Digital Divide Consults and Devices for VA Video Connect Appointments

Report Information

Issue Date
Report Number
21-02668-182
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Audits and Evaluations
Report Type
Review
Recommendations
10
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
In August 2020, the Veterans Health Administration’s (VHA) Office of Connected Care introduced a “digital divide” consult process where patients can receive a video-capable device (iPad) after obtaining a referral and a socioeconomic assessment. The VA Office of Inspector General (OIG) reviewed the efficiency and effectiveness of the process. The review found the program successfully distributed devices to patients but identified gaps in oversight and guidance. VHA issued devices to about 41,000 patients during the first three quarters of fiscal year 2021. The OIG found 51 percent did not use the devices to complete a video appointment. The OIG reviewed VHA’s data and found that 3,119 patients received multiple devices. A November 2021 assessment of the data also showed nearly 8,300 unused devices still did not have VA Video Connect activity and were not retrieved to make them available to other patients. The value of the 8,300 devices was about $6.3 million, and they cost VHA about $78,000 in additional cellular data fees. Moreover, as of December 2021, VHA paid about $8.1 million for the purchase of 9,720 devices, although a backlog of about 14,800 returned devices was pending refurbishment to be available for redistribution. Overall, the OIG determined VHA could have made better use of about $14.5 million in program funds with better device monitoring, retrieval controls, and oversight. The OIG made 10 recommendations to the under secretary for health, including alerting the requesting clinic that a patient can be scheduled, adding procedures on duplicate devices, designating responsible officials to monitor for appointment activity and connected device use, clearly defining lead oversight responsibilities, and establishing an automated report of devices not being used for video appointments. Lastly, VHA should enhance tracking of device packages, implement more detailed refurbishment reporting, and use such data in new device purchases.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
Establish clear oversight roles and responsibilities of the program office and of regional network telehealth and medical facility leads to monitor medical facility social worker and telehealth staff compliance with the “Digital Divide Standard Operating Procedure” for conducting assessments, ordering, and scheduling.
No. 2
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
Develop and implement a mechanism to alert the requesting clinic that a patient has a loaned device and can now be scheduled for a VA Video Connect appointment.
No. 3
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Clarify timeliness goals for the digital divide consult, and video device order placement.
No. 4
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)

Update the digital divide consult training to include procedure updates and ensure social workers and facility telehealth and Remote Order Entry System coordinators who process digital divide consults and video device orders complete the training and take refresher training as needed.

No. 5
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
Implement procedures to require responsible staff to check for duplicate devices before submitting a device order consult.
No. 6
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
Establish an alert in the Remote Order Entry System to notify the responsible staff member that a patient already has an issued device before ordering another, and initiate retrieval activities for duplicate devices.
No. 7
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)

Delegate in the “Digital Divide Standard Operating Procedure” facility staff to monitor the tablet dashboard for VA Video Connect appointment activity and device use, and clearly define regional network telehealth leads’ oversight responsibilities to ensure facilities initiate retrieval activities when warranted.

No. 8
Open Recommendation Image, Square
to Veterans Health Administration (VHA)
Establish an automated mechanism using the tablet dashboard to routinely identify the devices that meet retrieval priorities and also initiate retrieval of those that already meet retrieval requirements.
No. 9
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Augment tracking mechanisms for packages sent to patients to ensure VA receipt of the retrieval kit so that devices are accurately recorded in inventory and available for refurbishment and reissue.
No. 10
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)

Address restrictions in the refurbishment process, implement accessible and trackable reporting of devices waiting to be refurbished, and implement a structured purchasing model to guide new device purchases and maintain an appropriate inventory level.

Total Monetary Impact of All Recommendations
Open: $ 6,378,000.00
Closed: $ 8,100,000.00