VA incubates mammoth teleradiology network

Just as the Internet was spawned by the Department of Defense and its academic partners, so too the world's largest telemedicine network is incubating in government wards. This network, however, does not rely on the Web.

"In the course of this year, all 173 Veterans Affairs medical centers will be linked by T1 bandwidth or above," said Dr. Adam Darkins, acting chief consultant for telemedicine at the Department of Veterans Affairs. "The last data show the VA doing about 280,000 teleconsultations a year, the majority of those in teleradiology."

With such a sprawling, high-bandwidth network at its disposal, the VA uses the Web only for nondiagnostic purposes.

"Typically, for diagnostic reading, the Web is not being used," Darkins said. "Where it is being used is to give images to clinicians who don't need diagnostic quality."

The VA network will eventually include all 103 U.S. university medical schools with VA affiliation. A network so huge could only be fabricated by a ubiquitous federal agency, where the scale required is readily available. The VA operates the largest healthcare system in the U.S.: at least one medical center in each of the contiguous states, Puerto Rico, and Washington, DC; 650 clinics; 206 counseling centers; and 134 nursing homes.

Physician licensing is not an issue. Within the VA, as in other federal agencies, state licensing requirements for physicians do not apply, providing the practice is done on federal property.

In California, Nevada, and Hawaii, VA medical centers have already created clinical telemedicine teams to support patients of the regional spinal cord injury center at Palo Alto, CA. The team cares for patients completing rehabilitation at the center by videoconferencing among VA facilities and patients in their homes.

Darkins sees the system evolving beyond the VA, to government telemedicine in general.

"Once you become more sophisticated, you realize it isn't just about videoconferencing," he said. "You need the patient's chart. What telemedicine is about is a multimedia patient record."

The VA's systemwide computerized patient record system will eventually link to the Government Computer-Based Patient Record (GCPR), a federal healthcare initiative attempting to facilitate the secure exchange of electronic medical records across all government health organizations. GCPR pilot testing is under way in Anchorage, at the Alaska Native Medical Center, VA Medical Center, and Elmendorf Air Force Base Military Treatment Facility.