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Government Video
June 2007
VA Trains Health Care Providers To Be Comfortable with Telemedicine
by Joy Zaccaria
It's not exactly second nature for doctors to diagnose patients they see on TV. That's why for the past year the goal of the Veteran Health Administration's Rocky Mountain Telehealth Training Program has been to make health care providers competent and comfortable with telemedicine technologies. Once the provider is at ease, seeing a patient remotely without technology becoming cumbersome is easier to achieve.
The initiative has training center labs in Salt Lake City and Denver that conduct programs with participating VHA facilities across the country. As a program creating a new and unfamiliar way of practicing for many health care professionals, the challenge lies in linking the technical side of things with the clinical and business aspects.
At the Rocky Mountain Telehealth Training Center, Ron Schmidt is a training specialist and clinical liaison. He builds relationships with clinical personnel around the country, provides training, and develops ideas and strategies for training. "We're about the business of training the health care providers to make it seamless," he said. "Our job is to train via the same medium that providers will use to interact with patients, so they are at ease with seeing a patient remotely."
Jeff Lowe has several roles within telehealth and the VA. He works for the Office of Care Coordination in a half-time position overseeing this telehealth training center and also manages telehealth operations in VA's Rocky Mountain region. As a whole new way of practicing medicine, there is a learning curve -- and this technology was deployed for a group of providers who have not handled care using this type of environment.
"Having someone else be their eyes, ears, nose, and hands at another location is not the most comfortable environment for them," said Lowe. "Building that kind of relationship and trust in what is now a team of people providing care is part of the activity of deploying good telehealth initiatives. The providers are being trained to be comfortable in this technology so that they can succeed in meeting a patient's needs while providing high quality care at a distance."
Coverage Around The Country
Organizationally, under the VA there are three subsections: Veterans Benefits, Cemeteries, and the Veterans Health Administration, which is the largest of the three subsections. The VHA oversees all the veterans hospitals and community clinics, as well as a variety of outpatient services and mental health services.
The Office of Care Coordination falls under Patient Care Services and oversees social work activities and telehealth activities. The Rocky Mountain Telehealth Training Center benefits VHA employees nationwide including clinical staff, technical staff, and any staff members that are going to have involvement in telehealth development. Schmidt and his team are employees of and funded by the VHA.
There are about 160 VA hospitals in the United States, as well as about 600 community-based clinics and a number of nursing homes, domiciliaries, and other facilities. Telehealth pertains to those health-related activities that involve the use of video technologies to span distances to improve access for patients. With the VA, that could include a variety of programs, such as rehabilitation programs such as mental health, surgery, primary care, and radiology.
"Underpinning the interactive, real time, and all other telehealth activities is a computerized medical record system that is available throughout the intranet," said Schmidt. "If a person was being seen in New York, they can come visit us at the Denver VA. We would have that person's records and know who the primary care doctor is -- and follow up on issues pertinent to ensuring that the care we render here is going to be consistent with the needs."
IP-Based Consultation
At the training center, the equipment primarily used for live telehealth activities via videoconference is the TANDBERG Educator system. "We're using IP-based video," Lowe explained. "We're not using any ISDN-based video because we're a closed system. We have a wide area network -- a VA intranet -- national in scope behind a firewall that's quite sophisticated and quite functional. That enables us to use H.323 IP-based video."
The program uses videoconferencing to deliver consultation services to do demonstrations and perform mock telehealth/telemedicine encounters. "What's unique about the large classroom or the Educator Series is it easily integrates with a lot of peripheral equipment: the electronic stethoscopes, the heart monitors, derm cams, and such," said John Atkins, TANDBERG's manager of federal sales engineering. "The remote sites utilizing the TANDBERG Interns [videoconferencing systems] have the ability to view two video streams via the video call. They are seeing the instructor and they have the visual of what the instructor is talking about on that test equipment or secondary camera, be it the EKG or the stethoscope, at the exact same time."
In addition to the medical peripherals, multiple devices can be hooked to a TANDBERG Educator system such as a DVD player, VCR, laptop, and/or document camera. There are several different modalities used to provide training services. "We developed a Web-based foundation curriculum which has five courses that are somewhat general," said Schmidt. "We're going to use it as a foundation that most people can access, take the course, and have a general understanding of telehealth. We are in the process of developing a telerehabilitation Web-based curriculum."
There is also a course for telemental health that was developed by the Mental Health Strategic Health Care Group and the Office of Care Coordination and other courses are in the works in other subsections. "These Web-based courses, which can be accessed through a Web browser, will be available through the national VA Employee Education System, which is a very important part of what we do and one of our collaborators," said Schmidt.
Web-based forums are conducted on a monthly basis using a live meeting technology and audio conferencing. There are regular topics with presentations and then Q&A. "We have face-to-face forums," said Schmidt. "We have national and regional meetings for individuals to receive trainings."
Just getting started is "Just In Time" training, managed by Schmidt, which addresses the production concerns of video. A clinician or staff person at the Indianapolis VA, for example, could connect via videoconference with one of the two training center labs in Salt Lake City or Denver.
"He or she would be able to engage with one of our trainers for consultative services," Schmidt explained. "For example, maybe they would be advised on the lighting or the environmental conditions of the telemedicine room. They would cover technical considerations such as the audio and camera placement."
Different services may call for different production qualities. "What's different doing telehealth and telemental health versus doing telerehab would be different camera angles, different uses, different devices," Schmidt offered.
"We want the trainers to be able to train and the educators to be able to educate and not have to worry about tripping over the technology," said Atkins. "The Educator is pure electronic classroom. It comes with locator mats to go on the floor, so that if you walked around the room from point A to point B, when you reach point B, the camera would automatically move to point B."
The Rocky Mountain Telehealth Training Center uses a TANDBERG content server that is very similar to an on-demand server. "It gives you the ability to archive and stream the video call as well," said TANDBERG's Atkins. "If you missed that particular class or you want to go back and refresh, you can archive that video call in its entirety, go back from a Web browser, and view that call at any given time."
"Things are going extremely well at Rocky Mountain," said Atkins. "They like the security features that are built in or 'baked in.' The AES security in all the TANDBERG products out there ensures that the integrity of the call is there. They like the capability of reporting via the TANDBERG management suite. They know who is calling whom at any given time and what and where and how.
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