Understanding the value of virtual care technologies: development of a framework in the veterans health administration

IntroductionHealthcare systems, including the Veterans Health Administration (VHA), are facing tremendous growth in virtual care technologies that are intended to foster connections between patients, informal caregivers, and healthcare team members. The adoption of some of these virtual care technologies was accelerated by the onset of the COVID-19 pandemic, emphasizing the need to more comprehensively and rigorously assess the impacts of such technologies. An encompassing framework that represents the universe of outcomes relevant to virtual care technologies and can inform related measurement is necessary to understand such impacts in depth. Such a framework can inform how, where, and when these technologies may have the most impact, and by extension, contribute the most value. This article describes the participatory and literature-based development of a Value Framework reflecting the potential value of virtual care technologies for VHA healthcare stakeholder groups and the VHA healthcare system.MethodsWe pursued a combination of participatory co-design approaches involving key stakeholders representing different domains of expertise in VHA and completed a targeted scoping review of 96 prior randomized clinical trials funded by VHA to identify and describe outcomes related to virtual care technologies. Findings from these activities were synthesized and used to inform the Value Framework’s organization.ResultsThe Framework is comprised of five primary value categories reflective of healthcare’s Quintuple Aim: 1. Experiences of Care, 2. Access to and Utilization of Quality Healthcare, 3. Population Health, 4. Costs, and 5. Equity. Each of these primary value categories includes subcategories and sets of distinct outcomes related to the adoption and use of virtual care technologies.DiscussionSince its development, VHA has adopted this Value Framework to inform efforts in evaluating and communicating the impacts of its portfolio of virtual care technologies. The Value Framework may offer researchers and healthcare organizations a tool that can support the development of a cumulative evidence base regarding the value of virtual care technologies.