Response to CommentaryThe Virtual Care CORE and the Future of VA HSR&D's Telehealth ResearchBoth within and beyond VA, the use of different technologies to deliver healthcare services at a distance has evolved rapidly in recent decades. Telehealth has emerged as an optimal way to address what has been at times a fundamental mismatch between the supply of healthcare providers and their clinical expertise, and the demand among patients for their services. For example, academically-affiliated VA facilities (particularly in urban areas) often had an overabundance of providers across specialties, while Veterans living in rural areas often had limited access to local mental health or specialty care. In response, some VA medical centers created telehealth “hubs.” Several years ago, the VA New York Harbor Healthcare System established a telemental health hub to provide virtual mental healthcare to rural parts of Texas, Oklahoma, and Pennsylvania. This allowed efficient use of a stable pool of mental healthcare providers at a time when New York facilities experienced a decrease in Veterans walking through their doors due to demographic and geographic changes. Such lessons learned and corresponding practice changes have been a defining story in recent years across healthcare organizations. As Drs. Evans and Galpin described in their FORUM contribution, the COVID-19 pandemic has served as a powerful catalyst for change in how technologies like synchronous and asynchronous telehealth and remote patient monitoring are used to deliver services. Prior to the pandemic, researchers predicted that by 2025 providers would offer as much as 25 percent of primary care and other visits on a virtual basis. COVID-19 accelerated that time frame by five years. While some preferences for service delivery are drifting back towards pre-pandemic patterns, telehealth and the broader realm of virtual care are now fundamental aspects of the healthcare experience. The task at hand for all healthcare systems, including VA, is to find the right balance of care provided in virtual and traditional, brick-and-mortar settings that matches the needs and preferences of individual Veterans. In addition to telehealth services, VA offers a broad range of other virtual care technologies to support Veteran healthcare engagement. VA must now determine how to support sustained use of technologies such as VA’s patient portal; to identify and test effective strategies that promote wider uptake of technologies like VA’s automated texting system and suite of mobile health applications; and to think creatively about how these various modalities can be used together to enhance the overall care experience. Doing so will bring us closer to ensuring that virtual care lives up to its potential to improve both access and quality for patients while decreasing disparities. The Virtual Care Consortium of Research (CORE) was launched in June 2020 to support and foster collaboration among VA HSR&D investigators conducting research with a virtual care focus. Supported by HSR&D, the CORE’s goals are to:
Highlights of the Virtual Care CORE’s first year include the following.
In the coming year, the Virtual Care CORE will focus on strengthening the network, supporting virtual care research and QI projects, and undertaking the portfolio review and SOTA activities that will guide future research, policy, and clinical operations in VA. We welcome new network members! To learn more about the Virtual Care CORE, check out our website or contact us at VHAVirtualCareCORE@va.gov. |