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At White River Junction VA, Doctor Is In — and On Screen

Wednesday, July 31, 2013
White River Junction — Wendy Ottaviano’s throat was irritated, so much so that nurse Judy Audette could see the redness 100 miles away.

“Is your throat sore, Wendy?” Audette asked.

“I have allergies,” Ottaviano said. “So it’s always like that.”

Audette was looking at an image of Ottaviano’s throat on her computer screen in White River Junction, where Audette works at the Veterans Affairs Medical Center. Ottaviano, also a VA employee, was in an exam room at a VA clinic in Bennington, Vt., having images taken of the inside of her ear, mouth and the stitched wound from recent foot surgery. She offered herself as the guinea pig to demonstrate how the VA is using technology to treat veterans remotely.

From mental health services to physical therapy, the VA continues to expand telehealth capabilities at its 152 medical centers and related clinics throughout the nation, said Dr. Robert Petzel, VA under secretary for health. The VA spent $500 million on a telehealth expansion project last year, he said, and will continue to use technology to improve health care access for veterans.

“In the long term, this is a cost-effective way to deliver care,” Petzel said Tuesday during a media event in Washington, D.C. “The VA is the only place I know where we’ve brought all this stuff together and have a coherent way of (delivering care.”)

Telehealth is a broad term for all the ways in which technology can be used to provide remote care. It could be as simple as a text message to remind a patient to take her medicine, or as sophisticated as using robots to perform surgery. Many hospitals, including Dartmouth-Hitchcock Medical Center, use telehealth in treating their patients. But the Department of Veterans Affairs has been at the forefront, VA officials said, and the nationwide system was called one of this year’s “most wired” hospitals by Hospitals & Health Networks magazine.

On Tuesday, physicians at the White River VA participated remotely in an event at The National Press Club in Washington to demonstrate how the VA was using telehealth. Sen. Bernie Sanders, I-Vt., also attended the event in Washington and pointed out the advantages for veterans living in rural states like Vermont.

Telehealth is more than a convenience, Sanders and Petzel said. It is essential to making sure veterans receive the care they need, when they need it, as many would go without treatment because of the disruption to their lives from traveling an hour or more to appointments.

“(Telehealth) significantly improves access to health care,” said Sanders, the chairman of the Senate Veterans Affairs Committee. “It is especially important in rural America in states like Vermont.”

The White River VA, which treats around 25,000 veterans in Vermont and New Hampshire, began offering remote mental health services six years ago, before many other hospital systems, said Audette, the facility’s telehealth coordinator.

It has since expanded telehealth into diabetes care, weight loss, dermatology, speech therapy and other areas. Many telehealth services involve remote consults with doctors, where patients go to one of the VA’s seven community clinics and speak — via a secure computer affixed with a camera — with specialists in White River Junction. Patients are usually accompanied by a VA technician and talk with the specialist using a medical cart outfitted with screens, cameras and sensitive equipment that can be used to examine lesions, listen to a beating heart and do many of the things that a physician would do in-person.

Mental health has been an area where telehealth has had a significant impact, said Lanier Summerall, the VA’s chief of mental health and behavioral sciences. Around 300 veterans get remote mental health services every month through the White River VA, she said.

It makes it easier for veterans to keep their appointments, as they are able to talk from a nearby clinic or even their home, and allows therapists to reach people who otherwise would likely not seek care because of the inconvenience of driving to White River Junction, she said.

In some cases, telehealth also can open up conversations with patients that wouldn’t happen if a therapist were with them in the room.

“Often, people in the tele-encounter feel more private in a way,” she said. “That can actually be an advantage.”

Using technology to reach veterans remotely has its limitations. A physical therapist, for example, can’t do some assessments without touching the patient, said Kurt Armbruster, a physical therapist at the VA.

There may be a time when these obstacles can be circumvented using robots or other remote devices, he said. Right now, telehealth is not ideal for physical therapy, Armbruster said, but the improved access has convinced him that the investment in telehealth is worthwhile. He said it also has been embraced by the older veterans frustrated by past experiences trying to get appointments.

“Some of the older guys, the increased access has blown them away,” he said.

Joseph Krawczyk, 65, is among the veterans who have received physical therapy using telehealth technology. The Army veteran lives in Bennington, Vt., and last December had a full knee replacement. Traveling two hours to White River Junction, especially during harsh winter weather, would have been extremely inconvenient and likely would have forced him to miss some appointments.

The VA gave him a device, fully covered by his veterans benefits, that he installed in his kitchen at home and allowed him to consult with his therapist several times a week.

The device looks like a small television with a camera and secure connection, through which he can talk with his therapist and be guided through exercises.

Krawczyk was familiar with Skype, the Internet telephone service, and said he was easily able to adjust to telehealth technology.

“I wasn’t skeptical,” he said. “If you’d asked me 10 or 15 years ago before I was familiar with computers, I might have been. I think today, with the technology we have, it’s the way to go.”

Chris Fleisher can be reached at 603-727-3229 or


Valley News staff writer Chris Fleisher discussed this story on Friday's broadcast of VPR's Regional Report.


A caption for a photograph associated with this article has been amended to correct an earlier error. Judy Audette, telehealth coordinator at the Veterans Affairs Medical Center in White River Junction, is shown demonstrating a remote examination of a patient. She was misidentified in an earlier version of the photo caption.

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