Real doctors, onscreen: VA program makes online house calls on vets

A new pilot program will allow veterans in the Midwest to access behavioral health, oncology and post-operative care services wherever they have Web access. Using telehealth technology — a combination of streaming video, e-mail and text applications — the system is designed to help veterans in geographically remote areas or with mobility issues to conveniently contact clinicians and support services.

Part of the Veterans Affairs Department's VA Innovation Initiative (VAi2) Industry Innovation Competition, the effort uses the Online Care system developed by American Well to provide a variety of online services. The Online Care service allows veterans to visit their health care providers, both primary doctors and multidisciplinary care teams, online.

Patients and clinicians communicate via two-way video, secure text and/or telephone. Through the system, doctors can review patients’ health records, discuss symptoms, provide advice, make diagnoses and prescribe medications. Each session is automatically recorded, allowing veterans to share the information with health care providers to provide continuity of care.

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VA has been running telehealth services and programs for a decade and a half, said Jonah Czerwinski, director of VAi2. Among the technologies that the VA developed are clinical video teleconferencing, which has been in use for some time, and newer efforts such as store-and-forward technology used to quickly share large medical imagery files.

The goal of the new program, which launched this November, is to allow patients to continue to meet with their doctors without having to physically travel to a medical center. This is important because new hospitals are expensive to build, and the VA’s patient population is growing at a rate of 5 percent to 10 percent annually, Czerwinski said. He noted that 6.8 million patients were cared for in 2011 and another 8 million enrolled into the VA.

“If we want to provide access in a way that’s economically viable, we’ve got to be creative,” he said.

The technology for the VA’s Online Care system is already being used commercially, said Roy Schoenberg, CEO of American Well. The company provides services to commercial health providers such as WellPoint, Blue Cross and large hospitals across the United States. The VA effort is the company’s entry point into government health care, with its large numbers of patients and facilities.

“We’re actually taking traditional health care and bringing it to where the patient is,” he said.

There are three parts to the VA/American Well pilot program. They are an online behavioral health practice at the Minneapolis VA Health Care System, and oncology and perioperative practices through the VA’s Nebraska-Western Iowa Health Care System (NWIHCS). The oncology practice will connect health care providers from NWIHCS’ Omaha VA Medical Center with cancer patients across the state. The perioperative will permit surgeons to offer post-operative care to patients via Online Care as part of a collaborative team that also includes staff providing home-based primary and extended care.

Within these programs, there are three mini-pilot programs all targeting promising ways that technology can help patients. For example, the behavioral health and oncology efforts are important because the results will be useful to the overall U.S. population, not just those in the VA system, Czerwinski said. The other area is post-operative care which is a costly area that lends itself well to online applications, he said.

This effort is unique, but not a stand-alone project, Czerwinski said. By working with American Well, VA hopes to provide comprehensive clinical care and record-keeping. He noted that while the VA does well connecting personnel in hospitals, more work needs to be done in linking patients at home to clinicians. In a related area, he added that the program also seeks to link clinicians together to more efficiently share patient information.

For better online care and patient/clinician connectivity, American Well is providing a “virtual practice” and a “virtual waiting room” along with interactive patient care systems, Czerwinski said. This technology provides an end-to-end capability that links electronic health records to the patient care process, he noted.

Telemedicine has a number of advantages besides shrinking geography, Schoenberg said. For example, in the behavioral health segment of the program, it allows veterans afflicted with post traumatic stress disorder to privately meet with doctors without the attendant stigma. For post-surgical care, it allows doctors to check in with patients to avoid or mitigate complications. “The technology is changing the way the VA is helping veterans,” he said.

The program is run through the VA’s VAi2 initiative, which seeks to develop and turn programs around quickly — in less than 24 months, Czerwinski explained. If the pilot is working well at the end of this period, the VA will give it a final assessment and decide whether or not to proceed or if additional development is necessary. He added that the effort allows both patients and clinicians to work with new technologies in a controlled environment. “Everybody gets a lot out of this,” he said.