Already recognized as a leader in the development and use of telemedicine, the Department of Veterans Affairs is expanding its telehealth services to meet the growing needs of its patient population.

2015 was a banner year for telemedicine at the VA, which conducted 2.14 million telehealth visits, reaching more than 677,000 veterans—or 12 percent of all vets—using real-time telemedicine, home telehealth care, and store-and-forward telemedicine.

In fact, last year, VA reported that home telehealth reduced hospital bed days of care by 58 percent, hospital admissions by 32 percent, while telemental health reduced psych bed days of care by 35 percent.

According to Kevin Galpin, MD, acting executive director for telehealth at the Veterans Health Administration, the technology is now considered “mission critical” for effectively delivering quality healthcare to veterans, particularly for those in rural or underserved areas.

“Telehealth leverages health informatics, disease management principles, and communications technologies to deliver care and case management to veterans,” testified Galpin at an August 9 hearing before the House Veterans’ Affairs subcommittee on health. “This aspect of telehealth changes the location where healthcare services can be provided, making care accessible to veterans in their local communities and even in their homes.”

He told lawmkers that the VA’s telemedicine initiatives fall into three categories—clinical video telehealth, home telehealth and store-and-forward telehealth—delivering services to veterans in 50 clinical specialties.

Clinical video telehealth, which occurs as real-time interactive video conferencing to assess, treat and provide care to a patient remotely, is typically used to link a veteran at a clinic to a provider at a VA medical center in another location. However, he said that VA Video Connect (VVC)—which will provide fast, easy, encrypted, real-time access to care—represents the next step for clinical video telehealth and is currently undergoing field testing.

“VVC can be used to connect VA providers to a veteran’s personal mobile device, smartphone, tablet, or computer,” according to Galpin. “It allows for video healthcare visits, such as telemental health visits, where a hands-on physical examination is not required. It also makes it easier for veterans to choose where they’d like to receive services, whether that is in their home or any other place the veteran desires.”

In fact, he testified that the VA has found telemental healthcare to be equally effective, if not more so, than in-person appointments, bringing highly specialized care to patients who otherwise would have to travel long distances. According to Galpin, the VA’s National Telemental Health Center provides veterans across the country with access to clinical experts. And, this year, the VA announced the establishment of four regional telemental health hubs, with providers available for facilities in need of behavioral health resources.

The second category of telehealth—home telehealth—leverages VA-provided devices, as well as regular telephone lines, mobile broadband modems, cell phones, and web browsers to connect more than 85,000 veterans with providers, typically a registered nurse.

“Using home telehealth technologies, the VA provider can monitor the veteran’s health status, provide clinical advice, and facilitate patient self-management as an adjunct to traditional face-to-face health care,” said Galpin. “The goal of VA’s home telehealth program is to improve clinical outcomes and access to care while reducing complications, hospitalizations, and clinic or emergency room visits for veterans who are at high-risk due to a chronic disease.”

While home telehealth can help veterans live independently and spend less time on medical visits, at the same time Galpin acknowledged that not every patient is suitable for this type of care.

The third VA telehealth category is store-and-forward telehealth, which is the use of technologies to asynchronously acquire and store clinical information such as data, images, sound and video that is then assessed by a provider at another location for clinical evaluation.

“VA’s national store-and-forward telehealth programs deliver such services as dermatology and retinal screening, where a healthcare provider can use a photo or a series of photos for diagnosis or triage,” said Galpin, who noted that diabetes can cause problems with the blood vessels in the retina. “A special camera takes pictures of the retina, which are then sent to an eye care specialist for review. A report is returned to the patient’s primary care physician, who can provide any required treatment. This investigation does not replace a full eye exam but does mean that those at risk of eye problems from diabetes can be assessed easily and conveniently in a local clinic.”

Despite these capabilities, members of the subcommittee expressed their skepticism regarding the VA’s success in delivering timely, quality care via telehealth technologies.

“VA purports to be a leader in the use of telemedicine,” said Rep. Brad Wenstrup (R-Ohio), MD, acting chairman of the health subcommittee. “However, as the use of telemedicine continues to expand, we need to be sure that VA is keeping pace with modern technology and is effectively safeguarding private medical information through secure data channels. We also need to make sure that VA is effectively tracking telemedicine appointments to ensure consistent, quality care and monitoring patient outcomes.”

Wenstrup made the case that while the VA’s use of telehealth has been increasing over the last several years, patient waiting times have also been increasing.

“If VA truly is a leader in deploying telemedicine, it is important to track best practices, lessons learned, and the impact telemedicine is having both on individual patients and on the VA healthcare system as a whole, as well as to ensure that this technology is being leveraged to address the critical issues VA is facing,” he added.

In response, Galpin said that although the VA’s telemedicine capabilities are advanced compared with other healthcare organizations, he concluded that the department is “still at the beginning of its journey of leveraging its integrated national healthcare system and remote care opportunities through telehealth technologies.”

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