Connected Health: VA leads way for telemedicine

BOSTON—The Department of Veterans Affairs (VA) provides care for 461,000 veterans, more and more with remote healthcare, said Adam Darkins, MB, ChB, MD, chief consultant, care coordination services, speaking at the ninth annual Connected Health Symposium on Oct. 25.

The VA’s telemedicine portfolio is broad, Darkins said, including e-consults, mobile health and teleradiology. More than 110,000 patients have passed through the program and 75,000 veterans have their chronic conditions monitored.

Over the next year, the VA is planning to go from 461,000 patients to 825,000. “We are more or less where we planned to be back in 2003 when the programs started.” When the organization will be in another 10 years is hard to say, he said. “It’s like looking at a new color,” which is virtually impossible to describe.

Part of the VA’s success with telemedicine is the organization’s commitment. “This wasn’t thinking we might do it or we’ll try it and see how it goes,” said Darkins. Another important factor was the fact that “if you don’t have an underlying patient need driving telemedicine, you’re not going anywhere.”

The veteran population is aging, Darkins said, and as they get older they want to stay in their own homes. “There’s our patient need right there.” The results of a pilot program showed that telemedicine worked and the VA then took it to scale.

“The devil is in the details” is a phrase Darkins said he overuses but “there are no minor details.” That attitude makes the difference between your program growing and not growing. For many programs, the pilot starts off with relationships. “That is hugely important but as you grow your program relationships can only take you so far. You can’t replicate them. Ultimately, they can be the demise of your program.” A successful strategy is designed to replace relationships with processes.  

A typical program spends about $10,000 to get a team together to work through all the issues for about a day-and-a-half. If they roll out the pilot, they’ll probably spend $150,000 to $200,000. A full-scale program costs approximately $4 million. The time to resolve issues is when you’re spending closer to $10,000, Darkins said. “It’s much more important spending time getting everything right. If it fails the first time, it’s much more difficult to get somebody back a second time.”

Skilled staff is a big challenge to telemedicine programs, Darkins said. When the VA viewed going to scale back in 2004, they also set up training centers. The organization has now trained more than 4,000 people—98 percent of which was conducted virtually. A standardized curriculum is important as well and while it doesn’t have to be rigid, “the delivery pathway shouldn’t be infinitely varied” either. Not having enough support staff can be “the weak link in the chain,” he said. “Supporters are key to making it work.”

Reviews of telemedicine efforts have shown to reduce utilization, decrease lengths of stay and increase patient satisfaction. For the VA, telemedicine has resulted in $1,900 cost avoidance per patient, Darkins said. Such impressive findings “are consistently present since 2005 and are consistent across populations of patients.”

To clinicians skeptical of telemedicine, Darkins said, “Go see what it means to patients. The absolute test of this is smiles on their faces—not traveling 200 miles from home for healthcare.”