Dr. Hoffman is the
director of the Veterans
VA OFFICE OF RURAL HEALTH
Center, Eastern Region,
which is a division of
the U.S. Department of
Veterans Affairs, Office
of Rural Health. Three
years ago, with just five
patients, he started the
telemedicine program in north
Florida that Wilson participated
in. Today, the program includes
50 patients at 10 sites across
the U.S.
The program uses
monitors—each about the
size of a computer screen—
connected via high-speed
Internet. “The lines go from
the hub site, where the specialty
clinic is, to a community-based
outpatient facility—the closest
medical office these patients
can get to,” Dr. Hoffman says.
A trained nurse or physical
therapist assists the person
with MS in the office, while a
neurologist at the specialty clinic
directs the exam.
Barbara Giesser, MD,
clinical professor of neurology
at the David Geffen School
of Medicine at UCLA, is also
piloting a telemedicine program.
“With very few exceptions, we
will be able to do all the parts of
the neurologic exam,” she says.
“I can see the patient speak and
see a neurologist once
a year or not at all,”
Skutnik says.
Real-time, two-way video could
deliver telehealth services
directly to people in their
homes.
ask questions, and with a little
assistance from someone who
is with the patient, I can do the
salient parts of the exam. I will
make recommendations, and the
doctor who is seeing the patient
locally will be able to implement
my recommendations.”
The next phase of Dr.
Hoffman’s VA program is to
determine what other types of
MS care, beyond a follow-up
exam, doctors can provide
remotely. “Can we treat
acute flare-ups? Can we treat
infections?” he asks. “Can we
treat wound and bedsore issues?
And can we do rehabilitation?
Those are some of the questions
we will be considering.”
Telemedicine challenges
Despite telemedicine’s promise,
important questions remain
about its widespread use. For
example: How will doctors
be compensated?
Health insurers must
determine how much
reimbursement the
nurse or physical
therapist who is working
with the patient will
receive, and how
much will go to the
doctor who is working
remotely.
