Veterans are failing to use the tablets distributed to them through the Veterans Health Administration’s Video Connect program, according to an Aug. 4 audit report by Office of the Inspector General.

More than half (51%) of the 41,000 patients who received Apple iPads during the first three quarters of fiscal 2021 are not using the tablets to connect to virtual appointments, the report found.

According to Connected Care staff, these devices have annual unlimited cellular data plans that cost $257.50 per device per year.

The review team calculated that nearly 8,300 devices cost the VHA about $6.3 million and would have incurred about $78,000 in cellular data fees in the review period.

"With more robust oversight responsibilities and controls to ensure that medical facility staff monitor for VVC [VA Video Connect] appointments and device usage and attempt retrieval, when necessary, VHA could ensure better use of approximately $6.3 million in devices that could be loaned to other patients and over $78,000 in data plan costs," the report said.

While the review team notes that the program was successful in distributing devices to patients, several gaps in oversight and guidance are preventing the program from fully meeting its intended purpose for patients to receive virtual care via (VVC.

An estimated 10,700 patients never had a VVC appointment scheduled, as there was no requirement to schedule, and neither the patient nor the staff initiated scheduling a VVC appointment, the report found.

A lack of clear oversight roles and responsibilities for Veterans Integrated Service Network (VISN) and medical facility employees contributed to the low use rate, while there were also lapses in device issuance and management.

"Lapses in refurbishment and inventory controls also led to a backlog of over 14,800 devices pending refurbishment that could not be added back to inventory for redistribution or consideration in VHA’s device purchasing process," the report added.

The report also outlines 10 recommendations to spur patient use of the devices and better management of the program overall, with the OIG recommending that the VHA add procedures to prevent issuance of and retrieve duplicate devices.

THE LARGER TREND

In August 2020, the VHA's Office of Connected Care recognized the growing demand for patients’ access to video-based virtual care, and that many patients lack a video-capable device, or the internet connection required to access this care.

According to a study published in JAMA Network Open, providing a video-enabled tablet to veterans living in rural areas decreased emergency department visits and suicide behaviors.

Additionally, a VA-funded study published in Neurology in April found that a telestroke program helped prevent unnecessary hospital transfers for patients. 

ON THE RECORD

"Because VHA did not effectively track device issuance, use or returns, many unused devices were not retrieved and made available to other patients," the report concluded. "Not tracking these items from distribution through retrieval limits VHA’s ability to determine how many devices are available for patients."