The St. Cloud VA Health Care System takes in an expansive territory, spanning 27 counties in central and west-central Minnesota. That makes the concept of telehealth – delivering health care services through electronic communication methods – a natural fit for many of the system’s 40,000 or so veterans who often live far from St. Cloud or its three clinics.

One of those clinics, the Max J. Bielke Department of Veterans Affairs Outpatient Clinic in Alexandria, saw the number of veterans utilizing telehealth tools increase in 2019. But no one anticipated the degree that it would grow this year.

“It has been a sea change from where we were,” said Barry Venable of the St. Cloud VA System.

Stay-at-home orders and other responses to the COVID-19 pandemic have been the spark for even more veterans to seek health care through electronic means. The growth has been so dramatic that more than half of all routine appointments within the system are now being conducted using virtual tools, Venable said.

“For example, VA Video Connect appointments have increased 63 percent since February across the health care system," he said. "The Max J. Beilke VA Clinic conducted seven of these appointments in February and 47 appointments were completed in March."

Bringing in technology

Before all of this, the St. Cloud system had one of the highest veteran usage rates of any medical center.

“What makes that so remarkable is that central and west-central Minnesota are really rural,” said Joann Houge, the system's telehealth coordinator.

“We have the capacity to do more,” she said. “That’s one of the reasons for this push to expand telehealth. It allows us to serve more, and it makes it more convenient.”

The VA claims to be the largest provider of telehealth in the country, reasons for which Houge said are two-fold: many veterans live in rural areas where they travel an hour or two each way to the nearest VA clinic; and such a large percentage want to stay within the VA system.

Most of the early telehealth offerings were for mental health, since that involves mostly discussion, with no lab work or ancillary services.

“We have branched out to multiple specialties. We’re working with sites far beyond our reach,” Houge said, noting that primary care visits are the other most popular use of telehealth. Specialized cameras can be used to look in throats and ears, and some equipment even has the capability of listening to a patient’s heart and lungs.

“We also have a wound camera so if a veteran was recently seen for a surgery, instead of traveling all the way to St. Cloud to see the surgeon, they can go to Alex and the surgeon can actually look at the wound and see if its healing appropriately,” Houge said.

Clinical video telehealth provides a live video connection with health providers, such as a specialist in St. Cloud or anywhere in the U.S. That opens up possibilities for treatment areas where there is a shortage of specialists.

It can be a challenge to have psychiatrists on staff in rural areas, Venable said. However, the St. Cloud VA now has a provider in New York who sees veterans in Minnesota every day.

“In the past, (veterans) would have to travel out of state. Now they are able to go to their local outpatient clinic, and actually meet with those specialists throughout the country,” Houge said.

Staying at home

Depending on the service a veteran needs, a veteran may not even have to go to the Alexandria clinic.

Home telehealth involves putting a device in a veteran’s home that can monitor data such as blood sugar levels or vital signs and upload that information into a patient’s medical record. “They can do a health check every day,” Houge said.

The information is transmitted back to the VA where registered nurses or dieticians, for example, will look for trends and can contact that veteran with medication changes or possibly move up an appointment.

“The goal is to keep the veteran out of the hospital and to keep costs down,” Houge said.

Through another service, VA Video Connect, veterans can use their camera on a smartphone, a computer or a tablet to visit with their provider in virtual medical rooms. The visits could be with any clinical team member they would normally see in person, from an RN or doctor to social workers, psychologists or psychiatrists.

“This is secure and encrypted so the veterans don’t have to worry about privacy,” Houge said.

What’s more, this eliminates the need for a veteran to travel, which can be especially helpful in the winter, and avoids the difficulty of arranging for a ride. Then there’s this: some telehealth visits take less time than a face-to-face visit.

It also allows snowbirds who go south for the winter or otherwise travel for longer stretches to stay connected with their health care team. Even veterans who live right in Alexandria may prefer home telehealth services.

• To request a virtual appointment, veterans can send their provider a secure message on My HealtheVet by visiting myhealth.va.gov . Veterans may also call, but the VA is requesting that veterans only call with urgent needs at this time.
• Veterans needing help with virtual care tools or assistance with setting up a device can call the Health Hub at 320-252-1670, Ext. 7271.
• For more information about the VA's Connected Care technologies, go to connectedcare.va.gov