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Background: Like other integrated health systems, the US Department of Veterans Affairs has widely implemented telehealth during the past decade to improve access to care for its patient population. During major crises, the US Department of Veterans Affairs has the potential to transition healthcare delivery from traditional care to telecare. This paper identifies the types of Veterans Affairs telehealth services used during Hurricane Sandy (2012), and examines the patient characteristics of those users.Methods: This study conducted both quantitative and qualitative analyses. Veterans Affairs administrative and clinical data files were used to illustrate the use of telehealth services 12 months pre- and 12 months post- Hurricane Sandy. In-person interviews with 31 key informants at the Manhattan Veterans Affairs Medical Center three-months post- Hurricane Sandy were used to identify major themes related to telecare.Results: During the seven-month period of hospital closure at the Manhattan Veterans Affairs Medical Center after Hurricane Sandy, in-person patient visits decreased dramatically while telehealth visits increased substantially, suggesting that telecare was used in lieu of in-person care for some vulnerable patients. The most commonly used types of Veterans Affairs telehealth services included primary care, triage, mental health, home health, and ancillary services. Using qualitative analyses, three themes emerged from the interviews regarding the use of Veterans Affairs telecare post- Hurricane Sandy: patient safety, provision of telecare, and patient outreach.Conclusion: Telehealth offers the potential to improve post-disaster access to and coordination of care. More information is needed to better understand how telehealth can change the processes and outcomes during disasters. Future studies should also evaluate key elements, such as adequate resources, regulatory and technology issues, workflow integration, provider resistance, diagnostic fidelity and confidentiality, all of which are critical to telehealth success during disasters and other crises. [ABSTRACT FROM AUTHOR]

In 1995, the Royal Children's Hospital Mental Health Service in Melbourne developed the first telepsychiatry programme in child and adolescent mental health services (CAMHS) in Australia. A survey of 25 CAMHS clinicians in five rural regions who had used videoconferencing showed that 64% had used the technology for more than 18 months, and 20% had used it for 7–12 months. Also, 60% had used the technology on over 30 occasions, and 24% had used it on 20–29 occasions. Respondents clearly recognized its benefits in terms of their increased knowledge and skills (96%), strengthening of relationships with colleagues (92%) and decreased sense of isolation (92%). To build on the success of telepsychiatry there are a number of challenges that health service managers will need to address. Telepsychiatry works most effectively as a tool to complement face-to-face contact. It cannot be promoted as the total solution to the issue of isolation from mainstream services. [ABSTRACT FROM AUTHOR]