D.17 - VHA's Office of Connected Care Telehealth Manual.pdf

VA Telehealth Office of Connected Care Telehealth Manual (Updated June 2023)

1. Office of Connected Care Telehealth Manual The purpose of the Office of Connected Care Telehealth Manual is to identify the organizational roles and responsibilities of VA telehealth programs as well as highlight relevant VHA policies, guidelines, and resources. This manual describes how VHA deploys, implements, and evaluates telehealth and other virtual care resources.

2. Roles and Responsibilities The Office of Connected Care's mission focuses on improving health care through technology by engaging Veterans and care teams outside of traditional health care visits. By bringing together VA digital health technologies under one umbrella, the Office of Connected Care is enhancing health care coordination across the VA and supporting Veterans' participation in their care.

Below is an overview of the VHA telehealth organizational structure which has been developed to support any VHA staff member who starts, maintains, or evaluates telehealth programs.

For more information, please review the 2022-2028 VA Strategic Plan and the Office of Connected Care Strategic Plan (NOTE: This internal VA website is not available to the public.)

2.1 Office of Connected Care

The Office of Connected Care focuses on designing and delivering digital systems that seamlessly connect Veterans to their health care teams and their health information. By incorporating technology into the health care experience, Veterans can access health care in new ways, such as using virtual and home-based tools, mobile apps, expanded access to electronic health information, and more. Connected Care is divided into two major organizational units- Connected Health and VA Telehealth.

The Connected Care portfolio encompasses the following programs.

Connected Health Program includes:

o VA Web and Mobile.

o My HealtheVet.

o Connected Health Implementation.

o Clinical Analytics.

VA Telehealth comprises:

o Synchronous Video Telehealth.

o Asynchronous Telehealth.

o Remote Patient Monitoring ̶ Home Telehealth.

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o Telehealth Technology Management.

o Quality, Training, and Knowledge Management.

VA Telehealth works with team members within other VHA national program offices to forecast, develop, integrate, implement, oversee, monitor, and manage virtual health care delivery platforms and the virtual health care and health care-related services that are provided to millions of Veterans nationwide annually.

VA Telehealth provides the following enterprise-level infrastructure:

• The Office of Connected Care Help Desk for both patients and VA healthcare professionals provides troubleshooting assistance and telehealth technology support to increase confidence and technology acceptance (NOTE: This internal VA website is not available to the public.)

• National standardized clinical models for telehealth care that are approved by national clinical services.

• A comprehensive enterprise-level telehealth technology strategy that includes national contracts for purchasing telehealth technologies and peripheral devices as well as incorporates acquisition, inventory, maintenance, and logistics for distribution, retrieval, and disposal.

• National dashboards for monitoring the utilization and technical systems performance of telehealth platforms in real-time.

• A national telehealth training academy and platform with virtual care competency-based training accessible on-demand as well as information, knowledge management, and consultative support for Telehealth Communities of Practice for each telehealth clinical specialty, telehealth staff role, and telehealth modality.

• A national quality management program based on a continuous quality improvement model that has established the foundational telehealth standards, processes, and procedures required to ensure patient safety through evaluating performance data, benchmarks, and outcomes; critically reviewing program implementation and operations; and identifying and encouraging the implementation of strong or leading practices nationwide.

• National data models to identify, compile, and analyze numerous specific attributes of telehealth care through data reports and dashboards that measure performance metrics and/or quality indicators for telehealth programs operating at the local VA Medical Center (VAMC), regional Veterans Integrated Service Network (VISN), and national levels.

• National processes for the development and integration of telehealth applications into other VA systems and platforms, such as VA’s Electronic Health Record (EHR), for use by VA staff and patients and the ongoing maintenance and development of upgrades for these telehealth applications when required.

• A governance and communications structure to assist with directly communicating information to VISN and facility personnel and in managing barriers and challenges.

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For more information, visit the Office of Connected Care SharePoint (NOTE: This internal VA website is not available to the public) or the VA Telehealth Services website.

2.1.1 VA Telehealth Organization and the National Level

VA Telehealth’s Mission is to provide Trusted Care: Anytime, Anywhere for effective, cost-effective, and appropriate use of health information and telecommunications technologies. The vision is to make the home and the local community the preferred place of care whenever possible and practical (NOTE: This internal VA website is not available to the public.)

2.1.1.1 Executive Leadership

The focus of Telehealth Executive Leadership is to:

Develop VHA’s organizational vision for telehealth and implement it via the telehealth strategic plan.

Coordinate and collaborate with other national VA and VHA program offices, other Federal agencies, and other organizations to promote the expansion and sustainment of telehealth services.

Develop national policies for telehealth.

Chair the National Telehealth Advisory Board.

2.1.1.2 Technology Integration Division

The Technology Integration Division aims to:

Oversee and monitor the performance of the enterprise infrastructure that supports telehealth operations nationally.

Oversee the Office of Connected Care Help Desk.

Lead the development of new telehealth platforms/web-based applications (apps) and their integration into the Electronic Health Record (EHR).

Ensure data security in coordination with the Office of Information and Technology and follow information security and privacy guidelines.

Chair the Telehealth Technology Subcommittee of the National Telehealth Advisory

Board.

2.1.1.3 Telehealth Technology Management Division

The Technology Management Division works to:

Develop the national contracting strategy for telehealth technologies.

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Oversee and manage the national acquisition, maintenance, and updates of telehealth technologies.

2.1.1.4 Modality-Specific Division

Each of the telehealth clinical modality divisions — Asynchronous Telehealth, Remote Patient Monitoring ̶ Home Telehealth, and Synchronous Telehealth:

Provide national direction, troubleshooting, and consultation for all aspects of the modality to support and implement nationally agreed-upon strategies.

Define, launch, and execute enterprise strategies for maintaining and expanding services to patients that integrate into clinical care.

Guide, educate, and consult health care professionals and administrators about the modality and its oversight.

Provide expert input on the modality’s quality metrics, oversight, and training.

Lead special initiatives, pilots, or projects specific to their modality.

2.1.1.5 Quality, Training, and Knowledge Management Division

Members of the Quality, Training, and Knowledge Management (QTKM) Division perform the following functions:

Establish, oversee, and coordinate the National Telehealth Quality Management Program, including national review and periodic revision of the VA’s internal accreditation process for telehealth programs. Additional information can be found in the Quality Training and Knowledge Management Division Internal Operations Guidance

Facilitate the development of virtual care programs consistent with VHA goals and strategic objectives, including VHA’s strategic framework for quality and training.

Provide and manage access to content through knowledge and content management strategies, including content related to policies, standardized operating procedures, job aides, and guidance documents housed and managed in the Connected Care Academy.

Identify, develop, and manage virtual care role-based training developed from core competencies.

Assess the quality of training through standardized benchmarks and measurements of impact and outcome criteria.

Direct oversight, development, and management of Joint Accreditation, the Decentralized Telehealth Preceptor Training Program, and national certificate and certification programs.

2.1.1.6 Telehealth Advisory Board

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The Telehealth Advisory Board is an advisory group to the Connected Care Telehealth Leadership. It supports the top strategies of the VA by aligning telehealth policy, planning, and deployment with these priorities. This includes but is not limited to Synchronous Video Telehealth, Asynchronous Store-and-Forward Telehealth, and Remote Patient Monitoring ̶ Home Telehealth. Board membership includes national, VISN, and facility telehealth staff members (NOTE: This internal VA website is not available to the public.)

2.2 Telehealth Organization at the VISN Level

The VISN-level organizational structure of telehealth programs is designed to establish regional control and oversight of telehealth implementation, sustainment, and quality. As an operational center over multiple VA facilities, VISN leadership is uniquely positioned to ensure clinical supply and demand are met between large facilities in urban areas and small facilities in rural areas by leveraging telehealth. In addition, the VISN’s direct oversight authority over facilities enables it to consistently implement and oversee all programs. This includes oversight of national and VISN-defined telehealth care which includes ensuring adherence to external accreditation standards, integrating virtual care into routine quality-management practices, and managing the achievement of virtual care metrics and goals across VISN facilities. The VISN manages the implementation, sustainment, and oversight of all telehealth modalities across the

VISN.

2.3 Telehealth Organization at the Facility Level

The telehealth organizational structure at the VA facility level must be robust enough to support delivering high-quality health care through telehealth modalities effectively. This requires a more extensive workforce than the VISN level to support direct patient care, new service implementation, technology management, health care professional and patient education, staff competency-based training and assessments, scheduling, program oversight, and quality management oversight.

Facility responsibilities include but are not limited to:

Conduct a needs assessment and establish a business plan to ensure adequate resources are available to provide high-quality services and to promote collaboration across facility service lines.

Support and oversee telehealth services through scheduling, managing local technology, and providing modality-specific technical services.

Provide oversight to the Remote Patient Monitoring ̶ Home Telehealth Program staff during day-to-day operations.

Assist with clinical adoption of new telehealth technologies.

Ensure sufficiently trained staff uses telehealth technology as well as the clinical pathways and processes relevant to their clinical service by providing services either synchronously or asynchronously.

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Provide experts who facilitate training and staff competency within facilities.

Provide program support staff who perform administrative duties.

Provide staff with a telehealth designation who perform specific telehealth functions during patient care.

Ensure facility and community-based outpatient clinics (CBOCs) are staffed in accordance with the multiple services and telehealth service workload.

3. Using Telehealth to Deliver Care VA employs telehealth technology to expand access to health care resources by augmenting in-person care, functioning as self-contained tools, or working in combination with one another. VA Telehealth Services delivers telehealth through different experiences called modalities using various technologies, applications, and other virtual tools. These modalities are defined as Synchronous Video Telehealth, Asynchronous Store-and-Forward Telehealth, and Remote Patient Monitoring ̶ Home Telehealth.

Synchronous Video Telehealth is a real-time, interactive video conferencing modality through which health care professionals assess, treat, and provide care to patients remotely.

Information regarding synchronous technologies is located in the Synchronous Telehealth Manual. Asynchronous Store-and-Forward Telehealth is the use of technologies to asynchronously acquire and store clinical information (e.g., data, images, sound, or video), which is then forwarded to or retrieved by a health care professional at another location for clinical evaluation.

The Asynchronous Store-and-Forward Telehealth Manual provides detailed information and guidance on asynchronous technologies. Remote Patient Monitoring ̶ Home Telehealth is the collection, transmission, evaluation, and communication of individual health data from a patient to their health care professional or extended care team from outside a hospital or clinical office (e.g., from the patient’s home) using personal health care technologies such as wireless devices, smartphones, and apps.

The Remote Patient Monitoring ̶ Home Telehealth Manual offers guidance in using telecommunication technologies to provide clinical care and promote patient self-management as an adjunct to traditional in-person health care. These modalities incorporate telehealth technologies that make it easier for Veterans to connect with their VA care team from their home, clinic, hospital, or other non-VA locations. The Digital Divide Consult Process offers qualified Veterans a VA-loaned device as well as subsidized connectivity and device options to enable telehealth participation from home.

3.1 Telehealth into the Home

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Telehealth into the Home enables patients to meet virtually and securely from their homes with VA telehealth health care professionals. Patients benefit from the convenience of seeing and talking with their VA care team from wherever they are. Patients can also send important health data using a computer, tablet, smartphone, vendor-provided equipment, or mobile or web-based application (app) from their home or other non-VA location. Another significant benefit for patients is reducing travel time related to their VA care. This may be especially important for patients in rural areas where Veterans live far from VA facilities or those in urban areas (e.g., New York City) where commute times are quite long due to traffic congestion even though the distance to travel is relatively short. The Office of Connected Care recommends that video-to-home clinics be staffed with clinical and administrative support to emulate in person encounters.

3.1.1 Synchronous Telehealth into the Home

Synchronous Telehealth uses real-time, interactive video conferencing to enable health care professionals to assess, treat, and provide care remotely to patients at a location that is convenient to the patient, such as their home through a web-based application called VA Video Connect (VVC). VA Video Connect is a VA solution that enables Veterans to virtually meet with their VA health care professionals in a virtual medical room using encrypted video to ensure the session is secure and private. VA Video Connect Solutions contains comprehensive information on how to get started with VVC (NOTE: This internal VA website is not available to the public.)

3.1.2 Asynchronous Telehealth into the Home

Asynchronous Store-and-Forward Telehealth uses the My VA Images (MVAI) application to request, acquire, and store clinical information asynchronously (e.g., image or video) that is then forwarded to or retrieved by a VA health care professional. The patient can use the MVAI process at a location that is convenient to them. There are a variety of use cases for MVAI such as gait analysis and home assessments. In addition, MVAI is currently approved for dermatology and wound assessment when wounds cannot be visualized and assessed well by VVC or if the patient cannot come in for face-to-face care. The use of MVAI is evaluated on a case-by-case basis by the health care professional.

3.1.3 Remote Patient Monitoring- Home Telehealth

Remote Patient Monitoring ̶ Home Telehealth (RPM-HT) applies care and case management principles to coordinate care, using health informatics, disease management, and innovative technologies, such as in-home mobile remote patient monitoring, messaging, video technologies, or a combination of technologies. RPM-HT provides health information exchange from the patient’s home or other location to the VA care setting, eliminating time and distance constraints. The goal of RPM-HT is to improve self-care management, clinical outcomes, and access to care while reducing health complications, hospitalizations, and clinic or emergency room visits for patients.

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For more information, please refer to the Remote Patient Monitoring ̶ Home Telehealth Manual.

3.2. Telehealth into the Clinic

Telehealth into the Clinic enables patients at a VA or convenient clinic near them to connect to VA health specialists across the country. VA health care professionals can diagnose, manage care, and perform check-ups virtually. In addition, patients can receive telehealth services such as primary care, mental health care, specialty care, and Asynchronous Store-and-Forward Telehealth.

3.2.1 Synchronous Telehealth into the Clinic

Synchronous Telehealth into the Clinic allows a patient who is located at one VA location (e.g., outpatient clinic) to be virtually connected with a telehealth health care professional at a different VA location. For more information, please refer to the Synchronous Telehealth Manual.

3.2.2 Asynchronous Telehealth into the Clinic

Asynchronous Store-and-Forward Telehealth care is provided through a clinical consultation and enables health care professionals to communicate about a patient encounter through a defined information technology platform. This platform allows documentation of the patient encounter and associated clinical evaluation within the patient record. Asynchronous Store-and-Forward Telehealth includes services such as TeleDermatology, TeleEye Care, and TeleSleep Studies.

For more information, please refer to the Asynchronous Store-and-Forward Telehealth Manual.

For more information on the participating clinical specialties, please see the Asynchronous Connected Care Academy Community.

3.3. Telehealth into the Hospital

Telehealth into the Hospital helps telehealth health care professionals collaborate across the country. Telehealth health care professionals can share best practices, resources, and consult specialists at other VA hospitals to collaboratively develop a care plan for their admitted patients. Discharge planning can also be conducted with the patient and outpatient teams to ensure a smooth and informed transition from inpatient to outpatient care. Coding, billing, encountering, and workload capture for Telehealth into the Hospital follows an individualized process.

3.3.1 Synchronous Telehealth into the Hospital

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Synchronous Telehealth into the Hospital allows remote health care professionals to deliver care to patients in an inpatient hospital setting due to the need for consultation with specialists at other VA hospitals. Established Synchronous Telehealth into the Hospital programs, such as TeleStroke, TeleSurgery, TeleTransplant, and TeleCritical Care, provide comprehensive, specialty specific information that guides individuals on replicating the program at their hospital. The information provided in the specialty guidance is individualized to the specific program and modality set up. New Synchronous Telehealth into the Hospital programs will need to work with a variety of subject matter experts, Office of Connected Care, documentation specialists, coding specialists, and others, to determine the requirements for workload, documentation, coding, etc.

3.3.2 Synchronous Telehealth into the VA Community Living Center

Synchronous Video Telehealth into the VA Community Living Center (CLC) provides telehealth care to Veterans that reside in a VA CLC. Telehealth to CLC Veterans can provide after-hours services, sub-specialty visits, socialization, and imaging/data collection. Standard clinical guidance can be found in the Community Living Center Specialty Supplement.

3.4. Telehealth into Non-VA Locations

The VA has partnered with many non-VA locations to continue providing care to Veterans who do not reside near a VA facility. Providing care to non-VA locations through telehealth can bring care to Veterans in rural areas with scarce medical resources and serve Veterans that have geriatric needs or chronic medical conditions that cause a barrier to or lack of access to health care. Before partnering with non-VA locations, it is the policy that VHA must first enter into a Business Associate Agreement (BAA) with any entity that performs functions, activities, or services on behalf of VHA involving the use and/or disclosure of protected health information.

A non-VA program also requires a Telehealth Memorandum of Understanding (MOU) Between VA and Non-VA Facilities for Credentialing and Privileging, Interfacility Telehealth Service Agreement (TSA), and Sharing Agreement to be completed prior to the initiation of the care. Detailed policy information regarding VHA Business Associate Agreements can be found in VHA Directive 1605.05 Business Associate Agreements.

3.4.1 Accessing Telehealth Through Local Area Stations (ATLAS)

The ATLAS program was implemented out of a need to reach Veterans in rural locations and the motivation to provide timely, comprehensive, and quality care to Veterans close to their homes. The goal of ATLAS is to enhance the accessibility of VA health care and help bridge the digital divide by partnering with public and private organizations to create comfortable, private locations in communities where Veterans often have long travel times to VA facilities or poor connectivity at home. See the ATLAS Supplement for detailed guidance regarding this modality.

Also, refer to the ATLAS intranet page for further support and resources (NOTE: This internal VA website is not available to the public.) If telehealth is being provided by a Nationally Designated https://vaots.blackboard.com/webapps/login/?action=guest_login&new_loc=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_2531_1 https://vaots.blackboard.com/webapps/login/?action=guest_login&new_loc=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_2533_1 https://vaots.blackboard.com/webapps/login/?action=guest_login&new_loc=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_2536_1 https://vaots.blackboard.com/webapps/login/?action=guest_login&new_loc=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_2552_1 https://vaots.blackboard.com/bbcswebdav/xid-1533260_1 https://vaots.blackboard.com/bbcswebdav/xid-878815_1 https://vaots.blackboard.com/bbcswebdav/xid-878815_1 https://vaots.blackboard.com/bbcswebdav/xid-2332514_1 https://vaots.blackboard.com/bbcswebdav/xid-2332514_1 https://vaots.blackboard.com/bbcswebdav/xid-1540082_1 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=9178 https://vaots.blackboard.com/bbcswebdav/xid-1713140_1 http://vaww.telehealth.va.gov/pgm/atlas/index.asp

Telehealth Hub (NDTH), Clinical Resource Hub (CRH), or other Telehealth Hub, then the hubs will need to be listed on an addendum in the Memorandum of Agreement (MOA) as the distant site providing the care.

3.4.2 TeleContract Nursing Homes (TeleCNH)

The TeleContract Nursing Home Supplement provides operational and clinical guidance regarding the integration of telehealth services into Contract Nursing Home services as well as identifies the resources needed to support safe, quality TeleCNH services. The supplement explains the requirements for developing and managing TeleCNH programs, includes guidance on implementing and monitoring the quality delivery of care to Veterans via telehealth technology, and provides information related to contracting and payments. A TeleCNH program requires a VHA Business Associate Agreement and/or a Telehealth Memorandum of Understanding (MOU) Between VA and Non-VA Facilities for Credentialing and Privileging, Telehealth Service Agreement (TSA), and Sharing Agreement to be completed prior to the initiation of the care.

3.4.3 Telehealth for State Veterans Homes (SVH)

Many SVHs are in rural areas with scarce medical resources and serve Veterans with geriatric needs or chronic medical conditions that cause barriers to or lack of access to health care. Local VAMCs working with SVHs to provide telehealth to Veteran residents help deliver critical medical care to this Veteran population. Because SVHs are non-VA entities, establishing a telehealth program offers unique challenges and opportunities. Participation in the telehealth program will ultimately be driven and approved by the SHV medical provider. It is important to note that telehealth may not suit all SVH residents. The Telehealth for State Veterans Homes Specialty Supplement provides comprehensive information regarding enrollment and discharge criteria for a TeleSVH program.

A TeleSVH program requires a Telehealth Memorandum of Understanding (MOU) Between VA and Non-VA Facilities for Credentialing and Privileging, Interfacility Telehealth Service Agreement (TSA), and Sharing Agreement to be completed before the initiation of the care.

Additional resources can be found on Connected Care Academy’s Community pages for Telehealth for State Veterans Homes and VA Care for Contracted Non-VA Locations.

3.4.4 Telehealth at Other Non-VA Sites

In addition to State Veteran Homes and long-term care facilities, VA has partnered to provide care to many non-VA sites, including the Department of Defense (DoD), local medical centers, public mental health centers, and federally qualified health care facilities.

3.5 VA Research and Telehealth

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VA research is unique because of its focus on health issues that affect Veterans funded through the Office of Research and Development (ORD).

Approved VA research projects that list telehealth as a modality of care in the Institutional Review Board (IRB) Protocol documents do not need additional Telehealth Service Agreements (TSAs). If you have questions regarding telehealth, use for a VA research project, please contact your local Facility Telehealth Coordinator and/or VISN Telehealth Program Manager/Lead.

3.6 Privacy

Both audio and video privacy must be considered before, during, and after a telehealth visit with any modality that is used to deliver care. In all modalities, Synchronous Video Telehealth, Asynchronous Store-and-Forward Telehealth, and Remote Patient Monitoring ̶ Home Telehealth, headsets, white noise technology, and the strategic positioning of video and image-capturing equipment will increase the privacy of conversations and images. In addition, ensure that there are no other non-clinical persons in the vicinity to ensure patient privacy. Telehealth health care professionals also need to meet audio and video privacy standards for their workspaces. VHA Directive 1914(1) Telehealth Clinical Resource Sharing Between VA Facilities and Telehealth from Approved Alternative Worksites details requirements for telehealth health care professionals that are teleworking via an approved teleworking agreement to apply approved safeguards to protect government/VA records and patient information from unauthorized access, disclosure, or damage. Individuals participating in telehealth will follow all VA privacy policies including VA Directive 6300 Records and Information Management and VHA Directive 1605 VHA Privacy Program.

3.7 Chaperone Program

A chaperone is a person who serves as a witness for both a Veteran and a medical practitioner as a safeguard for both parties during a medical examination or procedure. VHA Directive 1353 VHA Chaperone Program (coming soon) states that utilizing trauma-informed care (TIC) concepts, all Veterans are offered access to a chaperone for sensitive or near sensitive examinations, procedures, or treatments. The Veteran has a right to request or refuse a chaperone at any encounter in all VHA settings. While sensitive examinations are discouraged for any telehealth modality visit, they may become necessary, either planned or unanticipated.

Video chaperones can be scheduled ahead of time to attend a visit (either a Synchronous Video or an Asynchronous Store-and-Forward Telehealth visit) remotely from anywhere. Video chaperones are remotely located and join the visit via video. The chaperone must be in a private space to ensure Veteran privacy. Veterans must be educated in advance regarding the availability and presence of a video chaperone including a full explanation of the examination, procedure, or treatment to be carried out and followed by validation the Veteran understood the information.

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4. Additional Telehealth Programs and Models To expand Veterans’ access to health care, additional VHA telehealth programs have been developed to bring care resources to patients during exceptional times of need. These programs utilize telehealth capabilities to support uninterrupted access to care for Veterans impacted by disasters, emergencies, resource-scare locations, or even long distances to medical clinics.

4.1 Telehealth Emergency Management (TEM)

The Telehealth Emergency Management (TEM) Program integrates telehealth capabilities into VHA disaster preparations and responses to help provide continuity of care to patients impacted by a disaster or emergency. Telehealth improves access by bringing care resources to the patient’s location. This benefit of telehealth can be a critical advantage in a resource-scarce environment like a disaster zone. Additionally, it can support a distressed care site experiencing surges in clinical demand by providing help from health care professionals around the country that does not add a burden to the care location.

In-depth information regarding TEM can be found in the Telehealth Emergency Management Supplement. For more details on how TEM can support emergency response and preparedness planning, please visit the Telehealth Emergency Management intranet site (NOTE: This internal VA website is not available to the public.) In addition, training and guidance materials can be found on the Telehealth Emergency Management Connected Care Academy webpage.

4.2 Telehealth Hubs

VA has developed Telehealth Hubs that allow Veterans to connect with distant primary care, mental health, and specialty care teams by utilizing Clinical Resource Hubs (CRHs), VISN-Level Clinical Contact Centers (NOTE: Both websites are internal VA websites not available to the public), and specialty hubs (such as TeleCritical Care, TeleStroke, TeleOncology, TeleNeurology, and others). A Telehealth Hub is a clinical and administrative organization at a national, consortia, regional, VISN, or VA medical facility level that facilitates and supports the sharing of telehealth services across VA medical facilities by health care professionals from one or more host VA medical facilities. These Telehealth Hubs act as networks of solutions that leverage telehealth to support medical facilities and Veterans in areas experiencing gaps in access to care. These gaps may be due to VA facility staff attrition, VA staff extended leave, clinical services not offered or planned at the VA facility, or an expanding Veteran population.

Telehealth Hubs also enable health care professionals across different specialties, including primary care, mental health, clinical pharmacists, specialty care, and rehabilitation to collaborate as part of the patient care team.

https://vaots.blackboard.com/bbcswebdav/xid-1045854_1 https://vaots.blackboard.com/bbcswebdav/xid-1045854_1 https://vaww.telehealth.va.gov/pgm/tem/index.asp https://vaots.blackboard.com/webapps/login/?action=guest_login&new_loc=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_2561_1 https://dvagov.sharepoint.com/sites/VHAOPCCRH https://dvagov.sharepoint.com/sites/VHAClinContacts/SitePages/Welcome.aspx https://dvagov.sharepoint.com/sites/VHAClinContacts/SitePages/Welcome.aspx

VHA Directive 1914(1) Telehealth Clinical Resource Sharing Between VA Facilities and Telehealth from Approved Alternative Worksites establishes policy to facilitate efficient sharing of clinical resources across VA medical facilities by sharing health care professional services through telehealth within the integrated VHA enterprise without re-credentialing or re-privileging the health care professionals at each VA medical facility. VHA Directive 1914 telehealth website provides key information regarding changes and implementation of this directive (NOTE: This internal VA website is not available to the public.)

4.2.1 Nationally Designated Telehealth Hubs (NDTH)

Nationally Designated Telehealth Hubs (NDTHs) are Telehealth Hubs that have been designated by the Assistant Under Secretary for Health for Operations by VHA Directive 1915 Enterprise Clinical Resource Sharing through Telehealth from Nationally Designated Telehealth Hubs to manage the provision of cross-VA medical facility telehealth services delivered by NDTH telehealth health care professionals from one or more host VA medical facilities to any VA medical facility in the enterprise. VHA Directive 1915 enables approved Telehealth Hubs to deliver health care services through telehealth to Veterans without requiring a unique signed agreement between the involved VA sites. For a Telehealth Hub to be considered a Nationally Designated Telehealth Hub (NDTH), the Telehealth Hub must follow the Standard Operating Procedure for NDTH Recognition Request and the NDTH Designation Request Memo. NDTHs operate via a Terms of Service (TOS) rather than a Telehealth Service Agreement (TSA). The TOS are established by the NDTH, and once established, apply to all VA medical facilities choosing to receive telehealth services from its health care professionals. The VHA Directive 1915 website (NOTE: This internal VA website is not available to the public) and VHA Directive 1915 Connected Care Academy Community include resources to assist a Telehealth Hub in becoming an NDTH.

5. Connected Health Connected Health within the Office of Connected Care aims to expand the use and adoption of virtual care technology among Veterans, their caregivers and families, and VA health care staff to improve access to care, care delivery, and health outcomes. Connected Health offers support, programs, and resources related to virtual care tools to augment telehealth and in-person care for Veterans. Connected Health programs and technologies are often used together with telehealth programs and technologies to enhance and support Veteran care.

5.1 VA Mobile

VA Mobile develops web and mobile applications (apps) that address a range of clinical and administrative needs to assist patients, caregivers, and VA care teams. VA Mobile offers safe and secure mobile access to patient data, facilitates communication between Veterans and their VA care teams, and provides more opportunities for Veterans to be active participants in https://www.va.gov/VHAPUBLICATIONS/ViewPublication.asp?pub_ID=8807 https://www.va.gov/VHAPUBLICATIONS/ViewPublication.asp?pub_ID=8807 https://vaww.telehealth.va.gov/resources/1914/index.asp https://vaww.telehealth.va.gov/resources/1914/index.asp https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=10116 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=10116 https://vaots.blackboard.com/bbcswebdav/xid-2664953_1 https://vaots.blackboard.com/bbcswebdav/xid-2664953_1 https://vaots.blackboard.com/bbcswebdav/xid-2153038_1 https://vaww.telehealth.va.gov/resources/1915/index.asp https://vaww.telehealth.va.gov/resources/1915/index.asp https://vaots.blackboard.com/webapps/login/?action=guest_login&new_loc=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_3079_1 https://vaots.blackboard.com/webapps/login/?action=guest_login&new_loc=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_3079_1 their health care. VA Mobile has over 30 apps available for Veterans and over 45 apps available for health care professionals. The information found on VA Mobile can be helpful to provide to Veterans who are looking for more information regarding VA applications, such as VA Video Connect.

For more information, visit the VA Mobile website. To access available apps, visit the VA App Store.

5.1.1 Self-Contained Apps

VA self-contained apps are mobile or web-based apps that are not connected to the VA’s Electronic Health Record (EHR) and require no login credentials to access. An individual that downloads a VA self-contained app owns the data and can delete the app at any time. Self-contained apps do not collect or require any personally identifiable information, and there is no need to create a user account. The user can simply download the app and begin using it.

Examples of VA self-contained apps include PTSD Coach, Mindfulness Coach, and Live Whole Health.

5.1.2 Connected Apps

VA-connected apps are mobile or web-based apps that connect to VA’s network. To ensure the privacy and security of VA health data, these apps require signing in via a secure sign-in partner.

Secure sign-in partners that provide Veterans access to these apps include DS Logon Level 2 (Premium), My HealtheVet Premium, and ID.me. VA health care staff can log in using their PIV credentials. Connected apps for VA care teams are available only through VA’s secure network.

Other security controls, such as explaining why permissions are needed, ensure that protection meets strict federal standards of security and privacy.

Examples of VA-connected apps include VA: Health and Benefits, Annie App for Veterans, and Virtual Care Manager.

5.1.3 Mobile App Development

For those interested in the process of developing mobile apps, including how to get started, development stages, app compliance requirements, and VA mobile app intake, refer to the VA App Developer Portal Home.

5.2 My HealtheVet

My HealtheVet is VA’s web-based private and secure Personal Health Record. It is a website designed for Veterans and their dependents, caregivers, health care professionals, and advocates. My HealtheVet enables patients to access their health information 24/7 and offers https://mobile.va.gov/ https://mobile.va.gov/appstore https://mobile.va.gov/appstore https://mobile.va.gov/app/ptsd-coach https://mobile.va.gov/app/mindfulness-coach https://mobile.va.gov/app/live-whole-health https://mobile.va.gov/app/live-whole-health https://mobile.va.gov/app/va-health-and-benefits https://mobile.va.gov/app/annie-app-veterans https://mobile.va.gov/app/virtual-care-manager https://mobile.va.gov/content/developer-portal-home https://mobile.va.gov/content/developer-portal-home online resources and tools to help them make informed decisions about their VA care. Through My HealtheVet, patients can view their VA health records, refill VA prescriptions, send secure messages to their VA care team, and manage VA appointments.

For more information, visit My HealtheVet. For help desk support, visit Contact My HealtheVet.

5.3 Connected Health Implementation

Office of Connected Care’s Connected Health is responsible for the Connected Health Implementation Strategies (CHIS) program which aims to foster the adoption and use of combinations of virtual health products (mobile apps, My HealtheVet, and telehealth) to improve access, quality, and efficiency of care for the Veteran Community (NOTE: This internal VA website is not available to the public). The program works in partnership with facilities, VISNs, and other national VA programs. The Connected Health Team is responsible for:

Programs that integrate multiple virtual care products and programs to increase the use of virtual care across the VA enterprise, include:

o Virtual Health Centers of Excellence (COEs) NOTE: This internal VA website is not available to the public.

o Virtual Health Resource Centers (VHRCs) NOTE: This internal VA website is not available to the public.

o Patient-Generated Health Data Implementation Strategies (PGHD) NOTE: This internal VA website is not available to the public.

o Virtual Care Best Practices (Training and Resources) NOTE: This internal VA website is not available to the public.

o Office of Connected Care Government Publishing Office (GPO) site.

Field/user testing and feedback of mobile applications and virtual care tools.

Training, implementation, and dissemination (e.g., of strategic plans and education).

Evaluation and quality improvement of virtual care products, COE projects, and CHIS programs.

5.3.1 Virtual Health Resource Centers (VHRCs)

VA’s Virtual Health Resource Centers expand the availability of virtual health support services to Veterans, their families and caregivers, and VA health care staff. VHRCs provide access to the education, training, and guidance needed to most effectively and efficiently integrate connected health tools that will support the delivery of evidence-based treatments.

VHRCs are established on-site at facility-level locations and are staffed with health technology experts who can provide education, training, and guidance regarding virtual care tools. These experts can help Veterans and health care professionals integrate virtual care into their https://www.myhealth.va.gov/mhv-portal-web/web/myhealthevet/home https://www.myhealth.va.gov/mhv-portal-web/web/myhealthevet/contact-mhv https://dvagov.sharepoint.com/sites/VHACCchi https://dvagov.sharepoint.com/sites/VHACCchi https://dvagov.sharepoint.com/sites/VHACCchi/SitePages/CentersofExcellence.aspx#expectations https://dvagov.sharepoint.com/:u:/r/sites/VHACCchi/SitePages/vhrcl.aspx?csf=1&web=1&e=zFpqdi https://dvagov.sharepoint.com/sites/VHACC/SitePages/Patient-Generated-Health-Data.aspx https://vaots.blackboard.com/webapps/blackboard/execute/modulepage/view?course_id=_2916_1&cmp_tab_id=_4025_1&mode=view https://orders.gpo.gov/vaocc respective lives and workflows. Such tools include telehealth, mobile, and web applications (e.g., My HealtheVet), VA or personally owned smartphones and tablets, peripheral devices (e.g., glucometers, blood pressure cuffs), wearable activity trackers (e.g., Fitbit, Apple Watch, Garmin), and more.

The establishment of VHRCs at facilities can increase efficiencies in the delivery of virtual care training and consultation to health care staff and patients. VHRCs may also increase capacity and decrease barriers to virtual care adoption. To meet the need for the spread of VHRCs across the VA, the Office of Connected Care offers a VHRC Implementation Consult Service (VHRC ICS) which provides guidance to facilities and VISNs on the establishment of VHRCs (NOTE: This internal VA website is not available to the public.)

For more information, please refer to Virtual Health Resource Center Library (NOTE: This internal VA website is not available to the public), VHRC public-facing website, and the VHRC Community in Connected Care Academy.

5.4 Patient-Generated Health Data (PGHD)

Patient-Generated Health Data (PGHD) is health-related data created, recorded, or gathered by or for patients, family members, and/or other caregivers to promote health and wellness or to help address a health concern. PGHD may include remote device-generated consumer-collected clinical data; health history; treatment history; biometric data; symptoms and other types of patient-reported outcomes; perceived quality of life data; and patient goals, values, and lifestyle choices. Health-related PGHD is distinct from data generated in clinical settings.

Patients are primarily responsible for capturing and/or recording these data, and patients explicitly decide to share these data through some form of authorization or consent process or by voluntarily sending or transmitting their data.

A suite of training, guidance, and resources related to the use of PGHD in clinical care is available in the Patient-Generated Health Data SharePoint and more are in the process of being developed (NOTE: This internal VA website is not available to the public.)

6. Field Support and Other Telehealth Communities Connected Care Academy Communities are designed to serve as virtual toolkits that act as repositories of information, so information is easily accessible by being in one place. Each specialty, role, and program have a community that contains links to documents, manuals, videos, presentations, trainings, and other products needed for the success of VA Telehealth.

6.1 Decentralized Telehealth Preceptor Training Community

https://leaf.va.gov/NATIONAL/National/vhrc_facility_implementation_consult/ https://leaf.va.gov/NATIONAL/National/vhrc_facility_implementation_consult/ https://dvagov.sharepoint.com/:u:/r/sites/VHACCchi/SitePages/vhrcl.aspx?csf=1&web=1&e=zFpqdi https://www.connectedcare.va.gov/vhrc https://vaots.blackboard.com/webapps/login/?action=guest_login&new_loc=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_3213_1 https://vaots.blackboard.com/webapps/login/?action=guest_login&new_loc=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_3213_1 https://www.myhealth.va.gov/mhv-portal-web/homehttps:/dvagov.sharepoint.com/sites/VHACC/SitePages/Patient-Generated-Health-Data.aspx

The Decentralized Telehealth Preceptor Training Program was developed to provide an opportunity for experienced telehealth staff to enter an educational role where they provide standardized telehealth training to new staff.