Q&A
But unfortunately, at this time, there is not an easy way to do that. I think a lot of innovation is required so that we can make it much easier for the veterans with 1-button access, both for the veterans as well as for the providers. And that’s going to require significant effort in the grid technology as well as overcoming certain legal requirements.
What Is Driving Telehealth?
Dr. Agarwal. The real driver here has to be the veterans’ needs, not the needs of telehealth nor the clinical services or operations. I think the whole goal here is that we must use technology to the extent possible. We have to move toward virtual access as the norm.
As much as possible, we should provide the virtual access in the veterans’ homes or wherever the veterans would like to receive their services. Make the connectivity as simple as possible for the veterans and move beyond the concept of the episodic visit so that the health information and self-care management tools are available to the veterans at all times. And that essentially needs to be the overarching strategy, and that should drive how we develop the technologies to provide the services.
Data Analysis
Dr. Agarwal. We have the general enrollee data. We look at access gaps in clinical services and the telehealth activity data for our program management and oversight as well as in developing an overarching strategy for the clinical services and telehealth services. It’s done somewhat in conjunction. And our outcome analysis shows that there has been significant reduction in admissions and bed days of care with the use of telehealth.
For example, in FY14, an analysis of 10,621 veterans who were newly enrolled in home telehealth with noninstitutional care needs and chronic care management categories had a decrease of about 54% of bed days of care. This was about a 32% decrease in the hospital admissions compared [with] the same patient data prior to the enrollment and home telehealth. The analysis of telemental health outcomes shows that there was a 35% reduction in acute psychiatric bed days of care for veterans receiving CBT [cognitive behavioral therapy] or the clinical video conferencing telemental health in FY14 when it was compared [with] the utilization in the prior year.
Telehealth Pilot Programs
Dr. Agarwal. I must admit that there are many more programs that begin in the facilities, but at the national level. The first one is the tele-ICU implementation, where VISN 23 is supporting VISN 15, 5 of the medical centers with clinical video teleconferencing capability for live interactive consults with ICU specialists; and it covers about 78 beds. VISN 10 is supporting VISN 7 in 7 of their medical centers, which covers about 72 beds.
Another program, which is in the pilot phase right now, is the telewound care pilot, which is being implemented in 6 VISNs and combines the use of home telehealth, clinical video teleconferencing, and store-and-forward telehealth technologies to create access to a continuum of wound care options across multiple patients and provider settings and locations, all with the goal of enhancing and improving wound care treatment and healing.… The initial phase has been that all the participating facilities have been identified, and some of the operations manuals have been developed.
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The third quarter of this year, we will have a completion of the operations manual Provider Training and Treatment Template. The local sites are also working on the infrastructure and knowledge base so that this project can be completed by FY15.
And the last highlight that I’ll mention, which is in its very early stages, is a low-acuity/low-intensity pilot with the focus on health promotion and health prevention behaviors, such as tobacco cessation, weight management, and newly diagnosed but stable veterans with diabetes, high blood pressure, and heart failure, using a web-based browser technology.
VA Telehealth Leadership
Dr. Agarwal. Overall, when we start to look at the monumental impact of technology on other industries, such as banking, shopping, travel, and even personal communications, the emerging technologies continue to change the overall landscape of all these environments. This is an exciting time to be in the health care industry, because I think we have lagged somewhat behind in using technology. But as we look forward, the consumer-driven health care is going to become the norm.
As you know, VA has long been a pioneer with electronic medical records and with virtual modalities, such as telehealth both in the home and in the community, the use of patient web portals, such as My HealtheVet, secure messaging for various apps, kiosks; and we remain on the forefront of developing and utilizing these approaches to enhance health care delivery.
