VA Central Iowa Health Care System
Modernizing Veterans' Healthcare Choices
VA Central Iowa Health Care System (VACIHCS) is known in the community for being a telehealth leader.
Since 2010, VACIHCS recognized the need to expand specialty services to rural Veterans and found virtually connecting rural clinics to providers at the Des Moines main campus as a good working option. Some of these first patients could meet with their oncologists to receive oral chemotherapy without having to travel the great distance to Des Moines. This virtual care embodies VA Secretary David Shulkin’s priorities of Greater Choice and Modernize Systems. Greater Choice acknowledges that Veterans and their families deserve greater access, choice and control over their health care, and empowers them to make decisions that work best for them and their families. Modernize Systems recognizes that Veterans and VA employees need 21st-century systems and technology that enable VA to deliver the high-quality care and services that Veterans deserve.
Iowa is a highly rural state, and our five Community-Based Outpatient Clinics (CBOCs) for VACIHCS are all over 95 percent rural or not near a metro area. The Veteran response to services was so positive that Veterans requested the ability to virtually meet with providers in other areas like cardiology, pulmonology and neurology, just to name a few.
To take it a step further, we then focused on bringing telehealth into the home to track specific chronic health issues like chronic obstructive pulmonary disease, diabetes and congestive heart failure with easy-to-use tracking devices that send daily readings from the Veterans home to their care teams.
Like clinic telehealth growth, demand for home telehealth rapidly grew as Veterans realized how efficient and cost effective this modality for care is. To bring care directly to the Veteran, Clinical Telehealth Technicians began taking in smaller versions of the clinical telehealth equipment directly to their homes for virtually any specialty service.
Modernization efforts continued as the team started using this technology to not only increase access and ease to services, but started focusing on providing better outcomes. By using store and forward telehealth, retinal or dermatology images can be captured remotely and forwarded on to a specialist for diagnosis and treatment. Within the first year, four Veterans with dermatology issues were triaged this way, diagnosed with melanoma and set up with treatment within weeks, rather than waiting for months. These reduced wait times also demonstrate the Secretary’s priority of Improve Timeliness.
We have also improved services for Veterans leaving our Community Living Center (CLC) needing home improvements by sending these trained specialists into their homes to virtually assess and track home improvements, shortening a four-month process into a less than four-week process. Some of the Veterans transitioning from the CLC with behavioral issues are traditionally hard to place because of lack of proper staffing and support in community nursing facilities.
By supplementing their services through tele-Geriatric Psychology, a hard-to-find specialist, telehealth primary care and medicine management, we have successfully placed Veterans back in their communities closer to their loved ones. These same types of services are also used in partnership with our state Veterans Home and follow Veterans to community hospitals as needed. A favorite success story is when a Veteran was inpatient at a community hospital needed to see their VA Oncology Provider, a technician could virtually connect the two to start chemotherapy right away rather than transporting that critical patient.
While the sky is the limit for telehealth modernization at VACIHCS, we are currently focusing on the Virtual Medical Room and Video on Demand, which send email links to any Veteran on their own technology to connect with a registered nurse or provider at any time. If the Veteran does not have compatible technology, it will be delivered with approved applications like the VA Post-Traumatic Stress Disorder Coach and MOVE software. This means a full-time, working Veteran could use his or her break to speak to a mental health provider and Veterans who travel south for the winter could continue to virtually connect with their provider back in Iowa.
We are also expanding telerespiratory for oxygen evaluations, which not only keeps the Veteran in their home but opens access to the respiratory therapists. Additionally, we are providing telehealth support to our community clinics for home sleep studies, and are connecting Veterans with requested chaplain services through telehealth.
On top of that, we are also connecting with a regional telehealth hub to provide primary care services in rural VA clinics where it is hard to recruit and retain these doctors.
We have experienced great success supplementing our services with teleICU and expect the same level or results and high patient satisfaction with this telehub option.
Each additional telehealth service has brought much needed modernization to VACIHCS services, increased access and provided comfortable, efficient care to Veterans, reflecting the Secretary’s priorities of Greater Choice, Modernize Systems and Improve Timeliness. Additionally, as we have paved this telehealth path in our community and led several national telehealth initiatives, we have also had the opportunity to work with the Iowa Congressional delegation to support the overall advancement of telehealth options for all Americans.
As VA is a proud teacher and advocate for training and research, this strategic telehealth cooperation will also benefit Americans for years to come.