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Within the VHA, the Office of Telehealth Organizations outside the VHA can learn from
Services (OTS) uses health informatics, disease man- its home telehealth experience. Core principles in suc-
agement, and telehealth technologies to support the cessful implementation include: a recognized respon-
remote provision of services and improve access sibility for the care and case management of patients
to timely care for patients in their homes and local across the continuum; a systematic approach to the
communities (Exhibit 1). The OTS offers veterans a introduction of a quality performance improvement and
program called Care Coordination/Home Telehealth management infrastructure; contracting with technol-
(CCHT) to provide routine noninstitutional care and ogy vendors on a national scale; and implementation
targeted care management and case management that is driven at the local clinical level to ensure that
services to veterans with diabetes, congestive heart benefits can be derived immediately. This is supported
failure, hypertension, post-traumatic stress disorder by a tremendous organizational readiness and capacity
(PTSD), chronic obstructive pulmonary disease, and for change that is embodied in all areas of practice. The
depression. CCHT uses remote monitoring devices in ability to directly control budgets for care services is
veterans’ homes to communicate health status and to also a strong motivator in making home telehealth pro-
capture and transmit biometric data that are monitored grams work. While complementary infrastructure ele-
remotely by care coordinators. ments at the VHA, including electronic health records
In fiscal year 2010, an estimated 300,000 (EHRs), help make home telehealth operational at an
patients received care across all programs within OTS. organizational level, they are not necessarily required
CCHT, which targets patients at risk for long-term for a program to work.
institutional care (approximately two-thirds of the cur- From an organizational perspective, it may
rent CCHT population), currently manages more than be easiest for other integrated delivery networks or
70,000 veteran patients using home telehealth tech- government-sponsored systems to draw lessons from
nologies. The program has demonstrated successful the VHA’s experience, particularly where there is a
outcomes. Through the end of fiscal year 2010, veter- recognized responsibility for the care and case man-
ans reported patient satisfaction levels greater than 85 agement of patients across the continuum. In terms of
percent for home telehealth services offered through care management and patient care coordination needs,
CCHT. In addition, the program was associated with the lessons of the VHA may be most applicable to the
a greater than 40 percent reduction in bed days of dual-eligible population.
care, as compared with pre-enrollment figures, for the
CCHT population receiving home telehealth. 1

Exhibit 1. Elements of Teleheath, Veterans Health Administration
Telehealth involves the use of information and communications technologies to deliver medical care remotely by connecting multiple users
in separate locations. The VHA Ofice of Telehealth Services uses health informatics, disease management, and telehealth technologies to
facilitate access to care and improve health outcomes in three main ways:

• clinical video telehealth uses interactive video technologies for the real-time delivery of physician visits to distant clinics to make
diagnoses, manage care, perform check-ups, and provide care in polytrauma, mental health, rehabilitation, and surgical consultations;
• store-and-forward telehealth supports the acquisition, transmission and storage of prerecorded information (sound, data, image),
such as X-rays, video clips, and photos, between providers and specialists in radiology, dermatology, and retinopathy; and
• care coordination/home telehealth uses electronic monitoring devices to capture patient physiological data related to symptoms
and vital signs in the home environment and transmit those data to health care providers for review and appropriate coordination
of care.

Source: U.S. Department of Veterans Affairs, VHA Ofice of Telehealth Services, “What Is Telehealth?” (Washington, D.C.: U.S. Department of Veterans Affairs, 2011).