Jul 31 2008

Wide Open Spaces

Videoconferencing extends services, saves money and fosters collaboration at VA medical facilities across the nation.

Located halfway between Denver and Salt Lake City, the city of Craig, Colo., is known for ranching, mining and big-game hunting. This rural outpost also is home to a state-of-the-art videoconferencing system that lets veterans get check-ups, attend counseling sessions and prepare for surgery without leaving town.

The Veterans Affairs Department runs the videoconferencing system at its Craig VA Telehealth Clinic, which has served more than 200 patients since VA opened it last September.

“I’m seeing guys here who haven’t had any medical care in 10 years,” says David Newman, a staff nurse at the clinic. “A lot of these guys are fairly poor, and paying out of pocket is very difficult for them. As far as VA access is concerned, they’d have to drive 160 miles to Grand Junction or 200 miles to Denver over the mountain range.”

Newman can adjust special cameras and electronic instruments, such as a digital stethoscope, on the clinic’s video-conferencing system to let a doctor at a distant VA medical center examine a patient at the Craig clinic.

“The doctor is able to get done all the things he would want to do,” Newman says. “He can listen to heart and lungs. He can look in eyes and ears. He can look at special things like rashes and wounds.”

In its first nine months of operation, the clinic is already saving VA money, he says, by diagnosing veterans’ medical problems such as high blood pressure and high cholesterol before they have heart attacks or strokes.

The VA’s use of videoconferencing exemplifies why the technology is gaining traction in government, says Henry Dewing, principal analyst for Forrester Research of Cambridge, Mass. The three chief reasons align with what most IT shops aim for: saving money, extending service and expanding collaboration. In the case of VA, video services provide more convenient care for the department’s main customers (veterans), provide a way for the department to extend its access to specialists from coast to coast, and create a mechanism for medical and administrative collaboration. And, VA officials point out that they can do these things at less cost because of videoconferencing.

The Big Picture

The Craig clinic is part of the VA Rocky Mountain Network of health-care facilities, which treat 700,000 veterans in Colorado, Montana, Utah and Wyoming.

“There is no doubt in my mind that the return on videoconferencing is coming out of a better satisfied population. We’re providing better care for our population,” says Jack Seymour, CIO for the network. “There are less miles traveled for our veterans, and in many cases less miles traveled by our clinical staff. When you sit in Denver and treat a veteran in the hinter-most part of Montana, you have saved everybody time and money.”

47,000 The square miles covered by VA's Rocky Mountain Network health-care system

SOURCE: Veterans Affairs Department

VA has embraced videoconferencing as a cost-effective way of extending its medical care into rural areas. The Rocky Mountain Network, also known as Veterans Integrated Services Network 19, is one of 21 VISNs run by the department’s Veterans Health Administration, and all 21 deploy videoconferencing.

“More than anything, this is about access to health care,” says Jeffrey Lowe, network care coordination and telehealth manager. “There are many geographic barriers to access. We have long distances. We have the climate. We have mountain ranges. It’s been difficult to recruit clinicians to work in these rural communities, and there weren’t enough veterans in these communities to justify dedicated staff. It’s a lot more cost effective to put in a videoconferencing system.”

For many agencies, videoconferencing is no longer a nice-to-have tool that lets far-flung employees occasionally interact face to face, Forrester’s Dewing says. Instead, it has become a need-to-have application, without which an agency can’t meet its mission or serve its citizens.

“The hard ROI for videoconferencing is in travel savings,” Dewing says. “A reduction in travel expenses alone is paying for these solutions.” As gas prices climb, along with worries about carbon emissions, agencies are finding that they also can reduce their carbon footprint through the use of videoconferencing.

A Closer Look

Nowhere are the benefits of videoconferencing more evident than in VISN 19, which has a relatively small veteran population, mountainous terrain and a harsh climate. It has been paving the way for videoconferencing for telehealth applications since 1999.

The health-care network has six medical centers — Denver; Salt Lake City; Grand Junction, Colo.; Cheyenne, Wyo.; Sheridan, Wyo.; and Helena, Mont. — and 34 community clinics. All of the sites have videoconferencing systems.

Photo: Stephen Collector
"When you sit in Denver
and treat a veteran in the hinter-most part of Montana, you have saved everybody
time and money," says
VISN 19 CIO Jack Seymour.

The VISN 19 videoconferencing systems run on VA’s wide-area network, using IP and the H.323 protocol for videoconferencing.

The Rocky Mountain facilities use their videoconferencing systems for a wide range of telehealth applications, including primary care, radiology, dermatology, rehabilitation and mental-health counseling.

“By far the clinical modality that’s represented the most would be telemental health,” Lowe says. “We’re doing telepsychiatry, telepsychotherapy and even group treatment for issues like substance abuse.”

Telehealth is taking off in rural areas, says Geralyn Johnson, vice president of telehealth services at DIANAssociates, a Severna Park, Md., imaging company. A dentist by training, Johnson is the former deputy director of Immigration Health Services.

“It started around teleradiology and telepsychiatry, but now you have videoconferencing equipment with different peripherals and tiny cameras. I can do a visual dental exam from miles away,” Johnson says. “You have the ability to capture accurate data about the patient and the network capacity to transmit it to far away places.”

Johnson says a chief reason that agencies have been avidly adopting video­conferencing systems is the technology itself. The systems offer high-quality video and don’t require special lighting for most uses, she says.

“You can see a better image with the camera than using your naked eye,” Johnson says. “And the quality of the image for people who are looking at it from far away is good enough for them to use to make a diagnosis.”

Focusing on Metrics

VISN 19 doesn’t have hard numbers for how much money it spends per year on videoconferencing systems because the application is integrated into its IT infrastructure. VA has a converged backbone network that carries video, imaging, Voice over IP and other data applications.

The expenditures for equipment and services are also distributed across multiple organizations, CIO Seymour says. “Some of these pieces are being bought by clinical people, some are being bought by the central office in Washington, D.C., and some pieces are bought by us.”


Veterans in Colorado,
Montana, Utah and Wyoming
who received telemental-health
videoconferencing services
in 2007, more than double
the 426 treated in 2005


He estimates that VA’s Rocky Mountain facilities have around 200 videoconferencing units, ranging in price from a few thousand dollars to $40,000 for high-end units with special cameras, electronic stethoscopes and other digital instrumentation. Each year, VISN 19 spends several thousand dollars in maintenance on its videoconferencing network and also replaces half a dozen units through its tech-refresh budget, Seymour says.

To determine the savings from its videoconferencing programs, VA is looking at statistics that show a reduction in the number of hospitalizations and the number of “bed days” — or days in the hospital for each hospitalization — for veterans who receive telehealth services.

“Without telehealth, veterans might not get the services they need, or they might get services once a year rather than once a month,” Lowe says. “As time goes on, I think we will have longitudinal studies that will show a reduction in how long they’re in the hospital and how many hospitalizations they have in a year.”

Johnson says the return on telehealth investments is not only in reduced transportation costs but also in reduced staffing levels and better-quality care.

“There’s so much prevention and so much intervention that happens with telehealth,” Johnson says. “How do you put a price tag on saving someone from heart surgery?”

And the veterans like it, says Newman of the VA clinic in Craig. “I thought the patients would be hesitant,” says the nurse, who sees mostly veterans of World War II, the Korean War and the Vietnam War. “But I’ve found the opposite to be true. They like having access to medical care. They like the technology. I’ll have 80-year-old guys ask me about the bandwidth it uses.”