Abstracts

Rationale: VA TeleEEG (TEEG) networks harness the innate connectivity of the VA Healthcare system to allow interpretation of Electroencephalogram (EEG) studies recorded from remote VA Hospitals and clinics. TEEG deploys specialty epilepsy care to rural and other underserved areas, reducing community care referrals, and promoting VA continuity of care. TEEG fosters collaborative relationships between epilepsy centers and referring providers. Creating TEEG networks require coordinated work between clinicians, technologists, biomedical staff, and telehealth and clinical applications specialists. To better understand parameters and barriers affecting TEEG networks, data was collected from VA sites providing TEEG.

Methods: VA Hospitals performing TEEG studies were identified from TEEG data reported annually by VA Epilepsy Centers of Excellence (ECOE) and from ECOE Technology workgroup Survey data collected in FY2020. TEEG site directors were contacted and asked to submit information on past, prior, and pending TEEG connections. Data included: connection start date, end date, startup time (from initial planning to first study), activity status, EEG study type supported, EEG system, reason for inactivity and perceived barriers.

Results: Compared to FY2011, TeleEEG volume increased from 8 to 621 studies annually in 2020, interpreted by 1-4 TEEG Hub sites. Since 2011, there have been 7 TEEG Hubs supporting 22 Hub-spoke connections. Routine outpatient EEGs were supported at 10 sites, inpatient EEGs at 10 sites and 24hr EEGs at 6 sites. Only 4 of 22 connections used dissimilar EEG platforms. The number of TEEG hub spoke connections ranged from 1 to 7 (Boston) and 4 sites had 3 or more connections for 2 or more years. TEEG startup time ranged from 2 months to 2.5 years (mean 7.78 months, 3 not reported). Only 10 of the 22 Tele-EEG connections remain active. Reported factors for inactive connections include: loss of technologist (8), reduced demand for services from new hires and referral paths (4), loss of neurologist (3), lack of biomed/IT support (3), and Covid19 effects (1). Distance between Hub spoke sites was not reported as a factor. Of 6 pending new TeleEEG connections for FY21, 2 were stalled by COVID19 and technologist vacancies while 3 involve site reactivations. Barriers for TeleEEG connectivity included technologist availability, lack of biomed/IT support, and change in demand for services.

Conclusions: Since 2011, VA TEEG has grown in volume and connectivity. Connection startup times are variable and average 7.8 months from planning to first study. Types of supported EEG studies vary by site. More than half (54.5%) of prior TEEG connections have become inactive and vacant technologist (36.4%) is the most significant factor, above departing neurologist, reduced local demand for TEEG, and lack of biomed/IT support. Addressing these barriers and reducing TEEG startup times in future TEEG models will be essential to optimize and scale TEEG to regional and national levels.

Funding: Please list any funding that was received in support of this abstract.: none.