The Department of Veterans Affairs plans to expand its use of information technology and telecommunications - including  mobile and landline phones and video conferencing - to deliver healthcare to aging veterans and others who suffer from chronic conditions, according to senior telehealth officials.

In fiscal year 2010, VA recorded 300,000 healthcare encounters in 36 specialty areas with the assistance of telehealth technologies, according to Adam Darkins, MD, VA's chief consultant for telehealth services, who spoke at an Oct. 12 innovation conference sponsored by West Wireless Health Institute, a wireless medical technology nonprofit researcher.

The VA has now begun to analyze data from these programs as part of a long-term goal to  change the location of care from the hospital to where the patient is, he said. The plan is ultimately to, "extend the electronic health record into the home."

"No evidence suggests that the best way to manage chronic conditions is in the hospital or office because they return again," Darkins said. Prime treatment targets include diabetes and hypertension in older veterans or traumatic brain injury suffered in battle by younger veterans in Iraq and Afghanistan.

Among the VA's major telehealth programs, the Care Coordination Home Program, which has 48,000 participants nationwide, enables senior veterans to continue to live at home instead of in an assisted living facility unless symptoms demand that a physician intervene.

So far, the program has reduced by 47 percent the number of days of facility-provided medical care, Darkins said. The technology has also lowered costs by reducing or avoiding the time spent in assisted living facilities. Over the next two years, VA plans to increase participation in this program by 100 percent.

Help for rural areas

A companion effort, the VA's Clinical Video Tele-health Program, uses video conferencing so patients can consult with a specialist from the office of their primary physician in VA community clinics. This program has 75,000 participants, most of whom reside in rural areas and have mental health conditions and need rehabilitation support. VA is about to pilot Internet video conferencing in the patient's home as part of this effort.

The Defense Department is also testing mobile health applications to extend patient management of healthcare for active service members.

One of its findings is that patients prefer to use their own phones as telehealth devices. Forty percent of the participants in a recent test of an application to send patients messages about their diabetes management did not even use the smart phone provided  to them.

"We early on decided that we're going to do mobile health on patients' pre-existing cell phone," said Col. Ronald Poropatich, MD, deputy director of the U.S. Army Medical Research & Materiel Command and Telemedicine & Advanced Technology Research Center.  "If you give them an extra device, they'll leave it at home."

Many current veterans are under 30 years old and have grown up engaging with friends and family over the Internet, said Tom Tarantino, legislative associate for the Iraq and Afghanistan Veterans of America.  "It's jarring to be thrown into an industry when they come for healthcare that's not anywhere near in patient engagement to what they're used to," he said.