 |
Thomas Mahl, M.D.
Hepatologist, Buffalo
VA Medical Center
 |
Veteran Mark
Moose has little
time to watch TV.
In fact, his job at
a busy hardware store leaves few
gaps in his schedule for necessary
tasks like medical appointments.
But recently, 30 minutes in front of
a screen saved him more time and
hassle than he ever expected.
When his nurse practitioner
suggested that he see a liver
specialist to double check some
slightly abnormal values on his
latest routine blood tests, Moose
resigned himself to taking a two hour
trip to Buffalo VA Medical
Center. But then he was offered
an unexpected opportunity — he
learned that he could see Thomas
Mahl, M.D., without leaving his
hometown of Bath through something
called telehealth. “I’d never
done anything like that before,
but it sounded much easier than
driving all the way to Buffalo,”
he says.
On the day of his appointment,
Moose went to Bath VA Medical
Center, the facility minutes from
his home where he receives most of his medical care. A nurse
ushered him into a room with
a camera and high-definition
TV monitor. Within
moments, Dr. Mahl
flashed onto the screen.
Dr. Mahl had already
reviewed Moose’s test
results and medical
history. “He’d done his
homework on me,” Moose
says. “We chatted for a bit,
and then he asked me questions
about my health and any
symptoms I might be having.”
The outcome: Dr. Mahl reassured
Moose that although he’d benefit
from a few lifestyle changes and a
follow-up telehealth appointment
in six months, he was fine.
The best part? “I was in and
out of there,” Moose says. “It was
a huge savings in time, not to
mention gas money.”
“With telehealth, I don’t see any downside.
I’m sold on this technology.” — Thomas Mahl, M.D.
 |
Mark Moose meets with his VA specialist
from Bath VA Medical Center, saving him
a two-hour drive to Buffalo.
|
Improved Access to Care
Moose is one of many Veterans
using VA’s telehealth program
— the largest in the world. VA’s
telehealth program focuses on
providing better access to health
care for all Veterans, particularly
the 40 percent who live in rural
and remote areas.
VA Health Care Upstate New
York has 89 active telehealth
clinics. These clinics have enabled
more than 5,000 Veterans to
remain closer to home while seeing
medical professionals and accessing
services to help them stay
healthy, including:
• Losing weight
• Managing chronic illnesses
• Getting specialty care
And as Moose discovered, telehealth
certainly can help save time
and gas money. But the benefits go
deeper than that, particularly for
Veterans who have even greater
physical challenges and longer
distances to travel.
“It was a huge savings in time, not to mention
gas money.” — Mark Moose, Veteran
Ongoing Support
When Veteran Emerson Woodruff
was diagnosed with borderline
type 2 diabetes in January 2012,
he knew that he’d significantly
improve his chances of staying
healthy, and perhaps avoid medications
altogether, by learning all
he could about the disease.
 |
Instead of driving to Syracuse,
Emerson Woodruff and
his wife go
to the Binghamton CBOC to meet
with
Certified Diabetes Educator Gail
Serino, R.N., B.S.N.
(on right in monitor),
and D’Lorah Robbins, physician assistant
|
As a retired truck driver, he’s no
stranger to driving, but the prospect
of making a 200-mile round
trip to Syracuse VA Medical Center
for in-person diabetes counseling
was daunting. So he welcomed the
opportunity to participate in the
Tele Diabetes Education program
at the Binghamton Community
Based Outpatient Clinic (CBOC),
about 30 miles from his hometown
of Afton.
Woodruff has already completed
four one-hour sessions with
Certified Diabetes Educator
Gail Serino, R.N., B.S.N.,
to learn about diabetes,
monitor his blood sugar
levels, and get advice on
eating and exercise.
“If I had to go up
to Syracuse, I might
have only gone for one session
instead of making four sessions in
Binghamton,” he says. A bonus:
His wife, who is also diabetic,
attends the sessions with him.
“People need diabetes education
to come to them, and it has to be
personal,” Serino says. To make
the counseling even more effective,
she works with a nurse who
serves as her on-site eyes, ears
and hands. The nurse can take
vital signs and administer simple
diagnostic tests. That information
is instantly transferred back
to Serino. The nurse also can
help demonstrate techniques; for
example, if Serino is showing a
patient how an insulin pen works, she’ll have the nurse
go through the steps by the
patient’s side.
“If I had to go up to Syracuse, I might have only
gone for one session instead of making four sessions
in Binghamton.” — Emerson Woodruff, Veteran
Enhanced Exams
In some cases, telehealth may
help physicians perform more
productive exams. Wendy Cao,
M.D., a physiatrist (specialist in
rehabilitation medicine) at Buffalo
VA Medical Center has conducted
telehealth appointments for
patients with multiple sclerosis
(MS). This degenerative neurological
condition has symptoms
that include loss of mobility and
fatigue. A key part of her exam
involves putting patients through
a series of balance, walking and
strength tests.
 |
Wendy Cao, M.D.
Physiatrist, Buffalo
VA Medical Center
|
“Because telehealth patients are
much less tired from traveling,
they’re more willing and able to go
through those types of tests,” she
says. “Consequently, I’m able to do
a more accurate exam.”
She recalls a recent patient who
came in with his wife, who was
concerned that he might be having
difficulty walking. By having an
assistant angle the camera down a
hallway, Dr. Cao was able to watch
the patient walk.
She ended up
suggesting a new type of walker that steadied
him immediately. On
the other hand, if that
patient had been worn out
from travel, he may have
been too tired to perform
the walking test and the
problem could have been
missed.
Greg Woz, who has MS,
recently had a telehealth
appointment at the Olean
CBOC with his wife, who
also has the condition.
During the appointment,
“they tested my reflexes,
how I walked, my eye
tracking, my strength —
just what they would have
done at a regular appointment,”
he says.
He admits to some initial
reluctance, even though he knew
telehealth would save him a twohour
trip to Buffalo. “One thing
you learn in the service is ‘never
volunteer’,” he jokes. “But I did
it anyway, and it worked out this
time. I was quite pleased with it.”
Telehealth providers can also
detect when a symptom requires
urgent treatment, even when the
patient might not. Serino, for
instance, recently saw a patient
who casually mentioned that he’d
been experiencing some vision
issues since his last appointment.
She was immediately concerned
that this might be a sign of retinal degeneration, one of the most
damaging side effects of diabetes,
and scheduled a visit with an eye
doctor, who was able to examine
him the same day.
 |
Greg Woz completes eye tracking and
other tests
during an exam.
|
Myth of the Virtual Barrier
Before walking into their first
telehealth appointment, Veterans
may wonder if it’s going to feel
impersonal — or downright weird
— talking to their doctor on a
TV screen.
Moose had his doubts, but within
moments after the appointment
began, “I felt like Dr. Mahl knew
me, and he put me at ease,” he
says. “We even commiserated
about how we both needed to
lose weight.”
“In some ways, I feel that I have
even more fruitful conversations
with patients and have more
time to answer their questions
— perhaps because they’re more
relaxed and they didn’t have to
wait long to see me,” Dr. Mahl says.
The Future of Telehealth
Dr. Mahl sees applications for telehealth
in nearly every specialty. In
his own field, he hopes to expand
the types of conditions he monitors,
eventually including illnesses
such as ascites, a condition that
causes fluid in the belly. “Those
patients require a 15-minute
appointment every two weeks,
and there’s no reason for them to
travel,” he says. Dr. Cao hopes to
expand her program to include
patients with movement disorders,
stroke and spinal cord injuries.
Dr. Mahl also envisions more
types of patient education, such
as group telehealth sessions to
prepare patients for elective procedures
such as colonoscopy, and
physician education, with medical
students completing a telehealth
rotation in every specialty.
That’s quite an about-face for
a former tech-phobe. “I’m not an
early adopter,” Dr. Mahl admits.
“But with telehealth, I don’t
see any downside. I’m sold on
this technology.”
Woodruff reassures his fellow
Veterans that telehealth is as userfriendly
as it gets. “I would recommend
this to anybody. Go ahead
and try it.”
| Types of Telehealth
Services |
VA’s telehealth program offers
three types of services:
Clinical Video Telehealth
(CVT): This involves real-time
videoconferencing with a
health care provider through
high-definition cameras and
video monitors.
Store-and-Forward: This
involves transferring data and
digital images to a specialist
for evaluation. |
Care Coordination/Home
Telehealth
(CC HT):
Veterans
are set up with a home telehealth
device that connects
them with a VA hospital via a
regular phone line. It enables
VA health care providers
to monitor vital signs and
respond to symptoms before
they become serious.
Talk with your VA Patient
Aligned Care Team (PACT)
about telehealth services that
may be right for you. |
See
Telehealth
in Action
Watch free videos
demonstrating VA
telehealth programs
and their benefits at
www.telehealth.va.gov. |
|
