Rural veterans are older and have more complex medical issues than their urban counterparts. Veterans aged 65 and above represent 57% of all rural veterans who are enrolled within the Veterans Health Administration (VHA; Department of Veterans Affairs, 2019a). These older adults often have multiple chronic conditions and aging-related issues that need care from multiple disciplines, including medical aid, specialty care, psychological state care, and coordinated health and social services; and yet, accessing these services at a health-care facility may require extensive travel. this text describes telehealth approaches by the VHA, including the Geriatric Research Education and Clinical Centers (GRECC), Connect clinical demonstration project, to extend access to geriatric look after aging veterans and family caregivers residing in rural areas.
In 1996, the Institute of Medication, now called the National Academies of Science, Engineering, and Medicine, defined telemedicine as “the use of electronic information and communications technologies to produce and support health care when distance separates participants” (Institute of medication, 1996). Attention to telehealth has rapidly grown over the past 20 years within the public and personal sectors.
Multiple stakeholders, including innovators, health-care providers, health systems, payers, and also the federal are actively engaged in developing and implementing technology, practices, policies, and payment models for telehealth. the utilization of telehealth to produce clinical support to individuals separated geographically has the potential to extend access to worry and facilitate “healing at a distance” (Dorsey & Topol, 2016).
Telehealth has become a very important tool for enhancing health-care service delivery, reducing costs, and increasing quality (Wade, Karnon, Elshaug, & Hiller, 2010). To optimize clinical video telehealth, there are opportunities to revamp reimbursement systems to mitigate challenges to adoption. Under Medicare Part B, clinical telehealth visit reimbursement remains limited to once monthly.
For telehealth services to be broadly available outside of the VHA, Medicare and other payers will have to address several policy levers, including breaking down barriers for reimbursement, establishing shared electronic health information systems, and ensuring patients have access to reliable and secure telehealth technology (including technical support). The implementation also will require systematic training in telehealth technology and expanded knowledge of the health and social services that are proximal to the patient.
Telehealth competencies are rarely a part of the health-care professionals’ curricula, and there are few educational resources to coach providers on the utilization of telehealth. Notably, quite 60 VHA requirements exist regarding the establishment of telehealth programs, and that they are often beyond the competency of most individual VA staff (Institute of medication, 2012). Therefore, VHA training and support infrastructure provide system-wide training and staff to help front-line clinical teams.
As the VHA and other health-care systems adopt telehealth services, evaluations of clinical effectiveness and quality monitoring, likewise as adequate staff training, are essential. The VHA has national databases, reports, and analyses for metrics of performance and also the quality of telehealth programs at the degree of the local VA centre, the VHA networks, and nationwide.
As telehealth services are increasingly utilized, analyses that include VHA and non-VHA health care clinical data can estimate the standard and impact of telehealth, while also evaluating the health outcomes of the population served.