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Rural Vet, there May be More Options for Telemedicine

The Veterans Affairs Department is research into improving the quality of care for veterans in rural areas with serious or chronic conditions.

A telehealth tested collaborative care study announced in January is surveying approximately 800 veterans in rural areas in Texas and Georgia who have been diagnosed with the human immunodeficiency virus or HIV. Led by Dr. Michael Ohl, the research focuses on regions where the VA has an HIV-specialty clinic.

“Veterans should have easy access to HIV testing and state-of-the-art HIV care, regardless of where they live,” Ohl, an infectious disease specialist, said in a press release. “We know that, in comparison with their urban counterparts, rural veterans with HIV enter care with more advanced disease, less likely to receive the latest developments in the treatment of HIV, and have a lower chance of survival. We want to change that.”

In addition, suppliers and organisations in the healthcare system of telehealth tested medicine in Alaska, where most communities of the countryside, may be able to offer their expertise to the effort.

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Laurali Riley, a former Army combat medic and program manager of a cheap HIV initiative, and the outreach service through the Alaska Native Tribal Health Consortium, said the state is one of the precursors for “having telemedicine for not only does it have integrated in our healthcare system, but if a proper health care.”

Riley said she has seen a daily average of 20 to 30 video appointments — provided by AFHCAN telehealth tested Solutions — between doctors and patients.

Alaska is a low-incident state for HIV-patients by the general segment of the population. However, because the communities are so small, care options are few and far between.

“But the problem is, if you have a community of about 400 people, and you have a person who is affected by HIV, can be your option for care is going to be diminished greatly,” Riley said in a recent interview with Military.com.

ANTHC supports the telehealth tested solutions network, which serves veterans with HIV.

By means of the VAs research, Ohl, who works out of the Iowa City VA Healthcare system, and his team found that telehealth tested choose to make use of the option.

The “VA provides almost 50 telehealth tested specialties. During the year 2016, more than 700,000 veterans completed approximately 2 million telehealth tested appointments,” the department said.

The research, funded through September, claims that about 18 percent of the 24,000 veterans in care for HIV infection in the U.S. live in rural areas and have limited access to specialized care for their illness.

From an external perspective, Riley said it is now up to the VA to get patients to feel “confident in [telehealth tested] employability.”

Each state of the health care system is a reflection of the wishes of the patient and the services offered. Alaska, for example, only 268 km of paved roads, Riley said. “Any place that we have to go by boat or plane,” she said. But an infectious disease such as HIV requires continuous communication between doctors and patients, Riley said.

“Live delivery is really setting of a patient-to-provider video visit, that makes a lot of sense for rural healthcare delivery as we have access to the technology — and we do that,” she said. “And it really helps with many chronic diseases, in particular HIV,” Riley said.

Or the contact is face-to-face or via video, “were still the same information that we need” to treat the patient, Riley said. “It is as it is securing Skype. It is going to be on a secure platform.”

Although some of the systems have been available for quite some time, the technology is still in development, in particular for patients who do not know how to approach telehealth tested as an option for medical care, ” she said.

“What I’ve seen, the VA is doing, is a piece of information provided to patients about their options,” Riley said. Because “the people are very averse to change when it comes to their care, and not only veterans. Everyone.”

Riley said AFHCAN for HIV clinical delivery even encourages televideo conferencing outside the home in a clinical setting, because it is much easier to pair with lab work, medication changes with a nurse or mid-level physician assistant available for questions or problems.

Apart from video conferencing — will be provided by a clinic through the computer’s webcam — Alaska has also experimented with a ‘store-and-forward” technology for more than a decade, ” she said.

“You’re thinking about things like labs, you’re thinking about things like health records, … and if you ever need a referral … for someone who is outside of the primary care, access to your accounts can [sometimes] be a nightmare,” Riley said.

But with a ‘ store-and-forward, a cloud-based system, “we can that information be well … and be able to use that information for the patient that is outside” a primary care network, she said.

“Telemedicine is all about the technology that is available,” Riley said. In addition, providers, “we need to make sure that if we’re going to be supplying any form of telemedicine-whether it is live or store-it-forward-that the security options are not only in place, but they have been tested and performed.”

Since suppliers more often than not are in a dense urban area like Anchorage, and patients can live anywhere, Riley said that the work develops in the telehealth tested field is now focused on the implementation of protocols, policies and procedures for credentialing purposes.

“All of our suppliers, including myself, that the delivery of telemedicine, were under a telemedicine agreement with other clinics, we are providing care to patients outside of the Anchorage area.

“So we have credentialing agreements between [a], the hospital, and then the patient … site, clinic, or ‘hub’ hospital so that we can work with their nurse case managers,” she said.

Riley has said that it is difficult to quantify, the whole ANTHC-both for store-and-forward care and live video-conferencing for every ailment — in the fiscal year 2015 had a total estimated travel cost avoidance of $10.8 million because of telehealth tested.

And as a certified service, “we can bill and be reimbursed for the telemedicine visits, which is great for our providers,” she added.

The goal is simple: to continue to talk to patients at all costs.

“People with HIV, and especially veterans, it is necessary that the continuity and care; they need that consistency,” she said. “Not only the providers, but in a program. They need to know someone has their back — they need to know that they are not alone.”

— Oriana Pawlyk can be reached at oriana.pawlyk@military.com. Follow her on Twitter via @Oriana0214.

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