PURPOSE: To describe the use of video-conference telemedicine for outpatient consultation at a VA medical center. To report data on the effect of telemedicine on access to sub-specialty care, referral volume,diagnoses and outcomes of telemedicine visits.
METHODS: Milwaukee VAMC telemedicine clinic provides pulmonary telemedicine services to veterans at the Iron Mountain,MI VAMC located 250 miles from Milwaukee. Patients are accompanied by a clinic nurse to assist with the telemedicine visit. The VAMC’s electronic medical record is used for documentation. Patients who received telepulmonary visits between 1-1-1998 to 12-31-2004 were included in this report.Data on demographics, reason for consultation, access to clinic, process of telemedicine care, and outcomes of consultation were collected by two investigators (TR&MJ) directly from the VAMC’s electronic medical records and entered in a datacollection form desgined using Microsoft Access. Descriptive and stastical analysis was done using SPSS.
RESULTS: A total of 314 patients (684 visits) were seen in telepulmonary clinic over the study period. Patient demographics and most frequent reasons for consultation are listed in Table 1.The most common diagnoses were COPD (29%), benign pulmonary nodule (11%), bronchial asthma (6%), and lung cancer (5%). Telemedicine consultation resulted in a change in management for 41% of patients. A lifestyle change was recommended for 20% of patients. A follow-up telemedicine visit was requested for 51% of patients, 43% had follow-up with primary care provider or referral services and only 6% required in-person pulmonary clinic visit or procedure at Milwaukee VAMC.
CONCLUSION: The above results demonstrates the feasibility of providing pulmonary telemedicine services in outpatient setting to an underserved rural community.In this series,the vast majority of patients with broad spectrum of pulmonary conditions were managed either by telemedicine alone or referred to their primary care provider.However, the delivery of medical services to remote sites is difficult to assess in terms of effectiveness/cost-effectiveness and varies considerably on parameters studied, type of care delivered, geographic location and resource availability.
CLINICAL IMPLICATIONS: Telemedicine can provide outpatient pulmonary specialty care to areas without access to subspecialities.
DISCLOSURE: Manish Joshi, None.