通过远程医疗为退伍军人提供医疗服务

If there were an institution anywhere in the nation facing enormous challenges for which telehealth would seem to offer tantalizing solutions, 那就是退伍军人事务部.  

Tens of thousands of soldiers returning from physically and mentally crippling overseas deployments in need of ongoing health care. 农村和小镇上的英雄们在远离医疗的数百英里处苦苦挣扎. A cashstrapped and oft-beleaguered federal administration always in search of more providers and more locations to serve a mushrooming clientele.

所以, 事实上, the VA has for decades now tried to push the telehealth frontier in 科罗拉多州 and across the rural and frontier West.

The early evidence is in black-and-white photos of 1950s-era VA psychologists in Nebraska trying a “two-way television link” for mental health counseling. 从那里追踪到2016年东科罗拉多州弗吉尼亚州, 50多年后, placing new tablet computers directly in the homes of rural veterans so they can “see” their doctor by videophone from their living rooms.

在这两者之间, 经历了50年的科技和健康变革, have been a relentless series of experiments and upgrades to the Eastern 科罗拉多州 VA’s embrace of telehealth technology. 一个常数, 玛丽·威斯罗-希尔说, 部门的家庭远程医疗项目经理, 同情一个生病的老兵为了得到照顾所经历的一切吗.

“开了很久的车, some veterans are so mad at their provider and the system that they won’t even fully reveal their conditions. 他们太生气了，无法好好拜访。. “当人们被愤怒分散注意力时，有些事情是不会提出来的, 疲惫和沮丧. 当他们到丹佛去看医生时，他们已经筋疲力尽了. 然后他们还得回家.”

Long veteran waiting times for appointments in 科罗拉多州 and other states have prompted negative headlines and congressional queries. 科罗拉多斯普林斯诊所, part of the Eastern 科罗拉多州 unit and home to the state’s largest concentration of veterans, had wait times of at least 31 days for more than 10 percent of appointments in a six-month period in 2014-15, 据美联社报道. That made the clinic the 12th worst out of 940 VA clinics and hospitals nationwide, 远高于全国平均水平2.8%的约会迟到. 科罗拉多州, 和其他州一样, 从海外战场归来的退伍军人是否大量涌入, but also has a general population surge from a robust economy and attractive lifestyle, 退伍军人事务部官员当时说.

仅弗吉尼亚州的东科罗拉多州就照顾着126,000名登记退伍军人. 格伦代尔也是弗吉尼亚州第19大区的办公室所在地, 包括蒙大拿州数十万退伍军人, 俄克拉何马州, 犹他州, 怀俄明, 爱达荷州, 内华达, 内布拉斯加州和科罗拉多州东部办事处未覆盖的部分地区.

略低于1,这些退伍军人中有000人现在在科罗拉多州东部使用家庭远程医疗, 和33,000 use video telehealth at a local clinic to get specialty care from long distance, 道格·范·埃森说, 丹佛VA医疗中心的设施虚拟健康协调员.

“多年来，我们看到它逐渐增长, 特别是在过去的三年里，它已经开花结果,范埃森说.

Roy Hamilton is a 科罗拉多州 Springs veteran who lost a leg in a motorcycle accident just before he left the U.S. 军队. 乐观的汉密尔顿说，保持活跃对他来说很重要, 遛狗, 和适应能力小组一起骑自行车和滑水. 虽然他看到了退伍军人事务部在当地诊所的日程安排压力, he said videoconferencing with VA doctors and consultants helped speed the fitting of a special waterproof prostheses.

科罗拉多州弗吉尼亚州的远程医疗工作始于2004年, 有慢性病的高风险退伍军人和大量的护理访问. Telemonitoring devices using their home phone lines could gather daily health readings and transmit them to a central office, 这可能会相应地改变护理.

Even that simple technology resulted in cuts in hospitalization of as much as 50 percent due to better care coordination.

Demand for video telehealth visits from satellite VA offices grew as “more and more soldiers returned from Iraq and Afghanistan, 很多都有心理健康因素,范埃森说. “One thing that made them uncomfortable was driving long distances and being at a large hospital with a large number of people.”

Improved and cheaper video technology made it possible for the VA to set aside remote clinic offices in Pueblo, 拉军政府或其他地方, 并与丹佛的供应商建立了实时视频访问, 盐湖城或其他主要医疗中心.

视频访问对供应商来说也是一大福音. A specialist scheduled for a rotation in Pueblo could spend four hours or more of the day driving to and from the Denver home office. 远程听诊器的技术得到了改进, 例如, to the point where a doctor listening remotely can hear more than an in-person visit in a noisy clinic.

“A primary care clinic in a tiny place like Salida can basically have all the access they would in Denver, 鉴于我们的专业关系,威斯罗-希尔说.

听力学是采用更多远程医疗的蓬勃发展的专业之一. Hearing problems are rampant in veterans returning from loud training or combat zones. 很少有乡村VA诊所能负担得起这种专科. But specially designed audiology “carts” in a small-town clinic can test a local veteran’s hearing and then offer critical adjustments to a hearing aid once it is delivered.

威斯罗-希尔说:“这项技术正在赶上我们想要做的事情。.

What she wants to do next is help the VA region dive even deeper into her favorite new technology: tablet computers allowing veterans to securely talk to their provider from the comfort of home. “对我来说, the greatest issue is still why are we dragging these patients into clinics when we could see them at home,”她说。.

Veterans may qualify for the tablet computer connection by the severity of their condition, 他们的家庭偏远或各种心理健康需求. 除了预约的实时视频链接, 该平板电脑还可以作为退伍军人与医疗记录十大菠菜靠谱平台的门户, 测试结果和积极的健康建议. 90人中的3万人,000 actively seen veterans in Eastern 科罗拉多州’s division are using the personal health portal, 范埃森说.

这些平板电脑可以安装各种适合退伍军人需求的应用程序. 有自杀想法或表达自杀意愿的退伍军人已经开始使用“希望盒子”,，这是一个收集家庭照片的应用程序, 个人笔记和其他可以提醒用户继续生活的理由的物品.

科罗拉多州的退伍军人之家已经安装了300多台这种平板电脑, Withrow-Hill说, 每天都有更多的人走出家门.”

One Vietnam-era veteran who was shown the new technology at a southeastern 科罗拉多州 clinic called it “Buck Rogers-type stuff,弗吉尼亚州东科罗拉多州发言人丹尼尔·瓦维说. 

The seemingly long wait for telehealth to move from science fiction to real life is ending now, Withrow-Hill说. “这是在这里.”

VA试图连接一个遥远的地区，以拥抱远程医疗

 

本文最初发表于2016年秋季期的《十大菠菜靠谱老平台》杂志.