Can expanding telehealth help VA solve veteran access crisis?

The Department of Veterans Affairs (VA) has been both one of the largest US users of telehealth in various forms–and widely criticized for practices including veteran patient wait lists for care, a lack of accountability, a scheduling system full of problems, an ancient EHR (VistA), and an inability to meet interoperability and modernization goals set over years. Telehealth is, in fact, one of VA’s bright spots with store-and-forward imaging, clinical video telemedicine and home telehealth.

At the American Telemedicine Association ATA 2016 meeting Monday, Under Secretary for Health and VA Chief Executive Dr. David Shulkin noted that the crisis has pushed VA into other options for achieving the goals set for the end of year: every VA medical center provides same day primary care services and same day mental health services. One area of focus is telemental health. Dr Shulkin announced in his plenary speech the opening of five new Mental Health Telehealth Clinical Resource Centers this summer, located in Charleston, Salt Lake City, Pittsburgh, and a consortium of facilities in Boise, Seattle, and Portland, Oregon. West Haven, Connecticut is already open as a specialty hub focused on the most severe and complex mental health issues, such as chronic depression and bipolar disorder. Other VA telemedicine initiatives include kiosks and text messaging to help with medication adherence and chronic condition management. (We’ve reported on their partnering with nhssimple to develop ANNIE, a sister of NHS’ Flo in text messaging to encourage patients in their health monitoring, TTA 2 Dec 15.)

VA delivered 2.1 million episodes of telehealth care last year (FY 2015), in 45 specialty areas of care, including 400,000 telemental health visits. They also reduced bed days by 56 percent, reduced readmissions by 32 percent, and decreased total psychiatric admissions by 35 percent, maintaining high user satisfaction scores at 89 percent.

Dr Shulkin also noted that four generations of veterans are served by VA–WWII, Korea, Vietnam and Desert Shield through current Iraq/Afghanistan–and all four have different delivery requirements. He closed with what is, for VA which has been very proud of their ‘home grown’ solutions from the time of Dr Adam Darkins in the early 2000s on, something unusual: “We’re looking to learn, we’re looking to work with all of you who are innovating to help take better care of veterans.” (Next on tap: the award of the next five-year round of home telehealth providers, which is presently down to two Grizzled Pioneers, Medtronic (Cardiocom) and Viterion.) MobihealthnewsVA press release

Flo and ANNIE: text messaging with a personality to improve health (UK/US)

Flo–the Florence Simple Telehealth text messaging system–is well known to our UK Readers as a successful initiative of the NHS. Over the past five years, starting from a test with NHS Stoke on Trent, it has been used by more than 30,000 people in over 70 health and social care organizations to help them monitor their health in areas as diverse as managing diabetes, living with COPD and managing breast feeding. Flo is customized by the clinician for the individual patient on questions, information, and speaks to the patient with a sometimes sassy ‘voice’ to help keep him or her on track. The Health Foundation has spotlighted Flo (named after Florence Nightingale) in ‘The Power of People’ with an overview page here and the video ‘Telehealth with a human touch’.

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/12/1109151630.jpg” thumb_width=”150″ /]nhssimple, a Social Enterprise is now tasked with developing the Flo program and since 2013 has partnered with the Veterans Health Administration in the US to develop a counterpart. Named ANNIE after Lt. Annie G. Fox, Army Nurse Corps, who was the first woman awarded the Purple Heart for her actions at Pearl Harbor, the VA is shortly testing it at four sites with intent to roll out nationally in 2016. This Editor has seen two presentations by Neil Evans, co-director of VHA connected health, in 2014 and this year at mHealth Summit (HIMSS Connected Health–see left). The Health Foundation video also includes an interview with Dr Wyatt Smith, prior Deputy CIO of the US Military Health System, and mentions the VHA. Hat tip to Phil O’Connell, Global Lead of nhssimple, for the update.

Widespread remote GP consultations getting closer; no shortage of implementation advice

Following our previous item on the topic, on January 16th, Tim Kelsey made it very clear to this editor at a PICTFOR event that the £1b promised to GPs for premises improvement included a strong requirement that GPs also invest in electronic support, including remote consultation technology.

It is therefore particularly pleasing to see in yesterday’s Pulse Today, an item on a Skype trial in Central London that both patients and GPs seem to love. Some key quotes:

Almost all patients surveyed about their experience of the remote consultation service said they ‘would use it again’ (95%).

Although patients were warned that ‘the security of Skype isn’t 100%’, 83% also said (more…)