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TELEHEALTH Technology helps VA clinic’s patients

The Daily Commercial - 12/31/2016

OCALA — When retired U.S. Marine James Monroe turned to the local Veterans Affairs health clinic for treatment of complications from post-traumatic stress disorder, telehealth — a computer link-up between a remote doctor and patient supported by health care providers in a local health care facility — became an important part of his care plan.

"I'm comfortable with (the telehealth system). I live in Marion County and could be treated at the (local clinic) and the doctor was good," Monroe said. He said he is doing better, and telehealth is important to his healing.

Monroe, 54, a veteran of at least three tours of combat duty since 1991, was connected via computer link-up to a psychiatrist at a VA facility in Lake City.

Monroe's doctor visit was made possible by on-site medical personnel and electronic equipment at the VA Community-Based Outreach Clinic (CBOC) in the Cascades Professional Center on East Silver Springs Boulevard.

Specialists at other locations are able to examine and talk with patients in a room set up at the local clinic.

Ocala CBOC Chief Medical Officer Dr. Mark Knapp is a staunch advocate of telehealth, which he calls "the future of medicine." Telehealth reduces travel, reduces the workload on local medical personnel and improves health care by giving patients access to "super specialists" nationwide.

At the local clinic, most veterans requesting an appointment are seen in 24 hours and about half of the facility's mental health patients are seen the same day.

According to the Henry J. Kaiser Family Foundation, Florida has only 52.53 percent of needs met when it comes to mental health care professionals. Telehealth can help mitigate that shortage. Ronda Hemminger Evan, director of communications for The Centers, which offers mental health and substance abuse services in Marion and Citrus counties, said The Centers has used telehealth for at least two years.

"Our doctors really like it, especially when you have (multiple campuses). More importantly, it's convenient for our clients," Evan stated in a text message. She said the system is used by as many as 20 patients daily.

"We are very happy with it and will be considering expanding it in the near future," Evan stated.

Michelle Zimmerman, public information officer with Munroe Regional Medical Center, said the hospital is not currently using teleheath but is looking at options.

"We regularly consider ways we can respond to the needs of our patients with technology and resources. Although we do not have telemedicine services available at this time, we continue to examine electronic and other solutions to best serve our community,” Zimmerman stated in an email.

At the local VA clinic, medical professionals including LPN Valerie Wilson, the clinical technician for teleheath, assist patients and effectively becomes the extension of the remote physician's hands.

Wilson works with patients directly and operates the computer as well as the television camera so the off-site doctor can view the patient. A wand-like camera can transmit close and clear pictures of, for example, suspected skin cancers and wounds.

A stethoscope and special monitoring system are tied into the computer and can transmit heart and chest sounds for cardiology exams, which can include a check of the carotid arteries. These are often sent to the Malcolm Randall VA hospital in Gainesville.

Wilson also adds a human touch and has been known to dispense a hug here and there along with overseeing the digital age health care. The doctor visit is confidential and nothing is recorded, Wilson explained, although doctors may take notes as in a conventional exam.

The telehealth system was put in place at the Ocala clinic in 2012. Wilson, who has been with the VA since 2006, was the inaugural local operator of the telehealth equipment.

"We started with one patient on telehealth and he's still a patient here," Wilson said.

Now, many of the clinic's 12,000 established patients make use of telehealth. More than 1,500 images have been taken of cancers and wounds for medical review.

Telehealth is also used for orientations and sessions on living wills.

In Ocala, Mondays are set aside for psychiatric and PTSD telehealth exams, Tuesdays for occupational and physical therapy, and Wednesdays for cardiology exams.

Wilson said patients seen in the psychiatric teleheath exams — about 30 weekly — include those diagnosed with mental health concerns such as PTSD, bipolar disorder, schizophrenia and military sexual trauma. She said the clinic provides specialized counseling for about four transgender patients by telehealth.

Both Knapp and Wilson envision computer link-ups placed in remote veteran patients’ homes at some point so that care can be immediately on hand.

Many veterans have had telehealth supplement their local treatment. One is World War II veteran Fred King of Belleview, who was also involved in U.S. Marine aviation training.

King, 90, had close-up computer images taken of a suspected skin cancer. The use of electronic equipment "is all good," King said.