Virtual Care for the Longitudinal Management of Chronic Conditions: A Systematic Review

ABSTRACT

As both the largest integrated health system and largest provider of telehealth in the country, the Veterans Health Administration (VHA) has a particular interest in understanding how best to implement and utilize virtual care. VHA has long embraced virtual care as part of its mission to "serve all who have served" regardless of their socioeconomic and geographic circumstances. Having begun conducting "virtual care" in the 1960s when doctors first communicated with patient's via TV screens,1 VHA has since provided over 2.6 million episodes of care to more than 900,000 Veterans in 20192 and has distributed over 50,000 data- and video-enabled iPads for Veterans throughout the country.3 Virtual care within VHA includes services such as MyHealtheVet secure messaging, the Home Telehealth program that combines case management principles with remote monitoring to improve access and coordinate care, and the VA Video Connect (VVC) video platform for synchronous visits within both specialty and primary care.4 Increasing Veteran access to care via virtual care has been an integral part of VHA's strategy for improving chronic disease management for a population that is on average older and sicker than their civilian counterparts.5,6 Given the importance that virtual care has for Veteran care even beyond the COVID-19 pandemic, understanding the strengths and limitations associated with synchronous virtual care will be critical in shaping how VHA utilizes virtual care going forward.