Using Telehealth and Databases to Expand Multiple Sclerosis Specialty Care in the VA Health Care System

Background: Because of the shortage of subspecialty multiple sclerosis (MS) clinics in the VA health care system, patients often travel great distances to access specialty care. Compounding this, disability, cost, awareness of the availability of specialty clinics, and obtaining accessible transportation remain barriers to treatment. Clinical Video Telehealth (CVT) provides a mechanism by which veterans can receive care from specialty clinics without incurring the burden of traveling to distant medical centers. The Integrated Neurology Project was launched in 2014 to expand the reach of specialty neurological care, focusing on Parkinson’s disease, epilepsy, and MS.

Objectives: In relation to MS, the primary aim of this project was to identify all active patients with MS in VISN 5 (Veteran Integrated Service Network) and expand access to care through the CVT system, electronic consults, and traditional face-to-face care. The secondary aim of the project was to enter patients with MS in a national MS surveillance registry using the MS Assessment Tool (MSAT).

Methods: Coordination with outlying medical centers and clinics without a specialty care clinic was established. Veterans who had been assigned ICD 9 code 340.0 between 2011 and 2013 were identified and captured using the Computerized Patient Record System. These patients were contacted by a nurse from an MS specialty clinic and offered participation in the CVT program. CVT establishes a secure audio and video link between patients and providers. Using this system, MS specialty providers conducted outreach to outlying medical centers, community-based outpatient clinics, and to individual veterans in their homes. Concurrently with each visit, the MSAT was completed, which both populated the national MS registry with core data and established a baseline for care. Veterans who established care within the specialty clinic were then seen by a neurology provider from the MS Centers of Excellence.

Results: From the initiation of the project in January 2014 to the end of the project in January 2015, 442 veterans with MS were identified in VISN 5. Twelve percent had not previously been seen by an MS specialty care clinic. By establishing these patients at the DC or Baltimore medical centers, a total of $673,002.00 was recovered. Additionally, sixty-one veterans chose to connect with the MS specialty clinic via the CVT system. This saved a total of $30,500.00 in travel costs for the VHA. During the project, 154 veterans were assessed using the MSAT.

Conclusions: Patients who established care with MS specialty clinics using the CVT system have been able to connect with MS specialty providers as well as access important resources. An additional benefit was that use of CVT represented cost savings to the institution as well as decreased burden to the veteran.  Telehealth and the MS Surveillance Registry are important tools to optimize MS access and management.