Center in West Virginia Brings Care to Vets
By Kathy Millar
of telemedicine in all its variations is simple - to bring care
to the patient instead of bringing the patient to the care.
arrived at the ER with a mysterious arm wound that signaled serious
trouble. A bite. Probably. But what kind? Doctors at the Veterans
Affairs Medical Center in Martinsburg, WV werent sure, but
they did know a timely diagnosis was critical. A mistake could mean
precious minutes lost for a patient who might be short on time.
rushed the man from the ER to a room on the second floor of the
VAMC. The sign on the door read "MDTV" - Mountaineer Doctor
Television. Inside, the room was outfitted with the standard diagnostic
table and, except for the imaging equipment, cameras and monitors,
could have passed for an ordinary examination room. It wasnt.
hospital staff had the cameras rolling and an image of the patients
wound had been transmitted electronically to a dermatologist at
the Health Sciences Center of West Virginia University at Morgantown,
said physician James Brick, whose image suddenly appeared on the
monitor in the VAMC, "It looks like a brown recluse spider
The news was
bad - a bite from a brown recluse spider, if left untreated, can
often trigger necrosis, leading to severe flesh damage that might
require amputation. The veteran who visited the VAMC in Martinsburg,
WV, where he was diagnosed by a specialist working almost 150 miles
away on the other side of the state, enjoyed a happier ending to
his story - an ending made possible by telemedicine.
Funded by the
federal government, Mountaineer Doctor Television, or MDTV, is a
perfect example of how telemedicine networks across America are
reshaping health care delivery. The goal of telemedicine in all
its variations is simple - to bring care to the patient instead
of bringing the patient to the care. Funded by federal grants -
the government will spend more than a billion on telemedicine this
year - academic institutions, teaching hospitals and private health
organizations are reaching out to partners like the Veterans Affairs
Medical Center in Martinsburg and re-engaging medical communities
enervated by increasing workloads and limited budgets.
Affairs Medical Center in Martinsburg, WV serves 125,000 veterans
from 22 counties and 4 states: West Virginia, Virginia, Maryland
and Pennsylvania. Many of its customers - even those who live hours
away - depend on the VA Medical Center in Martinsburg for all their
health care needs.
In the past,
a patient who arrived at the Martinsburg VAMC with a dermatological
problem could end up traveling even further in a search for a diagnosis
and cure - to the VAMC in Baltimore, MD or Washington, DC. The Martinsburg
facility has no dermatologist on staff and specialists in other
disciplines who are difficult to recruit are missing as well. For
a veteran in Petersburg, West Virginia, with a suspicious skin lesion,
this might mean a two and a half-hour drive to Martinsburg and then
an additional hour and a half on the road to Baltimore or DC.
No more. The
T-1 and T-3 technology that lights up the lines between Martinsburg
and the Robert C. Byrd Health Center in Morgantown has put both
a dermatologist and a rheumatologist on staff at the VA Center.
And theyre not just "virtual" members of the staff,
detached images floating in cyberspace, but living, caring physicians
- "real" doctors who after five years on the job have
become as familiar to their colleagues and patients at the VA Health
Center as the doctors who regularly walk the floors.
knows Dr. Brick - our dermatologist from WVU," says Terri Dantzig,
the LPN in Martinsburg who presents patients electronically to the
dermatologist twice a week. "He understands how important it
is to create a rapport with our patients - that the key to making
patients comfortable with this new technology is convincing them
that hes as attentive and concerned about them as any doctor
who might be in the same room."
Murray, who oversees the clinics, sees a big future for telemedicine.
"We started working with MDTV as a way to enhance our emergency
room services," she says. "But it quickly became apparent
that the best use of this technology was clinical. Right now, MDTV
gives us access to two types of specialists we dont have on
staff here at the VA -- a dermatologist and rheumatologist. But
theres no reason we couldnt expand the project to include
a cardiologist, a pulmonary specialist and a physician skilled in
diagnosing and treating upper GI problems."
points to a "digital" stethoscope. "I can hold this
up to a patients chest here in Martinsburg," she says,
"and the doctor at WVU can listen to his heartbeat." Jim
Haines, Chief of Learning Resources Services, is also sold on the
possibilities of telemedicine. "Soon," he says, "well
have what we need for teleradiology and well probably be doing
telementalhealth as well."
the future, and the staff at the Martinsburg VAMC is doing everything
within their power to make it happen. Right now, staff members in
charge of telemedicine at the Martinsburg VAMC are pulling double
The two LPNs
who "run" the teleclinics at the Martinsburg VAMC are
actually occupational health nurses pinch-hitting until the hospital
can hire separate staff to operate the telemedicine clinics. They
make appointments for the teleclinics, present the patients, schedule
tests, enter test and consultation results into the records, do
follow-ups, fax results to the physicians involved and maintain
patient charts. Labor intensive work, but also a vote of confidence
in the future of telemedicine and what it means for the VAMC.
isnt just changing the way health services are delivered -
its also changing the culture of medicine. In the past,
many rural health providers were often forced to work in a vacuum,
to make the hard decisions alone. Telemedicine means that rural
physicians now have access to "teams" of skilled health-care
professionals located around the country, if not the world. There
is no more going it alone.
that telemedicine is an idea whose time has come. What is less clear
is how potential users can eliminate remaining barriers to its use
- payment issues, the uneven development and acquisition of technology,
the varying costs imposed by telecommunications carriers and the
increasing need for the broadband technology medical systems need
to transport detailed images at rapid speed. Last September, telemedicine
advocates presented many of these issues and their recommendations
at a Congressional Hearing on Telemedicine Technologies.
In many situations,
public sector organizations on tight budgets must wait for private
institutions to obtain federal funding for projects that eventually
benefit them. In other cases, federal agencies move forward aggressively
with their own funds and strategies, breaking ground and leaving
other members of the pack behind. It may look like a patchwork effort,
and given that some patients appear to be better served than others
are, its easy to complain that when it comes to medicine,
progress should be even and benefit the whole.
we wait. Not for a day when "virtual" physicians can cure
brain tumors with a beam of light or restore sight to a patient
with a pair of space-age specs - but for tomorrow, when another
community clinic in West Virginia gets a video camera and a monitor,
or an amputee in a rural area is able to undertake a regimen of
physical therapy by himself while a therapist coaches him via interactive
video. We wait for the next acquisition, for the next innovation,
for the momentum and then, as they say, for the wave. Because when
it arrives, it will change the face of medicine forever.
On the telemedicine
program at the VAMC in Martinsburg, WV, call Ms. Doris Griffin at
304-263-0811 or email her at email@example.com.
represents her agency, U.S. Customs, at the National Partnership
for Reinventing Government in Washington, DC. You may contact her
either by phone or e-mail at the Telecommuting Center in Charlestown,
WV: (304) 728-3051 x255 or firstname.lastname@example.org.
Congressional Hearing, 9/15/1999
Recluse Spider bites