A priority of the Veterans Health Administration is to provide timely access to quality healthcare and specialty services in locations that are convenient and accessible. One of the most innovative programs that the West Palm Beach Veterans Affairs Medical Center has implemented to meet the health care needs of veterans is Telehealth. Telehealth incorporates a broader scope of care than Telemedicine and encompasses provision of services by a variety of disciplines. Combining and coordinating traditional treating disciplines with secure modalities and high-end telecommunication technologies, patient care, education and healthcare administration can be accomplished in situations and locations where distance separates the veteran from the care providers and/or services. Telehealth allows veterans to access care or services in their local communities or their homes. Distance no longer separates VA providers and veterans. Combining electronic health records with digital imaging, videoconferencing technologies and diagnostic peripherals, allows West Palm Beach VA Medical Center healthcare providers, specialists and disciplines to evaluate, plan and deliver care to veterans much like a face-to-face visit. Access to care is significantly improved because patient travel time is minimized or eliminated.
The West Palm Beach VA currently provides a variety of real-time, Clinical Video Telehealth (CVT) and Store & Forward (S&F) Telehealth applications that encompass a broad range of consultative, diagnostic, treatment, follow-up and educational options. This includes:- Mental Health referral, evaluation, treatment, individual and group therapy and medication management.
- Psychology & Behavioral Health referral, evaluation, treatment and individual or group therapy.
- Diabetic Retinal Imaging (Store & Forward).
- Dermatology (Store & Forward).
Other CVT programs focusing on weight reduction and smoking cessation are currently being developed. Program expansion and future programs will target special need veteran populations such as returning Iraqi and Afghan veterans, Spinal Cord Injury & Disease (SCI/D) and Traumatic Brain Injury (TBI).
In addition, Care Coordination Home Telehealth (CCHT) programs provide in-home monitoring and problem-focused care coordination services to veterans meeting program-specific criteria. CCHT programs allow those with chronic conditions to more effectively manage their conditions from home. RN and/or MSW Care Coordinators utilize disease management protocols, videophones, message monitoring and telemetric devices to monitor, evaluate and coordinate care for veterans at home. Proactive monitoring and early intervention limits the need for arduous trips to the Medical Center for appointments or admission. Current in-home monitoring programs are targeted to chronic disease management of:- Mental Health
- Congestive Heart Failure
- Chronic Obstructive Pulmonary Disease
- Diabetes Mellitus
- Hypertension
Due to the implementation of Clinical Video Telehealth and Care Coordination Home Telehealth, specialty care access has improved, patient travel times and costs have decreased, high-cost Medical Center utilizations have been maximized, and the needs of our veterans are being met. In fiscal year 2009, approximately 6,000 Telehealth encounters were provided to roughly 2,500 individual patients across all programs and modalities (CVT, S&F and CCHT). When comparing data from 6 month pre-CCHT program enrollment to data from post-CCHT program enrollment, organizational care delivery and effectiveness reflected a 27% decrease in hospital admissions and 45% decrease bed days of care (BDOC)
As an innovative care delivery model, the utilization of Telehealth modalities averted 9500 patient travel miles and 2200 travel hours. Telehealth programs decrease or eliminate barriers to care, improves care quality, facilitates care coordination, access of services, and veteran independence. This coordination of care provides visionary 21st century leadership in providing our veterans “the right care, in the right place at the right time”.