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V
irginia
C
apitol
C
onnections
, S
ummer
2015
10
Joe Ratliff, director of Four County
Transit, says his peers call his system, based
in the counties of Tazewell, Dickenson,
Russell, and Buchanan, the “little country
transit.” However, it is apparent that this
transit system is much more. It is an
innovative and resourceful system, working
to meet the needs of its ridership with good
service and affordability. Riders can travel
via established routes and make requests
for pick up and off routing to meet their
transportation needs, all for an affordable
price ranging from $0.25 to $1.00. It is programs and services like
these that prompted a meeting in Christiansburg on April 30, 2015, to
discuss and develop a plan to address two priority, intertwined areas for
veterans’ needs in Southwest Virginia: Transportation and Telehealth.
Those in attendance included Secretary of Veterans Affairs, John
Harvey; Deputy Secretary of Health, Jennifer Lee; and Debra Ferguson,
Commissioner of the Virginia Department of Behavioral Health and
Developmental Services (DBHDS), as well as a diverse group of
stakeholders representing agencies such as the Virginia Department of
Health, the Department of Veterans Affairs, the governor’s office and
cabinet, Carillion Clinic, and various representatives from non profits
and associations.
Transportation
Krista Henderson, Senior Director for Carillion’s Patient
Transportation, highlighted the vast emergency service transportation
options available to veterans, including the need to think about emerging
trends and innovations in EMS that will expand the reach of services.
Regina Sayers, Executive Director for the Appalachian Agency for
Senior Systems, outlined the myriad of services available via her
organization. She specifically highlighting the PACE transportation
program, which provides door-to-door service, and when needed,
hand-to-hand assistance.
Challenges exist to develop a rural Southwest Virginia transit
system aimed at supporting veterans and their families, but the systems
presented can be integrated and held up as models to other rural
localities; particularly areas that are challenged by greater distances to
cover and other geographic hardships not faced by the typical urban-
based transit system.
Telehealth
Telehealth provides another tool in the toolbox to help veterans gain
increased access to quality healthcare. Historically, the VA has been a
leader at the forefront of telehealth and telemedicine, and has been using
telehealth in its practices for a number of years. The agency has built a
variety of services and modalities of telehealth options. These include
the standard Clinical Video conferencing for face-to-face consultations;
a Store and Forward method that uses clinical images routed through
a centralized reading center which are then passed to specialists for
consultation; a home telehealth option to monitor patients through
video and mobile devices in the patient’s home to help manage chronic
diseases; and a project called SCAN-ECHO, which allows for providers
to communicate with each other for continuing education, mentoring,
and case management advice. Another organization working to build a
robust telehealth system is the University of Virginia. The UVA Center
for Telehealth has established an integrated telemedicine program, which
includes not only clinical services throughout the state, but education
and research components to advance the practice and usage of telehealth.
It is estimated that the VA and UVA Center for Telehealth combined
have saved Virginians over 19 million miles of travel through telehealth
practices.
Despite the community assets presented, the questions still
loomed: What are the options now? What do we do from here? From
a transportation perspective, the discussion turned to one of a basic
economic principle, supply and demand. Several group members
were tasked with looking at all of the existing transportation options in
SouthwestVirginia. An exhaustive look at transportation systems, public,
private, and informal, is needed to identify where the gaps exist. This
strategy is complemented by others taking on the demand side to work to
understand what transportation options veterans and their families need
and want. Pairing the two analyses will allow a picture of a way forward
for expansion of transit for those who have certainly earned it.
What options exist for expanding telehealth in Southwest Virginia?
The answer lies in a continued effort to expand services and service
options coupled with increased use of the services by providers and
patients. The VA is in the process of upgrading clinics’ and hospitals’
bandwidth capacity. Meanwhile new telehealth models and options are
being explored by UVA and other partners to grow service options.
From a technical capacity, one of the primary barriers typically
thought of for telehealth is access to bandwidth. However, the meeting
shed some light on another often overlooked, but equally important
technological barrier: wireless cell phone coverage. A dual push to
increase bandwidth and cellular coverage is fundamental for increasing
Transportation and Telehealth:
Building a System of Veterans’ Access
to Quality Healthcare in Southwest Virginia
By Mike Mallon
Transportation was the first matter on the docket. The discussion
highlighted local rural transit currently available in the Southwest part
of the state, senior-specific programs, hospital based options, and other
veteran-specific services.
Ronnie Smith, Assistant Director for the Tennessee Valley
Healthcare System, shared a model used in Oregon aimed at increasing
transportation options for veterans. The program helps coordinate and
provide transportation for veterans to and from medical appointments.
Several main tenets of the program include a one call, one number
centralized routing system to coordinate transportation logistics;
VA scheduling of medical appointments to align with veterans’
transportation needs; expanded service into the community via
establishment of community outpatient clinics; aggressive outreach to
the DAVs for assistance and coordination; and expanded options for
vehicle purchasing through Oregon’s DOT.
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