12 percent of US veterans now using VA telehealth services

October 15, 2014 | by

The US Department of Veterans Affairs (VA) has some good news (for a change)–that during the just-closed Federal FY 2014, 690,000 veterans, or 12 percent, used telehealth services. This was a 13.3 percent increase over FY 2013 (608,900). While this report is preliminary (beware!), we see a slowing of growth in the number of veterans accessing telehealth and a concentration–not dispersal–of telehealth services in rural areas (+ 10 points). This chart compares the numbers:

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/10/VA-2014-vs-2013.jpg” thumb_width=”350″ /]

Chart: EIC Donna. Please note that percentage of telehealth users add up to over 100 percent due to usage (one patient could access two or three forms of telehealth. FY14 telehealth user breakout is estimate based on FY13 percentage, to be eventually compared to official figures.)

Telehealth as defined by VA: (more…)

The King’s Fund videos, presentations online

October 4, 2014 | by

The King’s Fund has posted video highlights from last month’s International Digital Health and Care Congress. Talks include those from futurist Ray Hammond, Kathleen Hammond (US Department of Veterans Affairs), Dr Ali Parsa (Babylon), Paul Rice (NHS England) and Sian Jones (NHS Bristol). Click on the tabs at top for presentation decks and posters. TTA was a media partner of the Congress. Hat tip to Mike Clark via Twitter (@clarkmike).

Brain neuroprosthetics, stimulation for TBI, PTSD

August 11, 2014 | by

A signature injury of the Iraq and Afghanistan wars has been traumatic brain injury (TBI), as well as an outcome of all wars–post-traumatic stress disorder (PTSD). Over 270,000 veterans since 2000 have been diagnosed with TBI–along with 1.7 million civilians per year. The US Department of Defense (DOD) has been funding research in several areas to help veterans–and eventually civilians–with these traumas.

  • DARPA’s RAM: Restoring Active Memory program is seeking to compensate for brain injury by developing a neuroprosthetic to aid memory function. (more…)

VA reduced bed days by 59%, hospital admissions by 35% in 2013

June 20, 2014 | by | 1 Comment

Not all is gloom ‘n’ doom at the US Department of Veterans Affairs (VA), rightly excoriated for cooking the books on wait times for admissions, allowing an estimated 40 veterans to die waiting for care at the epicenter of the coverup, a Phoenix VA hospital, its secretary resigning. A consistent bright spot has been its use of telehealth and telemedicine, along with the Department of Defense (DOD), making them the largest US telehealth contractors. Neurosurgeon Adam Darkins, MD, who is their chief consultant for telehealth services, kept a speaking date at Tuesday’s Government Health IT Conference in Washington, DC to present encouraging results.

  • The VA’s FY2013 telehealth program totaled 608,900 patients and 1.8 million telehealth episodes of care. 45 percent of the patient population live in rural areas, receiving care from 151 VA Medical Centers (VAMC) and over 705 Community Based Outpatient Clinics (CBOCs)
  • 2009 to 2012 data show showed a 4 percent cost reduction after a year in a telehealth program, versus a one-year spike of 48 percent in costs for those veterans outside telehealth
  • Cost savings are estimated at just under $2,000 per year per patient
  • Over 41,000 patients were enabled to live independently in their homes using telehealth
  • VA also leads in telemental health, with its National Center providing 2,893 video consults to 1,033 patients at 53 sites in 24 states
  • The program is expanding at a rate of 22 percent per year

VA’s telehealth covers six areas: clinical video telehealth, home telehealth, (more…)

A snapshot of telehealth and telemedicine in rural America

March 28, 2014 | by

Telehealth and telemedicine (virtual consults) are moving forward in large and largely rural Nebraska and neighboring Iowa. The Nebraska Medical Center not only has an executive director for telehealth (not buried in an HIT department) but also no less than 13 initiatives in process from stroke to cancer care. Video networks connect rural hospitals with medical centers. The VA’s leadership in this geographic area has been crucial, with over 550 patients in home telehealth in Nebraska – Western Iowa and additional telemedicine programs for psychiatry, wound care, nutritional counseling and infectious diseases. Videoconferencing equipment in hospitals and public health centers, installed in a mid-2000s program, is being repurposed for video consults. Interestingly, its use in this region is not new. For 10 years, a University of Nebraska Medical Center (UNMC) psychiatry associate professor has been having routine video psychiatric consults with elderly nursing home patients. Telemedicine’s first use in Nebraska was also psychiatric–55 years ago–by a University of Nebraska Medical Center dean using undoubtedly black-and-white two-way video. Doctor’s home visit is back — kind of — as telehealth flourishes nationwide (?–Ed.), Omaha World-Herald

Telehealth & telemetry to push US monitoring market to $5.1 bn by 2020

March 20, 2014 | by

New market research predicts that the health monitoring market in the US will exceed $5 billion by 2020. The research by iData Research covers devices and equipment for both hospital based telemetry and home based telehealth markets.

According to the report, the US patient monitoring market was valued at over $3.5 billion in 2013 and will grow to over $5.1 billion by 2020 due most notably to the expansion of multi-parameter vital sign monitors, electroencephalograms (EEG), electromyograms (EMG), cerebral oximeters and pulse oximetry devices. The pulse oximetry monitoring market alone is expected to exceed a billion dollars by 2020.  Players leading this growth are Medtronic, Bosch Healthcare, St. Jude Medical, Honeywell, Boston Scientific, Philips Healthcare and Biotronik.

Interestingly, the report notes that the Veterans Health Administration (VHA) represents the largest example of telehealth success within the U.S. and that they serve over half a million patients who receive telehealth-based solutions.

New products which feature smartphone integration and Bluetooth capabilities entering the market will further drive sales, say iData; other remote monitoring devices such as modern pacemakers, implantable cardioverter defibrillators (ICDs) and hemodynamic monitors are paving the way for substantial growth in this market. So it is not all telehealth by any means.

VA, DoD aren’t collaborating on EHR: GAO

February 28, 2014 | by

Your ‘Dog Bites Man’ item for the weekend (no, it’s not in reverse!) is that the Government Accountability Office (GAO) has determined that Veterans Affairs (VA) and the Department of Defense (DoD) have not yet proved that their current two-system path, having rejected a single EHR, actually will be workable. In February 2013, both agencies abandoned a joint system after $1 billion in spend, and $4 billion in fixes/upgrades to their separate VistA and AHLTA systems. [TTA 15 Dec] By the two agencies going their separate ways, the GAO is mystified on what is going on with interoperability. The answer: not much. And as mentioned in our 15 December article, there was a 31 January deadline for an interoperability plan (or single system) to be implemented by 2016, mandated by the 2014 National Defense Authorization Act (NDAA). Obviously, this deadline has come and gone. FierceEMR article, GAO recommendation (full text PDF)

One way to overcome the interoperability problem and too much in the EHR? Get rid of those pesky backlogged patient records! The Daily Caller uncovered a VA whistleblower’s complaint to the VA’s Inspector General and their office of special counsel, plus Congress, that VA officials in Los Angeles intentionally canceled backlogged patient exam requests going back more than one year–and that the delay on exams went back 6-9 months. The deletions started in 2009. There is a wrongful dismissal (of said whistleblower) suit and other joy. Article, audio (02:21) Updates 3-4 March:  according to Under Secretary for Health Robert Petzel, the Daily Caller report was ‘scurrilous’. He stated that about 300 records were closed but not deleted after administrative review, generally for old imaging requests, and there was no effort to delete records to boost performance.  According to FierceHealthIT, the backlog is about 400,000. Also Military Times. According to EHR Intelligence, both DoD and the VA agree with the GAO recommendations; GAO will update its findings once the agencies have taken action. Also iHealthBeat.

Powerhouse DC lobbying for telehealth, telemedicine

February 13, 2014 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /]The Gimlet Eye observes from a houseboat anchored at a remote Pacific island, with coconuts and occasional internet to Editor Donna.

Telehealth and telemedicine have reached a US milestone of sorts: the formation of a Washington, DC-based ‘advocacy’ (a/k/a lobbying) group constituted as a business non-profit. The Alliance for Connected Care is headed by three former Senators (two of whom were ‘amigos’) from both sides of the aisle and backed by a board including the expected (giants Verizon, WellPoint, CVS Caremark, Walgreens)–and the surprising (much smaller remote consult provider Teladoc and HealthSpot, the developer of the HealthSpot Station kiosk–hmmm, must be a fair chunk of their marketing budgets there) flanked by six well known ‘associate members’ including Cardinal Health and Care Innovations (another hmmm). There’s also a hefty ‘advisory board‘ including the American Heart Association and the NAHC (home care). The leadership team members are all members of major Washington law/lobbying firms. Tom Daschle is recognized as one of the most influential former Senators in town via DLA Piper, though himself not a registered lobbyist (OpenSecrets.org). Trent Lott and John Breaux hung out their own shingle and were recently bought by mega-lobbyist Patton Boggs. To put a fine point on it, more high-powered one does not get. The Eye sees that the time is prime for the Big Influence and…

What the Eye sees is Big Financial Stakes: Private insurers are required to cover telehealth in 20 states, as does Medicaid in most. The VA is a major user. But the great big trough of Medicare is new territory; covering 16 percent of the population, the use of telemedicine and telehealth is limited to certain geographic areas. (MedCityNews) This marks the infamous tipping point: the clarion call to ‘build significant and high-level support for Connected Care among leaders in Congress and the Administration’, ‘enable more telehealth to support new models of care’ and ‘establish a non-binding, standardized definition of Connected Care through federal level multi stakeholder-input process’ (whew!) Big companies want in, insurers want reimbursement, and they want it from somewhere as well. Toto, we’re not in the Kansas of Small anymore with ‘connected health’–we are now in the Oz of Big Money and Power Players. Alliance release (Oddly the website looks preliminary despite the big announcement and backing.)

More on this strategy: It’s called ‘soft lobbying’ and it is the latest thing in the Influence Wars. The Alliance for Connected Care is a 501(c)6 non-profit, similar to a business league like the Chamber of Commerce, and this has become a popular tactic. It’s also a less regulated, less transparent way to shape coverage, public opinion and exert influence on legislators. See this well-timed examination from the Washington Post on the corn syrup versus table sugar wars. ‘Soft lobbying’ war between sugar, corn syrup shows new tactics in Washington influence

Telepsychiatry: a new practitioner’s experience

January 27, 2014 | by

Daniel W. Knoedler, MD in Psychiatric News chronicles his first week as a full-time telepsychiatrist, working for the Green Bay VA Hospital in Green Bay, Wisconsin. He is definitely a bit stressed as he adjusts to working alone in a cold basement, his image in the video system and the Loneliness of the Long-Distance Psychiatrist who doesn’t have face-to-face contact with patients–and his own socialization. Yet he thinks telemedicine is useful in addressing the lack of access to care for patients and that the technology is not much of a barrier. He does worry about the consequences of not shaving, leading to some musings on Howard Hughes.  Telepsychiatry: First Week in the Trenches

Telecare – time to lose the last “e”?

January 12, 2014 | by | 1 Comment

Many years ago when I co-founded eForum to promote what was then called “eGovernment”, it was common for smart speakers to begin their conference presentations by saying that it’d soon be plain “government”, which indeed it has been now for many years; around the world, government sector workers have embraced technology to offer huge improvements in quality of service to citizens at reduced cost. Sadly health services have proved far more resistant to the beneficial use of technology, so eHealth & mHealth seem likely to take rather longer to lose their prefixes, in spite of pleas from the VA. If any support for this view was needed, the telehealth news from the flat earth society of a recent survey of GPs (more…)

NIH-NFL research grants on brain injury awarded (US)

December 19, 2013 | by

In September 2012, the National Football League (NFL) donated $30 million to the Foundation for the National Institutes of Health (FNIH) to focus on brain injury. The Sports and Health Research Program (SHRP) now has a somewhat wider scope inclusive of joint diseases, sudden cardiac arrest, sickle cell anemia and hydration/heat injury. Last week they announced eight projects to be supported. Two ($6 million each) are cooperative agreements focusing on brain injury and after multiple concussions. These research projects are:  Boston University, which has pioneered major CTE research [TTA 5 June], and the VA on CTE; the pathology of CTE and delayed TBI from Mount Sinai Hospital in New York City. The six other studies are ‘pilots’ totalling about $2 million over two years and range from cortical GABA in pediatric sports concussion, the Spot Light concussion management app developed by Inlightened, LLC, and eye movement tracking for concussion detection. FNIH release

EHR interoperability redux for VA, Department of Defense (US)

December 15, 2013 | by

Back in late February, the US Department of Defense and Veterans Affairs announced that they would not achieve their goal of a single EHR by 2017, and would stick with their creaky AHLTA and VistA systems for the foreseeable future [TTA 3 April]–along with the general lack of interoperability–eyes rolled at the $1 billion down the drain, but seemingly not much else budged. (And this does not include the $4 billion spent on failed updates and fixes in both systems–TTA’s ‘Pondering the Squandering’, 27 July) To this Editor’s utter shock, the 2014 National Defense Authorization Act (NDAA), agreed to by the House and Senate this week, mandates a plan for either interoperability or a single system by 31 January–about 6 weeks from now–and to adopt it by 2016. Moreover, both systems must be interoperable with private providers based on national standards by 1 October 2014. A close reading of the NextGov article indicates that the bill adds levels of complexity and perhaps unworkability. Getthereitis, anyone?–or does this sound like Healthcare.gov, redux? FierceMobileHealthcare

And it takes a grad student to find a major info security flaw in VistA.  (more…)

Exoskeleton to aid paraplegic in charity walk (US)

November 21, 2013 | by

This past Sunday, architect Robert Woo walked a mile in NYC’s Riverside Park for Generosity NYC 5K. Now that would not be remarkable at all except that Mr. Woo is a paraplegic, and he is walking that mile with the aid of an Argo ReWalk exoskeleton. He and his ReWalk-equipped teammates are raising funds as Team ReWalk to aid the Bronx Medical Veterans Research Foundation/James J. Peters VA Medical Center’s Exoskeletal-Assisted Walking Program. Mr. Woo’s story is a memorable and courageous one from the time of his injury in a horrific construction-related accident six years ago; more in Paralyzed By Seven Tons Of Steel, Man Now Walks With A Bionic Suit (Gothamist). Video in this local CBS News clip. This is certainly the most developed version of an exoskeleton and robotics to enable paraplegics to walk, yet it is still not easy and requires specialized training; most exoskeletons to date have concentrated on assisting lower body movement. Hat tip to Donald Andrews of New York-Presbyterian/Lev El Medical via LinkedIn Groups.

Bill to expand military telehealth services introduced (US)

November 19, 2013 | by

Two House representatives from California, Mike Thompson (Congressional District 5) and Scott Peters (District 52) have introduced HR 3507, the 21st Century Care for Military & Veterans Act. This expands coverage of telehealth services (including remote monitoring and virtual consults/telemedicine) for active-duty service members, their dependents, retirees and veterans, including physician reimbursement for telehealth services under TRICARE (the health plan for active duty and military retirees) and the Department of Veterans Affairs (VA). (more…)

Mental health apps for veterans (US)

November 13, 2013 | by

The US Department of Veterans Affairs (VA) has signed a 12 month contract with Chicago-based Prevail Health Solutions to further develop the Vets Prevail online supportive behavioral health program in 2014. In development for five years in various pilots, it has corporate support from Goldman Sachs Gives, the Robin Hood Foundation. the Bristol-Myers Squibb Foundation and PepsiCo. Vets Prevail is an online program using Cognitive Behavioral Therapy (CBT)-based e-learning lessons and peer-to-peer support, also routing into select established Veterans Health Administration resources. Mobihealthnews profiles the 10 apps Prevail is using plus others that the VA has developed such as PTSD Coach, smoking cessation app Stay Quit Coach and Care4Caregiver.