Report blasts DoD, VA for failure to track PTSD treatment

Despite the massive electronic health record systems used by the Defense and Veterans Affairs departments, neither department tracks the treatment of post-traumatic stress disorder, according to a report from the Institute of Medicine.

The two agencies don't keep track of the PTSD services they provide and whether they work, the report reveals. Such treatment varies from base to base, and if similar services are provided, they may be carried out in varying ways. The report insists that both agencies do better.

"[N]o single source within the DoD or any of the service branches maintains a complete list of such [treatment] programs, tracks the development of new or emerging programs, or has appropriate resources in place to direct service members to programs that may best meet their individual needs," the report says.

The two agencies are working on a joint EHR system, although that's not expected to roll out until 2014. Once live, however, it should provide the kind of tracking required in the move toward accountable care.

Sandro Galea, a professor of epidemiology at Columbia University and the chairman of the committee that authored the report, told the New York Times that in the rush to provide treatment, "assessment and monitoring has not been implemented rigorously. "[T]hat is a missed opportunity," he added.

The report also dinged the DoD and the VA for their inability to track the efficacy of PTSD treatment beyond prescription of psychotropic drugs, according to Nextgov.

The report is the first of two funded by the Pentagon. For the second report, the committee hopes to get comprehensive data on veterans diagnosed with PTSD, their treatment and its cost--information the agencies' IT systems should be able to provide.  

The study estimates PTSD affects somewhere between 13 to 20 percent of the 2.6 million soldiers who fought in Iraq or Afghanistan since 2001. It can take years, though, for the problem to manifest, and only about half those who need treatment seek it, many fearing it will hurt their job prospects.

The report recommended annual screening for PTSD, which the VA provides, and research into telemedicine, Internet-based treatment and other technological avenues to overcome patient barriers to getting help.

The VA has been expanding its remote mental health services to vets in rural areas, setting a goal of providing 200,000 remote consultations this year. New legislation could make that easier. The Veterans E-Health & Telemedicine Support (VETS) Act, introduced in the House last week, allows VA providers to practice across state lines.

What's more, in response to the increased demand for services--and criticism about long wait times for an appointment--the VA is adding 1,600 mental health clinicians and nearly 300 support staff. VA Secretary Eric Shinseki recently said veterans increasingly are communicating with the department's staff through online chats and text messages, which is being encouraged.

To learn more:
- here's the report
- read the New York Times article
- check out the Nextgov piece