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VA: A National Leader in Adoption of Telehealth

VA has long been considered a national leader in the use of telehealth, connecting Veterans with critical VA clinical services in their homes, in their communities, and in VA facilities. VA’s telehealth efforts are enhancing the accessibility, capacity, quality, and experience of VA healthcare for Veterans, their family members, and their caregivers. Telehealth is an essential part of VA’s long-term strategy. VA’s connected care mission is to deliver high-quality Veteran-centered care, optimize individual and population health, advance healthcare that is personalized and proactive, and enhance the healthcare experience through virtual modalities of care. In driving toward this goal, VA strives to provide trusted care to Veterans, anytime and anywhere.

VA’s telehealth efforts reach millions of Veterans every year. In fiscal year 2020, more than 1.6 million Veterans used telehealth to access VA care. It is this vast telehealth experience that enabled VA to pivot quickly to a virtual-first healthcare delivery model during the COVID-19 pandemic, meeting Veterans at the location of their choosing and ensuring delivery of high-quality care while following safe physical distancing guidelines.

VA delivers telehealth primarily through three modalities: synchronous, asynchronous, and remote patient monitoring.

Synchronous telehealth: sometimes referred to as clinical video telehealth, connects Veterans and their care providers in real time using video modalities of care.

Asynchronous telehealth: sometimes referred to as store-and-forward telehealth, leverages technologies that allow clinical care to be rendered without the provider and Veteran needing to be connected at the same time.

Remote patient monitoring: sometimes referred to as home telehealth, is a combination of both synchronous and asynchronous care. VA care teams monitor Veterans over time, allowing more immediate care interventions by VA and supporting Veterans’ long-term health goals.

Care Settings for Telehealth

VA telehealth supports enhanced care delivery in one of three locations – in Veterans’ homes and communities, in the VA ambulatory care environment, and in the VA acute care environment. Examples include:

Home and community

  • Remote patient monitoring through VA’s home telehealth program supports Veterans in their homes as they manage complex chronic
  • Video visits through VA Video Connect (VVC) support Veterans at home and in their communities, allowing them to receive video-based care at their location of choice.

VA ambulatory care environment

Clinical video telehealth visits hosted at VA’s community clinics allow Veterans to be seen and remotely examined by specialists elsewhere in VA – connecting Veterans to providers best suited to meet their needs 

  • Store-and-forward telehealth encounters in specialties such as dermatology and eye care allow primary care teams and Veterans to access key screening tests and clinical opinions more readily and
  • VA’s telehealth-based clinical resource hubs help assure consistent access to ambulatory care across the entire VA network, allowing VA to hire healthcare professionals in markets where professional resources are more readily available to provide services elsewhere – often in rural or underserved

VA acute care environment

  • VA’s tele-critical care program connects VA’s intensive care units with experienced critical care nursing and physician staff located in one of VA’s continuously- operating tele-critical care hubs. The program leverages advanced analytics, evidence-based practices, and the benefits of a hybrid team to proactively support local critical care
  • VA’s tele-stroke program provides rapid, remote evaluation by highly-trained stroke neurologists, for Veterans who present to a VA emergency department with symptoms of acute stroke – providing faster access to the expertise Veterans need in such a circumstance and supporting local care teams in therapeutic decision making

Telehealth is being integrated into core operations throughout VA, with adoption growing remarkably over the past several years. As an example, in 2018 VA set a goal for all ambulatory care providers to be capable of delivering care to their Veterans through VA Video Connect by the end of FY2021.

The goal requires staff to have access to the necessary equipment and scheduling support, to complete training, and to successfully initiate at least one video visit. As of third quarter 2021, over 94 percent of primary care providers, over 97 percent of mental health care providers, and over 81 percent of other ambulatory care providers have achieved the goal, which has proven a critical part of VA’s COVID-19 pandemic response. Another example is seen in the growth of VA’s tele- critical care program, which was supporting about one third of VA’s facilities with ICUs prior to the pandemic. The program quickly scaled to offer support to 100 percent of VA’s facilities with ICUs on a temporary basis during the COVID-19 pandemic, and is now initiating permanent support for nearly three quarters of VA facilities with intensive care capabilities.

The COVID-19 pandemic had a dramatic impact on VA operations and more specifically led to remarkable increases in the use of telehealth. Safe access to healthcare for those who didn’t have a compelling need to be seen in person, in the context of COVID-19 related physical distancing recommendations, quickly became the main driver for VA telehealth utilization.

This change in priorities led to a dramatic shift in the location of care delivery across VA. Instead of providing care in the clinic, VA shifted the location of care for many Veterans to the home, using both video and telephone technology. Prior to the pandemic, 78 percent of video telehealth visits were between one VA clinic location and another VA location, with the other 22 percent occurring in a Veteran’s home or other offsite location. During the pandemic in the first half of FY2021, only 3 percent of video telehealth visits occurred between one VA location and another, with 97 percent of video telehealth visits occurring in a Veteran’s home or other offsite location.

VA provided over 3.8 million video visits to Veterans’ homes in FY 2020, an increase of greater than 1,200 percent compared to FY 2019. FY 2021 has seen continued high utilization with over 6.7 million video visits to Veterans’ homes through early June 2021. The shift in location of care for Veterans, coupled with many providers shifting at least part-time to their homes, represented a paradigm shift in clinical operations and also contributed to the utilization of telehealth at unprecedented levels.

In addition, the COVID-19 pandemic highlighted the importance of leveraging telehealth to share clinical resources across the enterprise, matching demand for care with supply provided by experts from across the healthcare system. Examples include the clinical resource hubs in every VISN that are meeting clinical needs across each of their networks and that were able to flex to support pandemic-related demands. VA’s tele- critical care expansion described above offers another example.

As we now look to a post-pandemic future, we anticipate continued growth of telehealth utilization across VA, making quality VA healthcare more accessible, convenient, and efficient. VHA has endorsed a five-year strategic vision for connected care that is organized into three high-level goals, supported by eight key strategies. The key goals include enhancing Veteran digital engagement, delivering healthcare without walls, and solidifying connected care’s foundations. This vision includes deploying digital tools that allow Veterans to connect with VA and their healthcare services at any time, delivering even more care into the home through video telehealth and remote monitoring, expanding clinic capacity by using telehealth to match supply and demand across VA’s expansive geographic footprint, enhancing Veteran access to rare national expertise irrespective of the Veteran’s location in the country, and much more.

Despite VA’s history and leadership as a provider of care through telehealth, understanding how best to leverage modern technologies to deliver healthcare remotely, at significant scale, and evaluating the impact of doing so, is still an emerging opportunity for research efforts, to include better understanding of the impact of telehealth on health disparities, best practices to enhance adoption and use of virtual care, new barriers to access such as the digital divide, the long term financial impact of expanded telehealth services within VA, the outcomes of telehealth- enhanced VA clinical programs, and more.

HSR&D and the VA Office of Connected Care have partnered to launch the Virtual Care CoRE (Consortia of Research), which has formed a network of over 200 investigators at more than 36 VA Medical Centers who, along with the broader research community, are helping advance our knowledge in this important and strategic space.

VA is committed to building on its success and leadership as a provider of technology enabled care through telehealth. By continuing its connected care innovation, VA strives to further enhance the human connections that are at the heart of healthcare, to help more Veterans turn to VA as their healthcare system of choice, to enhance quality and convenience, to support efficiencies in care delivery within the VA healthcare system, and to deliver trusted care, anytime and anywhere.

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