In June, President Donald Trump officially signed the VA MISSION Act, more formally known as the VA Maintaining Systems and Strengthening Integrated Outside Networks Act, or the Caring for Our Veterans Act of 2018. Section 151 of the Act, entitled “Licensure of Healthcare professionals of the Department of Veterans Affairs providing treatment via telemedicine”, formalized a new authority that allows VA employed Healthcare professionals to practice regardless of the location of the provider or patient.
Recently, FedHealthIT’s Executive Vice President, Susan Sharer, had the opportunity to speak with Dr. Neil Evans, Veterans Health Administration Chief Officer for Connected Care, about telemedicine, how it is paving the way as a positive disruption in Healthcare delivery, and the challenges that remain.
Why is Section 151 of the VA MISSION Act Critical?
Section 151 of the VA MISSION Act is critical for VA, establishing unambiguous authority for VA Healthcare providers to deliver care via telehealth across state lines to wherever the Veteran is located. This may not seem transformative, but this authority is critical for VA to leverage its talented clinical workforce across the country, and to be able to better support Veterans at home or in their communities.
This new authority allows us to leverage telehealth and virtual care delivery as part of all our core operations. We’ve already seen significant progress on this front since the Anywhere to Anywhere initiative was formally finalized. Over the past year, more than 100,000 encounters have been delivered via video connection. That’s roughly 700 visits per day and we expect that number to increase as more providers are trained and become capable of using VA Video Connect, our direct-to-Veteran video solution.
The combination of our Anywhere to Anywhere initiative and the VA MISSION Act allows for delivery of care to Veterans in their homes, workplaces, or through community partners, and it allows us to connect Veterans with the right specialty providers anywhere in the VA system, and with specific and unique clinical skills they may require.
How do You Maximize the Potential?
With a workforce as large as VA’s, step one is ensuring the entire clinical team is aware of the virtual care and telehealth technologies available to support the provision of care. Secure email through My HealtheVet, video visits through VA Video Connect, or text messaging through VA’s Annie program, are all tools at the clinician’s disposal that can enhance the provider/ patient relationship and provide innovative and convenient ways to meet the needs of the patient.
As the clinical community becomes aware of these technologies and as they experience how virtual care can enhance patients’ experience and outcomes, adoption is likely to increase. Provider adoption of virtual care is critical – and by extension drives patient adoption. Historically, we’ve found a provider’s recommendation is a powerful motivator for patients to try new technologies and new ways of engaging.
Every week, I see patients in clinic and have experienced the sense of helplessness busy clinical staff often feel, as they try to keep up and as they try to meet the expectations of all stakeholders. Virtual care technologies, when well-implemented, can be magical, making the provider’s tasks more efficient and simultaneously delighting the patient.
For instance, I was recently on a call with a patient and for a moment, suspected they might need an emergency room visit for evaluation. And then, “Ah ha!” – “I could spin up a VA Video Connect visit and solve this right now.” Within minutes, my patient and I were connected via video and after seeing the issue, I was able to explain what was happening.
He was thrilled to have an answer and didn’t have to come to the 
emergency room. I was happy to have saved him time and trouble, and there was the added bonus of saving the Healthcare system the cost and inefficiency of an unnecessary emergency room visit.
We’ve seen a lot of creativity in how people are using VA’s new video care solution – regular wound follow-up visits via video; group visits involving the Veteran, their VA provider and an external prosthetist fitting new artificial limbs or other prosthetics; mental health visits; collaborative home blood pressure checks, and more.
The Private Sector Connection
VA has been a leader for many years, using video and synchronous telehealth to connect Veterans who visit our community clinics with VA providers at our larger hospital locations. We’ve engaged with colleagues in the private sector to share VA’s lessons learned about telehealth. The interest in telemedicine and virtual care in Healthcare at large has increased; the entire industry is thinking about how virtual care should be integrated into their core operations. Every Healthcare system is focused on the patient experience and how to make care less inconvenient, while still maintaining high quality.
What Challenges Remain?
How do we ensure the increased adoption of virtual care doesn’t lead to unintended consequences? And how do we assure these new modalities for care delivery don’t create new disparities between those who have technology and those who don’t? We need to ensure we provide the same access to all Veterans, regardless of their technological means.
We’re thinking, at the system level, about ways to improve the ability of Veterans to access technology. We’re in regular dialog with the Federal Communications Commission (FCC) around support for broadband expansion and the need for Americans to have access to affordable high-speed internet from their homes and workplaces.
On another front, VA is working to make devices, such as videoenabled tablets, available to Veterans when they need to connect regularly and don’t have access to a device.
Another barrier is the challenge of integrating new virtual care workflows into VA’s clinical environment at scale. We’re deeply involved in the day-to-day work necessary to implement a successful virtual care program, including training, improving technologies, adjusting workflows, engaging with stakeholders, and making necessary changes.
The Opportunity to Think Beyond
Telehealth is disruptive. Telehealth has the power to transform how we think about Healthcare delivery – particularly in a large national system like VA. We can significantly enhance the Veteran’s experience by better supporting them and their caregivers where they are. We can increase the efficiency and capacity of the Healthcare system by connecting available clinical staff with the Veterans who need their services, even if the Veteran and provider aren’t in the same location. We can increase the quality of the care we deliver by connecting Veterans with the clinical staff best equipped to meet their needs.
Technology allows us to think creatively about how our Healthcare system adapts and responds to the needs of Veterans and citizens. I think a great example occurred last year in the aftermath of Hurricane Harvey. An impromptu telehealth emergency management team quickly stepped in and provided virtual care, helping decompress the massive load on the local Healthcare providers who were, in some cases, juggling their own personal losses in the midst of the crisis. We’ve expanded telehealth as part of our emergency plan for the current hurricane season, having recently stress tested it on the 4th of July.
Why else is the telehealth portion of the VA MISSION Act so critical (and exciting)? – Because it demonstrates the support we’ve seen at the highest levels of our Government for the expansion of VA telehealth and because it is a recognition of the transformative potential of virtual care technologies. The journey is just beginning.
About Dr. Neil Evans
The Office of Connected Care manages VA Telehealth, My HealtheVet, the VA Mobile program, and VHA’s Innovation initiatives. Beyond his role with the Office of Connected Care, Dr. Evans is also a primary care physician who sees patients at the Washington D.C. Veterans Affairs Medical Center.
