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FIGURE 11-2 VA store and forward encounters, FY2008-2011 and projected FY2012.

SOURCE: Reprinted with permission from Adam Darkins (2012).

Store and Forward Telehealth

In the VA, S&F telehealth is mainly used for teleimaging for diabetic retinopathy and for teledermatology. Both of these serve a demonstrable patient need. About 20 percent of the 5.6 million veterans in the United States have diabetes, and screening for diabetic retinopathy is a way to prevent avoidable blindness. Additionally, many VA organizations, particularly those in rural areas, have difficulty finding dermatology services. The VA is also exploring how to use this technology into wound care. Figure 11-2 shows the growth in S&F encounters. In 2005, about 1,500 patients were managed by S&F telehealth; by the end of FY2012, this number is estimated to be around 256,000.

Clinical Video Telehealth

Clinical video telehealth replicates the face-to-face consultation (e.g., between provider and patient, provider to provider) and eliminates the need to travel for certain services. The VA primarily uses this for real-time videoconferencing between VA medical centers and community-based outpatient clinics. It is mostly used for the delivery of mental health services and specialty consultations (e.g., telecardiology, teleneurology, tele-amputation care, teleaudiology, telepathology). In the past year, the VA has been moving



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