Abstracts

Rationale: Telehealth systems distribute subspecialty care through healthcare networks reducing costs and improving access. Veterans with epileptic and non-epileptic seizures (NES) living in rural locations have limited access to video EEG monitoring offered in select VA Hospitals. This results in longer wait times, excessive travel, delayed diagnosis and delayed targeted treatment. We established a Tele-EEG network in 2013 to provide EEG services to remote VA hospitals. Continuous Tele-EEG was deployed through this network as a practical alternative to inpatient epilepsy monitoring. This study examines the clinical effectiveness and cost of home based Tele-EEG monitoring through this network. Methods: Continuous Tele-EEG studies from VABHS were analyzed for: captured spells, recording time, electrographic seizures, epileptic discharges, focal findings, and slowing. Studies were graded as: Epilepsy confirmed (electrographic seizure captured), Epilepsy supported (epileptic discharges), NES supported (captured events with no associated EEG changes), Indeterminate-normal (normal EEG, no events captured), and indeterminate (focal slowing, findings of uncertain significance). VA records were reviewed for change in Antiepileptic drugs (AEDs) following study and subsequent inpatient video EEG monitoring. EEG and hospitalization costs were estimated by medicare reimbursement rates during the recording period. Results: Eighty-four continuous Tele-EEG studies were performed at 4 remote VA hospitals from 2/7/2014 – 9/23/2018 and interpretated at VABHS. There were 72 male and 2 female patients with age range of 21-77. Mean study recording time was 65.28 hours (range 18–75 hours).  Forty-seven patients were prescribed AEDs, 15 for pain, mood or tremor indications.  Thirty-six studies captured clinical events, including 29 with typical events (mean 2.72 events/study). Of these, 26 studies captured events with no EEG changes and 3 captured electrographic seizures. Grading distributions included NES supported (22), Epilepsy supported (6), Epilepsy confirmed (3), Mixed: NES and Epilepsy supported (4),  Indeterminate-normal (29) and Indeterminate abnormal (18), 4 with artifact vs focal seizure.Fourteen studies resulted in AED changes, 10 increased AEDs for Epileptic seizures (3), epileptic discharges (5), focal slowing with normal imaging and strong pretest suspicion for epilepsy (1), and Mixed NES and Epilepsy findings (1).  AEDs were decreased in 4 studies for NES diagnosis supported (1) and indeterminate/normal findings with strong pretest clinical suspicion for NES (3).Eight patients underwent subsequent Video EEG monitoring and another 2 patients were planning to have this procedure. Net costs of 84 ambulatory EEG studies were estimated to be $99,859.10. The cost of Inpatient video EEG and hospitalization for same recording period was estimated to be $775.272.50.  Conclusions: Tele-EEG monitoring is a cost-effective alternative to inpatient epilepsy monitoring for veterans living in rural locations. The majority (88%) of Tele-ambulatory EEG studies performed through our network, provided sufficient diagnostic information to direct treatment and eliminated the need for inpatient video EEG monitoring. Cost savings include reductions in: travel, wait times, hospitalizations, out-of-network care referrals, and delays in diagnosis and treatment. These changes favorably impact the Veteran patient experience. Wider use of home based continuous EEG through VA Tele-EEG networks will produce further cost savings and improve quality of epilepsy care in our veterans. Funding: National VA Innovation Award