AcuteCare Telemedicine Blog


Telehealth Takes Important Care To Veterans Through The VA

Even before the recent revelations of the administrative follies at the Veterans Administration (VA), it was common for each of us to know of a veteran seeking medical attention from a VA Hospital. Usually the discussion centered on the time it took the patient to travel to the nearest VA Medical Center, particularly for those patients living in more rural communities many miles from the urban centers where most VA facilities are located. It was even more difficult for those veterans who needed specialized care from a consolidated, regional VA Center located many more miles from their home, often one or more states away.

Despite today’s plethora of negative information coming from the embattled Veterans Administration, it appears that someone at the organization was doing something right in order to bring better and more accessible healthcare to our nation’s military veterans via telecommunication technology. The VA System seemed the perfect proving ground for implementing telemedicine on a larger scale. With patients scattered far and wide, doctors and caregivers were able to connect virtually with VA patients no matter how far they were from the hospital.

A recent review of the telehealth services initiatives at the VA indicates that more than 600,000 veteran patients received some element of their health care via telehealth in 2013. The patients represented 11 percent of the veterans in the VA health care system who participated in 1.7 million telehealth episodes of care. According to Dr. Adam Darkins, “telehealth in VA is the forerunner of a wider vision, one in which the relationship between patients and the healthcare system will dramatically change with the full realization of the ‘connected patient’. The high levels of patient satisfaction with telehealth and positive clinical outcome, attest to this direction being the right one.”

Forty-five percent of the patients live in rural areas, limiting their access to VA healthcare. The number of veterans receiving care via VA telehealth services is growing approximately 22 percent a year. Telemental Health is one of the leading specialties provided through telecommunication. The VA has delivered 1.1 million patient encounters through 729 community based outpatient clinics since 2003 and in 2013 the VA delivered 278,000 Telemental Health encounters to 91,000 patients.

The use of TeleDermatology is up by 279 percent from its inception, treating more than 45,000 veterans. New programs under development include TelePathology, TeleWound care, TeleSpirometry and TeleCardiology. Dr. Darkins says, “Telehealth is often described as helping provide the right care in the right place at the right time, which translates into many veterans receiving care in their own home and local community. In doing so, telehealth often avoids the need to travel, but can also alert the VA that a patient needs to be rapidly seen in the clinic or hospital.

Based on this report, the agency’s telehealth initiatives are positively impacting veterans by providing quality and accessible care.



Telemedicine: Modern Breakthrough or Timeless Concept?

Telemedicine is the practice of medicine at a distance; interaction that occurs remotely with the physician removed from direct contact with either the patient or other physicians. Telemedicine can include all phases of the physician-patient relationship, from evaluation (including pathology) to diagnosis and treatment. Although  recent breakthroughs in telecommunications technologies have accelerated the advancement of telemedicine, the desire to seek medical counsel regardless of the proximity of the healthcare provider is a common thread throughout medical history. The mechanism has changed, but medicine has long worked to remove the barriers of distance and time.

As early as the Middle Ages, “telepathology” was employed in the form of sending urine samples over distance to physicians for analysis. Prescriptions were carried over miles to patients before the advent of postal services. With the postal service came written letters describing symptoms to physicians, who would reply with diagnoses and treatment plans. These are all examples distinctly foreshadowing the emails and blog centered care that is now gaining a foothold.

Eventually, a milestone was reached when the telegraph allowed transmission of x-ray images. By the late 1800’s, telephony allowed direct 2-way communication between physicians. Still, a physical connection was required, and physicians at sea or without telephone access were at a loss. The radio broke that barrier by the 1920’s, and by the middle of the century, television technology brought real time images into the equation.

Near the end of the last century the most rapid, indeed explosive, growth of telemedicine utilization resulted from the symbiosis of computer technology, wireless communication networks and the internet. The ease of access to telemedicine that modern communication technology provides has broadened the scope of services. “Telehealth,” the utilization of remote presence to monitor health conditions, rather than responding to acute emergencies, is essentially commonplace. Moreover, well-care and health education have benefitted as well.

Today, we do not think twice about calling patients or colleagues on a phone, logging onto a computer for laboratory results, or reviewing radiology images on a TV screen. Soon, electronic health records (EHR’s) will be the norm. There are even technologies on the horizon which will become a partner with the doctor in establishing a diagnosis. The question for our future is when does new remote presence technology become standard of care? Inevitably, we will lose the “tele” and acknowledge that we are completely free of distance as an obstacle to patient care.