Telemedicine and Telehealth: Principles, Policies, Performances and Pitfalls
(Telemedicine and telehealth are changing the face of heal...)
Telemedicine and telehealth are changing the face of health care delivery and becoming a multi-billion dollar industry. Dr. Darkins and Dr. Cary share their knowledge and provide practical insights and advice on making telemedicine programs into successful clinical services and a productive business. The book gives background knowledge and useful tips on starting up and managing programs in an array of settings. Most importantly, the book is based on the recognition that patients are customers of health care and telemedicine companies developing new products vital to delivering care to rural or inaccessible clients is vital to health careís future.
Adam William Darkins is a British healthcare executive who is recognized internationally for his achievements in building virtual care networks that increase access to care, reduce the costs of care, and assure the quality of care. He is also known as a co-author of Telemedicine and Telehealth: Principles, Practice, Performance, and Pitfalls.
Background
Born in London, England, Darkins was the son of Jack, a former Wimbledon tennis player, and Ursula, an accomplished pianist. He grew up alongside his sister and two brothers in a spirited, unconventional household that embraced frequent moves and change. This bohemian upbringing led Darkins to leave school and home at 16, determined to chart his own path. He later completed his high school education at the College of Further Education in Oxford, where he earned recognition as the Outstanding Pupil of the Year, and went on to study medicine at the University of Manchester.
Education
Adam William Darkins received an education at the School of Medical Sciences of the University of Manchester. He earned a Bachelor of Medicine degree in 1974. In five years it was followed by a Bachelor of Surgery degree. Finally, in 1987 Darkins became Doctor of Medicine.
Later, he continued his education at the London School of Hygiene and Tropical Medicine. In 1991 Dr. Darkins got a Master of Public Health.
In 2011 Darkins received a Masters Certificate in Project Management at George Washington University.
After qualifying as a physician in 1979, he pursued a distinguished career in neurosurgery. He became a Fellow of the Royal College of Surgeons in 1984 and earned his M.D. in 1987 from Manchester University for research conducted as a visiting assistant professor at UCLA. In 1989, he completed his higher surgical training in neurosurgery from the Royal College of Surgeons. When reforms to the National Health Service in 1989 altered the landscape of UK medicine, Darkins redirected his career toward public health and healthcare delivery systems. He earned a Master of Public Health Medicine from the London School of Hygiene and Tropical Medicine in 1991, marking the beginning of his lifelong work in healthcare innovation.
From 1991 to 1993, Darkins consolidated this learning into practical experience by working at the King’s Fund, an independent policy and health services research organization. Darkins managed two major initiatives: implementing a national program supporting “shared decision-making” between clinicians and patients and supporting the transition of healthcare services from acute hospitals to community and primary care settings. Both areas of work were of strategic importance to the UK government, contributing to national policy development during an era of profound health system transformation.
From 1993 to 1997, as Medical Director at Riverside Community Healthcare, a central London healthcare provider, he worked at the nexus of clinical care, health policy, and public service. He played key roles in the implementation of “hospital at home” programs and the transition of specialty services from hospitals to community care, serving a population of over 300,000. Here, he developed a groundbreaking telehealth program to support nurse practitioners with remote decision-making assistance from emergency physicians in Belfast—200 miles away across the Irish Sea. Recognizing the limitations of the technology at the time and the urgent need for innovation, he also co-founded Global Telemed, a telemedicine startup based at the Royal Victoria Hospital in Belfast and partnered with international telecommunications carriers to design telehealth systems capable of supporting telehealth services nationally and internationally. This gave him practical expertise in IT project management and health system integration.
Darkins’ forward-thinking vision for telemedicine was ahead of its time, and by 1997, he recognized that the UK’s slow pace of change might not allow his ideas to thrive. In July 1997, he moved to the United States and began working as a healthcare consultant, focusing on telehealth and health information technology. He founded a successful consultancy before joining Siemens Medical Systems, where he developed integrated telehealth applications for radiation oncology and imaging systems.
In 1999, Darkins was recruited to join the U.S. Department of Veterans Affairs (VA) to lead VA's national Telehealth Strategic Health Group from Denver, Colorado – launching what would become a 15-year mission to transform how care was delivered to Veterans across the country. By the time he departed at the end of fiscal year (EOFY) 2014, his work had propelled VA’s telehealth program into a national model for innovation. The milestones reached by that point powerfully reflect his clarity of vision, tireless leadership, and the durable systems he helped build—systems that continue to improve the lives of Veterans every day.
In the beginning, VA’s telehealth efforts were mainly fragmented and under-resourced pilot programs. To develop the strategy to dramatically expand the national use of telehealth in VA, Darkins visited more than 90 VA Medical Centers and clinics to review these pilots and collaborate with early adopters of telehealth to create the necessary basic models. During his time in Denver, Darkins became a U.S. citizen—a milestone that deepened his personal and professional commitment to improving the healthcare system for Veterans in his adopted country.
In 2003, Darkins moved to Washington, D.C., where he was appointed as VA's national Chief Consultant for the newly-established Office of Care Coordination, later renamed the Office of Telehealth Services during his tenure. Darkins was first tasked with implementing an innovative national home telehealth program that enabled Veterans with chronic conditions to remain in their homes and avoid institutional care. Starting as an initial regional pilot program with 800 patients, by the time he departed VA in EOFY 2014, the program grew to support the care of approximately 156,000 Veterans nationally, with more than 94,000 active participants receiving telehealth-based care in their homes at any given time.
In 2004, Darkins assumed leadership of VA’s teleretinal imaging program which enabled virtual screening for diabetic retinopathy, growing it from a small pilot serving fewer than 3,000 patients to a critical national program providing routine eye care to approximately 379,000 patients by EOFY 2014. Driven by the growing number of Veterans returning from Afghanistan and Iraq and the pressing need to provide timely and effective care to those in remote locations, Darkins spearheaded a critical initiative to expand VA’s video telehealth capabilities. In FY 2008, he advanced clinical video telehealth by establishing the Polytrauma Telehealth Network (PTN), which connected VA Polytrauma Centers with Department of Defense hospitals to integrate specialist expertise in polytrauma and deliver coordinated care to Veterans in need of these services nationwide. By EOFY 2014, PTN evolved into VA’s Clinical Enterprise Videoconferencing Network with 9,000 video endpoints nationally, and the network provided telehealth-based care to more than 248,000 patients in clinics and more than 4,200 patients directly in their homes.
In FY 2009, Darkins led a major initiative with the VHA Office of Rural Health to expand telehealth access to rural areas, resulting in nearly half of all telehealth-based care being provided to Veterans residing in rural or remote locations. In FY 2010, he led in the creation of VA’s first national telehealth center – the National Telemental Health Center which provided specialist care via telehealth to patients nationally for pain management, bipolar care, schizophrenia, and compensation and pension exams. From FY 2010, he led the National Telehealth Transformation Initiative, raising the proportion of Veterans receiving telehealth care to 12.6% of VA's total healthcare population by EOFY 2014. Darkins recognized that the growing complexity of telehealth required both rapid and reliable technical support and the ability to schedule care across facilities and time zones. In response, he spearheaded the creation of VA’s national telehealth help desk in FY 2012 and led the development of its first cross-facility scheduling system for virtual visits in FY 2013—foundational efforts that enhanced the efficiency and scalability of VA telehealth services.
Darkins advanced telehealth with unyielding determination and singular strategic focus, relentlessly pursuing the resources and innovations needed to expand its reach nationwide. At VA, he drove the development of the strategic, clinical, technical, and operational foundations that supported a truly national telehealth system. His steadfast commitment to making care accessible for every Veteran propelled him to navigate bureaucratic complexities and technological challenges with tenacity and clarity of purpose.
He mobilized cross-organizational efforts to build consensus and sustain the trust of leadership, clinicians, and Veterans alike. He forged strong collaborations with IT and engineering teams to ensure telehealth services were clinically sound, secure, and had the back-up and redundancy necessary to maintain mission critical services and be scalable. He oversaw the creation of telehealth operations manuals, virtual training centers, and a national telehealth quality management system. In partnership with other program offices, he implemented additional national telehealth programs in VA, including telepathology, teleaudiology, telecardiology, teleneurology, tele-ICU, and telegenomics. Under his leadership, a dedicated telehealth workforce of more than 1,700 professionals along with thousands of clinicians trained to use telehealth technologies delivered specialized care across all 50 states and U.S. territories. His leadership scaled VA’s telehealth programs into one of the largest and most sophisticated networks in the world.
Darkins' vision and direction raised national and international awareness of VA’s role in telehealth. He testified before Congress five times and authored or co-authored more than 30 publications; 18 of which were peer-reviewed articles, including a 2008 paper on home telehealth implementation regarded as a seminal work in the field. He also collaborated with regulatory agencies such as the Joint Commission, FDA, and Department of Justice to develop standards for telehealth quality and safety for the VA, which also influenced the use of telehealth more broadly within the U.S. healthcare system.
Throughout his career, Darkins was a prominent figure in the global telehealth community. He co-authored Telemedicine and Telehealth: Policies, Principles, Performance, and Pitfalls, as well as chapters in several other telehealth-related books. He served on editorial boards and professional organizations, including the American Telemedicine Association and the Journal of Telemedicine and e-Health. He was a founding member of the Royal Society of Medicine's Telemedicine Forum and served on several UK national boards, including the Council of the Patient's Association and the Association of Trust Medical Directors. Darkins was also a trustee of the Swinfen Trust, a charitable organization that provided humanitarian assistance via telehealth to over 70 countries. During his career, he delivered more than 300 national and international presentations on telemedicine, health policy, and health services development.
Building upon this transformative work at the VA, Darkins transitioned into industry and advisory roles, including contributions as Vice President for Medical Affairs and Enterprise Technology Development for the Americas region at Medtronic and through his own consultancy practice, Empiricon LLC. In these roles, he continued to shape the telehealth landscape with the same strategic insight that had defined his public service.
From 1999 to 2014, it was Darkins’ privilege to lead the expansion of VA’s telehealth services, growing from just a few hundred visits to over two million annually by the time of his departure. His pioneering efforts established the national foundation for telehealth within VA — a foundation that proved critical in sustaining patient care during the COVID-19 pandemic and beyond. Through his tireless drive and enduring vision, Darkins not only expanded VA’s telehealth programs but transformed them, creating the foundation for a system that, as of EOFY 2024, served over 2.7 million Veterans through more than 13.3 million episodes of care across the nation. He was known not only for his expertise and leadership but also for his humility, wit, and deep commitment to patient-centered care. Darkins was always quick to recognize the many colleagues, staff, and partners who contributed to the progress he championed—many of whom remain unsung heroes within the telemedicine community.
The most fortuitous event in Darkins’ life came outside of his professional world: meeting his wife, Laura, while hiking in Washington, D.C.’s Rock Creek Park. Together, they settled in Garrett Park, Maryland, a small town that reminded him of the English villages he had always loved. There, he found a close-knit, accepting community and an oasis in which to swim, reflect, and find joy.
Darkins is survived by his beloved wife, Laura; his two sons, Luke (Sarah) and Joseph (Tracy); and his cherished grandchildren, Jack, Owen, Sophie, and Connie.
The team that Dr. Darkins built for the United States Department of Veterans Affairs became the largest and most sophisticated telemedicine/telehealth program in the world. By the time he left in 2014, more than 600,000 veterans were receiving care annually via this telehealth network, across all 50 states, Puerto Rico, and the US Virgin Islands.
