VA takes a leap of faith into telehealth

Telehealth has money and support, but does it have a plan?

The Veterans Affairs Department is already a step ahead of the rest of the federal government in promoting telehealth, also called telemedicine. Now VA is jumping forward again by proposing to double its telehealth investment over two years.

VA’s home telehealth program cares for 35,000 patients and is the largest of its kind in the world. According to the department's plans, it would grow to $163 million in fiscal 2011, more than twice the $72 million spent in fiscal 2009.

But without a broader federal strategy, VA’s leap into telehealth is, to some degree, a leap of faith.

It’s not that VA has gone too far; rather, other federal agencies possibly have not gone far enough. Federal policy-makers have not yet taken a comprehensive look at this technology. The government’s approach has been piecemeal, with various programs initiated for payers, providers and regulators. Federal regulations and reimbursements for telehealth practices are not cohesive, said Jonathan Linkous, executive director of the American Telemedicine Association.

“In telehealth, the federal government needs to educate, coordinate and get out of the way,” Linkous said.

Telehealth, defined broadly as the electronic communication of medical data as a means for providing care to a patient, has been around for decades. It includes the use of phones, computers and other devices, with or without video or images, to allow patients in remote locations to consult with medical specialists.

Advocates say telehealth is cost-efficient and improves care. “You can lower costs, improve outcomes and expand access to care,” said Dr. S. Ward Casscells, former assistant secretary of Defense for health affairs and a practitioner of telehealth.

VA, the Indian Health Service and the Defense Department all offer some telehealth services, as do many hospitals and clinics. Last year’s economic stimulus package set aside $7 billion for broadband, a portion of which will be devoted to rural telemedicine.

Because of that stimulus and federal programs, Timothy Deal, senior analyst at research firm Pike & Fischer, forecasts the U.S. telemedicine market will reach $3.6 billion by 2014, up from $855 million in 2009.

One area in which VA and others have advanced telehealth is in mental health. Training and protocols for online psychological practice are well-established, said Marlene Maheu, a clinical psychologist in San Diego who leads the Telemental Health Institute. “Telehealth is more research-based than many other forms of medicine,” she said. However, she cautioned that the Internet is spawning new types of clinics that purport to offer telehealth services that might not conform to protocols.

Although telehealth holds much promise, adoption has been hampered by potential legal liabilities, difficulties in receiving reimbursements for care delivered remotely, and legal complications regarding telemedicine practices that cross state lines.

Critics also worry about possible negative effects on patient care. VA’s inspector general recently investigated two deaths at a Colorado VA hospital that occurred while the patients were being monitored by cardiac telemetry, a form of telemedicine. “We substantiated the allegation that there were competency and training issues with medical support assistants and registered nurses assigned to telemetry,” the IG wrote in the report dated Jan. 21. The report also notes that hospital managers had been informed of the telemetry problems before the deaths but had taken no action.

VA managers agreed to evaluate the telemetry program in Colorado to ensure safety, and Linkous and Casscells said it was likely an isolated incident. However, more of the same can be expected, Deal predicts. “The rapid growth of the telemedicine industry will leave gaps in training and/or policy among its practitioners, which could spark an increase in litigation,” he said.

VA’s foray into telehealth could be a life-saver for some patients in remote areas who otherwise would not receive timely care.  But it also carries risks. “If the transition from legacy services to modern ones disrupts patient care, I expect to see some patient backlash,” Deal said. "There will be growing pains, and people need to understand this."

If telehealth expands dramatically at VA, it should happen within a broader context. The time is ripe for VA, DOD and the Health and Human Services Department to work together on a telehealth strategy.  

About the Author

Alice Lipowicz is a staff writer covering government 2.0, homeland security and other IT policies for Federal Computer Week.

The Fed 100

Save the date for 28th annual Federal 100 Awards Gala.

Featured

  • computer network

    How Einstein changes the way government does business

    The Department of Commerce is revising its confidentiality agreement for statistical data survey respondents to reflect the fact that the Department of Homeland Security could see some of that data if it is captured by the Einstein system.

  • Defense Secretary Jim Mattis. Army photo by Monica King. Jan. 26, 2017.

    Mattis mulls consolidation in IT, cyber

    In a Feb. 17 memo, Defense Secretary Jim Mattis told senior leadership to establish teams to look for duplication across the armed services in business operations, including in IT and cybersecurity.

  • Image from Shutterstock.com

    DHS vague on rules for election aid, say states

    State election officials had more questions than answers after a Department of Homeland Security presentation on the designation of election systems as critical U.S. infrastructure.

  • Org Chart Stock Art - Shutterstock

    How the hiring freeze targets millennials

    The government desperately needs younger talent to replace an aging workforce, and experts say that a freeze on hiring doesn't help.

  • Shutterstock image: healthcare digital interface.

    VA moves ahead with homegrown scheduling IT

    The Department of Veterans Affairs will test an internally developed scheduling module at primary care sites nationwide to see if it's ready to service the entire agency.

  • Shutterstock images (honglouwawa & 0beron): Bitcoin image overlay replaced with a dollar sign on a hardware circuit.

    MGT Act poised for a comeback

    After missing in the last Congress, drafters of a bill to encourage cloud adoption are looking for a new plan.

Reader comments

Please post your comments here. Comments are moderated, so they may not appear immediately after submitting. We will not post comments that we consider abusive or off-topic.

Please type the letters/numbers you see above

More from 1105 Public Sector Media Group