House Lawmakers Probe VA on Rise of Telemedicine

“Getting VA back on the right track will require us to use every available tool at our disposable to increase access to care,” said acting subcommittee Chairman Brad Wenstrup, R-Ohio. “One of those tools is telemedicine. … VA purports to be a leader in the use of telemedicine and, according to testimony VA will provide this morning, there were more than two million telemedicine visits across the VA healthcare system last fiscal year alone. However, as the use of telemedicine continues to expand, we need to be sure that VA is keeping pace with modern technology and is effectively safeguarding private medical information through secure data channels.”

“In 2015, the VA provided by far the most federal telehealth appointments, with 2.1 million consultations to over 677,000 veterans,” said ranking member Julia Brownley, D-Calif. “The VA expects the number of telehealth appointments to increase by over 12% in the coming year.” She wanted to know “how the VA is getting the word out about the availability of telehealth at the remote clinics, how veterans are being notified that telehealth is an option, and what strategies and technologies from the private sector the VA can look at to promote telehealth.”

The department “is recognized as a world leader in the development and use of telehealth," considered "mission critical" for effective care, testified Kevin Galpin, acting executive director for telehealth in the Veterans Health Administration on behalf of the VA. He cited ways the department delivers service: clinical video telehealth, home telehealth and what he called “store-and-forward” telehealth. He also cited the value of telesurgery. The VA “is still at the beginning of its journey of leveraging its integrated national healthcare system and remote care opportunities through telehealth technologies” and “would be able to accelerate expansion of clinical services if our clinical and technical capabilities to deliver healthcare through virtual technologies [were] supported by legal authority,” he said.

Galpin highlighted necessary telecom devices and connectivity. The next step for clinical video telehealth is VA Video Connect, now undergoing field testing, which will provide “fast, easy, encrypted, real-time access to VA care” that “can be used to connect VA providers to a Veteran’s personal mobile device, smartphone, tablet, or computer,” he said. Home telehealth service “uses VA-provided devices, along with regular telephone lines, mobile broadband modems, cell phones, or web browsers, to connect a Veteran with a VA provider, most often a registered nurse,” he said.

C30 Telemedicine CEO Herb Rogove testified in favor of establishment of a national medical license, the lack of which “is a significant barrier to telehealth” now: “The VA has a national license, but outside of the VA, companies have to apply to many states, costing time, money, and a significant delay up to one year to implement a program that a hospital needed yesterday.” The VA model is “both exemplary and successful,” he said, citing his study over many different models over the past 10 years.

“Unfortunately, my attempts to collaborate with the VA directly have been frustrating,” testified Grace Health System CEO Randy Hickle, based in Texas. He lauded a recent statement from Secretary Robert McDonald on telemedicine as an area identified for growth. Hickle implored McDonald and subcommittee members “to not reinvent the wheel with telemedicine.” There "are many talented and successful telemedicine programs that are currently available to immediately assist with the VA’s alarming backlog," said Hickle, citing long patient wait times.

Wenstrup said patient waiting times seem to have increased along with the rise of telemedicine. He said the department must be “effectively tracking telemedicine appointments to ensure consistent, quality care and monitoring patient outcomes,” saying the VA touts telemedicine. “If VA truly is a leader in deploying telemedicine, it is important to track best practices, lessons learned, and the impact telemedicine is having both on individual patients and on the VA healthcare system as a whole as well as to ensure that this technology is being leveraged to address the critical issues VA is facing,” he said.

Rep. Tony Cardenas, D-Calif., had several concerns. Telemedicine “has limitations” and on “behalf of the veterans in my district,” Cardenas wrote to the Veterans’ Affairs subcommittee in a letter dated Tuesday, citing the varying reactions veterans have to in-person versus remote mental health diagnosis and care. “In monitoring disorders like PTSD [post-traumatic stress disorder] and depression, how does telemedicine account for the nuanced signs that caregivers pick up from in-person observations, particularly given the varying level of comfort with the technology?” Cardenas asked. The VA “must provide education and outreach to veterans about the benefits of using telemedicine” and “provide thorough trainings in device usage and navigation,” he said. “The most troubling aspect that has been brought to my attention is the lack of communication between the telemedicine providers, the primary care providers and the veteran.” He said communications breakdowns are “unacceptable.” Cardenas is a Commerce Committee member who isn't on the Veteran Affairs’ Committee.

Galpin defended telemedicine’s abilities in the areas Cardenas raised. The Veterans Health Administration “uses information technology and telecommunication modalities to augment care provided by its mental health clinicians to Veterans throughout the United States,” he testified. “VA has found telemental health care to be equally effective, if not more so, than in-person appointments. ... Telemental health is also a way to bring highly specialized care to patients who otherwise would have to travel great distances to receive such care.”