Facing the Digital Divide: Increasing Video Visits Among Veterans Experiencing Homelessness

As three aspiring physicians looking to serve underserved communities and interested in the potential of telemedicine, we read your article with great interest. We were struck by your intervention's effectiveness and had some questions regarding the study design and possible nationwide implementation.

Overall, we were impressed by the increase in video call usage rates relative to telehealth visits in populations of veterans experiencing homelessness (VEH). It was remarkable that the intervention resulted in such significant results considering the short time period (5.5% increase over a 16 week period). The further increase following the intervention period hints at possible long-term, sustained benefits of this intervention. If implemented on a wide scale, this intervention could result in meaningful health improvements among populations without access to traditional in-person care.

In terms of questions, we were looking for insight into the logistics of how you standardized the visit process itself. How was the flowchart created and how were participating clinics selected? What previous roadblocks to using telemedicine to treat VEH contributed to different aspects of the flowchart’s implementation? With an assumption of efficiency as being a priority, how much time was needed to train clinic staff to be able to work through the flowchart with patients in an effective and fluent manner?
Do HPACTs exist across the country to allow for widespread implementation of this intervention? We believe that addressing these questions could be essential in determining how applicable this intervention is beyond Los Angeles, such as rural areas. We look forward to seeing how usage of interventions such as yours improves telemedicine accessibility and increases thereby healthcare among underserved communities.