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 Amy Kilbourne, PhD, MPH, Director of QUERI Director's LetterVA is Leading Telehealth Implementation in the U.S. to Improve Veterans’ Access to CareMore than 700,000 Veterans receive telehealth services in VA, more than any other system, and about half of which are from rural areas. In a recent op-ed, VA Secretary David Shulkin envisioned telehealth as a path to improve access to care for Veterans by enabling them to see their medical providers from anywhere, including community care, and even within their own homes.1 However, only a few states allow medical providers to use telehealth to practice across state lines. Subsequently, VA is leading the way in overcoming this national barrier to access through its Anywhere to Anywhere VA Healthcare initiative, which will enable VA medical centers to have clinicians licensed in any state to provide services to veterans in another state. VA’s ability to pioneer the use of telehealth services across state lines is also due to its extensive experience in using telehealth for the past four decades – and for a variety of conditions ranging from PTSD (post-traumatic stress disorder) to HIV care. Much of the groundwork in promoting the use of evidence-based telehealth services was borne out of VA’s research and QUERI (Quality Enhancement Research Initiative) programs, and, more recently, the VA Office of Rural Health (ORH) and VA Innovators Network program. Notably, E-Health QUERI has supported the implementation of electronic health solutions for Veterans, and helped VA implement and evaluate “Annie,” an automated telehealth program to help with patient care transitions that also incorporates self-management best practices. The Virtual Specialty Care QUERI is spreading the use of telemental health outreach for PTSD in rural settings, after research demonstrated clinical effectiveness of delivering virtual PTSD psychotherapy. Moreover, QUERI had led the way in integrating telehealth into clinical pathways for mental health and primary care services. The QUERI for Team-based Behavioral Health used telehealth to improve implementation of the collaborative care model for Veterans with bipolar disorder, a strong risk factor for suicide. Nonetheless, ensuring that telehealth will achieve improved access, timeliness, and efficiency of Veteran care in VA settings – and in community care – will require implementation strategies, especially for lower-resourced sites that do not have the economies of scale to pay for the start-up costs of telehealth implementation. For example, not all clinics have access to PhD psychologists to deliver telemental health, so efforts to enable nurses and social workers to provide the psychosocial interventions and care management via telehealth will be warranted. In addition, reimbursement models for telehealth services especially for Veterans receiving community care will need to be established, particularly across state lines. Finally, it will be important to support sufficient technical support to integrate telehealth within routine clinical care, especially when different providers and community care is involved. That said, VA will continue leading the way in the implementation and sustainability of technology best practices to serve Veterans wherever they will be.
Amy Kilbourne, PhD, MPH |
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