((Telemental Session at the Veterans Clinic at Cumberland Mountain, Virginia. Photo provided courtesy of J. Blankenship.)

The Veterans Clinic at Cumberland Mountain Community Services

The Veterans Clinic at Cumberland Mountain Community Servicesfacilitates mental health services for rural area eligible veterans. Mental health services are provided on an out-patient basis using the technology of videoconference via the Polycom Video Conference System. These Veterans would otherwise have to travel two to three hours one-way to receive services from the Department of Veterans Affairs. Veterans can travel to a closer site at the main office at Cumberland Mountain Community Services where a nurse facilitates the telecommunication link to Salem, Virginia. This clinic links the veteran to a VA psychiatrist for a consultation evaluation, medication management and provides referrals based upon identified needs.

The Polycom Video Conference System in Southwest Virginia: The two state facilities in Southwest Virginia, the Southwest Virginia Mental Health Institute (SWVMHI) and the Southwestern Virginia Training Center (SWVTC), use the Polycom Video Conference System to communicate with the Community Service Boards (CSB’s) for discharge planning, treatment team meetings, family sessions, consumer interviews and, as part of commitment law process, for hearings and re-commitments.

(The FMCNN Medical Staff. Photo provided courtesy of S. Dodson-McAdoo)

The Family Maternity Center of the Northern Neck (FMCNN) Grand Opening & Ribbon Cutting Ceremony was held on Saturday, May 29, 2010 2:00 p.m. in Kilmarnock, VA.The Virginia Commonwealth University Health Systems’ (VCUHS) Telemedicine Center, in collaboration with VCUHS' Department of Obstetrics and Gynecology, FMCNN and the Northern Neck Middle Peninsula Telehealth Consortium, established a partnership to address the urgent health disparity relative to infant mortality and poor pregnancy outcomes in rural Virginia. The FMCNN is a 501(c)(3) community based organization that was developed to address the lack of available obstetrical care in the rural community geographically defined as the Northern Neck region of Virginia.

The essential goal of the initiative is to improve access to women’s health, prenatal care and delivery services. The goal can be achieved through establishing close partnership and telemedicine links between the local health clinics, Family Maternity Center, and VCU Medical Center.This collaborative effort will provide real-time distant consultation services (including live-video feed of patient ultrasound studies as they are being performed) and education to ancillary support staff, health care providers and members of the community.

(Sentara Home Care Services - Telehealth)

Sentara
Sentara Home Care Services utilizes telehealth technology in all of its eight home care branches, located in Covington, Charlottesville, Richmond, Williamsburg, Hampton, Suffolk, Hampton Roads (including Norfolk, Portsmouth, Chesapeake and Virginia Beach) and Elizabeth City, NC.  Sentara employs close to 300 units, monitoring patients with chronic diseases such as CHF, COPD, and Diabetes.

Currently, the entire Sentara Healthcare system (including physician practices, rehab and skilled nursing facilities, and other outpatient facilities) is looking at incorporating telehealth on all its disease management patients.  The main focus this year (2010) is on patients with CHF.  

(Virginia Center for Diabetes Professional Education)

Virginia Center for Diabetes Professional Education at UVA
Two ongoing educational programs have been developed and implemented by the Virginia Center for Diabetes Professional Education. Both programs are free of charge to participants and targeted to multiple sites in rural, underserved areas of Virginia where the prevalence of diabetes is high and diabetes educational resources and programs are lacking.

1. Diabetes Telehealth Patient Education Program, which is in its fifth year. The program consists of two educational classes: an overview/introduction to diabetes and basic nutrition. Total attendance for each of the two separate educational classes during 2009 was approximately 115. The program has served critical access hospitals, health districts, and community health centers in southwestern Virginia, the Northern Neck area, and most recently, southside Virginia. Partners in this activity include the Virginia Department of Health Office of Minority Health and Public Health Policy, the University of Virginia Office of Telemedicine, and the Northern Neck Middle Peninsula Telehealth Consortium. 

2. Diabetes Telehealth Prevention Program, a year-long effort now in its 7th month. The program provides lifestyle change education and behavioral counseling for people at high risk of developing diabetes or pre-diabetes. It is being conducted in three sites: the Wise County Health Department, the Health Wagon (a free clinic in Clinchco, VA), and Riverside Warsaw Medical Arts (a private internal medicine practice in Warsaw, VA). Partners in this activity include the Virginia Department of Health Office of Minority Health and Public Health Policy, the University of Virginia Office of Telemedicine, and the Northern Neck Middle Peninsula Telehealth Consortium. 

(Dr. John Ward, VCUHS, is providing a neurosurgery consultation)

The Virginia Commonwealth University Health Systems Telemedicine Department

Real-time videoconferences are held in multiple conferencing studios. Telemedicine clinical activities include specialty consultations, chronic disease and medication management, preoperative assessments and postoperative visits. The department also supports various VCUHS outreach activities including professional conferences, training and patient education.

Clinical telemedicine service at VCUHS is divided in two programs in accordance to the patient population served, Correctional and Outreach.

Inmates from twenty-eight state prisons receive medical care in fourteen clinical specialties via telemedicine. VCUHS Telemedicine Department is currently providing an average of 257 consults per month.

The Outreach Telemedicine network encompasses 11 rural sites, and the Virginia Center for Behavioral Rehabilitation. The Outreach Telemedicine network supports other professional and educational activities within the Health System through videoconferencing.

The 11 rural Outreach Telemedicine sites include:

• South Hill Community Memorial Health Center in South Hill. Mecklenburg  County
• Riverside Tappahannock Hospital in Tappahannock, NNMP region
• Rappahannock General Hospital in Kilmarnock, NNMP region
  Middlesex  County Health Department in Saluda, NNMP region
• Gloucester County Health Department in Gloucester, NNMP region
• Richmond County Health Department in Warsaw
• Northumberland County Health Department in Heathsville, NNMP region
• King William County Health Department in King William Courthouse NNMP region
  
• Westmoreland County Health Department in Montross, NNMP region
  
• Lancaster County Health Department in Lancaster, NNMP region
  
• The Meadows, a Bay Aging housing community in Colonial Beach, NNMP region

(A NNMPTC telehealth consult)

Northern Neck Middle Peninsula Telehealth Consortium

The Northern Neck Middle Peninsula Telehealth Consortium was launched in 2004 as the product of a community-led process to address the inadequacies of the medical infrastructure and help meet the basic healthcare needs of the residents in Virginia’s Northern Neck and Middle Peninsula communities (King George, Westmoreland, Northumberland, Richmond, Lancaster, Essex, Middlesex, Gloucester, Mathews, and King and Queen counties).  With the expansion of its service area in the fall of 2009 to include Virginia’s Eastern Shore counties of Accomack and Northampton, the Consortium serves nearly 196,000 residents.  Through its telehealth applications, the Consortium has created resources that are enabling existing health care providers to better coordinate care and manage the medical needs of their patients in this very rural and geographically dispersed region.

The Consortium uses telehealth technologies to link healthcare providers, patients, educators, and consumers and their families to a comprehensive continuum of care that reduces the isolation of providers and their patients within its service area.  Supported by both the University of Virginia Office of Telemedicine and the Virginia Commonwealth University Health System Clinical Telemedicine Department, the Consortium offers a wide array of specialty consultations.  Specialty consultations are regularly offered in dermatology, endocrinology, and mental and behavioral health at the consortium’s two telemedicine outpatient clinics located at Riverside Tappahannock Hospital and Rappahannock General Hospital.  The Consortium also responds to provider needs for other specialty consultations on an as-needed basis.

In spring, 2009, the Consortium launched its Bridges to Health initiative with funding from HRSA.  Through Bridges to Health, the Consortium uses Telehealth technology to target chronic diseases, especially diabetes, in diagnosed and at risk older (55+) adults.  The population of the northern neck and middle peninsula region is predominantly lower income, older, and medically underserved.  The Bridges to Health project has three goals that, together, improve access to health care; enhance health care delivery; avoid re-hospitalizations; provide health information; and foster independent living for older adults.  These goals are:

1. Increase access to care for older adults (over 55) with chronic diseases who reside in the Northern Neck and Middle Peninsula by expanding Telehealth capabilities in the region and the number and types of consultations with specialty physicians using Telemedicine technology.
2. Improve diabetes/chronic disease self-management for older adults by collaborating with Certified Diabetes Centers to develop a diabetes education program to be broadcast widely in the region using Telehealth technology, thereby reducing  unnecessary use of higher-cost health care facilities and keeping older adults at home as long as possible.
3. Enhance provider capacity to meet care needs of patients with chronic diseases by developing and providing continuing medical education for allied health professionals, caregivers, and physicians using Telehealth technology.

(HCA/PAR TeleICU monitoring station)

HCA and Pulmonary Associates of Richmond
In 2005, The Hospital Corporation of America (HCA) and Pulmonary Associates of Richmond (PAR), a community based private practice, partnered to implement a TeleICU with the goal of improving the quality of critical care and reducing medical errors. HCA owns and manages five hospitals in Richmond, one hospital in Hopewell, Virginia and has recently opened a state of the art facility in Spotsylvania, Virginia (hcavirginia.com). In addition to the five HCA Richmond hospitals in which Pulmonary Associates has a physical presence on a daily basis, the TeleICU monitors patients in both Hopewell and Spotsylvania. A total of 9 critical care units in 7 hospitals are continuously monitored by critical care nurses 24 hours a day. Critical care physicians staff the station from 6pm to 7am seven days a week.

(Bon Secours)

Bon Secours
Bon Secours Home Care in Hampton launched the Home Telehealth program in 2007 with 50 home units by VitelNet.  In 2010 the program expanded to include the Bon Secours Richmond agency and units were converted to Honeywell with 65 Home Telehealth monitoring units with peripherals, including scales, BP cuff,  pulse oximeters, blood glucose monitors, and 20 Zoe fluid status monitors.  The Zoe monitors can detect fluid build up in the lung two weeks before it can be found by conventional means.  The Home Telehealth Program provides services to over 500 people/year, including several on private pay following discharge from Home Care.  Patients are monitored with the following diagnosis:  cardiac, including atrial fibrillation, MI, CABG; pulmonary, including COPD; and diabetics.  There is no charge to the patient for the monitor while active in the Home Care program.  The Home Telehealth program has resulted in reduced readmission rate to our 3 hospitals in Hampton Roads by 11% and reduced skilled nursing visits by 50% on affected patients.  Future plans are to establish monitoring kiosks in Assisted Living Facilities, expand throughout Bon Secours nationally, expand video monitoring capacity, link to Wound Expert in McKesson, and add LifeStream View for Physicians, Patients and Families.

(Photo at Harrisonburg Community Health Center of Dr. Chris Chisholm (on screen) providing a live video consult courtesy of the Daily News Record, Harrisonburg, VA)

UVA Telemedicine facilitated clinical consultations are available for patient consultation, remote diagnosis, and patient care in all clinical specialties. They have provided healthcare consultative services in 35 clinical specialties and 2,500 - 3,000 encounters per year. This number does not include the UVA Department of Radiology which does 30,000 reads per year. UVA also provides services to the following eight correctional facilities: Augusta Correctional Center Buckingham Correctional Center Coffeewood Correctional Center Dillwyn Correctional Center Fluvanna Correctional Center Red Onion Correctional Center Wallens Ridge Correctional Center The Albemarle/Charlottesville Regional County Jail Corrections is less than five percent of their encounters.

The most requested services are child psychiatry, adult psychiatry, dermatology, and pediatric cardiology. The other specialties are fewer but all involved.

The Southwest Virginia Community Health Systems has telemedicine connections with UVA at all of SVCHS’s clinics.

Dr. Chris Chisholm of the UVA Department of OB/GYN is providing high-risk obstetrics to the following sites: 1. Harrisonburg Community Health Center (funded by Governor's Productivity investment Fund); 2. Waynesboro Health Department; 3. Augusta-Staunton Health Department; and 4. Culpeper County Health Department (The last three are funded by HRSA Rural Telehealth Network Grant Program).

As a Level 1 Comprehensive Stroke Center the UVA Medical Center and its Stroke Center’s team of stroke neurologists provide telestroke consultative services for the care of patients with acute stroke at community hospitals and small rural hospitals. The Stroke Telemedicine & Tele-education (STAT) Program, provides 24-hour acute stroke expertise-on-demand, as well as a team of stroke neurologists, including Dr. Nina Solenski, Stroke Telemedicine & Tele-education Program Director, who is also Co-Chair of the Virginia Stroke Systems Task Force (VSSTF).

(Inova enVision eICU)

Inova Health System
Inova Health System is a not-for-profit health system serving northern Virginia. The enVision eICU supports 126 critical care beds in eight intensive care units in the five Inova hospitals utilizing voice and video technology. This technology remotely leverages critical care physicians and nurses as an adjunct to support patient care delivery to the critically ill. In partnership with the Northern Virginia Hospital Alliance, enVision is actively working on a project to provide 12 emergency rooms with mobile technology and clinical support in the event of a regional mass casualty incident.