Page 5 CaseStudiesinTelehealthAdoptionTheVATakingHomeTelehealthServicestoScaleNationally

The VeTerAns heAlTh AdminisTrATion: TAking home TeleheAlTh serVices To scAle nATionAlly 5

and matching them to the right technology (e.g., video- technologies at the VHA for noninstitutional care,
phones, messaging devices, biometric devices, digital chronic disease management, acute disease manage-
cameras, and telemonitoring devices); establishing a ment, and health promotion and disease prevention is
national training center to ensure a competent work- almost 70,000. The VHA plans to have 92,000 people
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force; awarding national contracts for technology, enrolled in its telehealth program by the end of 2012.
based upon meeting strict clinical and technological The most commonly used technologies in CCHT are
requirements; and integrating telehealth technologies messaging and monitoring devices (85%), followed
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with the VHA’s electronic medical record. Although by videotelemonitors (11%) and videophones (4%).
the growth of the national home telehealth program Messaging devices ask patients questions to help
has been managed largely at a VISN level to meet the assess their health status and disease self-management
needs of the veteran patient population each serves, capabilities. Monitoring devices record vital sign data.
the enabling clinical protocols, workforce training, and Videophones and videotelemonitors facilitate audio–
business processes have been developed at the national video consultations at home.
level. Today, CCHT programs are available at 140 The VHA has used home telehealth services
VHA medical centers. Forty percent of veteran patients for managing chronic conditions at an unprecedented
receiving care via CCHT live in rural or remote scale compared with other health service organiza-
locations. tions. The VHA’s underlying health information
Resistance from clinicians has been success- infrastructure, coupled with a strong commitment to
fully addressed by placing the emphasis on program standardized work process, policies, and training, has
outcomes, patient satisfaction, and training. The VHA contributed to the increase in the program’s capacity to
has established strategic communications initiatives, manage an increasing volume of patients. Of patients
like an annual telehealth meeting for key staff from enrolled in the program between 2003 and 2007, 96
around the country. In addition, a number of staff mem- percent were male and 4 percent were female. The
bers who helped start the program are now in senior age range was 20 to 101 years, with a mean of 66.5
management within the organization and have effec- years and 16.5 percent of patients 85 years and older.
tively become champions of the telehealth program. About 57 percent lived in urban areas, 37 percent in
Meanwhile, graduates of the national training program rural areas, and 2 percent in highly rural areas. About
have gone on to serve as advocates for the program. Dr. 48 percent of patients were managed for diabetes, 40
Darkins describes their role as critical in helping solve percent for hypertension, 25 percent for congestive
programmatic issues at the local level and serving as heart failure, 12 percent for chronic obstructive pul-
ambassadors for the program. This has helped informa- monary disease, 2 percent for depression and 1 percent
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tion about the program grow at an organizational level, for PTSD. Almost 67 percent were monitored for one
increasing buy-in and understanding. condition, and 33 percent for multiple conditions.
Within CCHT, care is actively managed by
CCHT AND THE HOME TELEHEALTH care coordinators who are health care professionals,
PROGRAM usually nurses or social workers, but who also include
First introduced into the VHA in 2003, CCHT uses dieticians, occupational therapists, physicians, and
home telehealth and disease management technologies pharmacists. An individual care coordinator handles
in the care management of chronically ill patients to a panel of 100 to 150 general medical patients or
delay, if not prevent, their being placed into long-term 90 patients with mental health-related conditions.
institutional care. Between 2003 and 2007, CCHT Care coordination is managed in association with the
patients increased from 2,000 to 31,570. Today, the patient’s clinician, and referrals to additional care ser-
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number of patients managed using home telehealth vices can be made by the care coordinator (subject to