorrie Smith, BN, RN and Jennifer Adams, BN, RN
Introduction/Background
Recommendations for Practice
Outcomes
Veterans with mobility challenges, along with chronic medical conditions, require regular monitoring to manage their care and prevent complications. Veteran patients with Spinal Cord Injury (SCI), Multiple Sclerosis, and Amyotrophic Lateral Sclerosis (ALS) are especially challenged in physical mobility. They experience limitations in access to care due to special travel requirements, clinical availability of providers, transportation availability, and personal caregiver’s schedule, all of which must be coordinated to accommodate their needs. This population might greatly benefit from remote monitoring.
Telehealth is an umbrella term that encompasses a variety of remote programs for delivering care for our Veteran population. Telehealth includes programs such as Clinical Video Telehealth (CVT) whereby patients in one clinic accompanied by a nurse can be visited electronically by a specialist at a remote clinic or hospital. Telemedicine involves use of videoconferencing between provider in a clinic who connects with a patient at home to provide care. With the Home Telehealth (HT) program nurses receive patient vital signs, weights, and other health-related assessment data using remote technology to aid in the management of chronic medical conditions. HT staff provide case management to the patients and data to the provider through the electronic medical record for review and interventions if warranted. It is logical to extend the use Telehealth practices to the care of patients with mobility challenges and chronic diseases to improve their access to care.
Telehealth principles can be applied to primary care visits.
Use telehealth to support patients with chronic, complex care needs at home.
Nurses in primary care should expect to learn how to use teleconferencing methods to support in-home care for patients with mobility challenges.
Supply all primary care provider’s with the equipment needed to support telemedicine visits.
Outcomes are pending
Response to being seen via the Telemedicine technologies have been well-received in the SCI Clinic. We have scheduled the following appointments: 2 ALS patients, 1 MS patient and 2 SCI patients.
Will monitor actual patient and caregiver response to the Telemedicine appointments through individual conversations.
Will monitor travel time savings
The 2 RVTRI Therapists report their patient’s are more relaxed in their home environment making the patient more receptive to PT and opening the lines of communication, all of which improve their outcomes to therapy. 1 1 1 1
Project Plan
Evidence
Providers in an ambulatory care clinic are currently receiving education on implementation of CVT/Telemedicine
Goal is to offer appointments to patients with ALS, SCI, and MS via CVT/Telemedicine in their homes within the next 2 months
Nurses who assist providers are also completing education on use of CVT/Telemedicine
Measure length of travel time for identified patients before and after implementation of project
Improve efficient use of nursing/social worker time to coordinate travel
Goal to reduce cost of travel for patients who require specialty transport for a clinic visit.
Conclusion
Patients who were enrolled in home telehealth programs had:
54% reduction in bed days of occupied care.
32% reduction in hospitalizations.
35% reduction in acute psychiatric hospitalizations for patients receiving cognitive behavioral therapy (1).
Use of Telehealth monitoring by one coordinator resulted in effective AIC control for 11 of 16 diabetic patients using telemonitoring technology.
Diabetic veterans who embrace the home telehealth program in its entirety have greater success with glycemic control (2).
Reduced travel time and cost, and increased access to care.
Two Rural Veteran Tele-Rehabilitation Initiative (RVTRI) Physical Therapists (PT) report a case load of patients enrolled in their Tele-rehabilitation clinic.
Veterans can benefit from utilization of Telehealth monitoring and Telemedicine visits in the comfort of their own homes.
Travel time and cost can be avoided through such technology use.
The implementation of telehealth technologies has implications for education and training needs of direct care providers and professional nurses.
Use of telehealth monitoring techniques can streamline care and improve access to care.
References
1. Agarwal, M., The Right Care at the Right Time and in the Right Place: The Role of Technology in the VHA. Federal Practitioner, July 2015;
2. Schramm, M., Home Telehealth; A tool for Diabetic Self –Management, January/February 2016;

2. Telehealth Increases Access to Care for Veterans with Physical Limitations and Chronic Disease Processes Lorrie Smith, BN, RN and Jennifer Adams, BN, RN

3. Introduction / Background
Telehealth is an umbrella term that encompasses a variety of remote programs for delivering care for our Veteran population. Telehealth includes programs such as Clinical Video Telehealth (CVT) whereby patients in one clinic accompanied by a nurse can be visited electronically by a specialist at a remote clinic or hospital.
Telemedicine involves use of videoconferencing between provider in a clinic who connects with a patient at home to provide care. With the Home Telehealth (HT) program nurses receive patient vital signs, weights, and other health-related assessment data using remote technology to aid in the management of chronic medical conditions. HT staff provide case management to the patients and data to the provider through the electronic medical record for review and interventions if warranted. It is logical to extend the use Telehealth practices to the care of patients with mobility challenges and chronic diseases to improve their access to care.

4. Evidence Patients who were enrolled in home telehealth programs had:
54% reduction in bed days of occupied care.
32% reduction in hospitalizations.
35% reduction in acute psychiatric hospitalizations for patients receiving cognitive behavioral therapy (1).
Use of Telehealth monitoring by one coordinator resulted in effective AIC control for 11 of 16 diabetic patients using telemonitoring technology.
Diabetic veterans who embrace the home telehealth program in its entirety have greater success with glycemic control (2).
Reduced travel time and cost, and increased access to care.
Two Rural Veteran Tele-Rehabilitation Initiative (RVTRI) Physical Therapists (PT) report a case load of patients enrolled in their Tele-rehabilitation clinic

5. Recommendations for Practice
1. Telehealth principles can be applied to primary care visits. 2. Use telehealth to support patients with chronic, complex care needs at home. 3. Nurses in primary care should expect to learn how to use teleconferencing methods to support in-home care for patients with mobility challenges. 4. Supply all primary care provider’s with the equipment needed to support telemedicine visits.

6. Project Plan
1. Providers in an ambulatory care clinic are currently receiving education on the implementation of VVC. 2. Goal is to offer appointments to patients with ALS, SCI, and MS via VVC in their homes within the next 2 months. 3. Nurses (RN’s and LPN’S) who assist providers are also completing education on the use of VVC. 4. Measure the length of travel time for identified patients before and after implementation of project. 5. Improve efficient use of nursing and social work time to coordinate travel. 6. Goal is to reduce cost of travel for patients who require specialty mode travel for a clinic visit.

7. Outcomes
SCI provider has The response to being seen via VCC technologies have been well-received in the SCI clinic. The 2 RVTRI Therapists report their patient’s are more relaxed in their home environment making them more receptive to PT and opening the lines of communication, all of which improve their outcomes to therapy.

8. Conclusion
Veterans can benefit from the utilization of VVC monitoring and Telemedicine visits in the comfort of their own homes. Travel time and cost can be avoided through such technology use. The implementation of VVC technologies has implications for education and training needs of direct care providers and professional nurses. Use of VCVC monitoring techniques can streamline care and improve access to care References 1. Agrawal, M., The Right Care at the Right Time and in the Right Place: The Role of Technology in the VHA. Federal Practitioner, July 2015; 2. Schramm, M., Home Telehealth: A tool for Diabetic Self-Management, January/February 2016;

9. POSTER UPDATE
The VA now calls this type of appointment: VA Video Connect.
The VA is encouraging all clinics to incorporate this type of appointment into their daily schedule.
Patient’s can use their own device, such as an I phone, computer, or I pad for the call. They are required to go to their “app store” and download the “VA Video Connect icon”.
The SCI clinic has completed at minimum 10 VA Video Connect appointments, saving the VA money.
Below is an example of vendor cost for transportation:
Wheel chair patient cost for loading on van from home and loading from appointment is $ each and $4.75 per mile to and from appointment.
Stretcher patient cost for loading on van from home and loading from appointment is $ each and $7.95 per mile to and from appointment.
The transportation cost varies from vendor to vendor.
The SCI patient’s like the VA Video Connect appointments because they are convenient and they do not have to travel outside the home.