Video Tools Improve Care, Save Money in Virginia

Historically, doctors in Virginia have faced many challenges in urgent rural medical care. In many instances they have been forced to drive to see patients in remote locations where services are not available. Due to schedule issues, a remote patient can be without a doctor’s hands-on attention for up to 29 days out of each month. Due to the scarcity of practitioners in rural areas, if a patient needs specialty or urgent care, relocation is necessary.

Recruiting and retaining remote practitioners in Virginia has also been difficult; if the practitioners do not receive continued support in their area, they leave at their earliest convenience. In parts of Virginia, the closest hospitals with specialists can be a two- to four-hour drive away.

To combat the state’s access-to-care issue, state and federal partners began telehealth programs in southwest Virginia to deliver health-related services and information via technology. These partners introduced the University of Virginia Health System’s (UVA) Center for Telehealth to community providers. The Center for Telehealth is a multidisciplinary unit that supports the UVA Health System’s missions of clinical care, teaching, research and innovation, and public service.

For UVA, the most critical component of technology within telehealth was high-definition video. “With HD technologies, we are able to evaluate a patient at the right time, when care is needed, with high-quality video that eliminates the barrier of distance,” says Karen Rheuban, MD, a professor of pediatrics, associate dean for continuing medical education and director of UVA’s Center for Telehealth.

The technology UVA needed had to allow unique applications to increase access to care and provide more types of specialty care to rural patients, no matter their age or condition.

Solution

In 1995, UVA’s Office of Telemedicine launched with two hospitals and experienced its first remote encounter with a patient. The current Center for Telehealth now has more than 120 sites across Virginia and provides 40 subspecialties.

To support the Center for Telehealth in its mission, UVA deployed a broad range of Cisco video-teleconferencing units. These interactive, high-definition and real-time video solutions enable effective, scalable and easy-to-manage videoconferencing deployments anywhere, on any device or hospital cart. Relying on Cisco TelePresence infrastructure, UVA used video to create a web of care across Virginia.

“Broadband availability has increased throughout Virginia, while the cost has decreased,” says Katharine Wibberly, PhD, director of the UVA Center for Telehealth’s Mid-Atlantic Telehealth Resource Center. “As a result, patient encounters have continued to grow steadily.”

With Cisco TelePresence, UVA has created an environment where both doctors and patients look to telehealth to improve access and increase outcomes in their communities. TelePresence also allows the Center for Telehealth to perform remote provider education, support assistance and peer-to-peer consultation, helping to grow the skills and expertise of practitioners across the state.

Video and Stroke Patients

Nearly 800,000 Americans have a stroke every year, and 87% of these episodes are related to a closed-vessel stroke. The best treatment to combat closed-vessel stroke is a clot-dispersing drug called tissue plasminogen activator (tPA), which must be administered within three hours from the onset of symptoms. In the past, the administration of tPA was limited to primary stroke centers with specialists. Small hospitals housed a scarce percentage of specialists needed to read the computerized tomography scan and assess the patient using a stroke scale.

With the adoption of Cisco TelePresence, UVA piloted its telestroke program in 2010 at a critical access hospital in Bath. Utilizing high-definition videoconferencing, UVA was able to provide access to stroke neurology services for patients in one of the most rural regions of Virginia. That effort led to an expansion of telestroke services throughout the commonwealth. 

In rural areas EMS often takes longer to respond, and at times it can be several hours before a patient reaches a larger hospital with stroke specialists. By that time the patient has frequently exceeded the opportunity for receiving tPA. “Adding telestroke allows a small, rural hospital to become as effective as a primary stroke center in its rate of tPA administration,” says Wibberly. “This is very significant in terms of morbidity and quality of life.”

At telestroke hospitals, medical staff also use hospital carts with TelePresence endpoints, which are ready 24 hours a day for potential stoke victims. Neurologists from the Center for Telehealth are equipped with endpoints in their homes as well as their medical centers. This technology enables the neurologists to administer lifesaving assessments in a fraction of the time needed to transport a patient to a primary stroke center.

The Center for Telehealth is also using Cisco Jabber, an interactive tool for presence, instant messaging, voice, video, voice messaging, desktop sharing and conferencing, to connect to remote hospitals and care facilities that cannot afford large endpoints but still desire the ability to use a webcam.

Results

Supported by immersive video, the Center for Telehealth has conducted more than 33,000 patient encounters, saving patients roughly 8.7 million miles of travel in healthcare support. In addition, the Center for Telehealth has supported thousands of hours of distance learning for patients and healthcare professionals.

Clinical services provided through TelePresence span the continuum from fetal care to high-acuity consultations, as well as postacute care and chronic disease management; mental telehealth services are also provided in a community setting. In addition, the Center for Telehealth has launched a remote patient monitoring center to mitigate chronic disease and reduce emergency room visits and hospital readmissions.

“Advances in technology have helped telemedicine to progress,” says David Cattell-Gordon, director of the Office of Telemedicine, of Rural Network Development, and codirector of the Healthy Appalachia Institute. “People used to look at the screen, see pixilation and be hesitant. Now we have a sense that technology is another tool in the physician’s bag; when it’s working and the quality is good, the relationship is the only factor that exists.”

The Center for Telehealth has also achieved strides in high-risk obstetrics projects due to immersive video technology. “Patients who are high-risk have to be transported to a maternal field center or be seen by a specialist, so UVA launched a remote pilot project with the Harrisonburg Community Health Center,” says Wibberly. “In one year, missed appointments were decreased from 11% to 4.5%, and the health center’s rate of preterm births decreased from 16.5% to 12.5%, which is a great cost savings for both low-income families and the state Medicaid program.”

TelePresence has also helped UVA combat the national diabetes epidemic. The Center for Telehealth allows individuals and families to connect over video and gives them sophisticated, professional levels of diabetes education, which is supported by the Virginia Department of Health. Telehealth has also led to strides in cystic fibrosis care, giving access to such care at rural clinics that do not always have the expertise. Enabled by technology, partnerships have been formed between physicians and nurse practitioners, bringing professionals together to care for patients.

Next Steps

Over the next several years, UVA will be working with Human Resources for Health (HRH), a joint initiative of the United States and Rwanda to build a strong, independent healthcare delivery system over a period of seven years. UVA is supporting HRH in the areas of anesthesiology and surgery, sending physicians to train residents who will provide healthcare and train future residents.

In December 2012 UVA participated in the first-ever teleconference with anesthesiologists of the National University of Rwanda, thanks to Cisco TelePresence. From the teleconference room at UVA’s Medical Center, anesthesiologists in Charlottesville will sit down with their counterparts in Kigali the last Friday of every month for case presentations.

Nationally, the Center for Telehealth is working on iTreat, which will provide ambulatory care for stroke patients, connecting them with neurologists before they arrive at the hospital. Doctors will not only be able to talk to patients immediately following their symptoms, but also perform assessments.

“UVA recognizes that mobile capability will be a part of the future,” says Rheuban. “Over time, and with strides in technology, we have enhanced our capabilities to not only improve our quality of care, but the quality of life in Virginia.” 

To find out more: https://www.cisco.com/go/telepresence, https://www.cisco.com/go/jabber.