Abstracts

Rationale: One of the primary goals of Veterans Health Administration (VHA) 17 Epilepsy Centers of Excellence (ECoE) is to establish a national system of care for all Veterans with epilepsy. An avenue to achieve this goal for improvement of services and enhanced access is through tele-medicine; which is implemented by leveraging the best possible technology options. The ECoE has taken a novel approach to expand the tele-medicine services for Veteran centric care. Methods: Since inception ECoE has successfully employed the following options sequentially to expand services. (i) Clinical Video teleconference (CVT) from patient’s nearest clinic location to a specialist at a distant location to include both epilepsy and psychogenic non-epileptic seizure (PNES) patients. Also, suitable patients can connect from their homes for a tele-medicine visit. (ii) telephone clinics provide opportunities for sharing test results and discuss patient’s specific issues such as medications’ side effects etc. (iii) Store and Forward EEG infrastructure provides patients with testing services at their nearest clinic and EEGs are interpreted by a specialist (iv) E consults allow consultation services among providers regarding patients. Results: There were 13 sites which provided CVT services to patients in FY18 compared with four when CVT began in FY11. During FY18 the number of patients for video telehealth in a sub clinic of a VA hospital (local station) was 389 with 579 encounters; whereas, 235 patients from a different hospital (other station) were treated with 323 encounters. Six ECoE sites treated 45 patients from their homes with 88 CVT patient visits. In addition, cognitive behavior therapy (CBT) sessions for PNES patients through CVT began in FY17 and 36 patients with 180 CVT visits were treated in FY18. Compared with only three in FY11 all ECoEs had telephone clinics in FY18 and 1,216 patients were attended in telephone clinics with 2,691encounters. In FY11 Portland started providing store and forward EEG services. During FY18 Store and forward EEG services were provided to 380 patients with 443 EEGs performed. ECoE specialists provided e-consult services (which began in FY12 with 36 patients served) for 250 patients in FY18. In all, ECoE provided CVT services to 90 sites, CBT to 21 and store and forward EEG to seven sites during FY18. Conclusions: Leveraging technology for the extension of the specialty care to ensure that there are no gaps in the care has been a priority of ECoE. Tele-medicine in the ECoE is refining the Veteran experience through patient centric care. The VHA is expecting to see positive changes in multiple measures as work continues in efforts to expand the hub and spokes model for the ECoE telehealth services which can be emulated by the other healthcare organizations. Funding: No funding