VA Pittsburgh Uses Telemedicine To Treat Vets And Address Access

Aug 20, 2015

Dermatologist William Leyva looks at a skin growth. This is using the "store and forward" method of telemedicine in which an image is captured and sent to a specialist to determine if further testing is needed.
Credit Deanna Garcia / 90.5 WESA

Once a futuristic pipe dream, video calls are now so commonplace they not only help family and friends feel more connected, but allow medical professionals reach patients that in the past either would not have been seen or would have had to travel hundreds of miles for treatment.

One of the largest users of telemedicine is the VA Pittsburgh Health System.

“We’ve been trying to address access for the past year in a number of different ways, but this one is a creative kind of way to be able to connect (veterans) with types of care,” said Barbara Forsha, interim system director.

The local Veteran’s Administration has come under increased scrutiny the last few years as fatal outbreaks of Legionella swept local facilities and a national crisis over wait times so long many patients gave up or died waiting.

Southwestern Pennsylvania is home to an estimated 260,000 veterans and their families, according to the Veterans Leadership Program of Western Pennsylvania. But not all are located in Pittsburgh where the VA hospital is.

Videoconferencing has long been the most common form of telemedicine. Here patients at two different facilities are conferencing with VA Pittsburgh dieticians for counseling related to bariatric surgery.
Credit Deanna Garcia / 90.5 WESA

Navy veteran Jessica McCabe, of New Castle, Del., plans to travel to Pittsburgh in the fall for bariatric surgery, but doctors require several visits leading up to the procedure to prepare and discuss any side effects of medications and other concerns. McCabe said she and her husband can’t realistically travel to and from Pittsburgh for every appointment.

“We have a vehicle, but the vehicle is very old,” McCabe said, “so we run the risk of trying to get to Pittsburgh and breaking down half-way there.”

Instead, VA officials agreed to perform most through video conferences, including appointments for follow-up care. VA officials said this helps improve outcomes, because if a patient had to travel long distances after an already long and strenuous procedure, he or she may opt not to go at all.

Now, vets have the option to schedule regular appointments with their local primary care physician and have that doctor or his or her office connect with the Pittsburgh VA. In-home components can also aid for follow-ups and regular treatment for chronic illness.

VA Chief of Medicine Fred DeRubertis said dermatology is one specialty already utilizing telehealth.

“Would you be happier going to see your primary care physician in Erie, having a picture taken along with your skin legion along with your history and having it transmitted to Pittsburgh, or would you rather drive back and forth to Pittsburgh round-trip five or six hours in winter to see the dermatologist in the clinic for 15 or 20 minutes?” he said.

Ideally, these services would’ve been available long ago, but advances in every day technology really only opened the possibility in recent years, according to dermatologist William Leyva.

“In the days when we didn’t have as sophisticated cameras, it wasn’t very effective to do this at all,” Leyva said. “The images were too blurry; you really couldn’t do this.”

Today doctors can make a reliable determination of whether something is harmless or needs further testing from afar, he said. Telemedicine is also helpful with eye care such as retinal scans, counselling and therapy.

DeRubertis said the VA considers telehealth a strategic initiative and important tool for veterans’ health and continues to provide funding for technology and infrastructure.

The system currently supports three modalities:

  • Clinical video conferencing – this is what most people think of with telehealth, a doctor on one side, patient on the other; this gets a lot of use for behavioral health;

  • Store and forward – in which images of a patient and clinical history are taken then forwarded to a specialist. In 50 percent of cases, this saved patients from a live visit, according to the VA. The other 50 had to visit for biopsy or other procedure;

  • Home telehealth program – aimed at and used as a chronic disease management tool.