Interview with Steph Warren, CIO, Department of Veterans Affairs on Telehealth

Recently, we’ve been focusing on telehealth here on TechSource. As we’ve written before, the military is leading the way in terms of telehealth adoption and serves as a shining example of the possibilities that telehealth technologies can enable. We had the opportunity to chat with Steph Warren, CIO, Department of Veterans Affairs (VA) on the agency’s role as a leader in and role model for civilian telehealth technology implementation.

TS: VA is widely acknowledged as a leader in terms of telehealth adoption. Can you describe some of the ways VA is using IT to improve veterans’ access to healthcare via telehealth?

I’d like to hit several key areas where telehealth is enabling VA to provide optimal care to veterans. The first is clinical video telehealth. Clinical video enables us to break down the walls of a physical medical center and extend care available from specialists located in more populated areas to veterans in rural areas. Rather than limiting specialist care to those who reside in the particular geographic area that houses physicians and healthcare givers, clinical video allows us to extend that care area, improving access to specialized care without regard to physical location. As a result of clinical video telehealth technology for delivering mental healthcare, we’re seeing a reduction in hospitalizations and veterans are reporting decreased levels of anxiety in terms of traveling sometimes prohibitive distances to appointments, instead being able to benefit from therapy from the comfort and privacy of their own homes. Another area where we’re using clinical video to provide service is with speech-language pathologists (SLPs). Veterans working with SLPs to recover speech after a stroke are able to make better progress with the increased access to care that clinical video provides. Telesurgery is another emerging area where clinical video is proving useful and helping to provide the best care no matter where a veteran is located geographically.

The second area that telehealth is enabling is the telehealth ICU. Telehealth is allowing critical care physicians and nurses from urban areas to bring specialized care to ICU patients in rural areas or smaller VA medical centers.

Home telehealth is another area where we’re seeing success and improved patient outcomes. A recent study of home telehealth revealed that home care can reduce bed days of care by 64% and hospital admissions by 32%, with particular success in treating veterans with diabetes.

TS: Can you tell us about some of the safeguards that VA uses to ensure that patient data from telehealth encounters is secured?

We take stewardship of veterans’ data very seriously. When we put a system in place to support telehealth tools, we ask how do we make sure we have the appropriate levels of security built into this system? In addition to making sure security is baked into new systems as we put them in place, we evaluate the security of existing systems on an ongoing basis. Our team recently conducted a review of all our telehealth applications to make sure they meet security standards. We take a proactive approach to ongoing security evaluation—we have protections in place but we’re always looking for new vulnerabilities and refreshing the system to make sure we continue to keep up with evolving threats. We also do “store and forward” with telehealth information, which means we acquire the data during a telehealth encounter and store it in a controlled area, then we forward it via secure channels to a secure network for clinical evaluation. This is all part of the layered defense strategy the VA employs across all our systems across the enterprise.

Another area of focus for us in terms of ensuring veterans’ healthcare data is protected is practitioner training on security best-practices. Data protection is not a one-and-done; every year we provide a refresher on data security for all VA employees and for healthcare personnel we provide an additional course dealing with HIPAA requirements. We update these courses on a continual basis, so we’re providing the most up-to-date information and making people aware of evolving threats and privacy safeguards. We look at this ongoing security education as “People, processes and paper”—when we fall short and incidents happen, we make sure we review and modify our processes to better safeguard information. We continue to look for ways to minimize the use of paper, as hard copies of records and data represent a large risk that can be easily mitigated by just eliminating the use of paper.

TS: VA is in the midst of overhauling its scheduling system to better meet veterans’ needs. Does telehealth present any specific challenges (or opportunities) in terms of scheduling?

We have deployed a tele-video scheduling application which allows multiple sites to schedule video telehealth engagements. As we review the four phases of the scheduling system revamp, we’re also looking into how schedulers loop in scheduling tele-video encounters and how those can be managed in a more cohesive way.

TS: What best practices or lessons learned can the commercial healthcare sector gain from VA’s early adoption of telehealth technologies?

We’ve learned some hard but good lessons as we’ve embarked on our journey into providing care via telehealth. The first is to make sure care providers and IT solution providers are working together early and often to make sure that solutions and infrastructure meet the needs of caregivers. You need to make sure you’re developing and deploying an integrated, coherent solution that meets the needs of healthcare providers and that the solutions are adequately supported by the appropriate infrastructure. You need to ensure you’re building an infrastructure that supports the demands of audio and video technology.

Another consideration companies deploying video telehealth technologies must remember is that it’s not only important to protect patient data during the healthcare encounter but also when you’re transmitting that information. Data stewardship is of the utmost importance during every step of telehealth provisioning.

And finally, telehealth is a new method of care delivery not just on the infrastructure/technology side but also in terms of the way the care is provided, it makes sense to start in a pilot method. Go in on a small scale and test and learn from those small scale deployments so when you roll it out on a larger scale, you’ve already discovered and addressed any issues. It’s very important when patients receive care via telehealth technology, their experience is a good one, so you want to make sure any glitches or roadblocks are addressed in pilot mode.

TS: What does the future hold for VA in terms of telehealth from an IT standpoint?

We are sold on the value of telehealth and the capabilities it affords in terms of allowing us to provide top-notch care to rural areas, enabling care in the comfort of the home and dramatically reducing hospital admissions and overnight stays. We had around 4,000 in-home care instances in FY14 and we plan to almost double that to 7,000 or more in FY15. As we do this, we need to expand internal capabilities to ensure we can support this new mode of providing care. We’ve reached out to the FCC to discuss ways they can be an enabler in terms of telehealth and service delivery to veterans in rural areas. We continue to work with them to emphasize the value to our nations’ veterans that telehealth offers, especially in rural areas, and the importance that connectivity plays in enabling those care encounters.

For more information and resources about telehealth, please visit our Resource Center.

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