Page 8 CaseStudiesinTelehealthAdoptionTheVATakingHomeTelehealthServicestoScaleNationally

8 The commonweAlTh Fund

strong clinical and business case that facilitates buy-in FUTURE OPPORTUNITIES AND
from clinicians and managers. The VHA has found that CHALLENGES IN MAINTAINING HOME
disseminating its findings broadly throughout the sys- TELEHEALTH AT SCALE
tem, through an annual meeting for key staff members While the VHA has become known for its focus on infor-
and a quarterly newsletter, for instance, reinforces the mation technology, pioneering research, high quality of
continuous cycle of learning within the organization. care, and remote health services, the organization con-
Standardization of core program elements. tinues to face challenges in translating theory and pilots
From the outset, the VHA tried to systemize clinical, into mainstream services and in ensuring the sustainabil-
technological, and business processes. A core principle ity of the clinical, technology, and business processes
of this standardized approach has been national poli- necessary to support home telehealth. Looking forward,
cies and operational procedures that ensure the care the VHA faces a number of related goal-driven challenges.
a veteran receives is consistent throughout the VHA Realizing greater economies of scale. CCHT
system. In addition, care coordinators monitor core has cited reduced health care resource use among the
biometric data and changes in patients’ health status, targeted high-utilization patients. This impact provides
provide support to patients through education and self- strong economic justification for home telehealth to
management, and intervene to prevent patients’ clinical be an integral component of standard noninstitutional-
deterioration and avoidable hospital admissions. ized care services for chronically ill veterans at risk
Technology-enabled tools and resources. for long-term institutional care. Because of the lower
The electronic patient record is a critical tool that marginal cost of adding services to the existing infra-
enables just-in-time decisions that support patient care, structure, the VHA is intent on expanding its CCHT
particularly in chronic care management. The VHA’s program to provide chronic care management, acute
electronic health information system, VistA, has been care management, and health promotion and disease
instrumental in providing a technical health informa- management for other patients in areas such as weight
tion infrastructure that supports systemwide imple- management, dementia care, and palliative care. In
mentation of the home telehealth program. Another April 2011, the VHA awarded six national contracts for
important technological tool is the algorithm the VHA home telehealth devices and services worth $1.38 bil-
uses to match patients to appropriate technologies. The lion over five years.
home telehealth devices have been chosen for their Advancing integrated models of care. Many
simple user interface design and ease-of-use to ensure veterans rely on providers other than the VHA for
they can be implemented systematically among a very services, which complicates efforts to coordinate their
large number of patients and perform reliably. care. This is particularly challenging as the VHA uses
Staff training and development. The OTS a primary care model that adheres to clinical guide-
has established national training centers dedicated to lines and sharing of information among providers. The
each of its three telehealth service areas with the capac- advent of a patient-centered medical home model on a
ity to facilitate remote training and to train hundreds of national scale is leading the VHA to think about how
staff members each year. A robust training program has care coordination for home telehealth can evolve and
helped contribute to overcoming the initial resistance contribute to successful care management that ensures
that clinicians have had to the telehealth approach. The patients receive the right care in the right place at the
training program for CCHT has also created a cohort right time and that patient engagement and adherence
of graduates who serve as ambassadors for the program are enhanced. This issue will become increasingly
and who can help solve programmatic issues at the important as more care takes place in the home and
local level. community, with informal caregivers playing a central