Telehealth Program For Veterans Expands

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The decade-old telehealth program of the Department of Veterans Affairs (VA) is expanding rapidly, far outpacing similar efforts in the private sector. The number of veterans receiving care via the VA's telehealth services is growing 29% annually, said Adam Darkins, MD, the VA's chief consultant for telehealth services and leader of its coordinated care/telehealth program, in an exclusive interview with InformationWeek Healthcare.

In fiscal year 2012, including remote consultations, home monitoring, and store-and-forware services, nearly half a million veterans received care remotely from 150 VA medical centers and 750 outpatient clinics in 1.429 million episodes of care, Dawkins said. Nearly half of these patients lived in rural areas and may have otherwise had limited access to VA healthcare.

Within that total, he said, 148,385 veterans participated in virtual visits, using videoconferencing equipment set up in VA medical centers and ambulatory clinics. Of those, 76,000 patients received behavioral health care remotely in 217,000 virtual encounters.

Also last year, said Darkins, 119,535 veterans enrolled for home telehealth services. Home monitoring of their conditions enabled 42,699 of these patients to live independently in their own homes, rather than going into nursing homes, he said. As of Aug. 1, about 83,000 veterans were participating in this program.

The VA's store-and-forward program is designed for tests and treatments that require the storage and transmission of images for remote analysis. For example, digital pictures of the retina or skin lesions can be uploaded to an information system and sent to clinicians hundreds or thousands of miles away to be read, Darkins said. The clinician's report is then sent back to the site where the patient was seen. Just for retinal screening of veterans with diabetes, 260,000 patients were involved in this store-and-forward program last year.

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Telehealth has been part of the everyday fabric of care in the VA system since 2003, Darkins noted. That was when VA decided to take the home telehealth program national after a successful three-year demonstration.

"These services aren't a pilot," he emphasized. "They're keeping 40,000 people living independently at home. If these services weren't there, these people would end up in nursing home beds."

The same is true of the store-and-forward initiative, which was rolled out nationwide in 2005, he noted. Screening a quarter of a million people for eye disease in primary care clinics means that they don't have to go to eye clinics. As a result, he said, eye care professionals have more time to see patients, and patients don't have to wait as long for appointments.

The remote consultation service also benefits patients, including those who have mental health issues, such as PTSD, that plague many veterans. By not having to drive to a behavioral health clinic, which might be far from where they live, these veterans find it easier to resume their daily lives and don't have to worry about taking time off from work, he pointed out. Also, he said, there's a stigma attached to visiting a mental health clinic, but none in visiting a primary care office that has videoconferencing equipment.

The rapid drop in the cost of both videoconferencing and home monitoring gear in the past few years has spurred the VA's use of telehealth. So have the cost savings from delivering care this way. For example, Darkins said, the initial pilot of the home telehealth program showed that it reduced hospital admissions by over 30%.

In addition, the VA has worked out the clinical and technical support needed to make these programs succeed, he observed. "It's very clear who's doing the care and which patients need to receive it, and the training process is in place." The VA trains more than 4,000 staff each year, most of them virtually. Also, he added, the VA has in place the necessary systems for telecommunications and help desk support.

The VA healthcare system is of "enormous importance to the VA," Darkins said. "Secretary Shinseki has really stressed its importance in terms of access to care and helping to support returning military and their families. It's more accessible and available to people and avoids the need to travel. And the movement of care into the home helps people live independently."