Bob Clark is a Marine veteran who served in Vietnam. It used to be that when Clark needed to see a doctor he had to either drive several hours to the Veteran’s Affairs (VA) hospital in Salt Lake City or Grand Junction, Colo.
Now, when Clark makes an appointment with his VA doctor Dr. Ono, he drives to Moab’s VA Telehealth Center and sits down in front of a computer screen and a camera. “If you are talking to your primary care doctor, nine times out of ten you don’t need them (physically) there,” Clark said.
That is the idea behind the VA’s telehealth clinics. Staffed by registered nurses and telecommunications technicians, the telehealth clinics connect veterans in rural and underserved areas with doctors whom they would otherwise have to spend hours driving to see.
Telehealth uses technology to deliver health care from a distance. It was originally developed in the 1960s by NASA to serve its astronauts. With the advent of widespread high-speed Internet and inexpensive telecommunications gear, the concept has gained traction closer to home.
The telemedicine business in North America has been growing at 10 percent annually, and in 2010 it generated more than $500 million in revenue. This has been due, in large part, to the fact that a fifth of Americans live in places where primary care is scarce.
The VA began its pilot project with telehealth in 2007 in Craig, Colo. With the success of the Craig clinic, coverage to the area was expanded and clinics were opened in Glenwood Springs, Colo. and Moab in 2010.
“This idea has been beneficial because most vet hospitals are in metro areas, so by the time rural vets get in they are already real sick,” said Shirley Ramey, a licensed practical nurse at the telehealth clinic.
The Moab clinic now has around 220 vets who use its services. For their initial visit veterans go to Grand Junction (free rides are available for those who are unable to get there on their own) where they meet with Dr. Ono in person. Most subsequent consultations are done with the assistance of the clinic’s nurses through the telehealth console in Moab. If Dr. Ono feels the need to see a patient in person, she will make arrangements for them to travel to Grand Junction, Colo.
“(With telehealth) we can do things like vital readings, blood draws, retinal screening, dermatology and EKG readings right here,” said Carla Bird, Moab’s telehealth registered nurse. During the exams Dr. Ono is connected by video and audio through the console, receiving all the readings, and listening to the stethoscope, in real-time.
A large portion of the clinic’s focus is on treating issues before they become serious problems.
“Probably the biggest issue we deal with our vets is diabetes,” said 20-year Army veteran Dan Lamont, who works as the telecommunications technician at the Moab clinic. The clinic offers diabetes education classes that cover the nutrition, exercise and health components of the treatment.
To put action to the ideas, Moab’s VA clinic also organizes group walks for its patients every Thursday at noon, starting from the Grand Center.
“It’s a great way to get us out of the house and interacting with each other,” Clark said. “Shirley calls all the guys on Wednesday afternoon to get them out there.”
Telemental, the mental health side of the clinic, is also one of telehealth’s core functions. With one in five of the 2.6 million service members who served in Afghanistan or Iraq from 2001 suffering from Post Tramatic Stress Disorder (PTSD), the Grand Junction VA hospital- the mental health program which serves Moab- has putting more emphasis on telemental. It has expanded its mental health personnel by 400 percent since 2007, from seven providers to more than 30. Another benefit of telemental, said Paul Sweeny, the public relations officer for Grand Junction, is that it brings vets in for treatment who might otherwise avoid it because they don’t want the local community to know about their condition.
There are also three mental health councilors at the vet center for vets who prefer a less formal approach; records are kept strictly in-house
A telehealth pharmacy has recently been added as well. This allows vets to connect with a pharmacist for any questions they have about their medication. It also makes it simple for Dr. Ono to call in a refill or a new prescription to the veteran’s pharmacy.
A major push is being made to reach out to vets who have yet to sign up for the VA. “Lots of vets have it in their minds that they can’t get help, but help is out there,” Lamont said. He and his wife carry VA applications in their cars to give to any vet that they run in to.
“If I see a vet, I give him the application, he sends it in and ten days later I get his name and we can start treatment.”
Most of the vets currently being treated at the telehealth clinic are older, but the staff expects the number of young vets to increase in the coming years with the withdrawals from Iraq and Afghanistan.
Many vets are worried that by coming forward to claim treatment they will be taking it from those ‘who really need it.’
This is a mistake, Sweeny said.
“Actually the more vets we sign up the more services we can offer everyone,” he said.
Many vets are also concerned that their income threshold may prohibit them from accessing the VA’s services; though this was a problem, the system is now much more inclusive. There are about 700 eligible vets in the Moab area and Sweeny eventually wants to see most of them in the program.
Jen Sadoff, the director of community relations at Moab Regional Hospital, and the daughter of Clark, the Vietnam War marine, agreed with her father.
“The clinic is great. Though some nuances are certainly lost by not having a doctor physically present, my dad feels known and safe. Vets go there all the time so the people that work (at the telehealth clinic) have relationships with them, they know them, they go walking with them,” she said.
“The VA used to be the VA of ‘we can’t’. The VA today is the VA of ‘we can and we will do anything to get it done,” says Mike Kelso, a Navy vet who served in Vietnam and now volunteers his time to drive other vets to Grand Junction for appointments.
Kelso tried going to the VA in the 1970s, “when it was pretty bad,” but decided to give it another chance after his friends told him that it had changed.
“Since I have gone back, it has been nothing but a grand experience,” he said.