COVID Lessons Learned: The Invaluable Need for Virtual Care
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COVID Lessons Learned:
The Invaluable Need for Virtual Care
Se s s ion 16, Augus t 10 , 20 21
Chris t ina Arms t rong, Ph.D.
U.S. Department of Veterans Affairs
DISCLAIMER: The views and opinions expressed in this presentation are solely those of the author/presenter and do not necessarily represent any policy or position of HIMSS.
1
Welcome
Chris t ina Arms t rong, PhD
Connected Health Implementation Strategies, Office of Connected Care (OCC),
Patient Care Services (12CC), U.S. Department of Veterans Affairs
#HIMSS21 2
Conflict of Interest
Christina Armstrong, Ph.D.
Has no real or apparent conflicts of interest to report.
#HIMSS21 3
Agenda
• VA Virtual Care
• COVID: Changing VA & Healthcare
• Our Tools and Our Lessons
• What’s Next?
• Questions/Answers
• Resources and References
#HIMSS21 4
Learning Objectives
• Learning Objective 1: Explain how VA’s virtual care strategy increased access to and
utilization of virtual care technologies, built capacity to match clinical supply and
demand, and reduced barriers to care
• Learning Objective 2: Demonstrate through data how the demand for virtual care
technologies and delivery changed from before, during and after the pandemic and
how VA is using information gleaned from that data to sustain clinical and Veteran
adoption of virtual care tools
• Learning Objective 3: Identify lessons learned from the pandemic response and
examples of increasing capacity, engaging clinicians, reducing barriers to adoption
to improve Veteran’s patient outcomes during COVID
#HIMSS21 5
VA Virtual Care:
Filling the White Space and VA Priorities
of Access, Capacity and Quality
#HIMSS21 6
Filling the White Space
#HIMSS21 7
Filling the White Space
#HIMSS21 8
Veteran Testimonial
#HIMSS21 9
VA Overview
20 MILLION
9+
MILLION
Veterans in Receive VA
the U.S. care
(Department of Veterans Affairs, 2021) #HIMSS21 10VA Mission
U.S. Department of Veterans Affairs
To fulfill President Lincoln's promise - “To care for him who shall have
borne the battle, and for his widow, and his orphan” by serving and
honoring the men and women who are America’s Veterans.
Veterans Health Administration
Honor America’s Veterans by providing exceptional health care
that improves their health and well-being.
#HIMSS21 11#HIMSS21 12
#HIMSS21 13
VA Virtual Care
#HIMSS21 14VA Virtual Care – Our Priorities
Bringing care to Matching clinical Providing the right care
the Veteran supply and demand at the right time
Accessibility Capacity Quality
• Video care, secure email, telephone • Resource hubs for primary care, mental • Expert consultation & coordination of
care – available in all ambulatory health, and other high- volume services that are difficult to find,
services for Veterans and caregivers specialty services, accessible as a expensive to manage, or low volume in
to access from their preferred location shared telehealth service, delivered any given market.
across VA facilities.
• Asynchronous modalities of care that • Promote self-management of health
can be used between scheduled visits • Increased clinic efficiency, resulting and proactively engage patients using
from more efficient just-in-time digital health tools that leverage
• Enhanced Veteran communication resolution of simple health issues or analytics
channels with their care teams (e.g. transactions through virtual modalities.
clinical chat, secure messaging, text) • Reduce hospitalizations & emergency
visits through remote monitoring
15COVID
Changing VA & Healthcare
#HIMSS21 1617 17
Encounters Before and During Pandemic
(Ferguson, Jacobs, Yefimova, Greene, Heyworth, & Zulman, 2021) #HIMSS21 18Growth in VA Connected Care Services
Telehealth
4,000,000
Total Encounters
Note: RPM-HT data not available prior to FY12
3,500,000
3,000,000
2,500,000
2,000,000
1,500,000
1,000,000
500,000
0
FY03 FY04 FY05 FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY19 FY20*
(Department of Veterans Affairs, 2021) #HIMSS21 19Growth in VA Connected Care Services
My HealtheVet
6,000,000
5,000,000
4,000,000
3,000,000
2,000,000
1,000,000
0
FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020
Rx Refills/Month MHV Users - Cumulative
(Department of Veterans Affairs, 2021) #HIMSS21 20Growth in VA Connected Care Services
Annie
20000
18000
16000
14000
12000
10000
8000
6000
4000
2000
0
FY 18 FY 19 FY 20
New Annie Users per Week Total Active Annie Users
(Department of Veterans Affairs, 2021) #HIMSS21 21Increase in Provider Utilization
• 64% to 94% - % of VA primary care providers that had
conducted at least 1video telehealth visit before and after
COVID
• 67% to 98% - % of VA mental health providers that had
conducted at least 1video telehealth visit before and after
COVID
#HIMSS21 22Patients Value Telehealth
“My HealtheVet is great! I use it “Annie contacts me at 8 every “Home Telehealth was the best
to message my provider and morning. It’s almost like saying that move I ever made. For me, my
order my meds. I also promote she has my back. I have other PTSD blood pressure is very important,
the use of My HealtheVet and apps, but I don’t go to them. Annie and using telehealth, they are
mobile apps at my VFW post.” comes to me.” able to monitor that from home.”
“The VA telehealth program really "VA Video Connect really is a “With TeleMental Health, I’m
saved my life when I had COVID-19, timesaver for Veterans. With VA able to receive the help I need
because every single day, I had Video Connect, I can receive my in a comfortable setting, without
someone who was checking on me care, no matter where my the stress of traffic and hospital
at home. My telehealth nurse specialist is.” waiting rooms. My doctor brings
checked on my symptoms and me back into focus and helps
encouraged me through my feelings me deal with a very dark time.”
of helplessness and depressive
episodes.”
#HIMSS21 23Our Tools and Our Lessons
#HIMSS21 24Innovation Under Quarantine: VA COVID Tools and Technologies
• In the first three months of the pandemic VA grew capacity, developed new
tools and provided additional services in areas hardest hit.
#HIMSS21 251 Education
COVID Coach 2 Tools for Managing Stress
Managing
Stress related
to COVID
3 Resources
#HIMSS21 26Automated text
messages for
COVID
“Annie” is the VA’s
automated text
message platform
#HIMSS21 27Let’s Test Annie
#HIMSS21 28VA Coronavirus
Chatbot
Get answers to questions about
COVID, VA benefits and services.
#HIMSS21 29VA Video
Connect Now
Streamlined access
#HIMSS21 30Connected Care
Academy
One stop access to all
virtual care training
31Telehealth Expansion in 2020 –
Advancing in Realtime and Maintaining Quality
• Maintaining continuity of care – quickly shifting to remote delivery of care and remote
work for staff
• Increasing access to tools/resources – quickly deploying necessary hardware and
software for staff and patients
• Expanding workforce trained in virtual care – quickly ramping up virtual care training
for healthcare staff
#HIMSS21 32VA Tele-Critical Care
Resource sharing across the enterprise to increase access and quality
#HIMSS21 33Clinical Resource Hubs
Resource sharing across the enterprise to increase access and quality
#HIMSS21Lessons Learned – Before & After COVID
Pre-COVID Building Virtual During COVID – Rapid Enhancements
Care Infrastructure For Providers & Patients
• Design technology with patients in mind, • Provider training is not one-sized fits all – rapid
put patients & caregivers at the center training, peer networks, provider supports
• Provider-centered design is essential. Your • Understand what policies & procedures are
staff matters holding your system back
• Optimize adoption, systems need • Partnerships & community-based agreements help
investments in people move the needle
• Think from a system perspective, capacity • Execute VA’s “4th mission” improve the
nation’s preparedness for response to war,
& responsiveness terrorism, national emergencies, and natural
• Leave no patient (Veteran) behind, mind disasters
the digital divide
35VA Emergency Response during COVID
Supporting VA’s “4th Mission”
• Deployed personnel to more than 50 states and territories, including Navajo nation support
• Distribution of personal protective equipment, acute and intensive care beds, and medical
equipment
• Admitting non-Veteran citizens into VA medical centers
• Vaccinated 3,311,795 people, including 2,877.037 million Veterans, 313,046 employees, 70, 947
family or caregivers through the SAVE LIVES Act, 49,793 others including federal partners (as of
June 11, 2021
36What’s Next?
#HIMSS21 37Beyond video visits:
Getting more out of the White Space
#HIMSS21 38The healthcare system is forever changed
• The healthcare system will be feeling the direct
impact for the next five to ten years we’re going to
continue feel the effects. To prepare we need:
• Further the development and integration of emerging
virtual care tools
• Changes in policies and practices to ensure continuity
of operations and prepare for future emergencies
• To invest in workforce expansion trained in virtual care
and in infrastructure improvements to support virtual
care
#HIMSS21 39Developing and Implementing Virtual Care Technologies
• Sensors, Wearables, and Remote Patient Monitoring
• Patient-Generated Health Data
• Prescribing Virtual Care
• Rolling out new EHR and creating interoperability with
existing infrastructure
#HIMSS21 40Changes in Policies and Practices
Pre-pandemic During pandemic
• MISSION Act • CARES Act
• VHA Directive 1914
• SAVES Lives Act
• VHA Directive 6506
• American Recovery
Plan Act
#HIMSS21 41“ It’s critical that we do everything we can to
empower our people, unleash their
ingenuity, unify their efforts and therefore
expand their capacity. “
Dr. Carolyn Clancy
Acting Deputy Secretary, Veterans Health Administration
#HIMSS21 42Questions
#HIMSS21 43References
• Armstrong, C. M., McGee-Vincent, P., Juhasz, K., Owen, J., Avery, T., Jaworski, B., Jamison, A., Cone, W., Gould, C., Ramsey, K.,
Mackintosh, M. A., & Hilty, D. M. (2021). VA Mobile Health Practice Guide (1st ed.). U.S. Department of Veterans Affairs.
Washington, DC. https://connectedcare.va.gov/sites/default/files/va-mobile-health-practice-guide.pdf
• Chao, G. F., Li, K. Y., Zhu, Z., McCullough, J., Thompson, M., Claflin, J., Fliegner, M., Steppe, E., Ryan, A., & Ellimoottil, C. (2021). Use
of telehealth by surgical specialties during the COVID-19 pandemic. JAMA Surg, e210979. doi:10.1001/jamasurg.2021.0979.
• Clancy, C. M. & Kirsh, S. (2021). Virtual care and the pandemic: are we reaching all patients? Ann Intern Med, 174(1), 116-117.
doi: 10.7326/M20-5593
• Congressional Research Service (May 20, 2020) Delivery of VA Telehealth Services During COVID-19.
https://crsreports.congress.gov/product/pdf/IF/IF11554
• Connolly, S. L., Stolzmann, K. L., Heyworth, L., Weaver, K. R., Bauer, M. S., & Miller, C. J. (2021). Rapid Increase in telemental
health within the Department of Veterans Affairs during the COVID-19 pandemic. Telemed J E Health, 27(4), 454-458. doi:
10.1089/tmj.2020.0233
• Department of Veterans Affairs. (2018). VA Maintaining Internal Systems and Strengthening Integrated Outside
Networks (MISSON) Act. https://www.congress.gov/congressionalreport/115th-congress/house-report/671/1. Accessed
April 15, 2021.
#HIMSS21 44References (continued)
• Department of Veterans Affairs. (2019). VHA Directive 0320.02, Veterans Health Administration Health Care Continuity Program,
Government Accountability Office. Veterans Health Administration Regional Networks Need Improved Oversight and Clearly
Defined Roles and Responsibilities. https://www.gao.gov/reports/GAO-19-462/.
• Department of Veterans Affairs (2020). Ethical principles for access to and use of Veteran data. (Memorandum VIEWS #01256748)
https://www.oit.va.gov/about/ethical-data-use/index.cfm
• Department of Veterans Affairs. (2020). Veterans Health Administration—Office of Emergency Management, COVID-19 Response
Plan Incident-specific. Annex to the VHA High Consequence Infection (HCI) Base Plan, Version 1.6. VA Releases COVID-19
Response Plan. https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5405.
• Department of Veterans Affairs. (2021). COVID-19 National Summary, June 14, 2021.
https://www.accesstocare.va.gov/Healthcare/COVID19NationalSummary
• Department of Veterans Affairs. (2021). COVID-19 Pandemic Response. Weekly Report.
https://www.va.gov/health/docs/VA_COVID_Response.pdf
#HIMSS21 45References (continued)
• Department of Veterans Affairs. (2021). Department of Veterans Affairs National Surveillance Data,
https://app.powerbigov.us/groups/me/apps/5b3696b5- ace4-44c8-9e0d-53eca3c29171/reports/93a22c14-7964-4b6f-93d2-
ba853297fe4f/ReportSection3dd692a49dd2b508b812?ctid=e95f1b23-abaf-45ee-821d-b7ab251ab3bf. (The website was
accessed on June 27, 2020. This is an internal website that is not accessible to the public.)
• Department of Veterans Affairs (2021). Fiscal Year 2021 Budget Submission.
https://www.va.gov/budget/docs/summary/fy2021VAbudgetInBrief.pdf#page=12
• Department of Veterans Affairs (2021). Review and Use of Patient-generated Health Data under the Office of Connected Care.
VHA Directive 6506, Veterans Health Administration, Washington DC.
https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=9252
• Department of Veterans Affairs (2021). Review of Veterans Health Administration’s COVID-19 Response and Continued Pandemic
Readiness. Report #20-02717-85 Review of Veterans Health Administration’s COVID-19 Response and Continued Pandemic
Readiness (va.gov).
• Ferguson, J. M., Jacobs, J., Yefimova, M., Greene, L., Heyworth, L., & Zulman, D. M. (2021). Virtual care expansion in the Veterans
Health Administration during the COVID-19 pandemic: clinical services and patient characteristics associated with utilization. J
Am Med Inform Assoc, 28(3), 453-462. doi:10.1093/jamia/ocaa284.
#HIMSS21 46References (continued)
• Gromatsky, M., Sullivan, S. R., Mitchell, E. L., Spears, A. P., Edwards, E. R., & Goodman, M. (2021). Feasibility and acceptability of
VA CONNECT: Caring for our nation's needs electronically during the COVID-19 transition. Psychiatry Res. 296, 113700. doi:
10.1016/j.psychres.2020.113700
• Hanlon, C., Huang, C., Sloss, E., Price, R. A., Hussey, P., Farmer, C. & Gidengil, C. (2017). Comparing VA and non-VA quality of
care: systematic review. J Gen Intern Med 32(1):105–21, doi:10.1007/s11606-016-3775-2
• Heyworth, L., Kirsh, S., Zulman, D., Ferguson, J. M., & Kizer, K. W. (2020). Expanding access through virtual care: the VA’ s early
experience with Covid-19. NEJM Catal Innov Care Deliv 2020; 1 (4): 1–11. doi: 10.1056/CAT.20.0327.
• Hilty, D. M., Armstrong, C. M., Edwards-Stewart, A., Luxton, D. D., Gentry, M. T., & Krupinski, E. A. (2021). A scoping review of
sensors, wearables, and remote monitoring for behavioral health: uses, outcomes, clinical competencies and research
directions. [Special Issue: Clinical and Educational Interventions for Technologies]. Journal of Technology in Behavioral Science.
doi:10.1007/s41347-020-00190-3
• Lin J. C., Humphries, M. D., Shutze, W. P., Aalami, O. O., Fischer, U. M., & Hodgson, K. (2021). Telemedicine platforms and their use
in the coronavirus disease-19 era to deliver comprehensive vascular care. J Vasc Surg. 73, 392-398. doi:10.1016/j.jvs.2020.06.051.
#HIMSS21 47References (continued)
• Myers, U. S., Birks, A., & Grubaugh, A. L., & Axon R. N. (2021). Flattening the curve by getting ahead of it: how the VA healthcare
system is leveraging telehealth to provide continued access to care for rural Veterans. J Rural Health, 37(1),194-196. doi:
10.1111/jrh.12449.
• National Academy of Sciences, Engineering, and Medicine (2020). Developing a patient-centered approach to optimizing
veterans access to health care services. Retrieved from: https://www.nationalacademies.org/event/03-12-2020/developing-a-
patient-centered-approach-to-optimizing -veterans-access-to-health-care-services-a-workshop.
• Park, E. R., Chiles, C., Cinciripini, P. M., Foley, K. L., Fucito, L. M., Haas, J. S., Joseph, A. M., Ostroff, J. S., Rigotti, N. A., Shelley, D. R.,
Taylor, K. L., Zeliadt, S. B., & Toll, B. A. (2021). Impact of the COVID-19 pandemic on telehealth research in cancer prevention and
care: A call to sustain telehealth advances. Cancer, 127(3), 334-338. doi:10.1002/cncr.33227.
• Reddy, A., Gunnink E., Deeds, S. A., et al. (2020). A rapid mobilization of ‘virtual’ primary care services in response to COVID-19 at
Veterans Health Administration. Healthcare, 8(4), 100464.
• Schueller, S., Armstrong, C. M., Neary, M. & Ciulla, R. (2021). An introduction to core competencies for the use of mobile apps in
cognitive and behavioral practice. Cognitive & Behavioral Practice, 27(4). doi:10.1016/j.cbpra.2020.11.002
• Shura, R. D., Brearly, T. W., & Tupler L. A. (2021). Telehealth in response to the COVID-19 pandemic in rural Veteran and military
beneficiaries. J Rural Health, 37(1), 200-204. doi: 10.1111/jrh.12454.
#HIMSS21 48Thank you!
Christina Armstrong, Ph.D.
christina.armstrong@va.gov
@_Armstrong1_
www.linkedin.com/in/christinaarmstrong
#HIMSS21 49You can also read
