Table 4.

Key Areas of Information, Stakeholders, Data Needs, Takeaways, and Next Steps for 4 Priorities

Priority 1: How can we take evidence-based practice and scale it (scaling-out programs)?
Necessary information	Key stakeholders	Data Needs	Takeaways	Next steps
Identification of the active ingredients and core practices of successful virtual care programs Articulation of roles and responsibilities for each part of the virtual care process at each level in the health care system	Global: Research, operations, systems level stakeholders; veterans and caregivers; policymakers; community partners Specific: Process & redesign teams; educators to train & retrain staff; local champions	Process data during implementation & adoption Veteran, caregiver, clinician, and staff satisfaction Cost and quality (ie, HEDIS, SAIL) Ability to capture unintended consequences	Certain data needs cut across all diseases, but further discussion should identify additional disease-specific data needs Standardized processes for virtual care use and implementation can decrease in variability in virtual care use Real-time analysis of virtual care can help accelerate virtual care implementation and adoption	Identification of generalizable components of virtual care in order to develop a best practice guide to focus virtual care implementation efforts
Priority 2: What virtual care services can be centralized, regional, or local (deciding central, regional, or local)?
Necessary information	Key stakeholders	Data Needs	Takeaways	Next steps
Clarification of what services the VHA should prioritize in-house and what services should be sent to the community Assessment of how quality of care and veteran experience differ at each of the different levels of virtual care	Global: Veterans and caregivers; Medical center directors Specific: Chief Medical Officers; VHA Central Office stakeholders	Data to address supply and demand for virtual care Patient reported outcomes, quality of care, and clinical outcomes Number of veterans who use VHA care for the 1st time, and retention of veterans in VHA care	Unclear pathways for decision-making make discussions about strengths and weaknesses challenging Tailoring virtual care can occur within service areas High amount of regulation may decrease innovation and slow time to implementation	Discussion of how to encourage use of VHA health care services Identification of how virtual care across the VHA functions in changing funding and policy climates
Priority 3: How can we create high-value care within the VHA with virtual care (creating high-valued care)?
Necessary information	Key stakeholders	Data Needs	Takeaways	Next steps
Clarification of what parts of virtual care are managed locally vs. nationally Identification of decision-making capabilities for initiating virtual care Examination of effectiveness of VHA virtual care vs. community care on outcomes	Global: VHA Offices of: Care in the Community; Connected Care; Patient Care services; Rural Health; Finance; Policy and Planning Specific: Service lines; local health system stakeholders	Veteran, caregiver, and clinician willingness to use, and satisfaction with, virtual care at the VHA Veteran and caregiver satisfaction and preferences for care in/out of the VHA Impact on care, referral time, clinic volume, and documentation by specialty	Examination of when, how, where, for whom, and by whom virtual care is an appropriate and equitable option Identification of methods to triage appropriate veterans and service lines for virtual care Identification of VHA’s capacity and resources to meet the needs of veterans	Identification of how VHA policies and procedures incentivize or disincentivize the use of virtual care Highlighting and positioning virtual care as a highly valued service at the VHA so that veterans will choose the VHA for their care
Priority 4: How can we align the virtual modality with the clinical problem (aligning modality and disease)?
Necessary information	Key stakeholders	Data Needs	Takeaways	Next steps
Identification of resources needed (e.g., finances, clinicians, staff to assist veterans in using virtual care) to ensure appropriate use of virtual care Identification of modality of care (i.e., fixed or flexible) and end-user (i.e., specific population, individual) Defining the right patient for virtual care	Global: Veterans and caregivers; Service lines; VHA Central Office; and VHA Offices of: Connected Care, Rural Health, and Health Equity Specific: Local facility directors, service line leads, and information technology stakeholders	Continuous screening for veteran, caregiver, and clinician preferences for satisfaction with virtual care Impact of virtual care on wait times for specialty consults and care	Challenges exist in aligning the patient’s abilities and preferences to use virtual care, diagnosis, and the virtual care modality Partnership between research or program offices to help inform the development, evaluation, and continued use of virtual care Developing partnerships between researchers, operations, and other stakeholders is important to use virtual care effectively	Determination of appropriate characteristics and screening measures that can predict modality use in veterans and clinicians Examination of how virtual care augments or replaces in-person care across disease states

HEDIS, Healthcare Effectiveness Data and Information Set; SAIL, Strategic Analytics for Improvement and Learning Value Model; VHA, Veterans Health Affairs