Mountaineer Doctor Television

VA Medical Center in West Virginia Brings Care to Vets
By Kathy Millar

The patient 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 weren’t 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.

Hospital staff 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 wasn’t.

In seconds, hospital staff had the cameras rolling and an image of the patient’s wound had been transmitted electronically to a dermatologist at the Health Sciences Center of West Virginia University at Morgantown, WV.

"Yes," said physician James Brick, whose image suddenly appeared on the monitor in the VAMC, "It looks like a brown recluse spider bite."

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.

Mountaineer Doctor Television

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.

The Veterans 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 they’re 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.

"Everybody 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 he’s as attentive and concerned about them as any doctor who might be in the same room."

Pushing the Limits

Dr. Ethelann 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 don’t have on staff here at the VA -- a dermatologist and rheumatologist. But there’s no reason we couldn’t expand the project to include a cardiologist, a pulmonary specialist and a physician skilled in diagnosing and treating upper GI problems."

Terri Dantzig points to a "digital" stethoscope. "I can hold this up to a patient’s 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, "we’ll have what we need for teleradiology and we’ll probably be doing telementalhealth as well."

That’s 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 duty.

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.

The Present and Future

Telemedicine isn’t just changing the way health services are delivered - it’s 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.

It’s clear 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, it’s easy to complain that when it comes to medicine, progress should be even and benefit the whole.

Meanwhile, 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.

For More Information

On the telemedicine program at the VAMC in Martinsburg, WV, call Ms. Doris Griffin at 304-263-0811 or email her at doris.griffin@med.va.gov.

About the Author

Kathy Millar 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 k.millar@jctc.org.

Web Resources

Mountaineer Doctor Television

Telemedicine Information Exchange

Telemedicine Congressional Hearing, 9/15/1999

Brown Recluse Spider bites