Q&A
Related: Committed to Showing Results at the VA
More than 717,000 veterans have accessed VA care through telehealth in fiscal year [FY] 14, and 45% of these veterans live in rural and highly rural areas. In FY14, the total for veterans using telehealth represented about an 18% growth from the prior year; and the telehealth services provide access to help in more than 45 different specialty areas, including those areas where VHA has a particular expertise, especially, for example, in mental health that may not be available from the local community partner.
Telehealth Uses
Dr. Agarwal. A veteran who is living in a rural area, let’s just say in some rural part of Maryland, and has to commute to the Baltimore VA, which you know is an inner-city VA medical center, to keep his appointment for a mental health condition with his VA provider. Now, using telemental health, this veteran can access this provider from his or her own home through encrypted video conferencing and complete the telemental health visit in the comfort of his or her own home so that they are not subject to the traffic and other challenges that they would otherwise face and get even more stressed than what they started out with. The ability, the convenience of having the service of counseling or cognitive behavioral therapy into their own homes, is just remarkable.
Another example that I could cite for you would be an appointment in the hearing aid clinic. So a veteran who lives in the Florida Keys normally would have to travel 5 hours from the Florida Keys, go to Miami, stay in a hotel overnight so that they can go to their appointment at 8 am. Instead, the veteran now can visit the Key West clinic and have his hearing aid adjusted by a VA audiologist who’s located in Miami; and it saves the entire trip.
The third one I will cite you has to do with the C&P [Compensation & Pension] exams. Now, a veteran living even out of the country can access a VA provider in Connecticut or some [other] state, using the encrypted video conferencing; and they can have the whole clinical evaluation for C&P completed using the video conferencing. These are some of the examples of how telehealth has been used very successfully.
Technologic and Educational Challenges
Dr. Agarwal. We have been a pioneer of telehealth. And with that, of course, all those challenges come into play. And we certainly have implementation challenges that include provider and patient education and their buy-in into the use of technology and providing services as well as the technology itself and some administrative issues. They can all be very closely linked.
You know, one illustrative example that I just cited earlier about video conferencing is one such example into the veteran’s home. It is very convenient.… We started to implement this home telemental health program a couple of years ago. But since then, about 108,000 veterans have accessed using the video conferencing technology; but fewer than 2,000 or so have done it from their own home. And that’s largely because the current video visit from home is quite cumbersome. It requires passwords for each visit. It requires that the veteran download VA-licensed software on their own device. And in addition, there are restrictions because of the availability of the broadband Internet connectivity, which is required for the video visit—more so in the rural areas.
Related: Preparing the Military Health System for the 21st Century
Our general counsel is reviewing and attempting to resolve state licensure requirements that have been raised by some states, because the veterans here receive care at home and outside of our VA brick-and-mortar facility, as well as the legality of VA providers potentially prescribing a controlled substance for a veteran at home without a prior in-person office visit.
But to overcome the provider challenges, the national telehealth training and resource center has been working on training the providers in the use of telehealth. Roughly 11,400 VA staff have been trained in the use of telehealth in FY14. We have currently 144 facility telehealth coordinators and more than 1,100 telehealth clinical technicians who assist with training and outreach for both VA staff and veteran patients.
Legal/Security Challenges
Dr. Agarwal. High-speed connectivity happens to be one of the key ones.… Using 4G services, I think, is going to be essential for every veteran regardless of rurality. And when these 4G services are not available, that certainly hinders the ability to provide telehealth to all veterans. Having the right security with full data encryption is essential so that we can protect the private health information of the veterans.
