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From Fantasyland to Tomorrowland: Wireless Health for Rural Vets

Cheryl Clark, for HealthLeaders Media, June 30, 2010

For example, the VA is using or experimenting with:

  • Very Small Aperture Terminal (VSAT) satellites, installed in its 50 mobile centers which its readjustment counseling service uses to provide outreach and counseling in primarily rural areas.
  • Cueing aids sent to PDAs, smartphones, personal pocket computers, GPS devices and the Livescribe Pulse Smart Pen all help veterans remember appointments or medication schedules, which is especially helpful for vets with memory loss, spatial disorientation or other cognitive difficulties.
  • Bar Code Medication Administration carts and laptop computers are now wireless offering “vastly improved access to critical patient information used for clinical decision making at the very point treatment is provided,” Graham said. “To date the VA has administered over 1 billion medications using this technology” to assure doses are correct.
  • Through the VA’s “My HealtheVet,” online personal health record, vets have been able to fill more than 15 million prescriptions, and efforts are underway through the VA’s Office of Rural Health to adapt the application for mobile use.

But, as several of those testifying pointed out, there are significant obstacles. For starters, there’s the U.S. Food and Drug Administration, which has been criticized as being too slow to approve life-saving devices.

There’s also a problem of state licensing purview, which requires that physicians be approved by a medical board before providing care in a given state. With electronic and wireless health that may dampen the ability for care provided across state lines. While the VA’s doctors don’t have to worry about that, wider application of the technology may require civilian doctors to practice across state lines.

Additionally, there is limited access to broadband communication. Kerry McDermott, an expert advisor for the Federal Communications Commission, told the Congressional committee that 29% of rural health clinics do not have access to adequate mass-market broadband. And, he said, “We estimate that 14-24 million Americans do not have access to broadband where they live, even if they want it.”

Though he did not testify at the hearing, Alan Morgan, executive director of the National Rural Health Association applauded the VA for “making significant efforts to reach rural America through focused outreach efforts. However, we certainly would like to see them increase their partnership efforts with local existing rural providers.”

In an interview this week, Adam Darkins, MD, the Veterans Health Administration’s chief consultant for Care Coordination, points out that "the devil is in the details" with wireless health technology, much of it may not be quite ready for widespread application in rural areas.

“There’s still quite a lot of work that needs to be done,” he says. “If you’re going to have that kind of ability to monitor, you really must have the ability to intervene if necessary,” which means if a wireless monitor does detect a problem, what should providers do about it when the patient is far away. Additionally, he says, these technologies still produce a lot of false positives as well as false negatives.

And, he says, “telehealth, whether it links to wired systems or wireless isn’t going to replace the need to go to a hospital and clinic.”

Smith, of the West Wireless Health Institute summed up yet another issue.

“The current regulatory disclarity is dampening investment in wireless health technology and chilling this promising engine of innovation because many investors and some telecommunication companies fear FDA’s regulation of non-medical devices (e.g., smartphones of all manner) if medical applications are utilized.

“The FDA should be supported in the view that the specific sensors, algorithms for interpretation, and specific therapeutic devices should remain the focus of regulatory activity, and the pathways for communication of the information should be understood to be the purview of the Federal Communications Commission.”

As the VA’s Darkins says, there are a lot of issues still to sort out, and much more research that needs to be done.

It would be a bad idea to install a lot of technology that can’t be used in rural settings, whether because of lack of provider oversight, poor broadband links, or too many inaccurate signals.

But if I know one thing about technology, as it is in Disneyland, Fantasyland and Tomorrowland are just around the corner from each other.


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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