The VA and DoD’s COVID-19 digital transformation

For many health systems, the transition to virtual care during the pandemic was like night and day. Before COVID-19 hit, they delivered most of their care, if not all of it, in person. Within a matter of days into the public health emergency, that all changed.

That was not the case, however, for the U.S. Department of Veterans Affairs, according to Christina Armstrong, a clinical psychologist at the VA’s Office of Connected Care.

“A lot of health care organizations around the world had to shift, or some just completely stopped providing any services [when the pandemic began]. They had no infrastructure in place whatsoever,” she told MobiHealthNews.

“Both the DoD and VA absolutely did. We completely had our infrastructure already in place, because at both the VA and DoD this is part of our requirement for providing anywhere-to-anywhere service. So there were some shifts that we definitely had to make – huge, huge, huge shifts. But for the most part, we have the basic infrastructure in place which allowed us to continue.”

Armstrong, who previously worked in the Connected Health branch of the Department of Defense, says that there was a concerted push within these federal agencies for years to implement virtual care processes.

A number of policies at the VA made all the difference when care was forced online, according to Armstrong.

The first allows licensed VA providers to give care to patients across state lines. So while other health systems were waiting for telehealth state licensing policies to get adjusted, the VA could continue caring for patients regardless of their physical location.

Another policy that was already in place is the Mission Act, which came in handy throughout the pandemic because it allows VA patients to receive care at out-of-network facilities.

“If veterans are not able to receive care in a VA facility – if they typically receive care in a VA facility and they’re unable to, for whatever reason – through the Mission Act, they can find providers and care outside of the VA system,” Armstrong said. “So we don’t want patients to unnecessarily be waiting for the care that they need.”

One of the biggest challenges for the VA during the pandemic was training their providers on how to actually deliver virtual care.

“So, [among] 400,000 health care providers all across the V.A. health care system, probably about 70% of them had to be trained immediately. And so that was huge,” Armstrong said.

But again, the health system was prepared. It already had virtual care specialists in its facilities who could offer in-person support, along with on-demand continued learning opportunities through the Connected Care Academy.

Despite its preparedness, there were still a number of gaps in the VA’s existing virtual care infrastructure that had to be addressed.

“We heard people say, ‘Hey, look, I don’t have a house. I lost my job. I don’t have food, where do I get food?’ You know, just basic needs,” Armstrong said. “But we also heard a lot of people say, ‘Hey, you know, I’m feeling isolated. I’m feeling depressed. I’m feeling lonely. I have a lot of anxiety.’ We heard a lot of this, and not just with our patients, with our staff as well.”

In response, the VA developed and released a comprehensive resources app called COVID Coach, which provides educational tools for coping during the pandemic and mood-tracking to see mental health progress over time.

The health system also updated its automated texting platform, the Annie App, with new protocols that allow people to record their symptoms for clinicians to overview, check-in during quarantine and receive emotional support during times of isolation.

It created a coronavirus chatbot that could field patient questions and direct them to the correct place for support.

The VA also launched VVC Now, which allows providers to initiate a video visit by inputting the patient’s contact information and sending them a link to join.

Looking back, Armstrong believes that the VA was able to release all of these tools during the pandemic because it didn’t have to worry about standing up an entirely new system.

“A lot of other healthcare systems either kind of went to a standstill, or they were just barely keeping their head above water,” she said. “We felt like that. We felt like we were barely holding our head above water, just like everybody else. However, in retrospect, I see that it was because we had that solid foundation in place that we could think outside the box and really meet the need where it was at.”

Moving forward, the VA plans to go full steam ahead with virtual care. It’s currently working on incorporating wearables in the healthcare process to give patients control of their health data.

Armstrong will be speaking at HIMSS21 in Las Vegas on “COVID-19 Lessons Learned: The Invaluable Need for Virtual Care” on Tuesday, August 10, from 10:15 a.m. to 11:15 a.m. in Caesars Forum 128.


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