Sunday, December 21, 2008

VA Telehealth in the Spotlight

Telehealth and health IT are used by the Veterans Health Administration to treat veterans in more than 30,000 homes, according to Adam Darkins M.D., Chief Consultant for Care Coordination at the Department of Veterans Affairs. Appearing at the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics Briefing held on December 17th, he said “the VA has made a remarkable transformation in delivering care in recent years and 5.6 million veteran patients are served annually.”

Even though veterans and their healthcare needs are growing, the number of hospital beds is going down today with most of the care taking place in local clinics and ambulatory settings. Dr. Darkins pointed out that before 1900, care took place mainly in the home but starting in the 20th century, more of that care took place in hospitals. However, care in the 21st century, can be given wherever it is safe to do so, feasible, and cost effective.

As Dr Darkins explained, the VHA in 2003 started the national home telehealth program called Care Coordination/Home Telehealth (CCHT) to take care of patients with chronic conditions. The program uses home telehealth and disease management techniques plus uses health IT. The program treats patients with single and multiple conditions and treats patients with diabetes, CHF, hypertension, PTSD, COPD, and depression. The program in 2003 had 2,000 patients, by 2007, the VA treated 31,570, and by December 2008, the VA treated 36,000 patients.

When treating patients at home, devices are used to send information on the patient such as vital signs, disease management data, and e-health information that goes to the National VHA Care Coordination Infrastructure where it then can go via the Internet or the Intranet and then be sent to VistA and to hospitals.

According to Steve Pirzchalski, Director of Enterprise Network Services for the Department of Veterans Affairs, in recent months, the VA joined Internet2 as an affiliate member and is connected to the nationwide network. Now it will be possible to deliver next generation medical services, provide for faster delivery of services, extend the reach for information, decrease costs of service, and so now data is able to move faster, better, and cheaper.

The medical services can provide include high resolution imaging, telepresence, telepathology, and mental health counseling. Also Internet 2 opens numerous opportunities for tele-teaching, training, and distance learning with universities, DOD, other government agencies, hospital health networks, rural communities, research organizations, and in the corporate setting.

In addition, the VA is working to enhance current partnerships and build whole new relationships through the Internet2 system by partnering with universities, medical schools, and research institutions all over the world, plus the VA is working on IPv6 technology for telehealth use in the home. Pirzchalski, said however, there are still challenges in developing the right infrastructure and bandwidth, dealing with security issues, and developing new applications.

Gail Graham, Director of Health Data and Informatics, reports that the VA program is trying to reach the 32% of the veteran population living in rural areas.VA is now opening 31 new outpatient clinics in 16 states located in Alabama, Arkansas, California, Florida, Georgia, Hawaii, Illinois, Iowa, Maryland, Michigan Minnesota, Mississippi, Missouri, North Carolina, Pennsylvania, and Vermont. The plans are for all the clinics to be operational by late 2010.

Graham said that Electronic Health Record System, Personal Health Record System, on line prescription refills, quick access to records, and being able to schedule appointments is really valued by the veterans. However, one of the primary goals is to move the delivery of care forward with the focus more on patient-centered care delivered separately from the geographical location but it has to be done in a seamless manner. The VA is going to expand health information exchanges to provide information at the point of care, do more work in the field of genomic medicine, nanotechnology, and medical devices.

Continuing Honorary Steering Committee Co-Chairs are Senators Kent Conrad (D-ND), Mike Crapo (R-ID), Sheldon Whitehouse (D-RI), John Thune, R-SD), and Representatives Eric Cantor (R- VA), Rick Boucher (D-VA), Bart Gordon (D-TN), Allyson Y. Schwartz (D-PA), and David Wu (D-OR).

The Steering Committee also coordinates activities with the “House 21st Century Health Care Causcus”, Co-Chaired by Representatives Patrick Kennedy (D-RI) and Tim Murphy (R-PA).

The Steering Committee briefings are now being produced by the HIMSS Foundation’s Institute for e-Health Policy. For more information on future briefings, contact Neal Neuberger, Executive Director for the Institute at or go to the web site at