The Right Care at the Right Time and in the Right Place: The Role of Technology in the VHA

VA Deputy Under Secretary for Health for Policy and Services Madhulika Agarwal on leveraging technology to create personalized, proactive, patient-driven care.

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Embracing technology is nothing new for the VHA, whether it is telehealth, e-consults, or electronic health records. “The VHA is in a unique position to create the first truly national telemedicine network in the U.S.,” Adam W. Darkins, MD, then acting chief consultant of telemedicine at the VA wrote in a 2001 newsletter. “It is our collective task to make sure that if this happens, we have a system that can ‘plug and play.’”1

To better understand the progress in delivering health care, Federal Practitioner decided to devote this entire issue to the topic and to discuss the VHA and technology with Madhulika Agarwal, MD, MPH. As deputy under secretary for health for policy and services, Dr. Agarwal has been at the heart of the VHA’s embrace of many of these technologies for health care delivery and has been in a position to oversee their execution. More than anyone else at the VHA, she is familiar with the potential and limitations of telehealth.

Below is an edited and condensed version of the interview. To hear the complete interview, visit http://www.fedprac.com/multimedia/multimedia-library.html.

Importance of Telehealth to the VHA

Madhulika Agarwal, MD, MPH. Our goal is to ensure that veterans have optimal health and that we deliver the best health care with a focus on timely access and with an exceptional experience. And over the years, we have been building technologic tools so that we can provide the right care at the right time and in the right place. Telehealth affords veterans the convenience of accessing primary or specialized care services either from their local VA community clinic or from the privacy of their own home.

Now we have many virtual access solutions. The home telehealth, clinical video teleconferencing, store-and-forward technologies, e-consults, My HealtheVet, plus SCAN-ECHO [Specialty Care Access Network-Extension for Community Healthcare Outcomes]; and these all have demonstrated that they are mission-critical tools, which improve and expand the access for veterans who may have difficulty accessing care for multiple reasons.

It could be some clinical issues where there are transportation difficulties, such as for veterans with spinal cord injury, or mild traumatic brain injury, or geographic barriers. Many of our veterans, I would say roughly 40% to 45% of them, live in rural and highly rural areas where they may not have access to care nearby. Or it could be further exacerbated with geographic challenges by inclement weather or the drive times. And lastly, I would say it’s the lack of specialists in these rural communities where many of our veterans live.

VHA is successfully integrating into the existing technical administrative clinical infrastructures, and this infrastructure provides a reliable and robust IT network. We have an electronic health record. We provide national policy guidance regarding health information security, credentialing, privileging, etc. And our strategic goal has been to have personalized, proactive, patient-driven care; and telehealth supports that goal.

Improving Veteran Access

Dr. Agarwal. It’s interesting that both the Choice program, which is part of the Veterans Access, Choice, and Accountability Act of 2014, known as VACAA, and telehealth aim at improving veteran access to care. Under the Choice program, many veterans now have the option to access community partner health care rather than waiting for a VA appointment, or traveling to a VA facility when the geographic distance is more than 40 miles, or if the appointment in the VA is not available for 30 days.

The Choice program and telehealth are 2 very concrete examples of VHA’s transformation from a facility or provider-centric health care delivery model to a model that puts the veteran’s needs at the center and improving the veteran’s access to resources to meet their health care needs.


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