Q&A: VA's Adam Darkins on telemedicine, EHRs and 'an Internet for healthcare'

Adam Darkins, MD

Healthcare IT News spoke recently with Adam Darkins, MD, chief consultant of care coordination services at the Department of Veterans Affairs, about the ways VA is deploying technology to deliver care to service members returning from Iraq and Afghanistan.

[See also: VA to help veterans with diabetes with remote monitoring.]

Do you feel the U.S. health system is adequately set up to meet the mental and physical health needs of the thousands of soldiers returning – and those soon to return – from Iraq and Afghanistan? How can health IT help make sure those needs are met, and how has VA made use of it?

The VA, as you know, is very advanced in terms of its computerized patient record. And up until it introduced that patient record in the late 1990s, VA had been predominantly an inpatient hospital organization.

If you want to move services from hospitals into other settings – which VA has done, to 900 other clinics since the mid-1990s – if you move the staff there but don't have the information to be able make decisions and care for them, then it's really not altering where care takes place.

This expansion has taken place in two stages. The first was the introduction of the patient electronic health record, which enabled the movement of care into other sites than hospitals, making it more accessible.

But then you can build on top of that, which we've done since the late '90s, which is to use telehealth to change the location of care, and to save specialists from having to travel out long distances to peripheral clinics, and also to make specialty care available in places where you ordinarily might not find a specialist.

[See also: Psychological sensors to be incorporated in telehealth for service members.]

What are you most concerned about when it comes to ensuring the best care for returning veterans? Quality? Access?

Access is a big challenge, and it's one that Secretary Shinseki is determined is going to be met. The challenge really is one that all healthcare systems face. The VA has a mandate to provide care to veterans throughout the whole of the continental U.S., in Puerto Rico and the U.S. Virgin Islands, the Hawaiian Islands, and Guam. Given that remit, to provide physical services and make them accessible everywhere is really a huge and daunting task.

[See also: VA awards $19M contract for mobility network.]

New technology makes it possible to provide services by bringing services effectively to the patient, in instances where that's appropriate, rather than the patient having to travel all the way to the services.

For example, you're in Maine. A veteran who may be up in Caribou, instead of having to travel down to the VA center in Togus, which could be an eight-hour return journey – and that doesn't bear in mind what it might be with the snow in winter – can now see the mental health provider from Caribou to Togus without having to travel all that distance.

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Topics: Telehealth