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As one of the nation’s largest health systems, serving more than nine million veterans and supporting over 400,000 healthcare providers across the country, the U.S. Department of Veterans Affairs knew the importance of virtual care long before the pandemic forced its acceleration.

To Dr. Christina Armstrong, a clinical psychologist at the VA’s Office of Connected Care, virtual care lets providers leverage the white space – the time between in-person doctor’s visits – to actually support healthy behavior changes.

“We just have this tiny snapshot of their lives and that’s where virtual care comes in, common withdrawal effects of celexa ” she said today during a HIMSS21 educational session. “It can really get into the white space in ways we never have been able to before.”

The system had implemented a number of virtual care tools well before the pandemic, including the MyHealthyVet patient portal, over 60 mobile apps on VA Mobile, and telehealth and remote patient monitoring capabilities.

This allowed the system to not only stay above water during the pandemic, but also grow its services, according to Armstrong.

“Although we were all in chaos at [the start of COVID-19] because the VA was so well prepared before the pandemic, we were not only able to meet the needs of our patients, but we were also able to innovate amid the chaos,” Armstrong said

During the early phases of the pandemic, the VA saw significant increases in its telehealth usage, patient encounters with the MyHealthyVet patient portal and demand for its automated text-messaging bot, Annie.

Based on these shifts, it also developed a slew of new apps, platforms, policies and clinical competencies.

These tools include the COVID Coach app, which provides educational tools for coping during the pandemic and mood-tracking to see mental health progress over time.

It updated Annie to allow people to record their symptoms for review by clinicians, to check-in during quarantine and to receive emotional support during times of isolation.

The VA created a coronavirus chatbot that could field questions and direct patients to the correct place for support. It also launched VVC Now, which allows providers to initiate a video visit by inputting the patient’s contact information and sending them a link to join.

Training its healthcare providers on how to conduct virtual care appointments and use its new technology was another critical undertaking for the VA, according to Armstrong. Roughly two-thirds of VA providers had conducted a telehealth visit before the pandemic, but since, nearly all (94%) of them are using telehealth.

“That was the gap we had to fill between March 2020 to now,” Armstrong said. “We had to help all of those healthcare staff members [regarding] how to get the equipment, how to get their training, how to get everything that they need to be able to deliver care.”

It did so by using the Connected Care Academy, its one-stop shop for on-demand learning opportunities.

Armstrong wants the VA’s virtual care experience to be a lesson for other health systems on the value of crisis preparedness.

“We hope that VA can serve as an instructive model for other healthcare systems,” she said.

Specifically, when building new digital tools, she says it’s key to have patient needs top of mind, followed by consideration of how providers will use these tools. It’s also important to make policy changes that will ensure the continuity of operations in future crises and invest in workforce training that will support virtual care infrastructure.


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