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Telehealth: The VA Connects with Healthcare

Among its myriad tools for improving the health of America’s veterans, the Department of Veterans Affairs (VA) has implemented a multi-element effort to introduce telemedicine technologies across its medical architecture.

The clear success of the early telemedicine efforts was recently evidenced by the naming of VA healthcare facilities to the 2013 “Most Wired” hospitals listing released by Hospitals & Health Networks, in partnership with McKesson, the College of Healthcare Information Management Executives (CHIME), and the American Hospital Association (AHA). The inclusion reflects the results of a national survey process aimed at ranking hospitals that are leveraging health information technology (HIT) in new and innovative ways.

“As the nation’s largest health network, VA is continuously working to improve and enhance our understanding of which technologies best meet the needs of our veteran patients.”

“At VA, we are committed to expanding access to high quality care for our nation’s veterans,” said Secretary of Veterans Affairs Eric K. Shinseki at the time of the award. “As the nation’s largest health network, VA is continuously working to improve and enhance our understanding of which technologies best meet the needs of our veteran patients.”

One of the new technology areas that has been introduced to meet the needs of veteran patients involves telehealth, which has been implemented in several areas as an adjunct to traditional face-to-face medical settings.

Home Telehealth

VA’s home telehealth programs are aimed at the 2 to 3 percent of patients who account for 30 percent of costs, are frequent clinic visitors, and require urgent hospital admissions. U.S. Department of Veterans Affairs photo

According to Dr. Adam Darkins, chief consultant for Telehealth Services in the Veterans Health Administration, Department of Veterans Affairs, the VA made the decision to implement telehealth as a national program around 2003, following the success of several pilot programs.

“These were not going to be pilots anymore,” he said. “Instead, VA was moving forward in using telehealth for routine delivery of care for mission critical services.”

“The reason for doing so was the driver to improve patient access,” he explained. “The VA has 151 hospitals and over 900 other sites of care. But in spite of that, the fact is that some veterans end up living in rurally remote areas. So in order to provide that access, telehealth really made sense to the VA.”

Darkins noted that the telehealth decision not only stemmed from the success of the early pilot programs, but also reflected VA’s Office of Research and great health services research and development expertise.

“The other thing it built on was the computerized patient record,” he added. “That computerized patient record is what really allowed VA to move from being predominantly a hospital-based system to being a system that is more primary care focused, with primary care clinics called community-based outpatient clinics. So if you think about it, with the telecommunications ability to move the clinical records about, it becomes a logical step to build from that and explore the possibility of moving the clinician to the patient, instead of the patient having to travel all the way to where the clinician is.”

He continued, “The other thing that really drove this is the fact that the nature of disease is really changing, in the sense that hospitals were really built to cope with acute life-threatening illness, while more and more, VA is dealing with older patients with chronic conditions. So the situation is not as much a question of how we get them into a hospital for urgent treatment, surgery, or investigation, but rather more a question of what is the right thing to do at a particular time with something like diabetes or heart failure.”

Against that background, the VA has implemented a telehealth program with three primary components: Home Telehealth; Store-and-Forward Telehealth; and Clinical Video Telehealth.

“From between 700 and 800 patients at the end of that pilot in 2003, we have systematically implemented the clinical processes, the business processes, and the technology to the point where today there are over 86,000 veterans who are being monitored around the country for diabetes, heart failure, chronic obstructive pulmonary disease, depression, posttraumatic stress disorder – not just as individual issues but in combinations.”

The first area where VA decided to develop a national telehealth program was with home telehealth – supporting veterans to live independently in their own homes.

“The veteran population is aging faster than the general population,” Darkins asserted, “particularly in the age group over 85. That is because of the aging of the veterans who have been through World War II, Korea, Vietnam.”

The Home Telehealth program started as a pilot effort between 2000-2003, before going to a national effort in 2003.

“From between 700 and 800 patients at the end of that pilot in 2003, we have systematically implemented the clinical processes, the business processes, and the technology to the point where today there are over 86,000 veterans who are being monitored around the country for diabetes, heart failure, chronic obstructive pulmonary disease, depression, posttraumatic stress disorder – not just as individual issues but in combinations,” he said.

“And there is a national infrastructure in terms of contracts we have for devices that VA supplies free to veterans in their own homes who are eligible to enter the program,” he added.

“In the Home Telehealth program, the veterans provide information, generally on a daily basis, that is monitored by a nurse practitioner or a social worker – usually a nurse,” he explained. “And the nurse then coordinates the care of that patient, with each of the care coordinators having a ‘panel’ of somewhere between 100 and 150 patients. If they notice any sort of deterioration in that patient’s health status, they can either help the self-management of the veteran or contact the primary care or specialist care physician to be able to make sure that the patient gets support and help. And what we have found is by intervening in this manner we are reducing hospital admissions by an order of 30 percent.”

In total, Home Telehealth helped care for more than 119,000 veterans in 2012.

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Scott Gourley is a former U.S. Army officer and the author of more than 1,500...