The VA serves a population of 23 million veterans, of whom 8.3 million are enrolled in the VHA, compared with 53.2 million people served by the NHS. The VHA's 2012 budget of $53 billion is around one-third that of the NHS' $160 billion budget, the report said. The average age of a VHA enrollee is 62, with more than 40% aged 65 and older. VHA patients are typically sicker than most Americans across a plethora of costly chronic conditions, including hypertension, diabetes, obesity, depression, congestive heart failure and chronic obstructive pulmonary disease. Many of the patients could be better served by various existing and emerging information technologies, according to the report. And while the NHS covers all ages of the population, providing care to all residents of the U.K.—“free at the point of delivery, irrespective of personal wealth”—including 11 million children under age 18, the proportion of the population in the U.K. age 65 and over is expected to rise 42% to 18 million by 2025, pushing up expected costs.
According to the report, with the collaboration beginning this year, both organizations expect to learn from each other in five areas: a general digital transformation of healthcare to improve patient outcomes; home telehealth, that is, the use of remote patient monitoring for chronic-care management; telemedicine and video conferencing between clinicians and patients to replace face-to-face visits; mobile health, using a range of devices to empower both clinicians and patients with the information they need to provide more effective care; and the use of secure messaging and personal health records to support provider/patient communications.
In a foreword to the report, Dr. Adam Darkins, the chief consultant for telehealth services at the VHA's Office of Patient Care Services, said large, integrated delivery systems such as the VHA and NHS “are uniquely placed to develop and refine new models of care that use innovative new technologies to provide care to virtually to patients.”
“Virtual care is not a panacea for all the challenges facing healthcare,” Darkins said, but these technologies can “offer the timeliness and convenience of access to care; benefits we have come to expect in other areas of our lives with on-line banking and shopping.”
Darkins, a neurosurgeon, spearheaded a VHA push in 2003 into care coordination via telehealth.
Peter Groen retired from the VA after working 34 years in healthcare information technology, lastly as the director of the health IT sharing program at the VA. He said people at the VA and the NHS have been talking “as far back as I can remember, at least 20 years, with lots of visits going back and forth and exchanging tools.” Groen, co-founder and senior editor of Open Health News, a website that tracks the use of open source software in healthcare, said this new exchange is a continuation of those earlier efforts.
There has been discussion within the past year or so about a grass-roots campaign to persuade the NHS to pilot test the VA's VistA electronic health-record system at a few of its hospitals, but Groen doesn't see this latest talent- and idea-swapping initiative as a precursor to that.
“They've got these companies and not-for-profit groups in England that are still pushing VistA,” Groen said. “I don't expect that to happen. With any bureaucracy like the VA—and the NHS is so much bigger—they don't get pushed. On the VA side, they'll say, look at some of that mobile activity the NHS uses.” But, Groen said, “by the time it pops out at the other end, it doesn't look the same.”
“Innovation has occurred,” he said, “because they were inspired” by the other organization, but the finished product will be uniquely its own.