VA’s telehealth device program struggles provide lessons for all

Patients who lack a video-capable device and internet connectivity don’t have the means to participate in virtual care. Yet, even when equipped with the requisite technology, they can still find themselves stalled on the wrong side of the digital divide. 

In August 2020, The Veterans Health Administration (VHA)’s Office of Connected Care sought to bridge the gap by introducing the “digital divide consult,” which added a socioeconomic assessment to the process of providing video-capable devices upon referral from a patient’s care team, licensed practitioner or designee.

The VA Office of Inspector General (OIG) reviewed the digital divide consult process to evaluate its efficiency and effectiveness, as well as controls over device issuance, monitoring and retrieval. While recognizing that VHA conducted the program during the stressful height of the COVID-19 pandemic, OIG identified significant oversight and guidance shortcomings that prevented patients from receiving virtual care.

VHA issued devices to approximately 41,000 patients during the first three quarters of fiscal 2021, but only an estimated 20,300 patients (49 percent) completed a VA Video Connect (VVC) appointment. OIG found that about 10,700 patients never had a VVC appointment scheduled and more than 10,000 did not complete a VVC visit due to technical issues or cancellations.

What can be learned from the VA’s telehealth device program 

OIG’s report concluded that VHA staff generally assessed patients’ eligibility and ordered devices according to agency guidance. However, OIG noted that VHA failed to communicate key updates to staff. For example, a December 2021 update required staff to attest that the patient would require a video telehealth appointment within 90 days — but the update did not include a mechanism to ensure subsequent VVC appointment scheduling.

Hospitals and health systems planning or engaged in a digital outreach program can take important cues from OIG’s recommendations in the following areas:

• Establish standard operating procedures for conducting patient assessments, ordering devices and scheduling patient appointments.

• Implement a process whereby your facility receives an alert when a patient has received a device and is ready to be scheduled for a telehealth appointment. VHA plans to develop an electronic medical record flag that indicates a patient possesses a loaned device and specifies that device setup has been completed.

• Include IT and logistics staff in training of telehealth workers regarding device ordering and fulfillment, and make sure all involved receive procedural updates as needed.

• Develop an automated process to prompt healthcare professionals to document in the medical record the ongoing need for a device at least annually.

According to researchers, future virtual-visit programs should also equip devices with improved user interfaces so that it’s easier for patients to get connected with less oversight from facility staff.

Frank Irving is a Philadelphia-based content writer and communications consultant specializing in healthcare, technology and sports.