How telemedicine is helping the VA address its access crisis

By Jonah Comstock
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The Department of Veterans Affairs has had a rough couple of years. The year 2014 saw the VA come under fire for an inefficient system that left tens of thousands of patients facing long waits for care with some even dying as a result.

The silver lining of this crisis, Under Secretary for Health and VA Chief Executive Dr. David Shulkin said at the American Telemedicine Association annual conference yesterday, is that it has pushed the VA into exploring new avenues to provide veterans with care including, increasingly, telemedicine options.

“One of the good things about crisis is that it does give you a sense of clarity,” Shulkin said in his plenary address. “And so in response to this access crisis we’ve recently released what we look at as our Declaration of Independence, what we call our Declaration of Access, that commits to the sustainable fixes we’re going to take at VA to address the access issue for veterans. That includes having same day primary care services and same day mental health services in every VA medical center in the country by the end of this year. It also includes a significant enhancement in our telehealth capabilities because we believe telehealth is such an important component of addressing the access issue for VA.”

The VA did 2.1 million episodes of telehealth care last year, Shulkin said, including home telehealth, site-to-site telehealth, and store and forward. That included 400,000 telemental health visits.

Because the VA is responsible for patients anywhere in the United States, whether they live in rural or urban areas, VA’s approach to telehealth involves creating hubs from which different kinds of care can be remotely delivered. A Palo Alto radiology hub serves 88 other VA facilities, for instance, and the VA also has hubs for tele-ICU and for remotely-delivered genetic counseling. 

At ATA, Shulkin announced the opening of five new telemental health hubs. The Mental Health Telehealth Clinical Resource Centers will be located in Charleston, Salt Lake City, Pittsburgh, and a consortium of facilities in Boise, Seattle, and Portland, Oregon. A specialty hub focused on the most severe and complex mental health issues, such as chronic depression and bipolar disorder, is already open in West Haven, Connecticut. The others will open this summer.

So far, VA telemedicine initiatives have reduced bed days by 56 percent, reduced readmissions by 32 percent, and decreased total psychiatric admissions by 35 percent, Shulkin said. User satisfaction scores are also high, up around 89 percent.

Shulkin also spoke about various other VA telemedicine initiatives, including new experiments with kiosks and text messaging to help with medication adherence and chronic condition management. That’s in addition to the 32 apps in the VA app store.

“At VA now we’re treating four different generations of veterans and each want their healthcare delivered in a different way,” Shulkin said. “We’re looking at using a veteran-centric approach, asking ‘How do you want your healthcare delivered?’ Obviously now more and more people want it delivered in their mobile apps for convenience, so that’s the direction we’re heading in. We have to continue to meet the veteran where they are right now.”

The VA wants to use technology to rise above its recent access crisis, Shulkin said, and they’re willing to do that with partners as well as with technology developed in house. 

“We know we can’t do this alone,” he said. “We know we need partners, we need all of you who are out there innovating to help us take care of our veterans. This is a shared responsibility. The crisis has helped us learn that we can’t do this alone. And this is a different VA than the past. We’re looking to learn, we’re looking to work with all of you who are innovating to help take better care of veterans.”