如果在全国任何地方有一个机构面临着巨大的挑战，远程医疗似乎提供了诱人的解决方案, it would be the Department of Veterans Affairs.
数以万计从身心残缺的海外部署归来的士兵需要持续的医疗保健. Rural and small-town heroes languishing hundreds of miles from care. 一个资金紧张、经常陷入困境的联邦政府总是在寻找更多的供应商和更多的地点来服务迅速增长的客户.
And so, indeed, 几十年来，退伍军人事务部一直试图推动科罗拉多州以及西部农村和边境地区的远程医疗前沿.
早期的证据是20世纪50年代内布拉斯加州退伍军人管理局心理学家试图通过“双向电视连接”进行心理健康咨询的黑白照片. Trace from there a direct line to the Eastern Colorado VA in 2016, more than 50 years later, 把新的平板电脑直接放在农村退伍军人的家里，这样他们就可以在客厅里通过可视电话“看”医生.
In between, through that five decades of technology and health change, 一直在进行一系列无情的实验和升级，以使科罗拉多州东部弗吉尼亚州接受远程医疗技术. One constant, said Marlys Withrow-Hill, the division’s home-based telehealth program manager, is empathy for what an ailing veteran goes through to get care.
“After a long drive, 一些退伍军人对他们的医疗服务提供者和医疗系统非常愤怒，他们甚至不愿完全透露自己的病情. They’re too angry to have a good visit,” Withrow-Hill said. “There are things people don’t bring up when they are distracted by anger, exhaustion and frustration. By the time they get in to see their provider in Denver, they are wiped. And then they still have to make it back home.”
在科罗拉多州和其他州，退伍军人等待任命的漫长时间引发了负面新闻和国会的质疑. The Colorado Springs VA clinic, 它是东科罗拉多部队的一部分，也是该州最大的退伍军人聚集地, 2014- 2015年6个月期间，超过10%的预约等待时间至少为31天, according to an Associated Press article. 这使得该诊所在全国940家VA诊所和医院中排名第12位, and far above the national average of 2.8 percent late appointments. Colorado, like other states, has a large inflow of veterans returning from overseas conflict, 同时，强劲的经济和吸引人的生活方式也带来了人口激增, VA officials said at the time.
The VA’s Eastern Colorado unit alone takes care of 126,000 enrolled veterans. Glendale also houses the offices of the VA’s larger Region 19, encompassing hundreds of thousands more veterans in Montana, Oklahoma, Utah, Wyoming, Idaho, Nevada, 内布拉斯加州和科罗拉多州东部办事处未覆盖的部分地区.
Just under 1,000 of those veterans are now using home telehealth in Eastern Colorado, and 33,000人在当地诊所使用视频远程医疗获得远程专科护理, said Doug Van Essen, facility virtual health coordinator for the Denver VA Medical Center.
“We’ve seen it grow progressively throughout the years, and especially in the past three years it has blossomed,” Van Essen said.
罗伊·汉密尔顿是科罗拉多斯普林斯的一名退伍军人，在离开美国之前，他在一次摩托车事故中失去了一条腿.S. Army. The upbeat Hamilton said it’s important to him to remain active, walking his dog, going on bike rides and water-skiing with an adaptive-abilities group. While he has seen the scheduling pressures on the VA at its local clinics, 他说，与退伍军人事务部医生和顾问的视频会议帮助加快了一种特殊防水假肢的安装.
Telehealth efforts in Colorado’s VA started in 2004, 有慢性病的高风险退伍军人和大量的护理访问. 使用家庭电话线的远程监控设备可以收集每日健康读数并将其传输到中心办公室, which could then alter care accordingly.
即使是这种简单的技术，由于更好的护理协调，住院率也减少了50%.
随着“越来越多的士兵从伊拉克和阿富汗归来”，对退伍军人事务部卫星办公室视频远程医疗访问的需求也在增长, many with mental health factors,” Van Essen said. “让他们感到不舒服的一件事是长途驾驶，而且要在一个大医院里和很多人在一起.”
改进和更便宜的视频技术使退伍军人事务部能够在普韦布洛设立远程诊所办公室, La Junta or other locations, and set up live video visits with providers in Denver, Salt Lake City or other major medical centers.
The video visits can be a big boon for the providers, too. 安排在普韦布洛轮流工作的专家每天可能要花四个小时甚至更多的时间开车往返于丹佛的总部. Technology in remote stethoscopes has improved, for example, 远距聆听的医生比在嘈杂的诊所里亲自就诊的医生能听到更多的声音.
“像萨利达这样的小地方的初级保健诊所基本上可以获得他们在丹佛所能获得的所有服务, given our specialist connections,” Withrow-Hill said.
Audiology is one of the booming specialties employing more telehealth. 听力问题在从嘈杂的训练或战区回来的退伍军人中很普遍. Few rural VA clinics can afford the specialty. 但在小镇诊所里，专门设计的听力学“推车”可以测试当地退伍军人的听力，然后在助听器交付后对其进行关键调整.
“The technology is now catching up with what we want to do,” Withrow-Hill said.
她接下来想做的是帮助弗吉尼亚州更深入地研究她最喜欢的新技术:平板电脑让退伍军人可以在舒适的家中安全地与他们的提供者交谈. “For me, 最大的问题仍然是，我们为什么要把这些病人拖到诊所，而我们可以在家里看他们,” she said.
退伍军人可以根据病情的严重程度获得平板电脑连接的资格, the remoteness of their home or various mental health needs. In addition to the live video link for appointments, 该平板电脑还可以作为退伍军人与医疗记录十大菠菜靠谱平台的门户, test results and proactive health advice. Thirty thousand of the 90,000名活跃的退伍军人在东科罗拉多分部使用个人健康门户网站, Van Essen said.
The tablets can be loaded with various apps tailored to the veteran’s needs. Veterans with suicidal thoughts or expressions have started using “Hope Box,” an app that collects family photos, 个人笔记和其他可以提醒用户继续生活的理由的物品.
More than 300 of the tablets have been set up in Colorado veterans’ homes, Withrow-Hill said, “and more are going out the door every day.”
一位越战老兵在科罗拉多州东南部的一家诊所看到了这项新技术，他称之为“巴克·罗杰斯式的东西”,” said VA Eastern Colorado spokesman Daniel Warvi.
远程医疗从科幻小说走向现实生活的漫长等待现在即将结束, Withrow-Hill said. “It’s here.”
VA Tries to Connect a Far-Flung Region to Embrace Telehealth
本文最初发表于2016年秋季期的《十大菠菜靠谱老平台》杂志.