To see his patients, Dr. Drury Armistead sits down in front of his computer and opens a video feed.
Armistead, a dermatologist with the Louis A. Johnson VA Medical Center in Clarksburg, is part of the growing telehealth program that connects patients and doctors, no matter the distance.
Two days a week, Armistead virtually examines patients at the VA medical centers in Altoona and Erie, Pa. -- more than 100 miles away from his West Virginia office.
On Wednesday, he sat in front of his computer in Clarksburg and spoke with Bruce Turner at the Erie VA Medical Center about a recurring rash on Turner's leg.
A camera in the Pennsylvania exam room gave Armistead a bird's-eye view of the room. On the other end, Turner had a close-up view of Armistead in his office in West Virginia.
Two nurses sat in on Turner's exam, and Armistead told them what to look for on Turner's foot. They moved the camera to give the doctor a close-up look at the problem spot.
"Dermatology is a lot of story and images," Armistead said -- getting the history of the issue and then taking a look at the problem area.
The high-definition image transmitted via computer is just as good as sitting in the same room with the patient, Armistead said.
"There is no reason why I can't [treat a patient] like in a regular clinic," he said.
During his exam with Turner, Armistead bounced between two computer screens in his office, one with a live video feed and the other with the patient's medical records.
He diagnosed Turner's rash, ordered a biopsy and scheduled a follow-up appointment.
"It couldn't have been easier," Turner said after his appointment. "I got two great nurses on this end that make it all work."
Tele-dermatology is one of six telehealth programs offered at the Clarksburg VA hospital. They connect patients to health professionals for mental health services, pathology, retinal exams and care coordination.
Armistead has run Clarksburg's tele-dermatology program for about six months, and sees about seven patients each day he holds the long-distance clinic. He expects to see more as the program becomes more established.
Hospital officials plan to add the VA medical centers in Huntington and Butler, Pa., as well as four others across the region, to the program.
The programs helps VA hospitals and clinics fill staff or specialist voids, and ensures that patients get treatment and care no matter where they live, said Ron Sandreth, operations manager for the community and rural health program for the Clarksburg VA.
"It's all about accessibility and reaching as many veterans as possible," Sandreth said.
Patients who have to travel several hours for an appointment or don't have easy access to transportation won't make the trip, Sandreth said. If they do come, they're less likely to have follow-up care, he said.
About 95 percent of patients who use the Clarksburg VA and its telehealth programs live in rural areas, Sandreth said.
The program reduces patients' wait time to see a specialist, and allows them to go to their closest VA hospital or clinic, no matter what they need, he said.
It also saves lives, said William H.D. Shelton, a registered nurse with the care-coordination home telehealth program.
Every day from his cubicle at the Clarksburg VA hospital, Shelton reviews the blood pressure levels, weight and blood sugar of more than 125 veterans from West Virginia, Pennsylvania, Delaware and Ohio.
Veterans transmit the data from their home through a portable device that hooks up to their landline or cell phone. The device includes a message board, a blood pressure cuff and a scale.
The program is designed to treat veterans who have been treated in an ER or admitted to the hospital from complications with congestive heart failure, pulmonary disease, diabetes or hypertension.
"We're able to catch problems quicker," Shelton said, "before it's too late."
If the numbers aren't within normal range, Shelton calls his patient to check in. "I'll ask if they have a fever or an ear ache, or are their feet or legs swelling," he said.
He then e-mails his assessment to a doctor, who can prescribe medication if needed, and mail the drugs to the patient.
In more serious cases, the veteran might be told to go to the hospital, where doctors and nurses are told to expect him or her and are updated on his or her condition.
"We are health-care coordinators. We not only help with the specific diseases, but with a patient's entire health-care picture, from the sniffles to help getting a hold of the pharmacy," Shelton said. "What you get are 365 visits a year [from a health-care provider] for absolutely free."
Overall, participants in the program have reduced their length of stay in the hospital from about 108 to 42 days, and the number of ER visits from 190 to 150.
Most patients in the care-coordination program are World War II veterans in their 70s through their 90s, Shelton said, but the program is starting to see more veterans from Vietnam, Iraq and Afghanistan.
Care coordination started about five years ago with one registered nurse monitoring a handful of veterans.
It has since grown to employ three nurses to manage about 125 veterans sending in their health statistics every day.
Hospital administrators hope to bring the enrollment up to 200 within the year, Shelton said.
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