Essential hospitals care for vulnerable populations that often face geographic barriers to care. In the first of a new Telehealth Spotlight series, we highlight one health system with successful telehealth initiatives that work to eliminate this barrier both at home and abroad — The University of Virginia (UVA) Health System, in Charlottesville.
Founded in 1995, the Karen S. Rheuban Center for Telehealth at UVA spans 60 specialties at 150 partner sites, ranging from a federally qualified health center to a critical access hospital. Telehealth Director David Gordon says the Center for Telehealth has saved Virginians more than 18 million miles of travel to seek health care, and leaders plan to expand the programs to include more in-home care.
“This is not technology for technology’s sake. This is not about buying more equipment or putting things in place,” Gordon says. “This is about the ability to form relationships over a distance in order to provide care.”
That focus on relationship-based care is central to UVA’s newest telehealth initiative, an aortic consultation partnership with Culpeper Medical Center (CMC). Currently, CMC patients who experience aortic emergencies—including aortic dissections, ruptured aortic aneurysms, and enlarged or symptomatic aortic aneurysms—must travel 45 miles to UVA for evaluation.
“Time is of the essence [in aortic emergencies],” says Nicholas Teman, MD, assistant professor of cardiac surgery at UVA. It can be difficult to share computerized tomography (CT) scan files across hospitals. Patients facing aortic emergencies often are rushed into high-risk surgery or, if physicians deem them unsuitable for surgery, directed to palliative or hospice care.
The pilot aortic consultation program, launched in September, allows CMC patients and their families to meet face-to-face and share CT scans with the referring physicians via VideoLink software. This new procedure mitigates communication barriers, facilitates smoother transfers, and enables patients to receive care in the appropriate setting.
For Teman, the ability for patients and their families to meet the care team ahead of a potential surgery is especially important. He hopes to expand the consultation program to include other cardiac emergencies and, eventually, create a cardiac emergency center.
Commitment to Quality
In addition to cardiac care, UVA works with other hospital emergency departments on telehealth, including what Gordon calls a “prized jewel”: the health system’s telestroke program. A stroke neurologist can observe patients at one of six partner hospitals via videoconferencing and view CT scans through teleradiology. When time is of the essence, telehealth enables the neurologist to determine quickly whether a patient is experiencing a stroke and prescribe tissue plasminogen activator (tPA), a treatment to dissolve clots and improve blood flow to the brain.
Before launching the telestroke program, UVA’s partner hospitals had a tPA utilization rate of less than 0.05 percent of eligible cases. Now, partner hospitals have a 20 percent utilization rate, which is equivalent to UVA’s utilization rate.
“The goal of telehealth is equivalency in care,” Gordon says. “When you’re achieving numbers like that in your outcomes, you know that you’re doing exactly what you need to be doing.”
He sees telehealth as an equalizer that bridges the disparity between urban and rural health, improving access to care for the old and the young. A recent study of clinical telemedicine encounters for low-income rural women with high-risk pregnancies showed a statistically significant reduction in the number of preterm deliveries and a reduction in length of stay in the neonatal intensive care unit for preterm infants.
A program called Imprint provides secure , HIPAA-compliant iPads for families of pediatric patients with complex conditions. Each iPad has detailed information for the patient’s family, a health record that sends data back to physicians and nurses at the hospital, and videoconferencing abilities.
“If they have a crisis, they have a video link, and they can connect to that physician to say, ‘What should do? Should I come into the hospital? Is this an emergency?’ Gordon says. “It reduces visits. It reduces unnecessary travel. It improves clinical outcomes.”
The Center for Telehealth extends this work on a global scale through the university’s teaching programs. Through cell-enabled iPads, UVA faculty and staff help train midwives in the Democratic Republic of the Congo. Anesthesiologists use telehealth to support surgeries and training in Ethiopia, and faculty work with diarrhoeal researchers in Bangladesh, to name a few of their initiatives.
During the 2014 Ebola crisis, UVA worked closely with a clinic in Liberia to treat Ebola patients. “In the midst of infectious disease like Ebola, some of the people at the highest risk are health care workers,” Gordon says. “We wanted to be able to design a system to, number one, reduce the exposure.”
In these clinics, patients are stationed in negative pressure rooms, and health care workers must don protective gear to enter the room for treatment. To reduce health care workers’ exposure to the virus, UVA and the clinic stationed cameras in patient rooms that connected to iPads stationed with hospital epidemiologists. UVA calls this system ISOCOMS—Isolation Communication Management Systems.
While exposure to health care workers is reduced, patients effectively have more access to health care personnel, and that face-to-face contact can help them feel less alone.
“You’re beginning to mitigate the impact of the isolation so that family can see you, social workers, chaplains, others…” Gordon says. “You’re both improving access to specialists and others, reducing the number of nurses that have to go into the room.” Staff are careful, however, to protect patient confidentiality and avoid making patients feel constantly watched.
While war has kept UVA from responding to the current Ebola outbreak in the Congo, the system has applied lessons from ISOCOMs to new endeavors back home. It recently received a grant from the Centers for Disease Control and Prevention to support chronic condition prevention and treatment efforts in Appalachia and rural Virginia. UVA also has piloted a program with the Health Wagon, a mobile health clinic, to use drones to deliver medication to patients in rural Southwest Virginia. And through Project ECHO, an online training program developed by another association member, the University of New Mexico Health System, in Albuquerque, UVA equips primary care clinicians to care for patients with opioid and substance use disorder.
Gordon looks back on the Center’s accomplishments with pride. “We’ve been a pioneer along the path, and when we started, you’d have fuzzy connections and complex, expensive technology, but all along we had the belief that we could overcome this time and distance barrier to caring for people,” he says. “Here we are, 23 years later, with such remarkable capacity and belief that we can connect anywhere with any device any time as we shift to a great digital world.”