The U.S. Department of Veterans Affairs (VA) is making great strides with regard to providing services to veterans via telemedicine. In fact, the VA is leading the way in deploying telemedicine on a large scale. In fiscal 2013, more than 600,000 veterans accessed VA care using telemedicine programs, for a total of more than 1.7 million episodes of care. According to a recent article on FCW.com, the reach of the VA’s telehealth services is growing nearly 22 percent annually.
The VA originally launched telemedicine programs in 2003 and now offers three services: clinical video, home monitoring and teleradiology. Clinical video is designed to reproduce face-to-face interactions between caregivers and patients using videoconferencing technology (VTC); home monitoring allows doctors and other caregivers to keep tabs on patients with chronic conditions and teleradiology allows clinicians to share imaging information for help in diagnostics and care.
Additionally, veterans of the wars in Iraq and Afghanistan are accessing telemedicine for mental health services, including treatment of post-traumatic stress disorder (PTSD). Last year, the VA tested a program that allows veterans to access those services from their homes via a secure video connection. Access to these telepsychiatry programs from the home is key, since many patients fear seeking help for mental health disorders due to the negative perception and stigma attached to them.
FCW.com reports that the VA did not get into telemedicine out of an inherent interest in technology; rather, it was a necessary step to help aging veterans with chronic diseases live independently, for clinical and financial reasons. Although the VA has a vast network of hospitals and other care facilities, it still faced the problem of having to cover a lot of territory, especially when it came to caring for the significant number of veterans who reside in rural areas.
Implementing telemedicine on a large scale poses challenges from a technology perspective, as well as a regulatory perspective. Video can be bandwidth-intensive, and requires that enterprises have sufficient management and monitoring tools in place to ensure that other traffic doesn’t degrade the quality of the video treatment sessions—a challenge considering the scale of the VA’s implementation. Devices used by both clinicians and patients must be standardized, and clinicians, and IT staff must work together for initial training and ongoing troubleshooting.
Technology aside, one of the biggest hurdles in telemedicine is regulatory—a significant hurdle that the VA is able to avoid because its network of caregivers are able to treat veterans throughout the system without regard to state licensing rules.
The Defense Health Agency (DHA) is another government agency that is leading the way when it comes to telemedicine. The National Center for Telehealth and Technology (T2), a division of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, was created to identify, treat and minimize or eliminate the short- and long-term adverse effects of traumatic brain injury (TBI) and mental health conditions associated with military service. In the T2 2013 Annual Report, T2 Executive Director, Greg Gahm, Ph.D., said, “We want to connect to each individual at a personal level, in a private way, anywhere and anytime they need it…We are determined to continue this mission through improving access to care, ongoing clinical research, and innovating new solutions. We are always focused on improving the quality of care for our military community.” T2 recommends, coordinates and manages the development of an integrated DoD telehealth system for the provision of quality, patient-centric psychological and TBI healthcare services. T2 telehealth programs include telemental health education and training, Deployable Telehealth Centers (DTeCs) and the Pacific Islands Mental Health and Substance Abuse Inventory.
As with the VA, the number of beneficiaries and the fact that they live across a very broad geographical area creates challenges in providing behavioral health care. Telehealth provides opportunities to leverage existing DoD health provider resources and increase access to care through telecommunication technologies, and also allows them to cultivate new, more efficient methods of care delivery. T2 works as a central resource center focused on the development of a telehealth network of systems across the DoD by leveraging partnerships with the Services, VA, TRICARE and civilian providers. T2 leads this network to expand the range of services available to rural and underserved locations through the use of various treatment facilities and telehealth technologies.
Much of the infrastructure required to support telemedicine is in place. The growth of robust, high-speed broadband and the ubiquity of high-definition video technology have made access to telemedicine services a reality for millions of Americans. Other technology requirements for telemedicine include data storage, information security, networking across multiple platforms and devices, mobility and multi-media collaboration technologies. Ongoing, assessable technical support for telehealth systems is a necessity, especially when implementing such a vast telemedicine network.
VTC and telemedicine are playing an increasingly important role in expediting care and increasing access to care for veterans. As the private sector moves forward with telehealth initiatives, it will be well-served to look to programs like these implemented by VA and DHA to guide its efforts and bring the benefits of telehealth to civilians across the U.S.
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