VA Using Technology to Help Quash Disparities For Rural Vets Needing Health Care
Technology plays a central role in helping the Department of Veterans Affairs (VA) work smarter, not harder, to medically treat veterans, particularly those who live in rural areas of the nation.
The Veterans Health Administration steered the use of telehealth technology, which now lets cardiac patients heal at home, and might one day help cancer patients avoid long drives to VA hospitals for follow-up care, says Tom Klobucar, deputy director for VA's office of rural health. “Our office of telehealth services actively engages in looking for enterprise-level technological solutions to the questions of access.”
The office launched a telephone-based cardiac rehabilitation program a few years ago, for example, for rural veterans in Iowa who had difficulty accessing cardiac rehab. The veterans received at-home exercise equipment such as stationary bikes or pedometers, and participated in weekly phone calls with cardiac nurses who assessed their progress and helped with lifestyle changes to promote better health.
“It turned out to be an economical, easy way to ensure that rural veterans had access to cardiac rehab, and it turned out to be really successful,” Klobucar says. “A return-on-investment analysis indicated that this was ripe for dissemination across the country. So we went from one site in Iowa City, Iowa, back in 2011, and we increased to four sites a couple of years later. Now, we’re adding another 12 sites across the country. The enthusiastic response from the folks at the VA medical centers that are adopting this is really indicative of the fact that this satisfies a really important need for rural veterans.”
Since its inception in 2006, the office has funded innovative ways to help quash the imbalance in health care between rural- and urban-based veterans. The office allocated $250 million in fiscal 2015 for pilot programs and projects focused on clinical interventions, studies and activities designed to address rural-urban disparities. The VA spends roughly one third of its budget delivering care to rural veterans.
“One small part in the office of rural health is to encourage innovative pilots to increase access for veterans with the idea that if a pilot proves successful in increasing access to care and services for rural veterans, then that pilot could proliferate across the country if [deemed] cost-effective and clinically-effective,” Klobucar says.
The VA contracted with Creative Computing Solutions Incorporated (CCSi) to place rural health community coordinators both in rural VA facilities to help teach veterans to navigate online services and at non-VA clinics and hospitals that treat veterans who live too far from VA medical centers, says Rich Mylod, the Virtual Lifetime Electronic Record (VLER) Health Program rural health community coordinator manager with CCSi.
The coordinators authorize the exchange of health care information between non-VA centers and the department to ensure key information is properly transmitted and veterans get the care to which they are entitled, says Mylod, a former command master chief hospital corpsman in the U.S. Navy.
Additionally, the coordinators help technology-challenged veterans better navigate online services and see to it that all documents are submitted correctly.
“Older veterans are remarkably accepting of these technological solutions,” Klobucar adds. “As we looked across the country, we have clinic-to-clinic video solutions and we also have a robust growing program in clinic-to-home video solutions.” In fiscal 2014, the office logged nearly 20,000 clinical video visits to veterans’ homes.
Many veterans see both private and VA physicians, which can complicate health care if the separate parties aren’t communicating. “Making sure that those physicians are able to communicate with each other … is hugely important,” Klobucar says of the CCSi-led effort.
Roughly 36 percent of the VA’s enrolled veteran population lives in rural or highly rural areas of the United States, a substantially higher number than the general population’s figure of 19 percent. “We are disproportionately rural in our enrolled patient population,” he says.
Klobucar is not entirely sure why rural-based veterans outnumber the overall population. Since the U.S. military became an all-volunteer force in 1973, the percentage of recruits hailing from rural parts of the nation has incrementally increased over the decades, he says. “The recruits come disproportionately from rural areas of the United States. That could be one explanation. I can’t speak authoritatively to any other possible explanation. We just know we are dealing with this fact that we have 36 percent of our enrolled population living in rural areas, so it’s important for us to address their particular needs and to make sure that they have access equal to the veterans who live urban areas.”
In addition to in-home cardiac rehabilitation, the office has a new way of treating veteran patients with HIV. Primary care physicians now link up with infectious disease specialists via telehealth technology from a doctor’s office when the patient needs access. “It turned out to be remarkably successful,” Klobucar says. “The customer satisfaction is extremely high. The veterans don’t have to drive long distances to go see the infectious disease specialist, and so it saves them time, it saves them money and it’s shown to deliver really effective HIV care along with primary care. That started this year. We’re expanding to three additional sites.
“Telehealth, in many ways, is a technological way to overcome those distance barriers that rural veterans have,” he adds.
While the VA does not allocate funding specifically to help veterans get either computers or Internet service, the department has partnered with other federal agencies such as the National Telecommunications and Information Administration within the Department of Commerce and the Rural Broadband Association for that purpose.
Future telehealth programs include post-cancer follow-up care. “Our telehealth-based radiation oncology request for proposal asks local clinics to connect to a hub, and the hubs will provide the post-treatment care to rural veterans in the clinics that are closer to where the veterans live,” Klobucar explains.
Officials too are putting together virtual teams for what they are calling tumor boards—specialists who can virtually get together to discuss treatment plans for tumors.
“We have been fortunate enough to work with a program office that is enthusiastically wanting to extend three tumor boards to rural areas so they can come up with treatment plans in a timely manner that doesn’t involve having to get everybody sitting in the same room,” Klobucar says. “Instead, they all will get in the same virtual room. That’s a pretty exciting.”
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