In both current and future programs, Darkins emphasized the close cooperation and coordination between telehealth efforts and some of the larger “connected health” activities being undertaken by VA.
Many of those activities were also instrumental in the VA’s “Most Wired” recognition.
“There are increasing opportunities to take what Adam [Darkins] and his team have done over the last 10 years in Telehealth and learn from some of those themes to then be able to deliver care not just through a video to the patient’s home or clinic, but perhaps even to their mobile device in their pocket. And that’s part of what we are working to coordinate in Connected Health: how all of these technologies that we use to interact with patients can also work together to provide greater connections to patients when they need it to manage their healthcare.”
“What has been done in telehealth in the VA hasn’t been done anywhere else to this degree,” enthused Dr. Neil Evans, co-director for Connected Health for the Veterans Health Administration and practicing primary care internist at the Veterans Affairs Medical Center in Washington, D.C. “It’s a very impressive implementation of telehealth technologies that is making a significant difference in the health and wellness of veterans across a really broad geography.”
Emphasizing the theme of technology convergence, Evans explained, “There are increasing opportunities to take what Adam [Darkins] and his team have done over the last 10 years in Telehealth and learn from some of those themes to then be able to deliver care not just through a video to the patient’s home or clinic, but perhaps even to their mobile device in their pocket. And that’s part of what we are working to coordinate in Connected Health: how all of these technologies that we use to interact with patients can also work together to provide greater connections to patients when they need it to manage their healthcare.”
Doctors at the VA Eastern Colorado Health Care System in Denver conduct a telemedicine training demonstration. Telemedicine is enabling veterans across the country to access VA expertise, wherever it may be. U.S. Department of Veterans Affairs photo by Shawn Fury
“For example, we have a personal health portal called ‘My HealtheVet,’ and in 2012, we served 2.4 million veterans through that website, of whom 750,000 communicated securely – electronically through secure messaging – to their VA healthcare team, and 842,000 downloaded their own personal health information from the site to review in managing their care or coordinating that care with other healthcare providers they may have been seeing outside of the VA,” he said.
“The key point that we want to make here is that the VA views itself not as a hospital system but really as a health system that is not constrained by the four-walled, brick-and-mortar healthcare clinics or hospitals managed by VA,” he continued. “We view healthcare as occurring as people are in their ‘life spaces,’ not just when they are with us in VA facilities.”
Asked for any messages for today’s veterans about the ongoing Telehealth and Connected Health efforts, Darkins offered, “We would want them to understand that Telehealth/Connected Health is a reality here and now. We are not ‘pilot’ programs. We are delivering mission critical services to very large numbers of veterans – just under a half-million – who are highly satisfied with that care. And it’s not only saving them long distances in travel but also really helping to get healthcare decisions made closer to the patient and more rapidly than they otherwise would be made.”
“All of this builds on an organization which has a tremendous expertise in implementing healthcare technologies, and it further marks VA as a leader in the implementation of those innovative technologies,” he said.
“This is a reality now and these services are available,” Evans echoed. Turning the message toward tomorrow’s veterans, he acknowledged, “We know that patients receive better healthcare when they are able to be fully engaged in the healthcare part of the process – when the healthcare is truly patient-centered. So we are designing our Telehealth and Connected Health system to meet patients where they are, and not force them to go over hurdles and through a whole bunch of hoops in order to receive the care that they need. For tomorrow’s veterans, I think the important concept for them to take away is that the VA is committed to continuing to innovate; to be able to deliver care in a way that meets veterans’ healthcare needs where they are and how they need it to provide them enhanced access to care – not just through face-to-face visits but through interactions with the healthcare system using technology that really extends our reach, allowing veterans across this country to access the deep expertise that is found in the VA.
“Just as the start of Telehealth, with the Home Telehealth, was driven by the needs of our veterans, particularly those of our older veterans, the directions that VA is taking now are being very much driven by the new veterans coming into the system. So we are working very closely with the Department of Defense in moving the thinking in healthcare toward the use of mobile devices and other areas where Neil [Evans] and his people are so closely involved. The Department of Defense is doing that because that’s what today’s service members want. And really what VA is doing in its Connected Health work is working to establish the healthcare systems for tomorrow’s veterans.”
“As Adam noted, the VA has tremendous expertise in deploying healthcare technology and making it work,” he added. “And I certainly agree with that. But I would also say that when you get down to it, healthcare is about a relationship. It’s about finding a trusted group of clinicians or healthcare team that you trust to help manage you at points in your life when you are at your most vulnerable. And VA has tremendous expertise across this country with specialists who are clearly recognized as leaders in their fields; primary care providers who have a deep dedication to providing comprehensive patient-centered care. And Telehealth/Connected Health are just the tools to help enable patients to more easily connect to those great resources that they have at their disposal if they are receiving healthcare from the VA.”
Darkins added, “Just as the start of Telehealth, with the Home Telehealth, was driven by the needs of our veterans, particularly those of our older veterans, the directions that VA is taking now are being very much driven by the new veterans coming into the system. So we are working very closely with the Department of Defense in moving the thinking in healthcare toward the use of mobile devices and other areas where Neil [Evans] and his people are so closely involved. The Department of Defense is doing that because that’s what today’s service members want. And really what VA is doing in its Connected Health work is working to establish the healthcare systems for tomorrow’s veterans.”
In fact, the work being done today may have national applicability beyond tomorrow’s veterans.
“For the American public, I think there’s something to be learned from what the VA has been able to accomplish here, because they are an integrated healthcare system,” Evans stated. “Our healthcare providers are employees of the organization. Our primary care and specialty/secondary care view themselves as a team that is serving patients together. And where some of the challenges faced elsewhere in the U.S. healthcare system – surrounding reimbursement, care across state lines, licensing issues – can be a struggle, this provides a lesson as to what an integrated healthcare system can do to proactively meet the needs of their patients.”
“I believe that what you are seeing in VA is a forerunner to what you are going to see in the wider healthcare system,” Darkins concluded. “Just as the Internet was developed essentially within the federal government – started by the Department of Defense, working with ARPA [the Advanced Research Projects Agency], then DARPA [the Defense Advanced Research Projects Agency], then academic centers – and took several years before it went out into the public domain, I think that many of the things we are talking about here – along with other forward-thinking healthcare systems – will represent the healthcare of the future.”
This article first appeared in the The Year in Veterans Affairs & Military Medicine 2013-2014 Edition.