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VA Telehealth Services


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Store-and-Forward Telehealth

 store-and-forward telehealth encounter

You have probably heard the expression that a picture is worth a thousand words? In some areas of healthcare pictures can be worth thousands of clinic visits. Three areas of healthcare where this is becoming commonplace in VA are: radiology, dermatology and checking for the effects of diabetes on the retina in the back of the eye.

Store-and-Forward Telehealth involves the acquisition and storing of clinical information (e.g. data, image, sound, video) that is then forwarded to (or retrieved by) another site for clinical evaluation. For many years, local and regional Store-and-Forward Telehealth programs have been providing consultation to VHA sites in need of specialty expertise. VHA's first national Store-and-Forward Telehealth program was a primary care-based model that screens veterans with diabetes for retinopathy using teleretinal imaging that expedite referral for treatment and provide health information.

store-and-forward Dermatology


Dermatology (skin) problems are common and often a source of discomfort and concern to patients. The diagnosis of a skin problem can often be made from a digital picture if it is sent to a skin specialist (dermatologist) to see. A report with recommendations for treatment can then be sent back to a patient's primary care, or other, physician. The recommendation may be for treatment in the form of a medication or may be a referral to a dermatology clinic for more detailed assessment. VA is using TeleDermatology to improve access to skin care for veteran patients who live in remote and other areas to save having to travel to a dermatology clinic.

Store-and-Forward Retinal Imaging

TeleRetinal Imaging:

Diabetes can cause problems with the blood vessels in the back of the eye (retina), especially if the diabetes is poorly controlled. A special camera is now available that can take pictures of the retina of the eye without needing to put drops in the eye to widen the pupil of the eye. The picture that is taken is then sent to an eye care specialist to review and a report is sent back to the patient's primary care physician who then follows-up if treatment to prevent blindness is required. This investigation does not replace a full eye exam and is not suitable for people who already have complications of diabetes but makes it does mean that those at risk of eye problems from diabetes can be assessed easily and conveniently in a local clinic.

Store-and-Forward Provider Side

The ability to acquire, store and then forward digital images for reporting is a crucial area of care coordination development within VHA. VA's computerized patient record called VistA has a component called VistA Imaging. VistA Imaging. VistA Imaging enables the communication of clinical images throughout VA. Using VistA Imaging VA is able to undertake.