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Office of Public and Intergovernmental Affairs

Remarks by Former Deputy Secretary W. Scott Gould

2010 Healthcare Innovation Day
Washington D.C.
October 12, 2010

Donald Casey [CEO, West Wireless Health Institute] — Thank you for that kind introduction, and for putting together this outstanding conference and making your challenge to industry. We are grateful for the assistance of the West Wireless Health Institute in the search for wireless solutions to today’s healthcare challenges. The role of innovation in this industry will certainly benefit from a strategic, well-resourced 501c3.

Thanks also to Gary and Mary West, founders of West Wireless, for taking the lead on wireless telehealth and making it possible for the Institute to bring together industry and government leaders on telehealth issues. VA is pleased to have an opportunity to share with all of you today our innovations and initiatives in this important market.

Telehealth offers exciting opportunities to accomplish two important goals of this administration — improving healthcare for all Americans, while also keeping costs down. The Veterans Health Wireless Innovation Challenge Don has just announced serves yet another goal — improving healthcare and healthcare access for America’s Veterans. We at VA are pleased to be partnering with West Wireless for this challenge, we are thrilled to have the opportunity to engage with such an innovative technology sector, and we look forward to seeing some fantastic results.

VA Transformation

As many of you know, VA operates the largest integrated healthcare system in the country. Over a third of the Nation’s Veterans are enrolled in the VA system — about 8 million out of 23 million. Last year alone, over five and a half million Veteran-patients walked through our doors. We operate more than 1,400 points of care, where nearly 18,000 VA doctors, 49,000 VA nurses, and an army of clinical and support staff provide some of the best care anywhere.

Those points of care include 153 flagship Medical Centers, which are affiliated with 122 of the top medical schools in the Nation. All are networked through VistA, our extensive electronic health record — the most comprehensive in the country.

Our hospitals are networked to 788 Community-Based Outpatient Clinics, 232 Vet Centers, and other outreach and mobile clinics that make up our system, extending our reach into rural communities, where many of our Veterans live.

VA has long been a leader in medical science. Our medical innovations and groundbreaking research have, for decades, made life better not just for Veterans, but for millions of Americans, as well — developing the first implantable cardiac pacemaker; performing the first successful liver transplants; designing the Seattle foot, which enables lower appendage amputees to run again; creating the nicotine patch to help smokers quit their addiction; designing myriad improvements to wheelchairs; and developing artificial limbs that move when stimulated by electrical impulses from the brain.

Our people are recipients of the Nobel Prize, Malcolm Baldrige award, and J.D. Powers recognition for their professionalism, their efficiency, and their service to mankind.

As proud as we are of our achievements, VA is in need of change. Today, we are in the midst of a sweeping transformation, aimed at realizing President Obama’s vision of a high-performing 21st century VA. This transformation can be defined in three sentences:

• Change VA’s culture from adversary to Veteran advocate.
• Deliver improved services and benefits in a demanding operating environment to achieve high standards of quality.
• Build strong and flexible management systems to help us achieve these results for Veterans and their families.

These are long-term goals, which will take years to achieve. For the short term, we are focusing on three immediate objectives that are of critical importance to Veterans: Increasing access to benefits and services now, eliminating the disability claims backlog, and ending Veterans’ homelessness. 

Making better, fuller use of existing and emerging technologies is an important part of the solution to each of these objectives. Over the next five years, VA expects to spend $7 billion on information technology product and service procurement alone.


We are also investing more in telehealth technologies to make VA healthcare available to Veterans wherever they live. In FY2010, we invested $121 million in telehealth. In FY2011, those investments will grow to $163 million. By the end of FY2012, we expect to have doubled our present use of telehealth.

We realized long ago that we couldn’t serve all of the Nation’s Veterans from our city-based medical centers. That’s why we have added 788 Community-Based Outpatient Clinics, or CBOCs, plus another 50 mobile clinics, which extend VA’s reach into more remote areas. We have added 20 new CBOCs just since July of 2009, and we plan to open another 21 in this fiscal year.

Today’s technology enables us to extend our reach even farther, right into Veterans homes, no matter where they live. Life-saving remote monitoring is ongoing today for roughly 40,000 chronically ill Veterans. It saves them the time, expense, and stress of having to drive or be driven to the nearest hospital or clinic, allowing them to go about their lives and take care of themselves in the comfort of their homes.

Telehealth also connects patients and doctors to distant specialists, to provide better care sooner and cheaper. It’s not a panacea — there will always be a need for on-site, in-person care. But for many patients, telehealth offers greater access, better care, at less cost, for less trouble.

VA’s first use of telehealth was in 1977, well before the days of PCs, email, and the World Wide Web. We spent the next 22 years experimenting with various telehealth applications, as the necessary information technology continued to evolve. Then in 1999, we began systematizing our telehealth programs to provide home telehealth, video-conferencing between hospitals and clinics, and remote use of digital imaging — or “store-and-forward” telehealth.

VA began progressive implementation of telehealth solutions in 2003. Our home telehealth came to include monitoring of patients with diabetes, heart trouble, hypertension, and depression. We now use clinical videoconferencing to counsel patients dealing with mental health issues, rehabilitation, and polytrauma. We use store-and-forward telehealth for diabetic retinal imaging and dermatology.

I would note that our advances in telehealth have been made possible by changes in VA’s national IT infrastructure and in our clinical and business processes. Those changes included several iterations of our very successful VistA electronic health record system. In some sense, telehealth could be viewed as a multi-media electronic health record extending into the patient’s home.

Today VA is a recognized leader in telehealth development and usage. We have treated over 300,000 patients through telehealth in the past fiscal year. Our telehealth network connects 94% of our Medical Centers and 70% of our Community-Based Outpatient Clinics. We have three dedicated telehealth training centers training over 2,800 staff members per year in the use of telehealth technologies and in changing clinical workflow so Veteran patients can access care in convenient locations. Our Lake City, Florida training center trains staff to provide home telehealth using commercial-off-the-shelf (COTS) technology. Our Denver training center trains staff to provide video-conferencing using COTS technology. And our Boston training center trains staff in store-and-forward image acquisition and reading.  Virtual technology accounts for almost all of our training in home telehealth and video-conferencing and about 60% in store-and-forward telehealth.

For the future, we want more needs of our patients to be met by telehealth, including — virtual ICU care, audiology assessments, telepathology reviews, care-giver support, Parkinson’s disease assessment and care, and wound-care management. We are looking at ways to extend telehealth through the use of cell phones and in-home video. We are also working to create new telehealth programs to meet emerging service priorities.

For example, as the Veteran population ages, more Veterans may suffer Age-related Macular Degeneration (AMD). As that happens, we want to explore the feasibility of using our 300 teleretinal screening systems to meet the challenge.

Successful telehealth programs depend on an integrated systems approach, which requires re-engineering of existing clinical, IT, and business processes. Re-engineering to integrate so many different systems is a tough challenge for any organization, but VA is now fully in the transformation mode.

With the support of the White House, the leadership of Secretary Shinseki, and the determination of our new Under Secretary for Health, Dr. Randy Petzel, we’re paving the way for progress on telehealth and in many other areas.

VA Industry Innovation Competition

In June, we launched the VA Industry Innovation Competition, as part of our ongoing VA Innovation Initiative, or VAi2. We’ve held innovation competitions using crowd sourcing, asking 40,000 VA employees to suggest improvements to the way we do business. They submitted over 10,000 ideas, the best of which we have funded and moved forward on.

For our latest competition, we asked industry to propose business and technology solutions in six high-priority areas. We identified the what and the why; we asked industry to provide the how. We designated up to $80 million to fund prototyping and pilot testing of the best solutions. And we put together panels of experts, from inside and outside VA, to review the proposals and recommend winners.

Telehealth is one of the broadest topics that we identified. You’ve heard a little bit about VA’s efforts in telehealth. Later this morning you will hear more from Dr. Adam Darkins, VA’s Chief Consultant for Telehealth Services. With the Industry Competition, we seek to build on our success and explore how new solutions can further improve the outcomes we achieve.

Other Industry Competition topics range from enhancing polytrauma care to finding innovative housing solutions that address Veteran homelessness. In all cases, engaging industry to devise ways to turn new technology into solutions that deliver better outcomes is key to our success.

The first round of the competition closed September 30. We received hundreds of outstanding proposals. In fact, the volume of submissions far exceeded our expectations. I had hoped to announce the first round of winners today, but it’s going to take us a little more time in order to give such a fantastic set of proposals a proper evaluation. You will hear more about VAi2 this afternoon from its director, Jonah Czerwinski, and our senior advisor for VAi2, Mike O’Neill.

In the meantime, I am delighted to join Don Casey in announcing the Veterans Health Wireless Innovation Challenge, which promises to produce innovative solutions that raise the quality and lower the cost of health care — not just for VA, but for the entire healthcare community. On behalf of Secretary Shinseki and all of the Nation’s Veterans, thanks again to West Wireless for taking an interest in them.

Concluding Comments

Veterans rightfully expect VA to meet their needs in increasingly efficient, convenient, and customer-friendly ways. “Business as usual” will no longer do. VA is changing to better serve the evolving needs of America’s Veterans, whether he or she is the 20-year old Veteran of Afghanistan, 40-year old Veteran of Kuwait, 60-something Veteran of Vietnam, or the 90-year old Veteran of Normandy.

By partnering with industry in the search for innovative solutions, VA can continue to provide them with the best possible healthcare. Wireless technology will certainly be a big part of that future. Thank you.