Department of Defense:
Telehealth Use in Fiscal Year 2016
GAO-18-108R: Published: Nov 14, 2017. Publicly Released: Nov 14, 2017.
DOD uses telecommunication technologies, such as two-way video visits between doctors and patients, to deliver health care across distances. This is called “telehealth,” and it gives servicemembers access to care in more locations and for a wider range of conditions.
We found that mental health and cardiology are common clinical services DOD provides through telehealth. Additionally, the Army provides the largest volume of telehealth services, compared to other military services.
Finally, while relatively few servicemembers currently receive telehealth services, DOD is beginning to expand this option.
Example of Telehealth Use at the Department of Defense
Figure shows a patient in one location interacting in real time with a provider at another location.
What GAO Found
The Department of Defense (DOD) uses telehealth to provide health care services to its beneficiaries who include active duty servicemembers, dependents, and retirees. DOD defines telehealth as the use of telecommunication and information technologies to provide health assessments, treatments and other services across distances. GAO's analysis of DOD telehealth service encounter data for fiscal year 2016 found that DOD provided about 59,000 telehealth service encounters between providers and patients or between two providers. Of DOD's 59,000 telehealth encounters,
- about three-fourths were provided through DOD's direct care component of military treatment facilities, while one-quarter were provided through its purchased-care networks of civilian providers; and
- about 88 percent were synchronous or "real time" interactive communications such as those between providers and patients during live video, and the remaining 12 percent were asynchronous or "store and forward" encounters involving the transmission and interpretation of medical images between providers.
GAO's analysis of telehealth use by active duty servicemembers shows that the types of clinical services that DOD provided using telehealth varied according to the type of encounter.
- Synchronous encounters were commonly used to provide mental health and pulmonary disease services.
- Asynchronous encounters were commonly used to provide cardiology and dermatology services.
Among all active duty servicemembers, GAO found that relatively few--about 1 percent--received telehealth services in fiscal year 2016. That is, among the roughly 1.2 million active duty servicemembers, about 11,000 were involved in at least one synchronous encounter and about 2,000 were involved in at least one asynchronous encounter, such as a consultation for a diagnosis.
The Army provided the largest volume of telehealth service encounters to active duty servicemembers, compared with the Navy, Air Force, and National Capital Region combined. Further, seven military treatment facilities provided almost all of DOD's telehealth encounters to active duty servicemembers. The seven facilities with the highest volume of encounters are located in the United States (Hawaii, Texas, Maryland, Virginia, Georgia, and California) and Germany (Landstuhl). DOD officials explained that a small number of facilities provided most of the telehealth encounters for several reasons: leaders at these facilities have actively encouraged telehealth use, four of the seven facilities maintain hubs, two facilities maintain portals that support a high volume of synchronous and asynchronous telehealth encounters, and these facilities have a large number of providers who can provide specialty care with telehealth.
Why GAO Did This Study
In 2015, DOD developed a plan to expand the use of telehealth across the Army, Navy, Air Force, and in the National Capital Region and has begun implementing parts of this plan. This expansion is intended to help ensure the health of servicemembers by providing access to care for a wider range of conditions as well as in areas where servicemembers may be injured. Further, the National Defense Authorization Act for Fiscal Year 2017 requires that DOD expand its use of telehealth by June 23, 2018. The Act also includes a provision for GAO to examine several issues related to DOD's delivery of health care, such as access to care.
This report describes DOD's use of telehealth for active duty servicemembers and other beneficiaries. GAO reviewed DOD telehealth data for fiscal year 2016, including data on the volume of synchronous and asynchronous encounters provided to beneficiaries through DOD's direct and purchased care components, the type of clinical service provided through telehealth, and the geographic location of providers. GAO assessed the reliability of the data by interviewing DOD officials about the coding of the data and any issues related to its accuracy and determined that the data were sufficiently reliable for its reporting objective. Further, GAO reviewed DOD documents such as DOD telehealth policies and reports describing DOD's telehealth services, and DOD plans to implement additional services using telehealth. DOD reviewed a draft of this report and provided technical comments, which GAO incorporated as appropriate.
What GAO Recommends
GAO is not making any recommendations.