Abstracts

Rationale: As one of the largest health care networks in the country, telemedicine has become a critical vehicle for fulfilment of the VHA mission, especially in areas where specialty resources are scarce. Leveraging technology to improve access for epilepsy health care services is a primary objective outlined in Public Law 110-387 (2008) that mandated the VHA Epilepsy Centers of Excellence (ECoE). Methods: In an effort to improve access to specialized epilepsy care the ECoE has employed telemedicine options nationally to include telephone clinics, e-consults, clinical video teleconference (CVT), and tele-EEG. Telephone clinics are utilized to share test results, side effects of medications and patient specific issues. E-consults offer an option for sharing medical recommendations between specialist and consulting provider through electronic chart reviews. Patients participating in CVT are instructed to go to nearest Community Based Outpatient Center (CBOC) where a teleconference takes place between epilepsy patient and specialist. Remote EEG paradigm involves a technical and clinical component. Technician at the remote site conducts the EEG testing and information is transmitted via secure network for interpretation of the results by specialist late at parent station. Results: All 16 ECOE sites are currently utilizing telephone clinics. CVT is available at 10 ECoE sites. Recent expansion of services has led to the implementation of Tele-EEG in two regions, Southeast & Northwest. Since FY11, the number of unique patients in telephone clinic has increased 4 folds, CVT clinics increased approximately 7 folds and tele-EEG 11 folds. The use of e-consults began in FY13 and continues to grow. Conclusions: Expansion of services through technology is believed to be key in the decrease of fee based care, resource management and increased patient satisfaction. The ECoE successfully leveraged technology for significant gains in provision of care. Improved access is critical for seizure patients who often have transportation limitations. With the current available telemedicine options, Epilepsy specialists are providing care closer to the patients' homes.