Digital Divide Consults and Devices for VA Video Connect Appointments

In August 2020, the Veterans Health Administration’s (VHA) Office of Connected Care recognized the growing demand for patients’ access to video-based virtual care, and that many patients lack a video-capable device, or the internet connection required to access this care. To bridge “the digital divide, which exists between individuals with access to a device and connectivity and those who [lack that] access,” VHA introduced the digital divide consult. This process enables patients to receive a video-capable device after obtaining a referral from their care team, licensed independent practitioner, or designee and the approval of a social worker who has conducted a socioeconomic assessment. The digital divide consult improved on the device-lending process by introducing the social worker assessment to help identify and resolve other needs and barriers to care. The review team found that VHA’s digital divide program was successful in distributing devices to patients but identified several gaps in oversight and guidance preventing the program from fully meeting its intended purpose for patients to receive virtual care via VA Video Connect (VVC). The review team concluded the low VVC appointment completion rates occurred for multiple reasons. VHA Connected Care did not establish clear oversight roles and responsibilities for Veterans Integrated Service Network (VISN) and medical facility employees. Additionally, the standard operating procedure does not include requirements or mechanisms for staff to schedule a VVC appointment for patients with a loaned device, though it does require staff to initiate retrieval efforts of unused devices if no VVC appointment has occurred within 90 days of receipt. Further, digital divide consult and video device order processing lacked clear timeliness standards, presenting a risk of delay in sending a video-enabled device and scheduling and completing VVC appointments. Also, staff did not follow or were not aware of SOP updates as VHA did not effectively communicate them to facility staff.  Overall, VHA loaned devices to an estimated 20,800 patients (51 percent) during the period who did not use the devices for a VVC appointment.