Making Connections: Tablet-Enabled Video Telehealth to Enhance Veterans' Access and Care

Background:

Telehealth is a cornerstone of enhanced access for Veterans and across a range of conditions is associated with improved disease control, quality of life, and patient satisfaction. Increasingly Veterans are able to monitor their chronic conditions and communicate with clinicians and care teams via tablets and other devices. However, this service is currently only available to Veterans with in-home Internet and video capability, or Veterans who are able to travel to a VA community based outpatient clinics to connect with providers at other facilities. In 2016, in order to address this access gap and disparity, VA launched an initiative to distribute tablets to Veterans who have clinical needs for remote care, and barriers to traditional in-person access.

Veterans who meet specific need-based (access, technology, and clinical) criteria may be issued one of two devices: Commercially available Off the Shelf (COTS) for basic connectivity or Healthcare Access Tablet (HAT) with a general exam camera and optional peripheral devices (i.e., stethoscope, BP monitor, pulse oximeter, thermometer, or weight scale). VA providers refer eligible patients for the devices using a consult template in VA's electronic health record. Care delivered via the tablet is indicated in the referral and may include one or more of the following: Home Based Primary Care, Palliative Care, Mental Health Intensive Case Management, Spinal Cord Injury, Mental Health Care, care for patients with marked mobility problems, care for patients with cognitive problems (these patients must have a caregiver who can assist with technology), home evaluations, and rehabilitation/prosthetics. Once the patient is issued the device, he or she will receive tablet services from trained teleproviders.

The VA began distributing tablets in the spring of 2016, with the plan of distributing 5,000 tablets over the following 1-2 years. Veteran eligibility criteria for tablets include the following: 1) Enrolled in VA Healthcare, 2) Does not own a device or does not have working broadband or cellular internet connection, 3) Physically and cognitively able to operate the technology (or has caregiver who can assist), 4) Barriers to access, such as a) distance or geography, b) transportation issues, c) homebound or difficulty leaving home, d) other (described by provider), and 5) Provider and patient give informed consent agreeing to utilize telehealth for care.

The tablet initiative and evaluation have been designated as Quality Improvement by VA's Office of Rural Health. The evaluation will include the following: