Abstracts

Rationale:

Rationale:
VA Telehealth has its roots in DOD Telemedicine which for decades has successfully deployed specialty care to the front lines of our armed forces. Veterans afflicted with epileptic and non-epileptic seizures (NES) have been logical targets for asynchronous TeleEEG (TEEG) which harnesses VA  connectivity to bring EEG testing closer to veterans in remote locations and improve quality of care and veteran experience.  While the COVID19 pandemic (C19P) has resulted in a dramatic increase in synchronous telemedicine via virtual video and phone clinics, the effect on TeleEEG has been less clear. VA Boston HCS, Durham VA HCS and Portland VAMC are VA Epilepsy Centers of Excellence (ECOE) with active TEEG networks operating before and during C19P.  In order to understand the impact of C19P on these networks, we reviewed TEEG studies from each site before and during C19P.
Method:

Method:
VA TEEG studies interpreted by VA Boston HCS, Durham HCS and Portland VAMC during C19P restriction period (3/15/20 – 6/29/20) were analyzed for # studies performed, type of studies, and recording site origin. Study results were categorized as normal, abnormal slow, abnormal epileptic.  Percent of TEEG workload of total EEG workload and monthly rates were calculated for each site during C19P and compared to TEEG workload during FY2019 as reported by National VA ECOE.
Results:
VA Boston HCS interpreted 24 TEEG studies (11 inpatient, 4 outpatient, 9 Amb 24hr) compared with 72 local studies (32 inpatient, 6 outpatient, 15 VEEG, 4 ICU VEEG, 15 amb 24hr) from same period. All TEEGs received were recorded from 2 of the 5 supported remote sites (Albany NY, Providence MA).  Other sites either lacked EEG technologist (WRJ VT, Togus ME) or closed EEG clinic (Bedford MA). There were 5 TEEGs reported normal, 4 abnormal epileptic, 15 abnormal slow, 3 captured events (all amb 24hr, NES).  In FY2019 20.0% of total EEGs were TEEG compared with 25.0% during C19P with calculated monthly rates of 14.7 and 6.4 studies/month respectively. Durham VA HCS recorded 2 TEEGs during C19P, both routine outpatient studies from (Ashville NC) which were normal. A second site (Greenville SC) remained closed during CP19.  In FY19 35.0% of total EEGs were TEEG studies compared with 11.2% during C19P with calculated monthly rates of 14.9 and 0.53 studies/month respectively. Portland VAMC interpreted 46 TEEG studies (all routine EEGs) of which 33 were normal, 13 abnormal slow, and 0 epileptiform.  There were 28 local EEG studies during same period (10 routine, 18 continuous ICU).  All TEEG studies were recorded from 2 of the 3 active sites (Seattle WA, Boise ID) and no requests from 3rd Site (San Antonio TX).  In FY2019, 14.9% of total EEGs were TEEG compared with 62.2% during C19P with calculated monthly rates of 7.77 and 12.3 studies/month respectively.
Conclusion:
Review of TEEG studies from 3 VA ECOE sites with active TEEG networks during C19P showed: •There were reduced volumes of local EEG studies at each site. •TeleEEG volume was increased for Portland VAMC and reduced at VA Boston and Durham VA. •Percentage of TeleEEG workload was increased for VA Boston and Portland VAMC and markedly reduced for Durham VA. •Majority of TEEGs from Boston were abnormal while Majority from Durham and Portland were normal. Study selection and use of Amb 24hr TEEGs at Boston may contribute. •Outpatient focused TEEG networks may be vulnerable to reduced TEEG volume. •Ambulatory 24hr TEEGs may be cost effective alternative to inpatient VEEG.
Funding:
:None