Electronic Health Records

Veterans Administration Sets the Telehealth Table

The Veterans Health Administration's pioneering telehealth program is drawing the attention of health care reformers

May 24, 2010

Federal Computer Week - Each day, thousands of retired veterans don an electronic cuff at home that records their pulse and blood pressure and sends the information to care coordinators at the Veterans Health Administration. The patients also punch buttons in an electronic desktop box to indicate whether they feel shortness of breath or have swollen ankles. The care coordinators flag all problems that need immediate attention.

For Dr. Adam Darkins, the top telehealth executive at VHA, the greatest benefit of the Care Coordination/Home Telehealth program is that it allows older patients with chronic conditions to live at home independently for a longer time. And the patients indicate that they like it, too.

"We are getting patient satisfaction scores of 86 percent, which are very high levels,” said Darkins, VHA's chief consultant of care coordination. “The patients have to do less travel, and they can get problems resolved quickly.… They feel the care coordination system is their lifeline."

The Veterans Affairs Department has taken a lead role in adopting telehealth strategies, and it is expanding those programs as word has spread of its good results, such as reductions in hospital admissions and shorter hospital stays for the telehealth populations, which result in lower costs.

“We have seen a sustained growth in telehealth, and it is exciting to be recognized for that,” Darkins said.

Now VA’s quiet leadership in telehealth is about to gain a much broader audience. Policy-makers are eying the technology as a possible means of reducing costs and improving access to care as part of cross-cutting health care reforms. The White House and Health and Human Services Department are preparing to take a much closer look at telehealth solutions to see how they might be applied on a more widespread basis.

Telehealth, also known as telemedicine or e-care, refers to the use of devices and communications networks to deliver health care or health information to or receive medical information from patients. It is often used to allow patients at remote locations to consult with a physician or other medical specialist via videoconference or telephone. The term can also refer to electronic delivery of health data, images or metrics to assist in treating a patient. If mobile devices are used, it is sometimes called mobile health or mHealth.

Although telehealth technology has existed for decades, it has recently become more popular as video images and other tools have improved in quality and availability and as care and training protocols are tested and adopted at places such as VA. A research study by Frost and Sullivan measured the global telehealth market at $6 billion in 2008 and estimated that it will grow to $8 billion by 2012.

Several factors are driving the adoption of telehealth solutions.

• The anticipated entry of 32 million previously uninsured U.S. citizens into health insurance plans because of recent reform legislation, along with the general aging of the population, is contributing to shortages of primary care physicians nationwide and exacerbating shortages of specialists in rural areas. At current rates of graduation and retirement, there could be a gap of 150,000 physicians in five years, according to the Association of American Medical Colleges.


• The economic stimulus package of February 2009 set aside $7 billion for broadband networking, a portion of which will be devoted to rural telemedicine. The Federal Communications Commission’s National Broadband Plan (see stories below), released in March, also points to telehealth as an area of emphasis. FCC’s plan calls on Medicare to increase reimbursements for telehealth and on the Food and Drug Administration to develop a regulatory regime for telehealth.


• The health care reform package includes provisions for exploring new models of care to reduce costs. It funds a Center for Medicare and Medicaid Innovation that has authority to test new modes of service delivery and payment, including telehealth. The reforms also set aside funds for HHS to conduct telehealth pilot projects.


• The telehealth industry, working with health providers, has developed new products and solutions in recent years, and standards of care, interoperability and training are being created. New devices and modes of care are still evolving.

The federal government serves as a provider of telehealth services at VA, the Defense Department, the Indian Health Service and the Justice Department. It also acts as a payer for such services through Medicare and various pilot programs, although reimbursements for telehealth are limited. HHS and state agencies also regulate aspects of telehealth, such as licensing physicians and establishing standards of care.

In the next phase of growth, telehealth might become a building block of health care reforms in the drive to reduce costs and improve care. It is too early to say how large-scale that effort might be, but there are some positive indications in favor of telehealth expansion ...

National Broadband Plan Promotes Health IT, Telemedicine

Plan calls for e-care incentives and regulation

March 16, 2010

Federal Computer Week - The Federal Communication Commission’s national strategy for broadband issued today emphasizes health care, including electronic health record adoption and use, health data exchanges, telemedicine and mobile health services.

The National Broadband Plan makes 11 recommendations for using high-speed broadband networks to increase the use of electronic health records, health data exchange and telemedicine, or “e-care.”

E-care is defined by the FCC as the electronic exchange of information — data, images and video — help the practice of medicine and advanced analytics. E-care also is referred to as telehealth or telemedicine. When applied in mobile devices, it is sometimes called "MHealth" or "mobile health."

For telemedicine, the FCC also calls for the federal government to expand reimbursements and to remove barriers to adoption by updating regulations to for device approval, credentialing, privileging and licensing.

“Congress and the Secretary of Health and Human Services (HHS) should consider developing a strategy that documents the proven value of e-care technologies, proposes reimbursement reforms that incent their meaningful use and charts a path for their widespread adoption,” the plan states.

The FCC suggests working with the Food and Drug Administration to clarify regulatory requirements and the approval process for “converged” devices that are used both for communications and health care.

The plan has garnered the support of the American Telemedicine Association.

"These changes will greatly improve the quality of care, lower costs and improve access to healthcare to all Americans," said Jonathan Linkous, chief executive of the association. "We encourage Congress and the Administration to approve and implement these recommendations without delay.”

The plan also sees creating a Health Care Broadband Infrastructure Fund to subsidize health care delivery locations where existing networks aren't sufficient. In addition to hospitals, clinics and doctors’ offices, the broadband grants should be made available to nursing homes, health care administrative offices, health care data centers and other locations, the plan said.

The FCC also recommended that the Indian Health Service get up to $29 million a year to upgrade its broadband services.