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Brief analytical summaries or syntheses #35

Telehealth : what can the NHS learn from experience at the

U.S. Veterans Health Administration?


Published on the website, this comparative study examines the largest implementation of telehealth anywhere, the Veterans Health Administration in the U.S. With the British government's announcement of the positive results of the Whole System Demonstrators and the launch of the 3 Million Lives Programme, this report is timely as U.K. stakeholders plan how to implement telehealth widely and deliver significant benefits.


As a large publicly funded system delivering comprehensive services to a veteran population of 23m and with an annual budget of over £30bn, the VHA has many parallels with the NHS. Extensive studies show that the VHA consistently provides a better quality of care than other health systems in the U.S., and at a lower cost. Central to its strategy of ‘keeping patients healthy’, the VHA aims to support patients with long term conditions through care ‘at a distance’ and the promotion of self-management skills. This strategy has led to the significant reduction in acute care facilities and the commensurate expansion of outpatient clinics. In this regard, the NHS can learn many lessons from the VHA’s overall strategy to integrate care and its use of telehealth technologies.

Analysis and results

Over the last decade, the VHA has implemented and assessed a major Home Telehealth programme to enhance access to care nationwide. It has undertaken to improve the health of designated individuals and populations, with the specific intent of providing ‘the right care in the right place at the right time.’ In 2011, some 50,000 VHA patients received telehealth services, and substantial growth is projected.

While the initial focus of the programme was around the active management of chronic conditions and post-traumatic stress disorder, this is now being extended to primary prevention of these conditions through programmes such as obesity management. The model for telehealth provision is defined nationally, with teams of local care coordinators managing the telehealth patients in each of twenty-one designated regions.


To address the huge challenge of effectively caring for the millions of patients with long-term conditions, the VHA serves as an excellent role model for the NHS in terms of scaling up new care management services involving telehealth.

Implications and recommendations

Reflecting on the key lessons learnt from the VHA, we have listed our ten-point plan for rapid telehealth impact in the NHS:

Transformational development

1. Success depends on senior leadership commitment to ‘care at a distance’ as a direction of travel, reducing the imbalance between hospital and primary care spend and making better use of scarce clinical resources.
2. A telehealth-enabled service needs considerable investment and time to generate results. It also needs substantial change to the organisational infrastructure (training and core competencies) and performance management system.
3. Care pathways incorporating telehealth would benefit from design and accreditation at a national level – e.g. by the National Institute of Health and Clinical Excellence.

Outcomes from telehealth programme

4. To achieve the staffing and logistical efficiencies seen in the VHA (between 20–56% reductions in patient utilisation, depending on disease group), the NHS needs to find ways to deliver a step-change increase in the scale of telehealth implementation.

Patient profiles

5. Best practice patient selection methodologies are critical to the success of any telehealth programme. Risk stratification must be used to identify the patients most in need of telehealth support, although not all patients will be suitable for telehealth.

Care coordination and telehealth

6. Those who manage the delivery of telehealth need not be local to the patient but do need to interact closely with the responsible clinician in primary care / community care. In particular, telehealth needs establishing as a centralised service of ‘care coordinators’ on a local/regional basis, rather than something additiive to existing Community Matron, District or Practice Nurse workloads.

Changing the culture

7. To provide the confidence needed for referrals into a telehealth service, clinician engagement is essential – based around clear evidence of benefit to specific patient and disease groups.


8. Training is vital to get an effective, stable and consistent level of service – with appropriate audit data to inform service delivery and decision making.

Integration with Electronic Health Record

9. In the absence of a common patient record (as generally the case in the NHS), there needs to be integration and sharing of data between those working in telehealth and those in primary care, using industry standard interface definitions.

Funding and reimbursement

10. Funding needs addressing through sustainable reimbursement policies, in particular revisions to tariff. 


Telehealth : what can the NHS learn from experience at the U.S. Veterans Health Administration?

Gouvernement du Québec
© Gouvernement du Québec, 2018