With 35,000 patients, the US Veterans Administration leads the way, with the largest telehealth program in the world and with plans to double its budget to $163 million next year.  Yet despite this, the approach across the Federal government (Defense, Indian Health Service) remains inconsistent and not cohesive, according to the American Telehealth Association.  And there are potential problems seen at the VA that have come with greater use: difficulties in receiving reimbursements for care delivered remotely, legal complications regarding telemedicine practices that cross state lines, staff training and quality of patient care.  Federal Computer Week