VA NY Harbor Healthcare System

Staff with some Veterans who make use of Mental Telehealth services.(L-R) Veteran Angel Diaz, Deborah Harris-Cobbinah, RN, Telemental Health Coordinator, Glen Kim , Left back: Adrian Jenkins-Jhalija-Program Assistant; Cynthia Miller, Program Assistant, Veteran Carlos Betancoart, Far back,:Geniva Hudson, RN, Telehealth

We all know what we can do to protect our health--get regular check-ups and screenings, control diet and weight, take medications as prescribed, exercise, and maintain intellectual and social interests. For many of us, though, carrying out those good intentions often proves difficult. Are your own recent New Year's health resolutions really happening, or are they still in the comfortable planning stage?

To make it easier for Veterans to make those good intentions a reality, VA New York Harbor Healthcare System has developed the Home Telehealth Program, which combines the latest technology with a caring human touch. Deborah Harris-Cobbinah, clinical nurse specialist in adult psychiatry and care coordinator of the Mental Telehealth Program, and Anthony Williams, a patient participant, described this innovative program. It is intended for Veterans with persistent and challenging medical conditions, such as congestive heart failure, diabetes, COPD, diabetes, high blood pressure, and mental conditions.

The program's aim to actively engage Veterans in the daily management of their own health conditions, which in turn helps catch problems early on, hopefully before they require an ER visit or in-patient stay. Veterans can self-enroll, or be referred by primary care or psychiatric clinics. Participation is entirely voluntary; at present, there are 120 Veterans in the Mental Telehealth Program. Harris-Cobbinah cautioned that the programs are "an adjunct to, not a substitute for, actual clinic visits." Veterans still need to keep their appointments with providers regularly, or obtain emergency care if needed.

Enrolled Veterans receive a small, attractive, user-friendly device, which is linked to their telephone, either landline or cell. Each day the Veteran calls, or is prompted to call, into their own Telehealth program, which then triggers a series of questions which appear on the device's screen. The questions are geared to the Veteran's particular health needs. The device also transmits recordings of pulse, blood pressure, weight, and blood sugar levels. The Veteran's responses are entered in a database, and then reviewed by his or her care coordinator. Anything that suggests the Veteran may be at risk prompt a call to the Veteran, and are conveyed to the Veteran's primary care physician, psychiatrist, or case manager for further intervention, as needed.

Williams, a VA volunteer, and current chairman of the Manhattan Veterans' Advocacy Council, shared that he has had depression in the past. For example, Williams' device may ask him about his mood, if he has a plan to structure his day, if he is taking any prescribed medications, and if there are any side effects. His knowledge of general health matters may also be queried. The device then responds with information, further instructions, and encouragement. To keep the interaction varied, and add a bit of fun, the device sometimes asks a non-health related question, for example, what State in the US has the longest coastline? Do you know the answer?

Harris-Cobbinah, a 31-year VA employee, and care coordinator of the Mental Telehealth Program since 2008, said she "aims to have 180 Veterans enrolled by October 2012. A new nurse has just joined the program to help us achieve this goal."

Williams, a participant for the past two years, often discusses the benefits of the program with fellow Veterans, some of whom have referred themselves. Williams is proud that he is taking an active part in his own medical care. He said, "It's important to have good rapport with your care provider, that he or she care about the patient." The Mental Telehealth Program has helped him learn about himself, and participate in his own care in "a cooperative spirit."