Like other health providers, the VA has seen a telehealth boom during the COVID-19 pandemic.
Specifically, telehealth video appointments using the department's VA Video Connect spiked 1,000% since February and Veterans Affairs' providers have conducted 1.1 million tele-mental health visits to more than 350,000 veterans this year. Through VA Video Connect, the department has provided 9 million additional virtual care interactions this year versus last year, officials said.
"We intend to sustain and grow from here. We think this is the beginning of a longer trajectory and there is more expansion possible with specialty care delivered at the bedside in the in-patient setting and emergency care settings," testified Jennifer MacDonald, chief consultant to the deputy undersecretary for health at the Veterans Health Administration, during a House Veterans Affairs Committee hearing this week.
But, leaders from veterans group testifying on Capitol Hill this week say there's still a digital divide that needs to be address.
Veterans who are experiencing homelessness or face economic barriers cannot buy technology or gain access to broadband Internet, said Lindsay Church, co-founder and executive director for the Minority Veterans of America. Socio-economic barriers exist for minority veterans as well, she said. Veterans with disabilities also face challenges with using new technology.
"The rapid expansion of telehealth has amplified systemic healthcare inequities across the country. It cannot be unseen nor can it continue. Some were afforded access to mental health services through telehealth while others are left without the means to access basic care," she said.
Church recommended the VA provide technology and Internet vouchers for low-income veterans.
"The VA needs to look at where the digital divide is and focus heavily on outreach for those folks and within communities of color," she said.
During the COVID-19 pandemic, the added burdens of chronic disease and persistent underfunding of American Indian health systems have put the nation’s indigenous population at a higher risk of poor outcomes from the disease.
The digital divide persists for American Indians and Alaskan natives as a result of limited resources and a lack of funding for health IT, testified Chief William Smith, vice-chairperson with the National Indian Health Board and a member of the Valdez Tribe of Alaska.
According to data from the Federal Communications Commission, only 46% of households on tribal lands in Alaska have access to broadband and 33% of households in rural Alaska have access.
While the VA service population is three times the Indian Health Service population, funding for the VA is 13 times higher than Indian Health Service funding, Smith said.
"It is imperative that Congress establish parity between the VA and Indian Health Service to equalize funds and for IT development. Without parity, the quality of care for native veterans will continue to suffer," Smith said.
MacDonald testified that the Veterans Health Administration is partnering with the Indian Health Service to support connectivity for tribal nations and to bring telehealth equipment to those areas. Moving forward, the VA plans to work with IHS, state, and local governments to address technology needs.
"The VA has a leadership role in this that we intend to serve," she said.
Under the $2 trillion stimulus law signed by President Donald Trump in April, the Veterans Health Administration was allocated $17.2 billion to care for veterans with COVID-19 and expand telehealth services.
The VA Office of Connected Care, which oversees telehealth services, has spent $39 million of CARES Act funding for equipment for patients and clinicians, such as iPads, webcams, and speakers, testified Kevin Galpin. M.D., executive director, telehealth services at the VHA's Office of Connected Care.
The office also has used that funding to expand and support the telemedicine help desk, he said.
VA officials also testified that the infusion of new funding went towards improving the IT infrastructure to expand the capacity and bandwidth for telehealth and telework capabilities.
As well, as part of the VA's $16 billion project to modernize its electronic health record system across all its hospitals, the VA Video Connect platform will integrate with the new Cerner EHR and that will further support the expansion of telehealth services across the veteran population, testified Neil Evans, M.D., chief officer of the VHA's Office of Connected Care.
"By integrating VA Video Connect into Cerner, providers will have video care more deeply built into their workflow and that will increase the blend of both in-person and virtual care," he said.
"We want every patient to be able to receive care by connecting electronically with the healthcare team, by phone, by video or in-person and do it in a way that makes the most sense to achieve the best clinical outcomes," Evans told lawmakers.