President Trump’s 2018 VA MISSION Act removed all geographic and licensing barriers for doing VA telehealth. This has made it possible to provide greater access and better care to more veterans. Join Sean O’Connor from the Oregon VA health system to learn: - How is the VA using telehealth to deal with COVID-19 today? - What are some key lessons learned from past telehealth deployments? - What are key technology and clinic considerations that need to be taken into account? - Where is VA telehealth going in the future? Interested in becoming a community provider? More information at https://www.va.gov/COMMUNITYCARE/providers/Veterans_Care_Agreements.asp

1. VA Telehealth and
COVID19 Response
SEAN O’CONNOR
DIRECTOR IF VIRTUAL CARE-VA PORTLAND HEALTHCARE SYSTEM

2. Introduction-Sean O’Connor
 Sean O’Connor began his telehealth engagement as a VA Community Based Outreach Clinic
local videoconferencing technology support technician, while also performing his duties as a
Laboratory Technician.
 From there, he became the Lead Telehealth Clinical Technician for the VA Southern Oregon
Rehabilitation Center and Clinics in White City, OR. While in that role, he supported the
configuration, deployment and maintenance of Telehealth technology for White City and
associated CBOCs. He was also a Master Preceptor for Teledermatology Imaging and Clinical
Video Telehealth, travelling around the country to train new VA Telehealth Staff.
 From there, he moved to VISN20, VA Northwest Healthcare Network as Telehealth
Technology Manager, overseeing Telehealth Technology for 8 VA Healthcare Centers. Mr.
O’Connor was also detailed to VA Central Office as the National Telehealth Technology
Manager for one year.
 He is now the Director of Virtual Care for the VA Portland Healthcare System. He oversees
Telehealth programs for over 60 different clinical specialty areas including Home Based Video
Telehealth services.

3. Telehealth at the VA Portland
Healthcare System
 The VA Portland Healthcare System has been at the forefront of Telehealth
innovation since 2009.
 The first VA Telehealth program that delivered Home Based TeleMental Health
Services began in Portland. Dr. Peter Shore, a VA Clinical Psychologist and
VISN20 Telehealth Director began piloting this program in 2009.
 In 2012, VA Innovation 669 began a pilot program to enable Veterans without
access to technology to participate in Home Based Video Telehealth. This
program loaned devices using videoconferencing technology to Veterans
without ability to engage in these services.
 VA Portland Healthcare System and VISN 20 have also been very involved in
the TeleJustice Program. This service delivers services to justice-involved
Veterans to assist with benefits access, community re-entry and enrollment for
VA Healthcare services.

4. Home Based Video Telehealth
 In early 2020, the United States was stricken with the COVID19 virus. As part of the
emergency response to this virus, most states have issued “stay at home” orders and
closed many local businesses. In addition, access to Health Care services has been
extremely limited due to the COVID19 response strategy of these organizations.
 To ensure that the healthcare needs of Veterans can be met, the VA has increased the
use of Home Based Video Telehealth services. This enables Veteran patients to
continue to have clinical visits with their clinicians while remaining in a safe, social
distancing posture.
 Due to the increase ins demand for Home Base Video Telehealth, the VA has
temporarily authorized the use of non-VA Videoconferencing Technology.

5. COVID19 and VA Telehealth Response
 Since COVID19 response procedures has resulted in an extreme reduction of
face-to-face visits, the VA has increased is use of the VA Video Connect
platform. Many of these F2F visits are being transitioned to virtual means, and
approximately 20-25% are conducted using VA Video Connect.
 VA Video Connect (VVC) is a system that uses Virtual Meeting Rooms to
connect Veteran patients and clinicians securely and privately.
 A VVC session is scheduled using a scheduling application developed by VA Mobile
Office.
 Once scheduled, the Veteran and the clinician receive and email notification of the
session, which includes a hyperlink to join the VMR.
 Once both individuals have joined the VMR, the clinical visit is able to commence.

6. Challenges-COVID19 and VA POR HCS
 While VVC is a viable alternative for Veterans in their homes, the VA POR HCS identified
inpatient areas where VVC was not the most effective solution to connect inpatient
Veterans with clinicians.
 Clinicians indicated that they would like to hold clinical visits with inpatient Veterans without
actually needing to be physically in the isolation rooms.
 Clinicians also identified Community Living Centers and State Veterans Homes where they had a
need to conduct visits that would traditionally only be available by clinician travel or phone.
 Due to this challenge, the VA POR HCS approved the use of VSee in order to connect
these Veterans and clinicians quickly, easily and securely.

7. VSee use in VA POR HCS Inpatient
Settings
 Currently, the VA POR HCS is using VSee to connect to inpatient and
residential areas. This provides the ability to:
 Reduce the COVID19 exposure risk to highly susceptible Veterans and
clinicians.
 Reduce the use of PPE in inpatient areas.
 Maintain the integrity of isolation areas and exposure risk protocols at these
locations.
 Quickly and easily connect clinicians to Veterans without the need for prior
VMR creation and email system notification. Point-to-point connections using
VSee has demonstrated ability to more efficiently provide services to these
Veterans, reducing time burden.

8. Services using VSee in VA POR HCS
 VSee is currently being used to deliver:
 Wound Care services to inpatient and residential Veterans.
 Infectious Disease services
 Podiatry services
 VSee will soon be expanding to Pharmacy Service for discharge medication
planning.
 VA POR HCS Telehealth is also working to expand inpatient video
connections using VSee to other specialty areas.
 VSee is not currently being used for Home Based Video Telehealth
services.

9. Other Telehealth Use in COVID19
Response
 VA POR HCS has been using Home Based Video Telehealth to conduct
Dermatology Assessments since traditional clinic-based Store and Forward
services are not available.
 VA POR HCS is in the process of piloting a Store and Forward process to
enable Veterans to take images of Dermatology conditions, email these
images to a VA Telehealth Clinical Technician, upload these images and
submit request for TeleDermatology review and recommendations.
 VA POR HCS currently offers Home Based Video Blood Pressure visits,
which enable Nurses to assist Veterans with Hypertension conditions
monitor and control their blood pressure. Using this model, a nurse is able
to manage the entry of BP readings into the VA Electronic Health Record.

10. TeleJustice and VA POR HCS
 Currently, the VA POR HCS and other VISN20 VAMCs are utilizing
videoconferencing technology to enable Veterans in a VA residential treatment
center to attend mandatory court appearances via video.
 VA POR HCS has conducted Compensation & Pension evaluations with Veterans
incarcerated in correctional institutions.
 VA POR HCS Veterans Justice Outreach Specialists use Video Telehealth to
conduct visits with incarcerated Veterans to provide Social Work Service to
Veterans to prepare Veterans for community re-integration.
 Services to provide Healthcare for Re-Entry Veterans (enrolling soon to be
released Veterans in VA Healthcare) are currently being planned for deployment.

11. Questions?