Discussion Board - Telehealth

Telehealth in VA is defined as: "The wider application of care and case management principles to the delivery of health care services using health informatics, disease management and telehealth technologies to facilitate access to care and improve the health of designated individuals and populations with the intent of providing the right care in the right place at the right time" Telehealth changes the location where health care services are routinely provided.

Telehealth Location Options: Can Be Clinic or Home Based:

Real-Time Clinic Based Video Telehealth

Traditionally, Veterans seeking health care traveled to the VA hospital or medical center. In order to increase Veterans' access to health care, VA has so far created over 700 hundred of community-based outpatient clinics to bring VA care closer to home for veterans. However, the nearby clinics may not have all of the specialty services and staff found at the regional medical center. For example, if specialty care is needed from a cardiologist (heart physician), neurologist (nervous diseases specialist), surgeon for follow-up after surgery, or psychiatrist for mental health care, the clinic provider may need to refer the veteran to the VA medical center.

For many Veterans travel to the medical center can be a very complicated and sometimes arduous task, particularly if the Veteran lives in a very remote or rural area, an area with sometimes severe weather, or even an urban area where congestion and traffic makes travel difficult. Some injuries such as traumatic brain injury or spinal cord injury further complicate travel. Travel time is time away from the Veteran's work or family.

VA is now recognized as one of the world leaders in this new area of health care. Clinical Video Telehealth (CVT) uses these telehealth technologies to make diagnoses, manage care, perform check-ups, and actually provide care.

Home Telehealth 

For Veterans who have a health problem like diabetes, chronic heart failure, chronic obstructive pulmonary disease (COPD), depression or post-traumatic stress disorder, getting treatment can be complex and inconvenient.

For some, especially older Veterans, conditions like these can make it difficult for them to remain living independently in their own home and make it necessary for them to go into a nursing home where their symptoms and vital signs (pulse, weight, temperature etc) can be checked frequently. Having this information means providers and nurses can change medications or other treatments and prevent serious health problems from developing.

Now there are new technologies that make it possible to check on symptoms and measure vital signs in the home. Special devices (home Telehealth technologies) can do this and are easy to use. Home Telehealth can connect a Veteran to a VA hospital from home using regular telephone lines, cellular modem (these act as doors for transmission of information) and cell phones (using a interactive voice response system).

VA has found that not every patient is suitable for this kind of care. But, for those that are, Home Telehealth can help them to remain at home and live independently.

Telehealth Specialties at the VA – 3 examples below:

1. TeleMental Health:

VHA uses information technology and telecommunication modalities to augment care provided by its Mental Health clinicians to Veterans throughout the United States. VHA TeleMental Health is the delivery of services using virtual linkages between VHA patients and Mental Health providers separated by distance or time.

2. TeleRehabilitation:

The delivery of services using virtual linkages like using video teleconferencing to link a speech pathologist located at the urban VA medical center with a post-stroke Veteran patient located at the local VA community-based outpatient clinic, or using home telehealth technologies to connect with Veterans at home to monitor their functional status and equipment needs.

3. TeleSurgery:

The main need VHA is meeting via telesurgery is not for operative surgery support but for specialist consultation to remote sites. The diagnosis of surgical conditions, the coordination of care for many surgical conditions and the triage of surgical patients can be favorably influenced by the availability of telesurgical consultation. Additionally, the use of telehealth can provide intra-operative consultation, patient and staff education as well as pre- and post-operative assessment.

Read Journal Article:

Perdew, C et al. Innovative models for providing clinical pharmacy services to remote locations using clinical video telehealth. Am J Health-Syst Pharm. 2017; 74: 1093-1098.

Link to VA Telehealth Website (optional):

https://www.telehealth.va.gov/index.asp