The case presented in Module 3 is another real-world situation using advancements in technology to improve health care and IT governance. The Veterans Health Administration case study highlights critical factors to the VHA’s success by discussing technology infrastructure, organizational culture, and managerial leadership. The student will analyze the case in six sections in the order followed. Also, these sections must be used to format level 1 heading titles in the case report.
This case was available free to read and download from the Palgrave McMillan Journal of Information Technology site. Cases for free change every week, but the journal offers this disclosure “Palgrave Macmillan and the editorial team have selected this set of papers from the archive of the journal to give a representative sample of the best of our content. These papers, listed in chronological order, are available free to read and download.” The case is included in this page for easy access.
Broderick A. (2013, January). The Veterans Health Administration: Taking home Telehealth services to scale nationally. The Commonwealth Fund. Retrieved from http://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2013/Jan/1657_Broderick_telehealth_adoption_VHA_case_study.pdf
Length: Minimum 3–5 pages excluding cover page and references (since a page is about 300 words, this is approximately 900–1,500 words).
Assignment-driven criteria (25 points): Demonstrates clear understanding of the subject and addresses all key elements of the assignment.
Critical thinking (10 points): Demonstrates mastery conceptualizing the problem. Shows analysis, synthesis, and evaluation of required material.
Scholarly writing (5 points): Demonstrates writing proficiency at the academic level of the course; addresses the Learning Outcomes of the assignment.
Quality of references (4 points) and assignment organization (3 points): Uses relevant and credible sources to support assertions. Assignment is well organized and follows the structure of a well-written paper.
Citing sources (3 points): Uses in-text citations and properly formats references in APA style.
Case Studies in Telehealth Adoption
The mission of The Commonwealth Fund is to promote a high performance health care system. The Fund carries out this mandate by supporting independent research on health care issues and making grants to improve health care practice and policy. Support for this research was provided by The Commonwealth Fund. The views presented here are those of the author and not necessarily those of The Commonwealth Fund or its directors, officers, or staff.
For more information about this study, please contact:
Andrew Broderick, M.A., M.B.A. Codirector, Center for Innovation and Technology in Public Health Public Health Institute [email protected]
The Veterans Health Administration: Taking Home Telehealth Services to Scale Nationally
ABSTRACT: Since the 1990s, the Veterans Health Administration (VHA) has used infor- mation and communications technologies to provide high-quality, coordinated, and com- prehensive primary and specialist care services to its veteran population. Within the VHA, the Office of Telehealth Services offers veterans a program called Care Coordination/ Home Telehealth (CCHT) to provide routine noninstitutional care and targeted care man- agement and case management services to veterans with diabetes, congestive heart fail- ure, hypertension, post-traumatic stress disorder, and other conditions. The program uses remote monitoring devices in veterans’ homes to communicate health status and to cap- ture and transmit biometric data that are monitored remotely by care coordinators. CCHT has shown promising results: fewer bed days of care, reduced hospital admissions, and high rates of patient satisfaction. This issue brief highlights factors critical to the VHA’s success—like the organization’s leadership, culture, and existing information technology infrastructure—as well as opportunities and challenges.
OVERVIEW Since the 1990s, information and communications technologies—including tele- health—have been at the core of the Veterans Health Administration’s (VHA’s) successful system-level transformation toward providing continuous, coordinated, and comprehensive primary and specialist care services. The VHA’s leadership and culture; underlying health information technology infrastructure; and strong commitment to standardized work processes, policies, and training have all con- tributed to the home telehealth program’s success in meeting the chronic care needs of a population of aging veterans and reducing their use of institutional care and its associated costs. The home teleheath model also encourages patient activation, self-management, and helps in the early detection of complications.
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Commonwealth Fund pub. 1657 Vol. 4
2 The commonweAlTh Fund
Within the VHA, the Office of Telehealth Services (OTS) uses health informatics, disease man- agement, and telehealth technologies to support the remote provision of services and improve access to timely care for patients in their homes and local communities (Exhibit 1). The OTS offers veterans a program called Care Coordination/Home Telehealth (CCHT) to provide routine noninstitutional care and targeted care management and case management services to veterans with diabetes, congestive heart failure, hypertension, post-traumatic stress disorder (PTSD), chronic obstructive pulmonary disease, and depression. CCHT uses remote monitoring devices in veterans’ homes to communicate health status and to capture and transmit biometric data that are monitored remotely by care coordinators.
In fiscal year 2010, an estimated 300,000 patients received care across all programs within OTS. CCHT, which targets patients at risk for long-term institutional care (approximately two-thirds of the cur- rent CCHT population), currently manages more than 70,000 veteran patients using home telehealth tech- nologies. The program has demonstrated successful outcomes. Through the end of fiscal year 2010, veter- ans reported patient satisfaction levels greater than 85 percent for home telehealth services offered through CCHT. In addition, the program was associated with a greater than 40 percent reduction in bed days of care, as compared with pre-enrollment figures, for the CCHT population receiving home telehealth.1
Exhibit 1. Elements of Teleheath, Veterans Health Administration
Telehealth involves the use of information and communications technologies to deliver medical care remotely by connecting multiple users in separate locations. The VHA Office of Telehealth Services uses health informatics, disease management, and telehealth technologies to facilitate access to care and improve health outcomes in three main ways:
• clinical video telehealth uses interactive video technologies for the real-time delivery of physician visits to distant clinics to make diagnoses, manage care, perform check-ups, and provide care in polytrauma, mental health, rehabilitation, and surgical consultations;
• store-and-forward telehealth supports the acquisition, transmission and storage of prerecorded information (sound, data, image), such as X-rays, video clips, and photos, between providers and specialists in radiology, dermatology, and retinopathy; and
• care coordination/home telehealth uses electronic monitoring devices to capture patient physiological data related to symptoms and vital signs in the home environment and transmit those data to health care providers for review and appropriate coordination of care.
Source: U.S. Department of Veterans Affairs, VHA Office of Telehealth Services, “What Is Telehealth?” (Washington, D.C.: U.S. Department of Veterans Affairs, 2011).
Organizations outside the VHA can learn from its home telehealth experience. Core principles in suc- cessful implementation include: a recognized respon- sibility for the care and case management of patients across the continuum; a systematic approach to the introduction of a quality performance improvement and management infrastructure; contracting with technol- ogy vendors on a national scale; and implementation that is driven at the local clinical level to ensure that benefits can be derived immediately. This is supported by a tremendous organizational readiness and capacity for change that is embodied in all areas of practice. The ability to directly control budgets for care services is also a strong motivator in making home telehealth pro- grams work. While complementary infrastructure ele- ments at the VHA, including electronic health records (EHRs), help make home telehealth operational at an organizational level, they are not necessarily required for a program to work.
From an organizational perspective, it may be easiest for other integrated delivery networks or government-sponsored systems to draw lessons from the VHA’s experience, particularly where there is a recognized responsibility for the care and case man- agement of patients across the continuum. In terms of care management and patient care coordination needs, the lessons of the VHA may be most applicable to the dual-eligible population.
The VeTerAns heAlTh AdminisTrATion: TAking home TeleheAlTh serVices To scAle nATionAlly 3
BACKGROUND The Veterans Health Administration within the U.S. Department of Veterans Affairs (VA) is regarded as a modern, responsive, efficient, and effective health care organization that many hold up as a model for deliver- ing cost-effective, quality outcomes. While it faces similar financial and clinical challenges as other health care delivery organizations, the VHA is unique in terms of the health care needs it addresses among the veteran population and in being directly accountable to Congress and financed primarily from public budgets. As one of the nation’s largest integrated health care systems, the VHA’s primary and specialty care ser- vices serve approximately 6 million veterans with an annual budget of more than $50 billion. It is organized around a service network model rather than hospitals. Each of the 21 Veterans Integrated Service Networks (VISNs)—or shared systems of care—operates with accountable clinical leadership responsible for mak- ing basic budgetary, planning, and operating decisions (Exhibit 2).
The shift toward continuous, coordinated, and comprehensive primary and specialist care services started in the mid-1990s.2 Observers have attributed the VHA’s successful transformation from a bottom- to
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