How the Veterans Affairs Department Went Digital During the Pandemic

There is no bright-side to a life-altering pandemic, but perhaps one silver lining of the modern one involves how it drove the Veterans Affairs Department to swiftly extend and adopt fresh digital and health technologies.

The massive agency manages the nation’s largest integrated health system, among other major responsibilities. When COVID-19 emerged in early 2020, patients overwhelmed medical facilities and hospitals, supply chains hit bottlenecks, and governments directed people to stay home. Many VA officials pivoted to implement tools and policies to cope with new needs and manufactured vital resources on their own grounds.

“Technology makes it possible for us to solve old problems in new ways,” the VA’s Chief Technology Officer Charles Worthington recently told Nextgov. “COVID-19 taught us we must be thinking of users interacting with their health care and other government services from home.”

All in all, the department introduced or updated more than 100 applications in support of its COVID-19 response, and officials reported seeing returns on investments in DevSecOps, cloud capabilities, automation, monitoring and more that they’d made prior to the pandemic’s onset.

“For instance, our investment in cloud allowed us to quickly scale and deliver an exponential increase in services,” Associate Deputy Assistant Secretary in VA’s Information and Technology Office John “Jack” Galvin explained. “We were able to leverage existing technologies and introduce new ones to stay ahead of demand for telework, telehealth, veteran communications, COVID-19 screenings, and vaccination scheduling and tracking.”

They and other VA executives recently briefed Nextgov via email about some technology-aligned implications of their department’s pandemic response. 

Going Remote

With decades of experience within various agency components, Galvin now directs the operations of information systems, technology and telecommunications at all VA facilities. He noted that his office helped make the huge shift to telework possible at the start, enabling more than 400,000 employees to connect remotely to the VA network.

“We quadrupled our remote connection capacity to support the dramatic increase in remote users, from 59,000 in February 2020 to over 127,000 unique daily users in June 2020,” Galvin explained. Officials also accelerated deployments of technologies well ahead of schedule, once the pandemic hit, which he noted meant “successfully optimizing new options for our cloud-based Office 365 suite and launching new collaboration tools such as Webex and Microsoft Teams enterprisewide, all during the first couple months of the pandemic.” 

The office also acquired more than 225,000 laptops and more than 12,000 mobile devices to support enterprise needs. 

“This enabled us to pivot quickly to the ever-changing pandemic response, including the ability to stand up over 700 small, medium, and large vaccination clinics as we entered the ‘vaccination response phase,’” Galvin said.

Like most health care offerers, VA experienced what he called “an unprecedented surge in demand for telehealth” from the start of the pandemic. Due to IT upgrades, the department has been able to support more than 12.4 million telehealth visits since then.

“For context, prior to COVID-19, VA was supporting just under 300,000 telehealth visits each year.  We quintupled telehealth capacity (by upgrading on-premises systems and introducing a scalable cloud-based option),” Galvin explained. “Prior to the pandemic, VA was conducting 40,000 telehealth appointments each month (and fewer than 2,500 visits a day); now VA is conducting about 40,000 telehealth appointments each day.”

OIT also helped the Veterans Health Administration fulfill its eight-year vision for tele-critical care in just four months. On the ground, this means that clinicians with critical care expertise can now more easily monitor and assess patients remotely—and also in concert with their bedside care team. Galvin said, to make this happen, officials configured dynamic port security for 139 VHA facilities, and more.

“We also stood up telehealth monitoring systems that pull data from 10 data sources and 72 million events per day to identify and mitigate potential system weaknesses before affecting user experience or system performance,” he noted. “These tools provide a comprehensive view of VA’s telehealth system.”

Data But Differently

Denise Kitts serves as the executive director of the Multi-Channel Technology Directorate within the VA’s Veteran Experience Office, which develops VA’s customer experience technology capabilities and serves as a sort of steward for customer data.

“COVID-19 really changed the way we use data,” she explained. “For instance, working in collaboration with VHA, OIT helped to build a summary and tracking tool that would help VHA gain better situational awareness of its patients and resources during the pandemic.”

That resource, dubbed the National Surveillance Tool, facilitated early detection and monitoring of cases, department-level biosurveillance, and emergency management at the national and local levels. The data feeds, Kitts explained, covered patient cases, available assets such as ventilators and masks, hospital capacity, and employee status. 

“Using this data, leaders could make timely and informed decisions, such as when and where to cross-level supplies or personnel,” she noted.

The OIT balances working with third-party developers to drive innovation with working to preserve veteran privacy. Earlier this year, Kitts noted, the department released an overarching, principles-based framework to promote ethics-based  practices for individuals or organizations that access or use veteran data. 

“The principles-based ethics framework represents an enduring standard to ensure that VA manages veteran data with organizational integrity now and into the future,” she said.

Supply Chain Support

This pandemic almost immediately inflicted severe shortages in acute healthcare materials, equipment and resources including personal protective equipment, hand sanitizers, and mechanical ventilators. 

VHA over the last few years has been developing a fully integrated 3D-printing network to print medical items, including custom pieces to fit patients’ needs. Its printing sites almost doubled amid the COVID-19 pandemic, as the manufacturing tools could help address medical supply chain issues spanning the U.S.

Deputy Chief of VA’s Healthcare Innovation and Learning Office Dr. Beth Ripley told Nextgov that establishing a VHA quality management system and registering three VHA hospitals with the Food and Drug Administration marked huge steps forward toward providing high value care that is both personalized and adaptable to Americans’ changing needs.

“The first VHA product use case was 3D-printed nasal swabs to meet supply chain deficiencies, but we are now actively working on patient-matched devices such as surgical cutting guides and presurgical planning models,” she said. “Dental solutions and orthotics and prosthetics products are also in the pipeline.”

Capabilities to Connect

VA’s OIT had been working to implement a DecSecOps-inspired transformation for years—and having to rapidly respond to an unplanned and unexpected event like the pandemic provided “further evidence” of the need for such federal modernization pursuits, according to VA’s CTO Worthington.

“DevSecOps processes, tools, and skills emphasize agility and responsiveness over detailed planning, and our investment in these capabilities positioned us to be able to quickly assess problems, develop and test new solutions, put changes into production, and respond to problems on a scale previously never seen at the agency,” he explained. 

During the pandemic’s early months, the agency’s contact centers encountered a significant increase in calls from veterans with concerns about COVID-19 and how it might affect their VA health care as well as other government-provided benefits and services. 

“The rapid surge in call volume led to frustrating hold times for veterans, staffing challenges for VA, and delayed access to clinical advice for callers with urgent health care needs,” Worthington said. “We knew we needed to quickly deploy a digital solution that would enable Veterans to continue to receive top quality care from the convenience of their homes.”His team worked with VHA’s Connected Care Office and the Veterans Experience Office, to produce and deploy the department’s first chatbot—all in roughly three weeks. The chatbot was designed to rapidly answer some of veterans’ most common questions associated with COVID-19. Throughout the pandemic, Worthington noted, the bot “served as a resource to better meet veterans’ increased need for information and services and reduced center call volume so representatives could help callers with urgent medical needs as quickly as possible.” 

Technology-focused officials also created a new clinical decision support tool—the COVID-19 Patient Manager—specifically for certain medical providers. 

“When seeing a patient with a mild to moderate COVID-19 case, physicians emphasized their need for data-backed disposition recommendations as well as an aggregated, organized set of up-to-date guidelines and best practices,” Worthington said. The resource is built on interoperability and other standards, and supports doctors’ decision-making, among other capabilities. Clinical leads working on this effort at specific pilot sites “are highly engaged with development and are very excited about the potential for a clinical decision support platform that would enable similar apps,” the CTO noted.

Further, the agency also used an existing platform—an automated engine built on top of mobile texting technology, called VEText—during their “vaccine response phase,” enabling veterans to schedule their first and second vaccination appointments. It essentially works by alerting vets of all ages over text that they are eligible for a vaccine, and allowing them to conveniently book a time that works for them.

“More than 230,000 veterans have scheduled vaccine appointments via VEText,” Worthington confirmed.

To Be Continued

Galvin said the department also onboarded six software-as-a-service and six platform-as-a-service applications during the pandemic and enhanced 42 COVID-specific SaaS and PaaS products in three months—far faster than typical deployments of two years. 

“We’ve seen the value of these and several other key technologies and processes during the pandemic and they are certainly already informing our ongoing digital transformation in new ways, with use cases that extend beyond COVID-19,” he noted. One example involves capabilities around telehealth. Officials are observing the utilization of some of those services leveling off right now, but VA is poised to support their continued use “well beyond” pre-pandemic levels. 

At this point, the department has also leveraged elements that were foundational to telehealth and telework implementations to launch other services, like virtual telehearings, where judges, veterans and their representatives use internet-linked devices to hold secure remote hearings regarding appeals.

“This capability has not only been invaluable during the pandemic but has positive implications for the future, as well,” Galvin said.