The Role of Telehealth in an Evolving Health Care Environment Workshop Summary (2012) / Chapter Skim
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11 Experiences of the VA and IHS
11 Experiences of the VA and IHS
Pages 99-114
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The VA uses off-the-shelf technologies, and has a dedicated national telehealth training center for their staff. Additionally, they use standardized business processes because of the need for interoperability.
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to provide non institutional care across the health care continuum: for chronic care management, acute care management, and health promotion and disease prevention. As shown in Figure 11-1, the census for VA patients receiving home telehealth has grown steadily.
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Clinical Video Telehealth Clinical video telehealth replicates the face-to-face consultation (e.g., between provider and patient, provider to provider) and eliminates the need to travel for certain services.
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Outcomes assessments show reductions in bed days for home telehealth programs (53 percent) and clinical video telehealth for mental health care (25 percent)
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To meet these and other challenges, and to ensure the quality of their programs, the VA has three telehealth training centers that develop and provide standardized training and resource materials. Additionally, a quality management team provides biannual reviews of each Veterans Integrated Service Network (VISN)
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The S&F training center has trained more than 3,200 unique staff through more than 250 training events, and the home telehealth national training center has trained more than 2,500 staff through 800 events. Training innovations include clinical practice forums, integrated telehealth master preceptor programs, interactive meeting rooms, new and improved methods of training, out options for super users, the use of video to capture the human element, scenario-based instruction evaluation, the use of animation, and rapid response training.
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Many models require new commitments. For example, the IHS ran telenutrition services from northern Arizona in Indian health sites in multiple states for years, resulting in thousands of interactions.
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Finally, there are the telehealth innovations that require fundamental changes, especially for open systems, systems that are collaborative in nature, and not within particular organizations. An example is chronic care coordination after hospital discharge.
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Learning from that, Care Beyond Walls and Wires, a collaborative project in northern Arizona among private industry, the IHS, community health centers, and the Flagstaff Medical Center, is built on the need for relationships. This model uses tools like smartphones and a 3G signal so patients who live in remote areas can stay in communication with health care coordinators, especially after a hospital discharge.
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Embedded in that are organization-to-organization relationships, and particularly for native patients; this relates to eligibility across multiple systems. For example, Community to-community relationships Organization to-organization relationships Program to-program relationships Patient-to provider relationships FIGURE 11-4 Multiple relationships of telehealth care.
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For example, Shore related that in working with female natives with a history of domestic violence or posttraumatic stress disorder, the women often say it is easier to begin working with an unknown provider over video because in the initial visits, the distance helps facilitate a feeling of safety. As the relationship builds over subsequent sessions, the need for this feeling of safety through distance lessens as the patient develops trust with the provider.
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The conceptualization of health care teams has not kept pace with the technologies and the models that are delivering these technologies. Organizational Relationships Providing care may also involve multiple organizational collaborations.
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We also need to understand how technology affects the process of health care, either positively or negatively. Finally, we need to learn more about appropriate adaptations to make sure that the development of telehealth services and networks focuses on enhancing the quality of and access to care in order to fulfill the promise of telehealth, especially for American Indians and Alaskan Natives.
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One participant stated that NASA would be a good collaborative partner for the IHS and VA for the sharing of electronic medical record modules. Linking Data Sources One participant asked if federal data might be made available for use by the private sector, especially to do point-in-time evaluations.
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Senate bill had previously been proposed to authorize Medicare telehealth reimbursement for community health centers and Indian health sites. Darkins stated that CMS has been actively supporting telehealth development with many pilot programs.
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