Long before high-speed internet networks made it fast and easy to transfer information, access services, and communicate with others the world over, VA had experimented with ways to deliver health care at a distance. One of VA’s first forays into telehealth occurred in 1959 when the Nebraska Psychiatric Institute set up a two-way television system to conduct group therapy sessions with Veterans at the Omaha VA Medical Center and other VA sites in the state. A few years later, VA physicians in Boston teamed up with Massachusetts General Hospital (MGH) and the New England Telephone Company on a telehealth project that allowed for remote monitoring of a patient’s vitals. Sensors by the patient’s bed or wheelchair picked up electrical signals from electrodes attached to the body and transmitted them via telephone lines to a device in the doctor’s office that functioned like a cardiogram.
In the early 1970s, Veterans at the VA Hospital in Bedford, Massachusetts, were the beneficiaries of another early telehealth venture involving Massachusetts General Hospital. In 1968, MGH set up a telehealth medical station staffed by nurses at Boston’s Logan International Airport, employing an interactive video system to connect travelers and airport employees with doctors at the hospital. MGH then expanded its telehealth network to include patients at the VA facility. The technology was still in its infancy and relied on a microwave relay to transmit video, audio, and physiological data collected from examinations. Even within the limits of the system, however, VA patients were able to receive medical care in specialties ranging from psychiatry and radiology to internal diseases and dermatology.
While these early initiatives were promising, they occurred in isolation and often petered out over time. For instance, Massachusetts General Hospital ended its telehealth program in the mid-1980s. However, the advent of internet-based telecommunications technology in the 1990s revived interest in telehealth across the VA medical system. From 1994 to 2003, thirty different VA medical centers launched pilot telehealth programs and research studies in select fields of medicine. These efforts were localized in nature, usually grant funded, and came about through clinical staff acting on their own initiative.
The virtual dermatology clinic created at the John J. Pershing VA Medical Center in Poplar Bluff, Missouri, in 1997 was typical of the start-up telehealth programs of the time. It began with a conversation between Timothy S. Moore, the center’s first telehealth coordinator, and his supervisor, who had just purchased a cart full of telecommunications gear and wanted to know if Moore had any thoughts on how to use it. He called around to other hospitals in the Heartland VA Network (the geographical region centered on Missouri and Kansas) and connected with the chief dermatologist at the Harry S. Truman Memorial Veterans’ Hospital in Columbia. At the doctor’s request, he set up a teledermatology clinic at the Poplar Bluff facility. A nurse practitioner conducted the exam while he operated the equipment. Digital images of potentially pathological areas of the skin taken during the exam were then transmitted to Columbia for subsequent evaluation by dermatology specialists. This form of telehealth, known as Store & Forward, is asynchronous since the remote physician is not interacting with the patient in real-time.
The positive outcomes reported by Poplar Bluff and other telehealth programs coupled with continued investment in VA’s IT infrastructure and videoconferencing capabilities led to the rapid expansion of the agency’s telehealth activities after 2004. By 2010, VA was managing national telehealth programs that provided care to Veterans in 44 different clinical areas. These programs have proved particularly important to meeting the health care needs of Veterans residing in rural areas, who comprise roughly 33 percent of the nation’s Veteran population. Many of these veterans experience geographic barriers to accessing in-person VA care and would have otherwise needed to travel long distances to reach their nearest hospital or clinic. In-home telemonitoring services have also been a great boon to Veterans with chronic health conditions, leading to fewer trips to the clinic and reducing the risk of hospitalization or complications..
Even before the COVID-19 virus hit the United States in March 2020, VA had established itself as the nation’s largest provider of telehealth care. In 2017, the agency rolled out VA Video Connect, an app enabling Veterans with a computer, tablet, or smart phone connected to the Internet to consult VA providers over live video. VA Video Connect and other technologies helped VA meet the soaring demand for telehealth services during the pandemic. In fiscal year 2021, over 2.3 million Veterans used some form of VA telehealth, a figure that represented about one-third of all Veterans receiving care from VA during this time period. Once a novelty, telehealth has become a core component of VA’s medical system.
The telehealth cart first used at the Poplar Bluff VA hospital in the late 1990s remained in the Heartland Network’s inventory until 2022, when it was accessioned into the permanent collection of the National VA History Center in Dayton, Ohio. Now a historic artifact, the cart attests to VA’s early commitment to finding innovative ways to improve Veteran access to health care.
By Katie Rories, Historian, Veterans Health Administration
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History of VA in 100 Objects
Object 80: LUKE/DEKA Prosthetic Arm
In the 19th century, the federal government left the manufacture and distribution of prosthetic limbs for disabled Veterans to private enterprise. The experience of fighting two world wars in the first half of the 20th century led to a reversal in this policy.
In the interwar era, first the Veterans Bureau and then the Veterans Administration assumed responsibility for providing replacement limbs and medical care to Veterans.
In recent decades, another federal agency, the Defense Advanced Research Project Agency (DARPA), has joined VA as a supporter of cutting-edge research into artificial limb technology. DARPA’s efforts were spurred by the spike in traumatic injuries resulting from the emergence of improvised explosive devices as the insurgent’s weapon of choice in Iraq in 2003-04.
Out of that effort came the LUKE/DEKA prosthetic limb, named after the main character from "Star Wars."
History of VA in 100 Objects
Object 79: VA Study of Former Prisoners of War
American prisoners of war from World War II, Korea, and Vietnam faced starvation, torture, forced labor, and other abuses at the hands of their captors. For those that returned home, their experiences in captivity often had long-lasting impacts on their physical and mental health. Over the decades, the U.S. government sought to address their specific needs through legislation conferring special benefits on former prisoners of war.
In 1978, five years after the United States withdrew the last of its combat troops from South Vietnam, Congress mandated VA carry out a thorough study of the disability and medical needs of former prisoners of war. In consultation with the Secretary of Defense, VA completed the study in 14 months and published its findings in early 1980. Like previous investigations in the 1950s, the study confirmed that former prisoners of war had higher rates of service-connected disabilities.
History of VA in 100 Objects
Object 78: French Cross at Cypress Hills National Cemetery in Brooklyn
In the waning days of World War I, French sailors from three visiting allied warships marched through New York in a Liberty Loan Parade. The timing was unfortunate as the second wave of the influenza pandemic was spreading in the U.S. By January, 25 of French sailors died from the virus.
These men were later buried at the Cypress Hills National Cemetery and later a 12-foot granite cross monument, the French Cross, was dedicated in 1920 on Armistice Day. This event later influenced changes to burial laws that opened up availability of allied service members and U.S. citizens who served in foreign armies in the war against Germany and Austrian empires.
