When President Trump and Veterans Affairs Secretary Dr. David Shulkin announced initiatives to expand veterans’ access to healthcare this summer, it may have been the first time many Americans had heard the term telehealth.
In fact, telehealth has been around for decades, although its use has expanded in the 21st century.
Telehealth “started back in 1967 when a VA mental health provider used a two-way TV system to provide care to a native American reservation,” said Rod Miles, Facility Telehealth Coordinator at Bay Pines VA Healthcare System, which serves veterans in west central and southwestern Florida.
Bay Pines began implementing telehealth, linking its facility to other VA facilities, in 2007.
“We’ve been providing care to veterans through those services for a decade now,” Miles said.
Telehealth allows physicians at VA facilities known as provider sites to examine a patient via video at a VA patient site.
The service is especially valuable for veterans living in remote areas or for whom travel is particularly inconvenient, giving them a way to be examined without having to make a lengthy journey to a more urban area.
One of the new initiatives announced by the president and the secretary will give veterans easier access to care from VA facilities such as Bay Pines.
VA Video Connect uses a secure, web-enabled video service to let veterans connect with VA providers by video using their mobile phones or computers.
The technology is new, but the idea behind it isn’t.
“The video into the home … where patients meet in a virtual medical room, that type of care we’ve actually been participating in already for about three years now,” Miles said.
The system Bay Pines has been using, though, is described by Miles as more “technical” and “complex for patients and providers” than the one referenced in the presidential announcement.
“The new video on demand system is a lot more user friendly and we do expect to have more buy-in from providers to participate,” Miles said. “And I think patients are going to be a lot happier.” He added that he’s “thrilled” with the new and simpler technology.
The new technology is an advance of what Dr. Paul Maas, has been doing since he began working at Bay Pines in 2014.
Maas is a primary care physician for the Alaska VA Healthcare System. Initially, he lived and worked in Alaska, seeing patients in VA facilities in Anchorage and Juneau.
However, he’s a Floridian at heart, hailing from the Tampa Bay area, and wanted to return. He kept his old job, though, despite moving nearly 5,000 miles away from his patients.
“I was offered a job doing telehealth because I already had a panel of patients in Alaska and [the Alaska VA] didn’t want me to leave and go to another VA,” Maas explains. “So they offered me a telehealth position and I took it.”
Telehealth is especially valuable in areas where there is a shortage of available physicians or locations to which healthcare workers aren’t willing to relocate.
“It’s difficult to recruit providers to go to Alaska,” Maas said. “We’ve been able to recruit and retain more physicians by having telehealth.”
Two other VA physicians see patients in Alaska from New Hampshire and California, Maas said.
“It’s been a huge success as far as Alaska is concerned,” Maas said. “We’ve been doing tele-primary care up there for four years. The first year there were 300 patient encounters, this year we’ve already done more than 3,000 encounters.”
In this type of telehealth encounter, known as clinic-based telehealth, the veteran visits a VA facility and is assisted by a nurse or nurses who are trained in working with telehealth patients.
Maas instructs the nurse on what he wants examined. “We can look in ears and throat. We can do heart and lungs. We can physically check joints. I can direct them as to what I want done,” Maas said. “And it’s standardized so that if one of the personnel are out for the day, someone else who is trained can come in and do the exact same exam.”
A specialized stethoscope allows Maas to listen to the patient’s heart and lungs through headphones, while a similarly-equipped otoscope allows him to check ear, nose and throat on his computer screen.
Maas’ office is configured for being on camera. His desk is uncluttered and the wall behind him is painted according to Veteran’s Administration specifications.
Not all of Maas’ exams are done from a distance. Some require an in-person visit.
“I am required to go up to Anchorage quarterly for a week to see some patients in person, so I identify patients who I want to see for specific reasons and I have a face-to-face with them because maybe there are parts of the exam that are not possible to do over telehealth,” Maas said. “I see probably 30 patients every time I go up there.”