Published in The Plain Dealer (front page of the Metro section). Print version (PDF) PAGE 1 and PAGE 2.
Also published on Cleveland.com: http://www.cleveland.com/healthfit/index.ssf/2012/07/cleveland_va_expands_telemedic.html
By Casey Capachi
CLEVELAND, Ohio — The Department of Veterans Affairs announced a new program Wednesday that with the help of telemedicine will make it possible to eventually treat thousands of veterans in their local communities for complex, chronic illnesses such as heart failure, chronic pain and Hepatitis C.
SCAN-ECHO, or Specialty Care Access Network-Extension for Community Healthcare Outcomes, is an expansion of Project ECHO, an existing program that originally started at the University of New Mexico in 2004 as a way to connect rural residents with medical specialists.
“The bottom line is we would like to provide care where the patient is rather than having to be referred to a medical center, which can be a bit of a drive,” said Dr. Rajiv Jain, the VAs chief patient care services officer.
Jain said the Louis Stokes Cleveland VA Medical Center and 13 of its outpatient clinics in Northeast Ohio are in the process of adopting the new program. The Cleveland VA has been given $1.2 million to date to implement the pilot and expansion of the program, with additional funding coming in the fall.
Jain credited the Cleveland area as having the “most evolved model” in the pilot and thus being well-positioned for the expansion.
Going forward patients at the VA outpatient clinics in Northeast Ohio will be able to choose a new way to obtain the opinion of a specialist.
“If the patient agrees to a SCAN-ECHO consult then the primary care provider will discuss the patient’s case with the specialist and pass the information on to the patient at the next visit,” said Jain. “If a patient wants a face-to-face consult, then the primary care provider will refer them for the standard consult.”
The VA is the largest integrated health care system in the United States, presently serving 6 million veterans, with the expectation of 1 million more entering the system in the next year.
The program will allow primary care providers and specialists to become partners in the long-term care of patients, said Jain. When primary care providers arrange a teleconsultation with a specialist, other physicians will participate in the call.
“What happens is we learn from each other’s example. When you’re discussing your patient, someone else is learning too,” said Jain.
Jain said the model reminds him of medical school, where as a resident he learned to present patients’ cases to a group of his peers and, in turn, he learned from other’s expertise. He hopes the program will attract more primary care physicians, an area where more doctors are needed.
“There are many physicians who are not electing to go into primary care for multiple reasons, but one of the reasons is that they feel they’re not being challenged enough,” said Jain. “I’m hoping for more satisfied primary care providers who will want to stay practicing primary care in the VA.”
Dr. Susan Kirsh, who is a general internist and primary care provider at the Cleveland VA, said, “I think primary care providers feel very empowered about the new knowledge and that they can take leading roles on specialties and become a mini-expert in their local clinic.”
Jain said the program will provide more efficient and cost-effective care with expected savings from using specialists at the VA, not referring patients to private physicians, and not having to reimburse veterans for travel to a specialist.
“We’re trying to leverage some savings over time but we are worried about patient care and safety more than financing,” said Jain.
If, for example, said Dr. Jose Ortiz, Cleveland VA cardiac team lead, we can keep heart patients stable “and in the care of their primary care providers, not only are we saving a substantial amount of dollars but we are giving better care to patients and providing better outcomes.”
“There are going to be barriers we uncover and it’s certainly a learning process,” said Kirsh.
“We’re still learning what is the best place and what is the best way to get veterans involved in veteran care.”