The VAs Long History with Telehealth

The U.S. Department of Veterans Affairs (VA) was an early adopter of telehealth services beginning in 2003. By 2013, their growing telehealth initiatives were treating over 600,000 veterans in 1.7 million episodes of care.

The VA encompasses the nation’s largest healthcare system, with more than 152 hospitals and 1,100 ambulatory locations. But with 45% of their target audience living in rural areas with no access to a VA facility, the agency learned early on that telehealth was a conduit to extend care to all veterans.

Today the department has extended care to veterans with the virtual visit to help eliminate the travel associated with receiving care at VA hospitals and medical centers around the country. While the agency has created more than 700 ambulatory sites, they do not offer all the specialty services found at VA hospitals. But traveling to the hospital “may be a very complicated and sometimes arduous task.”

The organization’s website says, “VA Telehealth Services uses health informatics…to improve access to care, improving the care of veterans.”

The VA finds value in telehealth not only to extend care to veterans in all 50-states but for education for chronic diseases, case management, and health informatics. The goal of the service “aims to make the home into the preferred place of care, whenever possible.”

Let’s look at the VA as a long-term case study for telehealth to determine the practical applications and benefits for the technology.

The VA calls their telehealth program the “anywhere to anywhere VA health care.” The agency runs three types of telehealth programs:

• Virtual visits designed to replace the traditional on-site encounter.
• Home monitoring of chronic care conditions.
• Teleradiology services which allow remote clinicians to share imaging information to help with diagnostic treatment plans.

The VAs interdisciplinary healthcare network uses both synchronous and asynchronous telehealth technology to provide these services:

• Synchronous is real-time two-way clinical video conferencing that features a clinician on one end of the call and the patient at the other.
• Asynchronous is a one-way telehealth application sometimes called store-and-forward. It allows a clinician to upload and store data like medical images or voice recordings. That data can be transmitted to another clinician for an online assessment. Both parties need not be present simultaneously.

The VA’s Telehealth Fact Sheet lists 38 clinical programs currently being offered to veterans around the country. Here are a few examples:

• TeleAddiction Services
• TeleAmputation Care
• TeleDentalCare
• TeleCardiology
• TeleIntensive Care
• TeleOccupational Therapy
• TeleSurgery (Pre and Post Care)
• Women’s Telehealth

The VA reports that in FY 2016, about 12% of our nation’s veterans experienced treatment in some sort of telehealth model. By the numbers, that’s more than 2.17 million telemedicine episodes in just one year.

Veterans have a whole host of issues not widely seen in the civilian population. Severe spinal cord injuries and head trauma, as well as PTSD, can all make traveling to a remote clinical site challenging and stressful for a wounded veteran. But telehealth can extend treatment right to where the veteran lives, decreasing stress while providing needed treatment. The VA’s own fact sheet on these services lists some of the benefits:

• Applying telehealth for remote care and home monitoring of veterans with chronic care conditions reduced VA hospital admissions by 31% and inpatient bed days by 59%.
• Providing mental health counseling via TeleMental Health services reduced acute psychiatric VA inpatient admissions by 32% and days of care by 39%.

Further, veterans express their comfort with the service in the following ways:

• 92% patient satisfaction with virtual visits.
• 88% patient satisfaction with remote monitoring.
• 94% for asynchronous telemedicine consults.

As far back as 2014, Becker’s was reporting on positive outcomes from a variety of VA telehealth initiatives. They included:

• Reducing inpatient bed days by 59%.
• Remote monitoring telehealth patient satisfaction scores were 84%.
• Synchronous virtual visit patient satisfaction scores were 94%.
• Home telehealth saves $1,999 per patient over inpatient treatment on chronic care conditions.

In 2017, more than 700,000 veterans used the VA telehealth programs. These programs continue to expand, based on overwhelming evidence that telehealth improves outcomes and cuts costs. Some more recent outcomes reported by the VA include:

• February 2018: The American Hospital Association released a case study showing the benefit to one VA rural care hospital in Martinsburg, West Virginia. The hospital is using telehealth to benefit more than 45-medical specialties offered, with better quality scores and extended service experienced by all. Use of these programs is rapidly increasing. For example, dermatology went from 47 telehealth visits in 2013 to 408 visits in 2017.
• August 2018: The VA released a study showing their telemedicine rollout to 23 rural hospitals was extremely effective in reducing the number of ICU patients transferred between facilities. Moderate to severely ill patients accessed tele-ICU intensivists that provided ICU teams in remote facilities additional support and guidance. This led to a reduction in inter-hospital transfers, which ultimately reduced patient risk and clinical costs.

The VA’s telehealth program is growing by about 22% every year. New pilots are being conducted each year; currently, they’re testing an online tool for mobile devices that allows patients to enter self-monitoring data from chronic care conditions.

In the summer of 2017, the President announced another expansion of the VA’s telehealth program to include:

• Introduction of a new mobile app for appointment setting.
• The expansion of VA virtual visits, particularly for veterans with mental health disorders.

New pilot programs are launching all the time; in 2018, a telemedicine program linking remote VA hospitals with infectious disease control specialists launched. MHealth Intelligence says the program has already helped improve stewardship of antibiotic treatment programs with the goal of reducing multi-drug resistant organisms.

The U.S. VA has led the nation in telehealth applications. They are obviously improving care; the Rand Corporation released a study in 2018 showing that the VA healthcare care system performs at higher levels of care than private or other public facilities. While Congress and veteran’s groups have expressed concern about the quality of care in these facilities, the study noted, “the VA health care system generally providers care that is higher in quality than what is offered elsewhere in communities across the nation.”

Clinical providers can look to these innovations when considering telemedicine for their hospital or clinical practice.

OrthoLive offers these providers a low-cost telehealth solution designed specifically for the busy orthopedics provider. Contact us and get started on your own telehealth innovation service line.