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OIG: VHA's Digital Health Program Saw Less Than 50% of Devices Used

Analysis  |  By Eric Wicklund  
   August 09, 2022

According to a report by the Office of the Inspector General, the Veterans Health Administration's Digital Divide program issued about 41,000 telehealth tablets to veterans to conduct virtual visits, yet less than half actually had those visits, and many of those devices haven't been returned properly.

The Veterans Health Administration has found that it's one thing to give veterans digital health tools, but another thing to see them use the technology.

The VA's Office of the Inspector General (OIG) has issued a report on a VHA's Digital Divide program, developed by the Office of Connected Care and launched in late 2020, which furnished roughly 41,000 veterans with iPads so that they could connect with care providers on a virtual platform. Investigators found that more than half of the veterans hadn't used the devices by late 2021.

And that was only one of many problems with the program.

"In total, the review team determined that VHA could have made better use of approximately $14.5 million in program funds with better device monitoring and retrieval controls and oversight," the OIG report concluded.

The study highlights the challenges with developing and launching a telehealth program, along with the many boxes that need to be checked to make sure it's working properly. And this is all before any clinical data is even collected.

Launched during the height of the pandemic, the program was designed to give veterans access to digital health tools so that they could connect with care providers without having to go to a hospital, doctor's office or clinic. Those in charge of the program said it would not only reduce the chance of infection for veterans, but improve access to care and lead to better clinical outcomes.

According to the report:

  • Only an estimated 20,300 of the 41,000 patients, or 49 percent, used the device to schedule and complete a virtual visit.
  • An estimated 10,700 patients never scheduled a virtual visit, in part because there was no requirement to do so and neither the patient nor the care team took the initiative.
  • Another 10,000 patients scheduled a virtual visit but didn't follow through.
  • Multiple devices were issued to 3,119 patients.
  • Some 11,000 devices were not retrieved after the patient's participating in the program ended, and after a review was launched in November 2021, nearly 8,300 devices were still unaccounted for, costing the VHA roughly $6.3 million, plus another $78,000 in cellular data fees.
  • As of January 2022, some 14,800 devices that had been returned had not yet been refurbished, in part because of technical issues within the refurbishment process, so those devices were not yet ready to be used again. Despite that backlog, the VHA purchased 9,720 new devices, at a cost of $8.1 million.

Many of the issues cited in the OIG report are blamed on poor program design and management, with no clear protocols for scheduling virtual visits, managing the devices or returning them. In response, the OIG listed 10 recommendations:

  1. Establish clear oversight rules and responsibilities for care providers involved in the program with a "Digital Divide Standard Operating Procedure."
  2. Create a mechanism for alerting care providers when their patient has received a device and is ready to schedule a virtual visit.
  3. Clarify the value of scheduling virtual visits and establish timelines, combined with a timeline for device ordering.
  4. Make sure all care providers involved in the program are properly trained and updated whenever protocols are changed.
  5. Implement protocols to ensure that each patient gets one device, and no patients are given more than one device.
  6. Establish an alert if a patient receives a second device and a protocol for retrieving that device.
  7. Make sure program managers are monitoring a dashboard for device use, virtual visits scheduled and completed, and devices retrieved.
  8. Establish an automated mechanism for identifying devices that need to be retrieved and initiating the retrieval process.
  9. Track all devices sent to patients and returned to the VHA so that they can be refurbished and ready for use in an appropriate time frame.
  10. Address challenges in the refurbishment process, improve the tracking process for devices waiting to be retrieved and refurbished, and create a structured purchasing model to ensure these problems donโ€™t happen again and new devices are purchased when they're needed.

In response to the report, VHA officials said they "concur or concur in principle" with all of the OIG's recommendations.

Eric Wicklund is the Innovation and Technology Editor for HealthLeaders.

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