VA health facilities encourage patients to use telemedicine programs

  • The Manchester Veterans Affairs Medical Center is seen July 17, 2017. NICK REID

Granite State News Collaborative
Published: 3/27/2020 2:59:44 PM
Modified: 3/27/2020 2:59:33 PM

Long before COVID19 made its way into the American population, the U.S. Department of Veterans Affairs had a problem: In rural areas, veterans had to travel long distances to access medical and mental health care. 

Some of the steps the VA took to address that problem mean veterans in states like New Hampshire got a head start using telemedicine to meet with their providers and monitor their health. 

“We’ve been doing it for over two and a half years and have focused a lot of effort, as far as staff and marketing to our veterans, to engage them in this service,” said Lisa Eisele, RN, the program director for connective care at the Veterans Integrated Service Network (VISN) of the VA that serves New England veterans, known as VISN 1. 

Still, Eisele said usage of the VA’s telehealth program, including a service called VA Video Connect, is up about 463 percent in New England for the fiscal year that started in October. This month, compared with March, 2019, has shown a 600 percent increase. While some of that bump is a result of a pre-COVID push to engage veterans online and on the phone, a majority of it comes from the virtual shutting down of non-urgent care at the VA’s hospitals and clinics.

Veterans across the Granite State have, in recent years, been able to access care at VA medical centers in White River Junction, Vt., and Manchester, NH., as well as VA clinics in Conway, Keene, Littleton, Portsmouth, Somersworth, and Tilton. There are also arrangements with non-VA health care providers who provide care. Patients are now being asked to call first rather than show up at those facilities to determine whether they need to show up in person. 

The increased volume of calls and online appointments has led to some glitches – the VA reports long waits on hold, and Eisele said the telehealth program “certainly showed some system strain.” 

The New England VISN has doubled its server capacity, she said, to manage the new load. And Craig Coldwell, MD, the deputy chief medical officer for VISN 1, said the network is in the process of redistributing personnel to the phones to keep up with this surge in demand. 

The problems that necessitated this rejiggering are the ones facing all health care facilities in this country and even globally: They will be overwhelmed, if they’re not already, with COVID19 patients, and many patients or their loved ones may be infected and spread the virus. As a result, the VA is postponing most elective procedures and asking veterans to call their providers first before going to their usual VA hospitals or clinics.  

“We are asking all of our clinical services and our community-based outpatient clinics to optimize virtual means” of working with veterans, Coldwell said. Regular transportation to medical facilities has also been shut down, but he said if someone needs to be seen in person and doesn’t have a way to get to their clinic, “we’re finding a way” to get them there. Officials would not give specifics on what that entailed.

In normal times, for those who don’t have access to the internet, the VA has social workers and community workers who usually help. According to Coldwell, If they can't video with them they're calling, if they need to be in person they are. 

Those who do need to go to those facilities, Coldwell said, are being screened when they get there.

“Veterans who present for care, if they have symptoms, will be directed to a COVID-specific area,” he said. Others will be cared for separately, and visitors are not being allowed into medical facilities or nursing homes. 

The primary exception has been in hospice situations, when family members are being allowed to join their dying loved ones. 

Otherwise, Eisele said, family members are being encouraged to talk with hospitalized patients through the established telemedicine channels, online and on the phone. Social workers and others who usually interact in person with veterans in the community are also checking in first from a distance to assess whether needs can be met without face-to-face interactions. 

VA Video Connect meetings with doctors are scheduled by the VA at the request of a provider. Conversations can be held from most devices – phones, tablets, or computers – and patients receive a link to the “virtual medical room” in an email. With the exception of a few devices that require users to download an app – including iPhones – the user clicks on the link and begins a videoconference with their provider. Veterans can call the TeleHealth Coordinator at 844-822-2737, though given the volume of calls the VA is requesting that people send a secure message to their provider at, when possible, instead of calling.

There are 261,316 veterans using VA health care in the New England states, according to a spokesman. New England VA officials did not answer a request for testing numbers for New Hampshire or the region, but as of Thursday, the VA said on its website, it had tested 7,425 nationwide. Two outpatients had tested positive for COVID19 at the White River Junction VA Medical Center in White River Junction, Vt. 

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