A chance encounter at a local store sparked a telehealth partnership between the Alabama Office of Rural Health (AL SORH) and Alabama Veterans Affairs (VA).

“A couple of years ago, I was out shopping on a Sunday night and ran into Dr. Randall Weaver, whom I hadn’t seen in awhile,” said Chuck Lail, AL SORH Director. Lail, a military veteran, already knew Weaver from the VA hospital where Lail has gone for his annual physicals. “I said to him, ‘We really need to get something going with the VA—I think there are good opportunities for telehealth.’ And he said, ‘Why don’t you call me and we’ll explore it.’ ”

“Our office has always been a strong advocate of telehealth,” Lail continued. “The state health department was starting to install telehealth carts in our county health departments, so I thought there might be an opportunity to marry the needs of the VA with the county telehealth program.”

The Alabama SORH has the advantage of being located within the Alabama Department of Public Health (ADPH), explained Rob Boyles, PCO Program Manager at the AL SORH. “We have access to other divisions and bureaus, including the Distance Learning and Telehealth Division.”

With the aim of creating a partnership between ADPH and the VA, the two groups began having regularly scheduled telephone conferences, Boyles said. “We worked together to assess which rural county would be the best site to pilot the project, in terms of rurality, the number of Veterans, and the distance they travel for healthcare services.”

Through those discussions, Lail said, they determined that mental health services would be a good place to start. “It seemed to be one of the greatest needs of the VA,” Lail explained. “And telemental health and delivery of telepsychiatry have been proven to be deliverable seamlessly over telehealth media.” The long-term objective of the program, he said, is to expand beyond mental health to many types of services for VA telehealth delivery.

Cullman County Health Department was the site of the first VA telehealth pilot, which began in spring 2017. The VA provided the services, Lail said, while ADPH facilitated the telehealth encounter. “Veterans there can visit their local county health department and have a virtual visit with their mental health care team from the Birmingham VA,” he said.

An initial evaluation by participants at the pilot site was done via an informal survey, Lail said. “The veterans stated that they were pleased with their telehealth consults, and that they liked being able to receive services from the VA at their local county health department,” he said.

Michael Smith, (ADPHTP) Director, said the county telehealth program has benefited from having funding from a variety of sources. “In Alabama, we’ve had telehealth with small networks,” Smith said. “You wrote a grant, the grant ended and the funding went away, and then the technology got pushed into a corner. But ADPHTP has been aggressive in terms of expanding our sites at county health departments and collaborating with health care providers.”

Smith said the expansion of the county telehealth program has been possible through several infrastructure grants from organizations including: the , the Centers for Disease Control (), and the USDA (); and from AL-ORH, using federal Health Resources Services Administration funding (SORH and Primary Care Office grants). Each grant award, Smith said, has funded a number of telehealth carts given to county health departments. “We’ll have a total of 60 county health departments with telehealth carts by this summer,” he said. Alabama has 67 counties.

“We’re looking at health departments to be single point of entry for a variety of services for all patients, such as counseling prior to a procedure, mental health services, genetic counseling, maternal fetal medicine, and pediatric neurology,” Smith said. “Patients shouldn’t have to travel a long distance for a routine appointment that can be just as successfully achieved via telehealth technology.

Lail reflected on the chance meeting that started it all. “It can be a small world,” he said. “Dr. Weaver and I had been acquaintances for some time. It was from that rapport that the rest of this story sprang.”