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Helmut Schmidt, Published May 26 2013

Telemedicine helps Fargo VA Medical Center increase reach

FARGO – The Fargo Veterans Affairs Medical Center and its outreach clinics are expanding the use of telemedicine to provide health care to more vets in rural areas.

The Fargo VA center is also adding a 10th community-based outreach clinic, in Devils Lake, N.D., before the end of the year, said Chief of Staff Dr. J. Brian Hancock.

Telemedicine is used for a variety of services in the VA system, from mental health care, contact with social workers and pharmacy services, to physicals, and consultations for specialties including dermatology, cardiology and neurology, he said.

“We’re looking at this as a way to provide a range of services to rural veterans who would otherwise have to travel long distances,” Hancock said.

A few years ago, telemedicine in the Fargo VA region had perhaps 200 appointments a month for mental health or nutrition counseling, said Rollie Blixt, the Fargo VA’s telemedicine coordinator.

More patients and doctors are now linking up using what Blixt calls, “Skype on steroids.”

There were 500 doctor-patient contacts through telemedicine in April. In the first three weeks of May, there were more than 700 visits.

That doesn’t include about 200 veterans who provide data electronically from their homes, Blixt said. Those patients have in-home monitors to determine the glucose levels (for diabetics), or blood pressure, weight and blood oxygen levels, which are sent to VA specialists.

Older vets don’t want to drive four hours, or their caretakers can’t take the time off from other jobs to bring them in to the Fargo VA Medical Center, Blixt said.

Younger vets are immersed in technology, so having medical care done electronically seems natural, he said.

Gas is also pricey and travel in the winter can be dicey, Hancock added.

Warren Tobin tried telemedicine six months ago.

The Stutsman County Veterans Service officer knew it was available in Jamestown’s VA clinic for two years before he did a nutrition consultation.

The former Air Force Minuteman missile officer said it was a huge timesaver – 90 minutes each way to and from Fargo.

“Those (consultations) usually take about 10 minutes. That’s an awful long way to drive from Fargo and back for a 10-minute appointment,” Tobin said.

“A face-to-face consult versus a two-way video consult is about the same thing. So that worked out real well,” he said.

The Fargo VA Medical Center serves North Dakota, northwest Minnesota, and parts of Montana and South Dakota. Outreach clinics are in Bemidji and Fergus Falls in northwest Minnesota; and Grand Forks, Grafton, Minot, Dickinson, Williston, Bismarck and Jamestown in North Dakota, Hancock said.

Fargo VA figures show that in fiscal year 2012, which ended Sept. 30, the VA spent $281,592 in direct costs reaching 2,957 patients in this region.

Dr. Breton Weintraub is the director of primary care for the VA hospital and its clinics.

“We have clinics as far away as Williston, and that’s seven hours if it’s a minute by car,” Weintraub said.

If he has a provider that’s sick or is out with an emergency, he must find a replacement. Telemedicine allowed Weintraub to cover the Jamestown clinic for six weeks, Minot for a few weeks, and short stints in Fergus Falls.

“Instead of driving up there with all that entails, I can hook up with this,” he said, pointing at his computer and monitor set-up, “and we can see patients.”

It’s surprising how much can be done with the equipment and a trained technician on the other end, Weintraub said.

“When I first tried it out, I was like ‘Wow, this is a little weird.’ And I think that’s how the patients view it. They try it out and they’re like, ‘Wow, that was little weird, but it worked out better than I thought it would.’ ”

Weintraub uses what the VA calls “peripherals,” stethoscopes, otoscopes and other pieces of medical equipment on a telemedicine cart that a technician use at a physician’s direction to check heart and lung function, or get a close-up of ears, nose and throat problems. The carts also have high-resolution cameras that give clear, ultra close-up views of whatever they’re pointed at, be it a lesion, a wound or a post-operative incision.

Instead of thumping a patient on the chest, arm or leg to see if something hurts, Weintraub can get similar information by asking him or her to bend and turn, and observe the expression on their face to gauge discomfort.

“It saves everyone a lot of trouble. It’s really great. Can it do everything? No. Of course not. But it can do quite a lot of stuff,” Weintraub said. “I’m very happy with it.”

Many visits to a doctor don’t require a physical exam, Weintraub said. They might simply include talking with the patient, answering questions or going over test results.

“I think this is an invaluable tool. I can’t tell you how many patients have gotten up and they looked into the camera and said, ‘Thanks, Doc, I really appreciate not having to drive all the way down there to Fargo,’ I’ve heard that numerous times. And you can really provide a service for that veteran.”

The Fargo-area network can also tap the expertise of physicians in other Veteran Integrated Service Networks around the nation, with connections made as simply as you might order a movie, Blixt and Hancock said.

A veteran and his or her physician can get the help of a cardiac specialist in Minneapolis, or a genomic specialist in Salt Lake City, Blixt said.

“This is like a light-year jump” in health care delivery, Hancock said. “We’re very committed to doing this and doing this right,” he said.

The only limiting factor for the system is the amount of bandwidth available in rural areas to transmit large amounts of data quickly, Blixt said.

For his part, Tobin said veterans should consider giving telemedicine a shot.

“I think it’s important that veterans that have not had the opportunity to do it, give it a try,” he said. “I think they’d be pleased with it.”

Readers can reach Forum reporter Helmut Schmidt at (701) 241-5583