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Background: Systematic reviews reveal that education and training to ensure high-quality telehealth delivery are lacking. Objective: Recognizing an unmet need for standardized training for telepresenting healthcare professionals, the U.S. Department of Veterans Affairs Office of Connected Care (VA OCC) built on its prior telehealth experience to create a Telepresenter Certificate Program (TCP) in partnership with the University of Florida College of Nursing (UF CON). The program's curriculum, the educational methods used, and learners' responses to a summative survey that evaluated the TCP's impact are described here. Methods: The curriculum encompasses two courses. The first introduces current knowledge regarding digital health, including the role of clinical informatics, electronic health records, patient-generated health data, and trends in data use in healthcare. The second helps learners understand required telehealth competencies through patient case scenarios and covers topics such as how to telepresent virtual medical exams and apply these skills in practice. Results: Among four TCP cohorts, 909 learners completed the programs, with 87% agreeing or strongly agreeing that "they will be able to apply the knowledge and skills learned to effectively assist telehealth providers in delivering patient care using tele-health technology." On average, 94% of TCP completers were satisfied with the program. Discussion: The VA OCC's partnership with UF CON successfully created a novel curriculum to standardize competencies and enhance professionalism for the telepresenter role through the TCP. Learners positively endorsed their acquisition of skills and their satisfaction with the program. The TCP offers a viable model for other healthcare consortiums to standardize competencies and enhance professionalism for telepresenters, resulting in improved telehealth quality and increased healthcare access. [ABSTRACT FROM AUTHOR]

The article focuses on the clinical study that compares the use of Department of Veterans Affairs (VA) inpatient and outpatient services of cancer patients enrolled in a Cancer Care Coordination/Home-Telehealth (CCHT) program in the U.S. Using a matched case-control design, two control patients per case were selected and matched by tumor type and cancer stage. The study revealed that their were 43 cancer CCHT patients and 82 control group patients.

We evaluated a Veterans Health Administration (VHA) care coordination/home-telehealth (CC/HT) program on the utilization of health care services and health-related quality of life (HRQL) in veterans with diabetes. Administrative records of 445 veterans with diabetes were reviewed to compare health care service utilization in the 1-year period before and 1-year period postenrollment and also examined self-reported HRQL at enrollment and 1 year later. Multi variate analyses indicated a statistically significant reduction in the proportion of patients who were hospitalized (50% reduction), emergency room use (11% reduction), reduction in the average number of bed days of care (decreased an average of 3.0 days), and improvement in the HRQL role-physical functioning, bodily pain, and social functioning. The results need to be interpreted with caution because we used a single-group study design that may be influenced by regression to the mean. Ideally, future research should use a randomized controlled trial design. [ABSTRACT FROM AUTHOR]

We assessed the utilization of health-care services and clinical outcomes in veterans with diabetes who were enrolled in two care coordination/home telehealth programmes. One group of patients was monitored weekly (n=197), with more intensive evaluations, while the other was monitored daily(n=100), but less intensively. Although patients in the two groups were fairly similar in demographic terms and in their clinical characteristics at baseline, they had different service utilization patterns during the 12-month pre-enrolment period. Over the 12-month study period, the proportion of one or more hospital admissions and number of bed days of care decreased in the daily monitoring group, and increased in the weekly monitoring group, more or less doubling in the former and being halved in the latter. Unscheduled primary care clinic visits were lower in the daily monitored group than in the weekly monitored group. The differences between the two groups were significant(P<0.01). There were no significant differences between the groups in the clinical outcomes. Future research should employ randomized controlled trial designs to determine if intensities of home monitoring lead to differences in service utilization and health outcomes. [ABSTRACT FROM AUTHOR]

Chronic illnesses account for approximately 75% of all healthcare costs in the United States today, resulting in functional limitations and loss of independence, as well as increased medical expenditures. The elderly population is at a higher risk for developing chronic conditions, increasing their risk for disabilities. Given the rapid growth of the aging population, and the chronic illnesses, disabilities, and loss of functional independence endemic to elders, novel methods of rehabilitation and care management are urgently needed. Telehealth models that combine care coordination with communications technology offer a means for managing chronic illnesses, thereby decreasing healthcare costs. We examined the effects of a Veterans Administration (VA) telerehabilitation program (Low Activities of Daily Living [ADL] Monitoring Program-LAMP) on healthcare costs. LAMP is based on a rehabilitative model of care. LAMP patients received adaptive equipment and environmental modifications, which focused on self-care and safety within the home. LAMP Care Coordinators remotely monitored their patient's vital signs and provided education and self-management strategies for decreasing the effects of chronic illnesses and functional decline. The matched comparison group (MCG) received standard VA care. Healthcare costs 12 months preenrollment and 12 months post-enrollment were examined through a difference-in-differences multivariable model. Using actual costs totaled for these analyses, no significant differences were detected in post-enrollment costs between LAMP and the MCG. For LAMP patients, the provision of adaptive equipment and environmental modifications, plus intensive in-home monitoring of patients, led to increases in clinic visits post-intervention with decreases in hospital and nursing home stays.

Between July 2003 and December 2007, the Veterans Health Administration (VHA) introduced a national home telehealth program, Care Coordination/Home Telehealth (CCHT). Its purpose was to coordinate the care of veteran patients with chronic conditions and avoid their unnecessary admission to long-term institutional care. Demographic changes in the veteran population necessitate VHA increase its noninstitutional care (NIC) services 100% above its 2007 level to provide care for 110,000 NIC patients by 2011. By 2011, CCHT will meet 50% of VHA's anticipated NIC provision. CCHT involves the systematic implementation of health informatics, home telehealth, and disease management technologies. It helps patients live independently at home. Between 2003 and 2007, the census figure (point prevalence) for VHA CCHT patients increased from 2,000 to 31,570 (1,500% growth). CCHT is now a routine NIC service provided by VHA to support veteran patients with chronic conditions as they age. CCHT patients are predominantly male (95%) and aged 65 years or older. Strict criteria determine patient eligibility for enrollment into the program and VHA internally assesses how well its CCHT programs meet standardized clinical, technology, and managerial requirements. VHA has trained 5,000 staff to provide CCHT. Routine analysis of data obtained for quality and performance purposes from a cohort of 17,025 CCHT patients shows the benefits of a 25% reduction in numbers of bed days of care, 19% reduction in numbers of hospital admissions, and mean satisfaction score rating of 86% after enrolment into the program. The cost of CCHT is $1,600 per patient per annum, substantially less than other NIC programs and nursing home care. VHA's experience is that an enterprise-wide home telehealth implementation is an appropriate and cost-effective way of managing chronic care patients in both urban and rural settings.

By its very nature, telehealth relies on technology. Throughout history, as new technologies emerged and afforded people the ability to send information across distances, it was not long before this capability was applied to the most basic need of all: maintaining health. While much of the early work in telehealth was driven by technology (e.g., making opportunistic use of the systems and devices that were available at the time), recent trends are beginning to push the demand for and the development of new technologies specific to the individual needs of telehealth applications. The future of telehealth will benefit greatly from this technology innovation, in particular, in areas such as home telehealth and remote monitoring, e-health and patient portal applications, personal health records, interactive Internet technologies, and robotics. Telehealth, while not a panacea for all of the challenges facing modern healthcare systems, has a substantial and ever-expanding potential to revolutionize the ways in which people receive medical care while offering the possibility to contain costs, manage chronic diseases, and prevent secondary complications. By demanding innovative solutions and speaking out in support of the field, the telehealth community can and should be leading the charge for greater attention to human factors in technology development, interoperable medical records, staff training and competencies, standards and guidelines, and support for expanded telehealth coverage at the national, state, and local levels.

Although telemental healthcare has been available for many years, is generally accepted as effective, and has steadily growing numbers of consumers and providers, more and better research in this area needs to be done in order to convince insurers, policymakers, and funding agencies that mental healthcare delivered from a distance is at least as good as that delivered face-to-face. Because there is a wide spectrum of potential mental health disorders that might be encountered, there are significant gaps in telemental health research that need to be addressed before payment for services or funding for large-scale studies of this application can be expected. This white paper will review the current state of telemental health research and will offer suggestions for future directions necessary for telemental research to take in order to firmly establish its effectiveness.

The number of home telehealth programs implemented both domestically and abroad and the number of peer-reviewed publications detailing positive outcomes for chronic disease management, preventive care, and self-management have increased over the past 5 years. The most dramatic growth has been in populations with diabetes, chronic obstructive pulmonary disease, and congestive heart failure. A review of home telehealth developments, current status, opportunities, and challenges provides a foundation for understanding why we need to mainstream what we already know works.

Properly designed randomized controlled trials (RCTs) are the gold standard to use when examining the effectiveness of telehealth interventions on clinical outcomes. Some published telehealth studies have employed well-designed RCTs. However, such methods are not always feasible and practical in particular settings. This white paper addresses not only the need for properly designed RCTs, but also offers alternative research designs, such as quasi-experimental designs, and statistical techniques that can be employed to rigorously assess the effectiveness of telehealth studies. This paper further offers design and measurement recommendations aimed at and relevant to administrative decision-makers, policymakers, and practicing clinicians.

Organizations that provide training for their employees are interested in translating training expenditures into benefits. Even though there are several common methodologies that are used to train employees, finding the right methodology to stimulate learning and develop a competent workforce while reducing fiscal burdens can be challenging. One such method that continues to grow in popularity is e-learning. For the purpose of this discussion, e-learning refers to Internet-based or online training. The Veterans Health Administration's (VHA's) Office of Care Coordination (OCC) was established in July 2003 to oversee the national implementation of its telehealth initiatives. As part of this implementation, the OCC created a national center, the Sunshine Training Center, to work directly with the VHA's Employees Education System (EES) to develop a home telehealth Web-based curriculum. After 3 years, the Sunshine Training Center and EES initiated an Impact Evaluation Process. Over five hundred staff completed the online impact survey. This number represented a 74% response rate. Staff responded overwhelmingly in the positive on the benefits of e-learning for building telehealth skills.

Objectives: To assess healthcare use among veterans with diabetes mellitus (DM) enrolled in a Department of Veterans Affairs (VA) Care Coordination Home Telehealth (CCHT) program during 24 months and to contrast this utilization with the service use of a comparison group of veterans with DM not enrolled in the program., Study Design: Two-year, retrospective, concurrent matched cohort study design., Methods: The VA CCHT program included older veterans with type 2 DM at high risk for multiple VA inpatient and outpatient visits. Healthcare utilization (hospitalizations, length of stay, and outpatient visits by type) was assessed at baseline and at 24 months after intervention for the treatment (n = 400) and comparison (n = 400) groups. Propensity scores were used to improve the balance between the treatment and comparison groups. A difference-in-differences approach was used to control for selection bias and for intervening time factors., Results: Two years after enrollment, the treatment group exhibited a statistically significant reduction in the likelihood of all-cause and DM-related hospitalizations. In a subgroup analysis in which we controlled for patients' baseline glycosylated hemoglobin levels, the treatment group had a lower likelihood of having any care coordinator-initiated primary care clinic visits (in which the care coordinator initiated referral to primary care based on health information received from patients' CCHT technology)., Conclusion: After controlling for selection bias and for intervening time factors, the VA CCHT program reduced avoidable healthcare services for DM (such as hospitalizations) and reduced care coordinator-initiated primary care clinic visits.

The American Telemedicine Association (ATA) established the Home Telehealth Special Interest Group (SIG) in 1999. Its mission is to support the expansion and use of telehealth, remote monitoring and disease management applications in the home. The SIG has many areas of interest and has focused on raising public and professional awareness about the benefits of home telehealth, developing and standardizing clinical guidelines for the delivery of services and advocating for reimbursement through state and federal funding. SIG membership has grown dramatically, to more than 425 members today. These numbers make it the fastest growing and largest of the ATA's Special Interest Groups.

Successful implementation of home telehealth programs require unique skills and personality traits of professionals driving the program. Understanding these traits and skills, and how they predict performance will help staff recognize superior applicants when recruiting individuals for such positions. An extensive literature review ties research published on human factors, what they are, the role they play in performance, and how this may translate into a successful telehealth program. We compared case examples of some successful home telehealth programs. Furthermore, a summary of problems approached and resolved by the home telehealth professionals illustrated decision making and action steps taken that correlated to research published on human factors. Further research is needed to validate the tools used by other fields of study to select and identify successful individuals.