Telehealth in Plastic Surgery

A Veterans Affairs Hospital Perspective

Stephanie Douglas, MD; Erik Geiger, MD; Andrew McGregor, MD; Amanda Norwich, MD; Deena Abbate, RN; Henry Hsia, MD; Deepak Narayan, MD


Plast Reconstr Surg Glob Open. 2018;6(10):e1840 

In This Article


Telemedicine refers to the provision of medical services by use of information and communication technology between patients and providers who are separated across geographic distances that may make in-person encounters otherwise impractical. Given the rapid development of telecommunication technologies, the concept of telemedicine has grown to encompass a wide range of applications. These include the simple transfer of static images between providers using cellular phones, the use of telemedicine studios to facilitate high-definition audio-visual connections with patients in real time, and even the ability to perform remote surgery.[1] Well-documented disparities in health care access exist between patients in rural communities and those in suburban areas.[2,3] In response to these inequities, various forms of telemedicine have been successfully employed to enhance the ability of patients in rural areas to be evaluated by a variety of medical and surgical specialists in fields including psychiatry,[4] cardiology,[5,6] dermatology,[7,8] orthopedic surgery,[9] and ENT.[10]

Military veterans face issues related to subspecialty health care access based on the distribution of providers within the Veterans Affairs (VA) health care system. In the Connecticut VA Healthcare System, there is 1 plastic surgeon located in West Haven to serve the 200,000 military veterans living in Connecticut and southern Massachusetts. In plastic surgery where visual examination contributes heavily to patient management, telemedicine can play a substantial role in expanding the ability of physicians to provide for many patients spread over great distances. Telemedicine has already been employed within plastic surgery in civilian contexts, including burn triage,[11,12] flap monitoring,[13] maxillofacial trauma,[14,15] and hand trauma.[16,17] However, little has been done to examine patient satisfaction during an in-office evaluation where patients may be in a position to share freely their experience in a nonurgent setting without feeling forced to participate.

Although studies have reported high levels of patient satisfaction with traditional models of health care, there are a few variables within this paradigm that seem to negatively affect the patient experience. Namely, difficulty in arranging multiple appointments and inconvenience of long travel times.[18,19] Both of these factors are applicable to the experience of VA patients attempting to obtain subspecialty consultation with plastic surgeons in New England. The introduction of the Clinical Video Telehealth (CVT) program in the 1990s by the Veteran's Health Administration was designed to address these issues by providing services in fields such as psychiatry and internal medicine. This has not yet been extended to the plastic surgery department. Our study connects patients via CVT at multiple VA community-based outpatient clinics (CBOC) throughout Connecticut and southwest Massachusetts with a plastic surgeon in West Haven through a real-time audio-visual link. The aims of this study are to review the CVT experience within the Connecticut VA health care system and survey patient attitudes toward telemedicine services in this context. We hypothesized that the use of CVT would be welcomed by patients while saving them the significant time and travel expenses otherwise incurred.