The Department of Veterans Affairs, via the Veterans Health Administration, oversees care for more than 9 million individuals through upward of 1,000 facilities.   

Many of those patients, however, face mobility hurdles and other challenges that can make it difficult to reach in-person care.  

Even before the pandemic, explained Dr. Neil Evans, chief officer for the Office of Connected Care in the Veterans Health Administration, the agency had laid the groundwork for virtual care expansion through established telehealth programs in more than 50 clinical specialties.   

In 2017, the VA announced a new initiative called "Anywhere to Anywhere VA Health Care," followed by bipartisan legislation enabling interstate telemedicine for VA providers and patients.  

"Earlier efforts included the expansion of telehealth to remote clinics, call centers, VA telehealth access points in the communities, and even the application of telehealth during disasters," said Evans, who will present at HIMSS22 next week with Dr. Leonie Heyworth, director of synchronous telehealth and a deputy director in VA's Office of Connected Care.   

"In fact, the VA Telehealth Emergency Management Team was established in response to Hurricanes Harvey and Maria in 2017," Evans continued.  

The COVID-19 crisis, though, triggered a rapid scale-up. As Evans explained, VA video-to-home telehealth encounters surged 3,147% from 294,847 encounters in fiscal 2019 to 9,575,958 in fiscal 2021.   

Also in 2021, VA provided more than 2.3 million veterans with more than 11.2 million telehealth episodes of care – a 98% increase in telehealth episodes of care when compared to fiscal 2020.   

"In response to the surge in demand for video telehealth, VA rapidly expanded its cloud-based architecture, offering vast increases in video capacity and performance," said Evans. "This was accomplished over several weeks early in the pandemic, and without that, VA care teams may not have been able to maximize video use during this period of time."  

Evans noted that nearly all mental health and primary care providers had already been trained on video visits, and specialty providers were offered accelerated access to training through a "just-in-time approach."   

"Oh, and one more thing: it wasn’t just video care to the home that VA was able to rapidly scale," Evans added.   

"VA also rapidly scaled its Tele Critical Care program to support intensive care units across the country as they managed surges of critically ill patients, particularly in COVID-19 hotspots," he said.

Evans continued, "Other digital and virtual care capabilities were rapidly stood up based on existing infrastructure, enabling VA to offer self-subscription protocols for remote COVID-19 symptom monitoring and, later in the pandemic, rapid vaccine scheduling through interactive text messaging."

When it comes to how COVID-19 changed things, Evans said, "I like to say that we met our five-year goals for telehealth in the first month of the pandemic, and we’re not looking back.  

"Connected Care is, and will remain, a critical part of how VA is able to care for the veterans we serve," he said.  

Heyworth added that the team learned just how many applications of telehealth technology were possible: "more than we might have imagined prior to the pandemic.  

"VA realized new opportunities in physical therapy, hematology, equine therapy and many more areas," she continued. "The key to pre-pandemic adoption – and it still holds true today – is provider buy-in and support.   

"Without frontline VA staff members' commitment to change and to meeting Veterans where they are, VA couldn't have even dreamed of scaling overnight," she said.  

Heyworth and Evans pointed to the ways telehealth can increase access for currently underserved populations among veterans.   

"To allow veterans in rural and broadband-poor areas the opportunity to more easily access care, the VA has developed a creative collaboration with private organizations, including Veterans of Foreign Wars, The American Legion, Walmart and Philips to bring care to local communities through Accessing Telehealth through Local Area Stations," said Heyworth.   

"ATLAS sites enable Veterans to meet with a VA provider by video in a private room and connect to their healthcare team through video."  

Currently, she said, there are 12 ATLAS sites across the country. VA also lends hundreds of thousands of devices to veterans, allowing them to miss fewer appointments and fostering patient satisfaction.   

Evans outlined a few lessons he hopes attendees take from the panel, including relentlessly focusing on the patient and provider experience, giving providers freedom to leverage virtual care tools in a way that best meets their need, and leaving no patient behind.  

"There is no true 'connection' in Connected Care without meaningful provider engagement and ownership," he said. "Provider endorsement of connected care is its most powerful marketing tool."

Evans and Heyworth will discuss more in their HIMSS22 panel, "Connected Care - Access, Capacity and Quality in a Pandemic." It's scheduled for Tuesday, March 15, from 4:15-5:15 p.m. in Orange County Convention Center W307A.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.