Neil C. Evans, M.D., Kathleen L. Frisbee, Ph.D., Kevin Galpin, M.D.

Listen to Neil Evans, Kathleen Frisbee and Kevin Galpin discuss their work:

With the most expansive telehealth system in the country, the Department of Veterans Affairs has played a critical role in caring for veterans during the COVID-19 pandemic. However, long before “coronavirus” became a household term, veterans were seeing doctors, therapists and other clinicians from the comfort of their own homes.  

During the past decade, a VA office called Connected Care has been ramping up the number and types of remote health services available to the more than 9 million veterans enrolled in VA health care.  

Leading today’s innovative and accelerated efforts on telehealth, mobile apps and other virtual health care options are Drs. Neil Evans and Kevin Galpin, and Kathleen Frisbee, whose combined skills and leadership in technology, policy, regulation, medicine and management are guiding the VA’s merger of health care with technology. 

“They’ve really set the vision for the future,” said Dr. Richard Stone, executive in charge, Veterans Health Administration. “The VA, in so many ways, has led this not only in the number of people served, but also in the breadth of services offered.”  

Veterans use the technology for everything from scheduling video medical visits to connecting with clinicians via secure email, text and chat. They can remotely fill prescriptions, receive text reminders to take their medications, make medical appointments, download apps for pain management, or consult with specialists from more than 50 health fields—including cardiology, nephrology, dermatology, pulmonology, mental health and epilepsy.  

Telehealth has been “life-changing for veterans,” said Jonathan Hinker, a National Guard veteran whose nearest VA facility is 90 minutes away. 

Indeed, when the coronavirus pandemic was spreading nationwide in early spring 2020, video visits between veterans and clinicians skyrocketed nearly sevenfold, to more than 18,000 per day in the middle of April. As the crisis unfolded, the VA relied heavily on the telehealth system to provide ongoing medical care to veterans at home, reduce the number of ill veterans entering medical facilities, establish contingency services for critical care consultation, and provide a mechanism to monitor and track patients under home care quarantine.  

The remote options for COVID-19 as well as other illnesses and conditions, have been critical for veterans who live in rural areas, sometimes hundreds of miles from medical facilities, and for veterans who have mobility or transportation challenges.  

Galpin oversees VA telehealth services—used by more than 900,000 veterans in fiscal 2019— and pushed for policy, regulatory and administrative changes so telehealth could succeed. He worked with Congress and others to pass the 2018 MISSION Act, which gives VA clinicians the authority to see patients across state lines, forming the basis for VA’s Anywhere to Anywhere Telehealth initiative.  

More than 32,000 VA providers at more than 1,400 VA facilities and sites have provided video telehealth services at least once, including more than 75% of primary care and mental health providers. Primary care and mental health are two of the telehealth services veterans use most.  

Frisbee drives the technology and pragmatic work to make telehealth a reality, managing VA’s mobile apps, secure messaging and other technologies for delivering virtual health care, Evans said. She developed mobile solutions for VA from the ground up, according to Shawn Hardenbrook, VHA’s director of web and mobile solutions.  

The success of the program can be seen by visiting the VA’s mobile app store, which has more than 50 apps related to medical care, or VA’s online patient portal My HealtheVet, which has more than 5 million registered users.  

Frisbee “has really cultivated and developed these different tools to help supplement veterans’ management of their own health care, to really get them engaged so, ultimately, they will have better health outcomes and lead better lives,” said Treva Lutes, communications director for Connected Care. 

Evans, who oversees Galpin and Frisbee, “has his eye on the big picture, introducing big ideas for the VA to take on,” said Galpin, adding Evans is a “forward-thinking leader.”  

He added, “he’s been championing a lot of these initiatives,” including, most recently, a clinical chat function for providers. Evans continues to do clinical work, giving him opportunities to assess challenges veterans face and propose additional ways to help, Galpin said.  

The VA’s offerings are gaining traction with veterans, including their ability to invite caregivers to video visits. In fiscal 2019, more than 1.3 million video telehealth appointments were held, a 235% increase over the previous year. And telehealth received a 90% satisfaction rating from veterans, according to the VA.  

A pilot program begun late last year called ATLAS, or Accessing Telehealth through Local Area Stations, aims to provide a convenient health care option for veterans who do not have the technology or bandwidth to support a video medical visit. In 10 places around the country, either a Walmart or a veteran service organization is hosting a facility to enable video visits between veterans and clinicians. These sites are located minutes away from many veterans who otherwise might have to travel hours to a VA clinic.  

Telehealth does not replace in-person medical care. It supplements it by, for instance, enabling veterans to ask questions and get advice, have a post-surgery test with a doctor performed via video with the help of an on-site nurse, or have a chronic illness monitored and managed.  

Galpin said, “We want this to be the most convenient health care system with consistent access for every veteran no matter where they are.”