The Office of Specialty Care Services ensures The Best Care Anywhere – preventive, clinical, spiritual and nutritional – is available to Veterans. The Chief Consultant for Specialty Care Services (SCS) heads the office, based at the Veterans Health Administration’s Central Office (VACO). SCS includes National Programs for Eye Care, Nutrition and Food Services, Emergency Medicine, Oncology and Hematology, Endocrinology and Diabetes, Gastroenterology, Nephrology, Cardiology, Pulmonology, Anesthesia, Podiatry, Infectious Diseases, Neurology and Chaplain Services. Program Directors lead each program, each of which has an eight- to ten-member Field Advisory Committee (FAC). FAC Chairs and members work as advisory board members for SCS. SCS contains field-based Specific Purpose Workgroups, each with specialized purposes. This arrangement encourages an open interface and networking of all SCS components.

• Allergy and Immunology Service - offers state of the art care for Veterans with allergic and immunologic disorders. These Veterans are evaluated and followed in specialized allergy/immunology clinics offering various diagnostic tests and therapy from board certified allergists and allergy staff.  The VHA-DOD Allergen Extract Program was established to provide state-of-the-art centralized immunotherapy and diagnostic testing material for eligible Veterans.  Stakeholders are Veterans with seasonal or perennial inhalant allergies, food allergies and insect venom sensitivities.

• Anesthesia Service - provides guidance and consultation on all matters regarding the practice of anesthesia. These include providing insensibility to pain during surgical, obstetrical, therapeutic and diagnostic procedures; monitoring and recovery; diagnosis and treatment of painful syndromes; and the management of cardiac and pulmonary resuscitation. Anesthesia collaborates with Surgical Services and Pain Management Program.  For more information please visit the Anesthesia site.

• Cardiology Service - provides information, guidance and oversight to VHA Cardiology initiatives to ensure quality heart care. More than 30% of enrolled Veterans have heart problems. VHA implants approximately 10,000 pacemakers and defibrillators each year. The Cardiac Implant Surveillance System was established in 1982 and remotely monitors implant performance. The National Implantable Device Registry follows Veterans with cardiac implants and tracks recalls and device related problems.

• Chaplain Services - Spiritual and Pastoral Care is an integrated part of VHA’s health care program, available for Veterans and their immediate family (caregivers) as they wish. VHA employs professionally educated and clinically trained chaplains to provide pastoral care and counseling as part of the interdisciplinary teams. Chaplains provide religious services and sacraments, guaranteeing Veterans’ free exercise of religion. Chaplains serve as subject matter experts on the interdisciplinary healthcare teams, ensuring patients’ spiritual and religious concerns are known and understood by the healthcare team. Every VA Medical Center has a chapel available for use by all Veterans and their families. Our Veterans represent a broad spectrum of religious traditions. All Veterans and their family members are welcome to attend religious services or use the VA chapel for prayer, meditation and quiet contemplation. For more information please visit the Chaplain site.

• Critical Care - concerns the management of patients who are severely ill and need specialized care in an intensive care unit. The VA admits more than 100,000 patients to its 173 intensive care units annually. Lung disease affects about 30% of Veterans with the most common diagnosis likely chronic obstructive pulmonary disease or COPD. The diagnosis of sleep disorders, like obstructive sleep apnea, is increasingly being recognized as an important problem that affects patient quality of life and outcomes. This Office provides guidance, consultation and oversight to the hospital based and outpatient programs and Intensive Care Units collaborating with cardiology, pharmacy, surgery, infectious disease, prosthetics, and the primary care teams.

• Dermatology - is the branch of medicine dealing with the skin and its diseases. VA does not provide elective cosmetic procedures.

• Diabetes and Endocrinology Service - oversees the care of patients with diabetes, disorders of the thyroid, male and female reproductive systems and calcium and skeletal health. This Program Office develops and implements clinical guidelines for prevention and treatment of diabetes and endocrine disorders, and tracks the use of these guidelines through assessments of medical outcomes. Nearly one in four enrolled Veterans has diabetes. The Diabetes Program Office collaborates with the National Prevention Center, Food and Nutrition Services, Podiatry, Eye Care, and the Office of Research and Development to optimize the care of Veterans with diabetes. The Office improves the health of Veterans with diabetes and endocrine disorders by advocating timely and appropriate treatment to avoid later complications.

• Emergency Medicine - specialists care for patients with acute illnesses and injuries that require immediate medical attention. Emergency Medicine specialists are available 24/7/365. They are trained and prepared to examine, diagnose and treat any emergent condition, regardless of gender, age or condition. Emergency physicians must have the skills of many specialists – the ability to resuscitate a patient (Critical Care Medicine), manage a difficult airway (Anesthesia), suture a complex laceration (Plastic Surgery), reduce (set) a fractured bone or dislocated joint (Orthopedic surgery), treat a heart attack (Cardiology), work-up a pregnant patient (Obstetrics and Gynecology), stop a bad nosebleed (ENT), place a chest tube (Cardiothoracic Surgery), and to read x-rays and conduct and interpret ultrasounds (Radiology). In FY 2011, Emergency Medicine treated over 2 million patients.

• Eye Care (Optometry and Ophthalmology) - work together to provide the full spectrum of primary, secondary and tertiary eye care services. The Office disseminates the national VA/DoD Diabetes Mellitus Clinical Practice Guideline. With the Office of Telehealth Services, this Office provides risk management via the VA Teleretinal Imaging Screening Program to improve access and reduce preventable blindness from diabetic retinopathy. With the Office of Rehabilitation Services, Eye Care performs traumatic brain injury specific (TBI) ocular health and visual functioning evaluations for Veterans with TBI and provides treatment of visual consequences when applicable as well as participates in the provision of visual rehabilitation care with Blind Rehabilitation Service. For more information please visit the Optometry Site.

• VA / DoD Vision Center of Excellence (VCE) – the incidence of vision threatening / disabling ocular injuries in returning Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) service members and the need for the seamless integration of Department of Defense (DoD) and VA care, prompted the creation of VCE, authorized under the FY 2008 National Defense Authorization Act (NDAA). The VCE provides national oversight and guidance to VA and DoD programs to ensure injured service members receive a synchronized and consistent process of care relative to the prevention, diagnosis, mitigation, treatment and rehabilitation of military eye injuries. This legislation mandated the VCE create and manage the Defense and Veterans Eye Injury Registry (DVEIR) to track these injuries and their treatment.

• Gastroenterology Service - provides guidance and consultation on all matters related to diseases affecting the gastrointestinal tract and the liver. One of its primary objectives is to optimize the availability, performance, reporting and follow-up of gastrointestinal endoscopy to provide the highest quality care. Important areas for collaboration include the development of policies on colorectal cancer screening and surveillance, sedation for gastrointestinal endoscopy and endoscope reprocessing, as well as the establishment of quality measures for endoscopy. TheIr key areas include the management of patients with chronic gastrointestinal disorders, including inflammatory bowel disease, viral hepatitis and chronic liver disease.

• Genomic Medicine Service (GMS) - was established in 2010 to facilitate the application of currently available genetic technologies to improve the health care of Veterans. The GMS coordinates genetic counseling functions, sets strategic guidance regarding the phased integration of genomic testing into clinical care and organizes the broad genetic education initiatives rolled out nationally. The service is delivers care through telehealth. Agreements with each VHA are being established to provide nationwide telehealth access. The GMS works closely with the Office of Research and Development (ORD) to translate genomics into clinical care within VHA.

• The National Infectious Diseases Service (NIDS) - provides national guidance and communication concerning infectious diseases and infection prevention and control through written documents, consultation, educational activities, and development of VHA national policies. NIDS provides national oversight for the Methicillin-resistant Staphylococcus aureus (MRSA) Prevention Initiative (now the Multidrug-Resistant Organism Prevention Initiative, including Clostridium difficile Infection Prevention) and leads the collaborative Antimicrobial Stewardship Initiative.  This office collaborates with other offices to address healthcare-associated infection issues. NIDS is the lead for VHA participation on national biosurveillance collaborations with other federal agencies. For more information please visit the National Infectious Disease Services site.

• Nephrology Services - includes the study, diagnosis and treatment of Veterans with kidney diseases. VHA is developing a strategic plan to address the increasing volume of Veterans with chronic kidney disease.

• Neurology Services - provides research, clinical care, and patient and family education on neurological disorders. Specialty care networks have been established for patients with degenerative neurological diseases (more than 200,000 Veterans) which include Multiple Sclerosis Centers of Excellence (MSCOEs), Parkinson’s Associated Disorders, Research, Education and Clinical Centers (PADRECCs), and Epilepsy Centers of Excellence (ECoEs). VHA is developing and implementing guidelines for the diagnosis and treatment of Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig’s Disease. Neurology Services collaborates with Emergency Medicine and Rehabilitative Services on stroke treatment and Traumatic Brain Injury (TBI). For more information please visit the Multiple Sclerosis Center of Excellence site or the Parkinson's Disease Research, Educational, and Clinical Centers site.

• Nutrition and Food Services (NFS) - develops and provides comprehensive nutritional services for our Veterans across VHA’s healthcare facilities. Registered dietitians serve as nutrition diagnosticians for Veterans in providing medical nutrition therapy and in using the nutrition care process to manage their diseases throughout the continuum of care. Nutrition professionals promote wellness and disease prevention through serving nutritious food selections. The nutrition team proactively contributes to multiple VHA initiatives including Telehealth, the Patient Aligned Care Team (PACT), Cultural Transformation and Social Media Communications. Through its newly created VISN infrastructure, NFS is transforming VHA in its advanced clinical nutrition practices and healthy teaching programs to improve Veterans family members’ health outcomes. For more information please visit the Nutrition and Food Services site.

• Oncology and Hematology Service - provides policy, guidance and oversight to the implementation of the National Cancer Strategy which addresses prevention and education, screening, early detection and diagnosis, treatment, rehabilitation and research. The VA Central Cancer Registry (VACCR) was initiated in 1995 and serves as a national data repository for over 750,000 VHA patients with cancer. The data set includes demographics, cancer identification, extent of disease and stage, first treatment courses, recurrence and subsequent treatments and final outcomes, 190 different data elements collected for each tumor being reported. Data standards meet the criteria of the American College of Surgeons’ Commission on Cancer, the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) and American Joint Commission on Cancer for cancer registries as well as the Center for Disease Control and Prevention’s (CDC’s) National Program for Cancer Registries and the North American Association of Central Cancer Registry for central.

• National Pain Management Program - In 1998 VHA chartered a VHA National Pain Management Strategy, establishing pain management as a priority. Pain is one of the most highly prevalent conditions among Veterans and is associated with a range of negative outcomes including emotional distress and functional disability. VHA’s Pain Management Directive provides policy and implementation guidance for the improvement of pain management consistent with the Strategy and with generally accepted Pain Management Standards of Care. The National Pain Management Program office has responsibility for policy development, coordination, oversight, and monitoring of the VHA National Pain Management Strategy. The Pain Management Program Office collaborates with multiple other patient care and operations partners, especially the Anesthesiology, Employee Education, Geriatrics and Extended Care, Mental Health, Neurology, Nursing, Pharmacy Benefits Management, Primary Care, Rehabilitation Services, Research, Telehealth, Women Veterans, among many others. For more information please visit the Pain Management site.

• Podiatry Services - is devoted to the study, diagnosis, and treatment of disorders of the foot, ankle, and lower leg. Veterans suffer from a variety of foot and lower leg conditions as a direct result of their service which can result from both traumatic and progressive etiologies. Since a large and growing number of Veterans have diabetes, putting them as risk for many disorders and amputation, the VA Podiatry Program Office a spends a great deal of its time collaborating with a number of other program developing and implementing initiatives relative to the prevention and treatment of diabetes and disorders related to diabetes. This program tracks data elements through the amputation/ulcer database and High-Risk for Amputation Registry.

• Rheumatology - is a sub-specialty of internal medicine and deals mainly with clinical problems involving joints, soft tissues, autoimmune diseases, vasculatures and connective tissue disorders. Our older Veterans have a higher incidence of these diseases.

• Specialty Care Transformation - is a critical component of the Veterans Health Administration’s (VHA) comprehensive medical benefits package of healthcare services. In the current system Veterans often experience fragmented care and services, long wait times and unaccepted delays. These experiences were exacerbated by the limited number of providers in many specialties and in certain geographic areas, particularly rural areas. The Office of Healthcare Transformation (OHT) established the Office of Specialty Care Transformation (OSCT) to transform specialty care services to be more Veteran-centric. VHA established telehealth and non face-to-face models for delivering care. Specialty Care is building a strong interface with Primary Care’s Patient Aligned Care Team (PACT). This relationship will ensure the delivery of services across VHA is patient-centered and that coordination is timely and accessible.