The VA’s Place in Telemedicine
The Affordable Care Act (ACA) signed into law by President Obama in 2010 represents the single most significant overhaul to the American healthcare system since the establishment of Medicare and Medicaid back in 1965. The ACA, commonly referred to as Obamacare, remains a highly contested and scrutinized hot topic issue that is poised to irrevocably change the landscape of healthcare for generations to come. One major area of concern is how doctors will be equipped to handle the influx of millions of new insured patients despite a significant and growing shortage of doctors and pediatricians. With the dilemma of more patients and less physicians, the US government has acknowledged the need for fundamental change in health care accessibility using telemedicine and new health technologies. Telemedicine, or Telehealth, allows patients to undergo medical examinations, consult with specialists, engage in therapy sessions, share diagnostic information, and more through phone calls, video chat options, emails, and other electronic communication tools from the comforts of their own homes or closer, more accessible medical centers.
Used primarily in the past to reach rural patients, telemedicine has been used by the federal government for decades now in the Department of Veterans Affairs (VA). Long established as a pioneer in the Telehealth movement, the VA’s history with telemedicine sets a precedence for nationwide public health research and implementation. In 2014 alone the VA treated 690,000 veterans, or about 12% of all individuals enrolled for VA healthcare by way of remote technology and shows no signs of slowing down anytime soon. A recent VA report estimate their use of telemedicine will grow around 22% next year.
The VA’s foray into telemedicine didn’t stem from wanting to be on the cusp of cutting edge health technology. The allure of telemedicine was growing in the mid 1990s as technology was becoming cheaper and more readily available. But for Adam Darkins, the VA’s chair of Telehealth services, the vision for veteran’s health optimization ultimately came down to patient access and increasing accessibility regardless of geographical location. Although the VA has a network of over 150 hospitals and over 1,100 other medical facilities, there were still huge populations of unreachable veterans living in rural areas that needed medical attention. Official US census reports found that 45% of veterans needing healthcare services were living in classified rural counties. So in the 1990s the VA developed a series of Telehealth pilot programs that aimed to reduce travel costs, expand its reach, and increase the quality of care for veterans.
From 2003 onward the VA has implemented a three tiered system of IT networks to administer Telehealth services. The first is video conferencing between hospitals and clinics and patients, basically replicating what would be a face to face doctors appointment, but from separate locations. The second is home Telehealth, which monitors people suffering from chronic diseases in their own homes. The third is called store-and-forward Telehealth and takes digital imaging and stores the information so it can be reviewed by specialists elsewhere. There is overlap between the three systems but all share the VA’s goals of increasing patient satisfaction and optimizing overall treatment productivity.
Dawkins and the VA’s ideas paid off and Telehealth use was a success. In 2013 the VA reported hospital admissions were down 35% due to home Telehealth services with enrolled patients saving around $2,000 annually. For the patients, treatment was less of a hassle, easier to maintain, and their medical knowledge was expanded allowing them to make more informed decisions regarding their health. The VA reports overall home Telehealth patient satisfaction scores of 84%, store-and-forward scores of 95%, and clinical video Telehealth scores of 94%. Besides the three branches of VA Telehealth, the agency is currently involved in a pilot program that allows veterans to enter vital information to an online tool that can be accessed through mobile phones, computers, or tablets to help their primary caregivers manage chronic conditions such as diabetes or glaucoma, two diseases suffered frequently by veterans.
As recently as November 2014, the VA has been on the forefront of Telehealth advancements not just in physical health, but mental health as well. Since 2003 more than 1,100,000 veterans have engaged in telemedicine treatment through the VA and in 2010 the VA established a separate National Telemental Health Center aimed at helping veterans cope with mental illness such as depression, schizophrenia, bipolar disorder, and post-traumatic stress disorder (PTSD). PTSD is a very common in veterans and more than 500,000 or 9.2% enrolled in the VA healthcare system have been diagnosed. For many veterans, there is a stigma attached to mental illness and conventional therapy sessions but through the VA’s telemental health programs they have been able to receive treatment in a setting more comfortable to them. Researchers at the University of Washington recently published a study highlighting the benefits of using telemedicine as a treatment for veterans suffering from PTSD. Research found that veterans had better clinical outcomes after using telemedicine as a form of therapy, and possibly preferred telemedicine treatment to traditional therapy sessions. Patients did not interact with psychologists in person but instead used interactive videos, phone calls and electronic medical records to get treatment. Subjects who used telemedicine had less severe PTSD at the end of the study compared with those who weren’t involved in telemedicine treatment.
In 2014 the US government acknowledged the vital and successful role telemedicine played in serving veterans health needs and proposed a $16.3 billion budget allocation to overhaul the VA’s existing system and placed an increased focus on telemedicine. The proposed bill would require all VA centers have the capability to provide telemedicine services and would require all VA medical centers to send an annual report to congress detailing such uses over the year.
The VA has done a commendable job implementing telemedicine work on a large scale and is poised to set an example for the inevitable boom of telemedicine for the rest of the American public. For Darkins, “The veteran population experience is a precursor of what is going to happen to the wider general population” and should be studied as such. When the VA was faced with a mounting number of aging veterans needing medical care and a substantial number of vets returning home from Afghanistan and Iraq, they adapted to meet the needs of such an inflow. This is not unlike what the US will face as millions of newly insured citizens start entering the medical marketplace, life expectancies continuing to rise, and the population size continues to grow. As the US healthcare system is about to embark into a brave new world, we can be comforted that other national programs have been finding successes for decades now in Telehealth.