VA Telehealth services recognized, build on successes

Even before the pandemic, telehealth was on the rise, but once in-person clinic visits became too risky, the number of video visits exploded and now show few signs of slowing down. Advocates and practitioners have guided its implementation in the field, helped ensure its security, and continued to expand its use. Some of those leaders are Internal Medicine faculty who also work within the Iowa City VA Medical Center.

Recently, two Iowa City VA telehealth programs received regional recognition from the Veteran Integrate Service Networks 23 (VISN 23) on behalf of the VA Midwest Health Care Network. VISN 23 is a network of VA Health Care Systems, VA Medical Centers, Outpatient Clinics, Community Service Programs, Community Based Outpatient Clinics, and Vet Centers in Iowa, Nebraska, Minnesota, western Wisconsin, western Illinois, North Dakota, South Dakota, and eastern Wyoming.

IC VAMC Telehospitalist recognized as VISN 23 Strategic Initiative
The IC VA Medical Center’s Telehospitalist Program was selected as a VISN 23 Strategic Initiative program and will receive a three-year, $1.3 million grant to expand their services. With 96% of rural VAMCs reporting staffing difficulties in the last three years, cost-effective programs that resolve these vacancies are crucial.

This program, led by Jeydith Gutierrez, MD, MPH, clinical associate professor in General Internal Medicine, aims to expand telehospitalist services to other understaffed, rural VAMCs. Gutierrez will work with Nathan Samuelson, Telehealth Coordinator, and Clay Surom, Telehealth Program Clinical Manager, to expand the first telehospitalist pilot program that they developed, piloted, and implemented over the last three years between the Iowa City VAMC and the Tomah VAMC in Wisconsin. Telehospitalists can assist with admissions, daily rounding, offering cross-coverage duties or consultative services, bringing hospital medicine expertise to areas of shortage, either in an ongoing or in as-needed basis to cover staffing gaps.

“The service has been successful, providing thousands of patient care encounters and resulting in a significant reduction in length of stay at Tomah VA,” Gutierrez said. “The program has been well-received by patients and local providers and has contributed to numerous quality improvement projects at the receiving facility.”

With this new grant, the team plans to add two additional hospitals to receive services from their telehospitalist program in the first year, and one additional facility each subsequent year.

“This proposal plans to build onto those achievements to support the expansion of a telehospitalist program to other VHA hospitals that are struggling with staffing shortages or simply need additional hospitalist expertise and support for their staff,” Gutierrez said.

Telenephrology tied for first place VISN 23 Network Star Award Program
Chronic kidney disease accounts for more than 49 billion dollars in health care expenditures annually. These costs increase substantially with more advanced disease, so early detection and intervention is vital. To address this problem, Bradley S. Dixon, MD, began the Iowa City VA Telenephrology Program, which is now led by Melissa L. Swee, MD. Dixon and Swee’s work was recognized last month with a VISN 23 Network Star Award. Their project tied for first place in the Outpatient Clinical Process category, outperforming sixteen other competitors nominated in VISN 23.

“Utilization of the telenephrology dashboard system contributed to an increase in consultations completed through electronic means without decreasing face-to-face consults,” Swee said. “Electronic consults now outnumber traditional face-to-face consultations at our institution. Telenephrology consultation improved early detection and identification of kidney disease and saved time and costs for Veterans in travel, but did not decrease the average number of days to complete consultation requests.” Overall, the average Veteran saved between $21.60 and $63.90 per trip.

In addition to Dixon and Swee, collaborators on the Telenephrology project include Angie Thumann, Marion Sanders, Kantima Phisitkul, George Bailey, Nikki Neuzil, Bharat Kumar, Amy MJ O’Shea, and Masaaki Yamada.

The Network Star Award Program acknowledges services within the VISN 23 community that make lasting improvements in service quality, accessibility, patient satisfaction, and efficiency. The IC VA’s Surgical Site Infection Prevention Program was also nominated for a Network Star Award in the Outpatient Clinical Process category.

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