VA Video Connect

VHA Caregiver Support Program

This document aims to provide Caregiver

Support Program staff a guide to ensure

Caregiver Support Coordinators are able to

setup, complete and document VA Video

Connect visits.

The following key elements will be covered:

• How to set up a VA Video Connect

(VVC) visit.

• How to ensure that your clinics are set

up correctly.

• How to prepare for a VVC visit.

• How to select appropriate dyads for a VA

Video Connect visit.

• How to conduct a VVC visit.

• How to document a VVC visit.

• Troubleshooting issues with a visit.

• How to hold a group via VVC.

VA Caregiver Support Program

SharePoint

VA Video Connect

VSSC Page

VVC IN THE CAREGIVER SUPPORT PROGRAM

Leveraging appropriate technology is the cornerstone of the Caregiver Support

Program’s ongoing improvement, development and expansion. This guide is intended

to provide staff with guidance to have successful VA Video Connect visits.

Additional education and information is available on the VA Video Connect website.

This guide was created by the CSP’s Knowledge and Data Management (KDM)

Committee, in collaboration with the Office of Rural Health (ORH). If you have any

questions or feedback regarding this guide, please contact either your VISN VA Video

Connect Champion (see Module 4) or one of the creators of this document (see Created

by section at the end of the document).

2 
 
Table of Contents 
 
Module 1 – Why Use VA Video Connect 
  For Veterans and Caregivers 
  For Providers 
  For VA 
 
Module 2 – Introduction to VA Video Connect 
  Introduction to VVC 
  How does it work? 
  Caregiver Support Coordinator Buddies 
  Requirements 
  VVC Terminology 
 
Module 3 – Clinic Codes and Scheduling 
  Clinic Profiles and Setup 
  Encounter Forms 
  Scheduling a Visit 
  Scheduling through Facility Telehealth Coordinator 
  Scheduling through Virtual Care Manager (VCM) 
 
Module 4 – Setting Up VA Video Connect and Connecting to VA 
Video Connect VISN Champion 
  Setting up Virtual Care Manager (VCM) 
  VISN VA Video Connect Champions  
 
Module 5 – Preparing for VA Video Connect Visits 
  Preparing for your first VVC visit 
  Preparing for every VVC visit 
 
Module 6 – Netiquette for VA Video Connect Visits 
  Staging 
  Framing 
 
Module 7 – Selecting Dyads for VVC 
  How to market VVC to dyads 
 
Module 8 – Conducting VA Video Connect Visits 
  Overview of VA Video Connect Features 
  Sharing a Screen  
Where can visits occur 

3 
 
  Security and Privacy 
  Joining the Visit 
  Identifying who is present in the Virtual Medical Room (VMR) 
  Preventing and Handling Emergencies 
   
Module 9 – Documenting VA Video Connect Visits 
  Documenting Visits 
 
Module 10 – VA Video Connect Troubleshooting  
  Troubleshooting Initial Setup 
  Troubleshooting Technology Failure 
  Troubleshooting Poor Connectivity 
 
Module 11 – Groups  
  Creating Group Video Visits 
  Selecting Group Participants 
  Telehealth Agreement and Informed Consent 
  Documentation  
  How to handle an emergency in telehealth/VVC visit 
  Ending the Group Visit 
 
Module 12 – Conclusion 
 
 
 
 
 
 
 
   

Module 1 – Why Use VA Video Connect

VA Video Connect (VVC) is another modality that can be used to provide excellent

support to dyads. VVC allows the dyad and provider to have face-to-face contact with

ease over a secure virtual connection. Scheduling home assessments can be very

difficult for a variety of reasons. Telephone assessments may be less informative and

personal. VVC gives Caregiver Support Coordinators the ability to reach dyads in a

whole new way.

There are several benefits to utilizing VA Video Connect for providing Caregiver

support.

For Veterans and Caregivers

• Reduces likelihood of rescheduling or appointment delays due to traffic, parking,

or dangerous weather conditions

• Less missed work for Caregivers and Veterans

• Less time away from family and/or coordination of care for Veteran/family

• Improved access to caregiver support and timely appointments

• Easier to fit into their schedule

• More convenient and comfortable; visits occur in their own space with much less

intrusion. Veteran is more at ease

• Reduce exposure to various contagious illnesses

• VVC is a web-based program. There is no software needed to use this program

o The only additional step would be an app download for iOS software

For Providers

• Less travel (reduces issues with traffic, weather, vehicle expenses)

• Avoid cancelled appointments due to weather, illness, etc.

• Saves time (patient documentation possible during video visit, no driving needed)

• Improves ability to assess clinical situations and home environment versus

telephone call

• Better opportunity to build rapport with face-to-face versus telephone call

• Improves access (easy to connect to dyad and/or create appointments on

demand)

• More convenient and comfortable; visits occur in your space and are easy to set

• Able to fit in more appointments

• Less concern for safety (e.g., animals, emotional outburst, neighborhood, etc.)

• VVC is a web-based program. There is no software needed to use this program

• Ability to conduct appointments with caregivers in multiple remote locations

For VA

• VVC supports the mission of the VA and the Caregiver Support Program

because we are expanding options for exceptional health care, support,

education, resources, and services

• VVC improves access. We can deliver the right care, at the right time, at the right

place

• There are fewer wasted resources and it’s better for the environment (travel,

vehicle wear and tear, saves time, fewer cancelled appointments)

Real-life success story

*Names have been changed to respect privacy*

Chris and Julie have been in the Program of Comprehensive Assistance for Family

Caregivers since it started in 2011. Chris has a severe TBI from an IED blast, is blind

and mostly wheelchair bound. They live about 90 miles from the local VA medical

center. Julie is truly amazing. She gets him to physical therapy, occupational therapy,

adult daycare and other doctor appointments several times each week. They also have

three (3) children in school. Things can get chaotic, but they manage very well despite

the frequent running around. Once video visits became available for a variety of

services in the medical center, they were onboard. This modality has made a huge

difference in his care. He can be assessed virtually and receive

treatment/equipment/medications without ever leaving his home. For the PCAFC

(Program of Comprehensive Assistance for Family Caregivers), the dyad and the

Caregiver Support Coordinator can visit with ease. Our last visit was particularly helpful

because Julie was able to show me their newly outfitted exercise room in the basement.

We troubleshooted space concerns and discussed a better set up. She was able to

show me a worn-down piece on his wheelchair that needed attention and introduced me

to his new service dog Quiz. Through this interaction, occupational therapy and physical

therapy was able to order the part that was needed for his wheelchair. Julie then

shared some news about her young nephew’s sudden death. I was better able to

support her in processing this because I could see her face-to-face on the video screen

making eye contact. VVC has been instrumental in facilitating the provision of better

care for many of the dyads.

Resources:

Telehealth Services Site for VA Video Connect

VA App Store Page for VA Video Connect

Module 2 – Introduction to VA Video Connect

Introduction to VVC

VA Video Connect is a VA program that enables Veterans to meet with their VA

healthcare providers virtually. These meetings are completed using encrypted video in

order to maintain a secure and private meeting space, called a virtual medical room

(VMR).

VVC is the latest step in the VA’s expanding telehealth services to Veterans in their

home or other non-VA settings. VVC visits can be scheduled in two ways (discussed in

Module 3).

How does it work?

When a VVC visit is scheduled, both the Veteran/caregiver dyad and VA healthcare

provider will be sent an email with the information about the visit. The email will include

the link to enter the VMR. To enter the VMR, the Veteran and provider simply click the

links they received. Once the Veteran and VA healthcare provider are in the VMR, they

can see, hear and communicate with each other to complete the clinical session.

Caregiver Support Coordinator Buddies

Though it is not required, the Caregiver Support Program is offering “Buddies” to assist

with the set up and first sessions using the VVC system. Buddies can assist with

practice sessions using VVC, answer questions, or be available for general support.

Information and instructions on how to obtain a buddy can be found in the CSP

SharePoint.

Requirements

There are several requirements to start working with VA Video Connect. These fall into

one of two (2) categories:

• Training

• Equipment

Training

The CSC will complete the following training in the VA Talent Management System

(TMS).

• VA 427971 – Telehealth to Home Using VA Video Connect Provider Training

Completion time – Approximately 40 minutes

This training gives an overview of VA Video Connect, including set up,

conducting a visit, documentation, safety plans while using VA Video Connect,

and some basic troubleshooting tips

• VA 4486527 – Virtual Care Manager Training

Completion time- approximately 20 minutes

This training explains how to use Virtual Care Manager. Virtual Care Manager

allows VA clinicians to view, create and start individual and group video

appointments with patients and caregivers. Additionally, Virtual Care Manager

allows providers to track scheduled appointments and send reminders for

upcoming visits

Equipment

Equipment that the VA healthcare provider needs in order to complete the VVC visit is

as follows:

• Computer or other VA issued device meeting the following requirements:

o Internet connection

o Webcam plus Microphone

o Webcam and microphone can be integrated with computer or device (i.e.

laptop webcam/microphone)

o Internet Browser

o Google Chrome – provides the best VA Video Connect experience

o Microsoft Internet Explorer

o VA Video Connect App if using iOS Device (iOS devices are iPhone, iPad,

etc.)

• Request two computer screens (ask your Telehealth Coordinator for another

screen if you only have one computer screen)

o You will need one screen to view the Veteran’s medical record

o The other screen is utilized for visual contact to interact with the

caregiver/Veteran

o Alert the participant that you have two computer screens and that you may

be looking at the other screen for relevant information during the visit

VVC Terminology

CAPS-Lock: This acronym helps providers to remember the procedure that begins

every VVC visit. This should be documented in every VVC note.

“CAPS-Lock”: Consent, Address, Phone Numbers, Survey, Lock.

• Consent: Obtain or confirm that verbal consent for telehealth has been

documented

• Address: Verify the address for each patient to validate if they have 911 services

available

o E911 (Emergency #): E911 is used to pre-validate the location of the

participant to ensure timely local response in the event of an emergency

o If E911 service is not available for the patient, the provider needs to ask

the patient for an emergency dispatch number for the patient's area to use

in an emergency

• Phone Numbers: Obtain or confirm participant’s current phone number for use if

the VVC visit is disconnected. Also get the emergency contact’s phone number

for use in an emergency

• Survey: Survey the environment and identify all participants

• Lock: Locking the VMR prevents others from joining the video visit. If the

conference is locked, VA health care providers (with Host PIN) can still join the

video visit, but Veterans and guests cannot join. Host PIN numbers are located

on the email that is sent for confirmation of the VA Video Connect visit and look

as noted below:

To join this VVC appointment manually or through a video conferencing

device: (Web address here) Host PIN- (PIN Number here)#

Facility Telehealth Coordinator: The Facility Telehealth Coordinator (FTC) coordinates

and oversees Telehealth initiatives at a local level, working closely with scheduling

points-of-contact to determine and communicate scheduling responsibilities.

The FTC determines local processes for onboarding new provider and

Veteran/caregiver telehealth users.

National Telehealth Technology Helpdesk (NTTHD) – Numbers that you can call for

questions or technical assistance with VA Video Connect are 866-651-3180 (Toll Free).

The alternate phone number is 703-234-4483. They are available Monday through

Saturday 7 am through 11 pm EST.

Netiquette (“Webside Manner”): Etiquette governing communication on the Internet.

See more information in Module 6.

VA Video Connect (VVC): VA Video Connect is a VA platform that enables Veterans to

virtually meet with their VA healthcare providers in a “virtual medical room” using

encrypted video to ensure the session is secure and private. VVC allows

Veterans/caregiver to see and talk to their healthcare team from anywhere, making VA

healthcare more convenient and reducing travel times for Veterans/caregivers,

especially for those in very rural areas with limited access to VA health care facilities.

Virtual Medical Room (VMR): Virtual medical room is a virtual meeting space that both

the Veteran/caregiver and VA healthcare provider can meet in to complete a healthcare

appointment that does not require any physical, hands-on assessment.

https://vaots.blackboard.com/bbcswebdav/institution/videos/vmr/vmr-

encounter/video.mp4

Virtual Care Manager (VCM): Virtual Care Manager provides clinicians a single location

to create VVC visits, view all pending video visits, and join scheduled sessions.

Resources:

VA Telehealth Website – VA Video Connect Solutions

VA Telehealth Website – VA Video Connect for Providers

VA Telehealth Website – The Virtual Medical Room Encounter Video

VA Video Connect YouTube Video

VA Video Connect Demo

Module 3 – Clinic Codes and Scheduling

Clinic Profiles and Setup

Before you schedule a VVC visit, you must set up a separate VVC clinic. Your VVC

clinic must include the following information to correctly capture your VVC work.

Contact your local Managerial Cost Accounting Office for assistance in setting up a new

clinic.

Clinic Names

• The clinic name must meet approved naming nomenclature

o i.e., (prefix: facility loc) CG VVC

Stop Codes for individual visits (group visits are discussed in Module 11):

• Primary Stop Code should be the 192 (Caregiver Support Program Stop Code)

• Must include Secondary Stop Code of 179 (Real Time Clinical Video Telehealth

to Home-Provider Site)

Count vs. Non-Count:

• This should be a count clinic because you are directly interacting with Veterans

and caregivers

Example of a VVC Clinic Built in VistA

**Clinic name and stop code for this graphic are not in line with current guidance.

Encounter Forms

When filling out the encounter form for the visit, you must make sure to check the

service connection box on the front page, if applicable:

Next, you must make sure to put the appropriate diagnosis:

The procedure code to use for VA Video Connect visits is T1016. Be sure to enter the

appropriate number of units. This code represents 15-minute increments.

Running Data Reports

The VA Video Connect Caregiver Support Coordinator Tracking Portal is a tool to track

your VVC visits. It is located at VSSC Data Reports

On the report page VSSC VA Video Connect Caregiver Support Coordinator Tracking

Portal, click on the tab at the top: VVC Use By Date.

The VVC visits can be sorted by VISN. The measures section will also display the

report in either Encounter or Patient Count:

Scheduling a Visit

There are two (2) main ways to schedule a visit for VA Video Connect.

• Schedule through your Facility Telehealth Coordinator (FTC)

• Schedule through Virtual Care Manager

Scheduling through Facility Telehealth Coordinator (FTC)

The process for scheduling through the FTC is as follows:

1. Provide the FTC with the information of the upcoming VA Video Connect

appointment (Patient identifiers, date, time and clinic for the visit)

2. The FTC will schedule the VVC visit in the VistA Scheduling Graphic User

Interface (VS GUI) system

3. The FTC then will be required to generate the video links in the Virtual Care

Manager (VCM). This will be discussed more in the next section

Scheduling through Virtual Care Manager (VCM)

1. Access Virtual Care Manager by visiting the VA Mobile App Store:

https://staff.mobile.va.gov/vvc-manager/#staff-video-visits

2. When you are in VCM select Create Unenrolled/Group Video Visit

3. You will see Staff Visit Video Information then select unenrolled Veteran

4. Select “This appointment is for me” – enter the initial information for yourself as

the provider. Then enter the visit date/time

5. Scroll down and enter the Veteran information

6. Scroll to the bottom and click “Create”

A confirmation screen appears once you successfully create your video visit.

At this point, an email confirmation is sent to both the provider and patient containing

instructions on how to access the Virtual Medical Room (VMR).

Resources:

Telehealth Services Site for VA Video Connect

Telehealth Services Site for VA Video Connect for Schedulers

VA App Store Page for VA Video Connect

Virtual Care Manager – Telehealth Intranet Site

VA App Store Page for Virtual Care Manager

Module 4 – Setting Up VA Video Connect and Connecting to VA

Video Connect VISN Champion

Setting up Virtual Care Manager (VCM)

1. Access VCM through the following link on the VA Telehealth Services Page:

https://mobile.va.gov/app/virtual-care-manager

2. Save the webpage to favorites or create a shortcut on your desktop:

https://staff.mobile.va.gov/vvc-manager/#staff-video-visits

Make sure that your PIV badge and your Vista accounts are synchronized.

• Instructions on how to link your PIV Badge to your VistA account are found at the

following address: https://mobile.va.gov/sites/default/files/piv-linkage-process.pdf

Keep in mind the following:

• Entering an appointment through Virtual Care Manager does NOT schedule an

appointment in VistA. VistA appointments are completed through your

designated scheduler. If you set up an appointment through the Virtual Care

Manager, please contact your scheduler to complete the appointment set up

through VistA per local scheduling policy

• Contact your Facility Telehealth Coordinator if you require any equipment (i.e.,

webcam, speakers, headset, etc.) to conduct VA Video Connect appointments. It

may also be beneficial during VVC visits to have two monitors. Telehealth

Coordinators or IT requests (depending on your facility policy) may be able to

assist

• For assistance with setting up Virtual Care Manager, please contact Mobile Help

Desk: 844-482-6624 x 1

VISN VA Video Connect Champions

There are a group of VISN VA Video Connect Champions that are available to assist

you if there are any needs. You can locate them at the following website:

VA Video Connect Champion page

https://vaww.infoshare.va.gov/sites/telehealth/Lists/leads/vvcchampion.aspx

Module 5 – Preparing for VA Video Connect Visits

Preparing for your first VVC Visit

• Connect with Telehealth Coordinator

o Connect with your Facility Telehealth Coordinator to establish a

relationship in the event you encounter an issue with VA Video Connect

(VVC). The Telehealth Coordinator can assist you with problem solving

any technical issues with VVC and/or clinic questions

o You may also want to consider talking to your Telehealth Coordinator to

complete a VVC test visit. This will provide a real-life experience in the

system and help you to understand the VVC process. The Telehealth

Coordinator in your VA can help you set up your equipment to conduct

VVC visits and help with understanding the technical aspects to connect

all the equipment such as the camera, mic and icon familiarization in the

Virtual Medical Room (VMR)

• Practice VVC with a VVC Buddy or a colleague

o Practice allows you to be more comfortable with the technology and more

engaged during visits with the participants. You can familiarize yourself

with the steps involved in connecting to the VMR, turning up the volume or

other items associated with your device

o Practice with a “VVC Buddy” or a colleague that is familiar with VVC. In

order to practice you will need to schedule a visit for you and your partner

in the VCM

o Role play completing a visit with your buddy. During your role play

consider the tips from Module 6 for Netiquette. It is important to become

familiar with the tips to assist with successful VVC visits. After your

practice sessions, ask for feedback. The more you practice the more

comfortable you will be with the technology and what you can anticipate

during a VVC Visit

• Consult with your Buddy

o Discuss any concerns or questions that you may have about completing a

visit with VVC

• Schedule the VA Video Connect visit as demonstrated in Module 3.

• Offer Test Calls to Veteran dyads

o As a best practice, it is recommended that each facility establish processes

so that Veterans/caregivers new to VA Video Connect can complete a non-

clinical test call prior to their first visit. This will ensure they are prepared and

able to effectively use the technology before connecting with their provider. It

is also recommended that providers glean a good understanding of the steps

involved in connecting, turning up the volume, positioning the camera and

other items associated with using the device

o The National Telehealth Technology Help Desk (NTTHD) has established a

similar test call service in their operations. Veterans can call the NTTHD and

ask for a test call; however, it is recommended that this be used as a back-up

service to the facility process

Preparing for every VVC Visit

• Review clinic list and know who you will be seeing via VVC

• Identify if the Veteran or caregiver wants other people to participate in the visit.

Enter an additional email address in Virtual Care Manager to generate the

additional link to join the clinical visit

• Review the Veteran’s clinical record and caregiver’s collateral record

• Verify all relevant information needed for the telehealth encounter

• Maintain an unobstructed view of one another

• Ensure as much privacy as possible; put a sign on your door indicating “Do Not

Disturb, Clinical Telehealth Session Happening Now”

• Do your best to look at the camera often to give the caregiver/Veteran the

sensation that you are looking at them (it will feel awkward at first)

Resources:

https://vaww.infoshare.va.gov/sites/telehealth/docs/vvc-spp.pdf

Module 6 – Netiquette for VA Video Connect Visits

Netiquette (“Webside Manner”) is the etiquette governing communication on the

internet. Netiquette includes the following:

• Explain what to expect during a telehealth visit with your clients

• Obtain verbal consent to do a telehealth visit & make sure this is documented

with each telehealth encounter

• Ensure you and the Veteran/caregiver can see, hear and understand each other

• Make eye contact often by looking directly at the camera

• Speak deliberately, slow the pace of your speech, and give a brief pause after

you or the Veteran or caregiver talks to allow for possible transmission delays

• Confirm understanding

• Sit relatively still during the visit to avoid moving in and out of the video frame

• Avoid extraneous noise e.g., pen clicking, tapping, or typing

• Avoid eating or drinking while on camera

• Be friendly and engaging

Staging

Provider

• Professional appearance

• Hair should be nicely groomed

• Wear professional clothing

• Avoid logos on clothing, pattern fabric, striped shirts, white coats and/or bold

colors

Environment

• Lighting: ensure that the room is well-lit, using natural light if possible, to avoid

shadows. The light source should not be behind you, as this will put you in

shadow

• Check to confirm the Veteran and caregiver can see your face and not just the

outline of your body

• Inform them if you can see them or not

• Background frame should be uncluttered and professional

• Avoid personal images in the background to protect your privacy

• Avoid symbols in the background to maintain a neutral tone

• Audio background: minimize extraneous background noise if possible

Framing

• Sit a comfortable distance from the camera

• Don’t sit too far above or below the camera

• Use self-view to check your framing

• Avoid looking down at your desktop, as your client will only see the top of your

head

• Be inclusive. Introduce yourself, all participants and the technology being used if

this is a new modality for your Veterans/caregiver

• If you have more than one computer monitor, set the VVC Camera directly over

the VVC screen that you are looking at. Otherwise, the client will be likely

looking at the side of your face

Module 7 – Selecting Dyads for VVC

VVC is a great modality that provides an option to meet the dyads needs in a

personalized way. However, some Veterans and caregivers may not be appropriate for

the VVC modality. Some may be unfamiliar with the technology or their clinical needs

may be more effectively addressed through in-person visits. It is the responsibility of

CSCs to work with the dyad to determine if VVC is an appropriate modality to use with

them.

Initially, offer VVC to those dyads with whom you have good rapport, are mostly stable,

comfortable with technology, and open to trying new things. These elements are key to

having success as you start VVC because they may experience technical trouble and it

may take more time to conduct your first visit.

How to market VVC to dyads

• Offer this modality with energy, positivity, and excitement. Buy-in is typically all in

the sell. Verbiage: “Hello! I hope you’re doing well! It’s coming up on our next

quarterly visit. We have this new nifty way of doing them- over video with your

smart phone or computer. Would you like to give it a try? It’s pretty cool and I’d

love to see your faces! I have other dyads using it and they find in preferable to a

phone or home visit.”

• Keep offering the modality regularly. You may get a “no” when first offered but

VVC may be something the dyad is open to later. Verbiage: “I just wanted to

touch base with you both about video visits for our next check in. Would you be

interested in giving that a try? If so, I can show you how to do this today while I’m

here.”

• Offer an “out.” Verbiage: “We could give this a try for our next visit and if it’s not

working for us to connect this way, we can do phone calls.”

• Use common language. Verbiage: “VA Video Connect is similar to Skype video

or FaceTime. It lets us see each other on your phone, computer or tablet.”

• Monthly visits are a great opportunity to offer VVC. Offer to do a test run. This is

most helpful to do when you are face to face and can show them how to set up a

visit on their device

Resources:

https://vaww.infoshare.va.gov/sites/telehealth/docs/vvc-spp.pdf

Module 8 – Conducting VA Video Connect Visits

Overview of VA Video Connect Features

** Picture Courtesy of https://vaww.infoshare.va.gov/sites/telehealth/docs/vvc-prv-brw.docx

Sharing a Screen

If the proper extension (Pexip Screensharing Extension) is set in Google Chrome, you

can share your screen with the Veteran and/or Caregiver. This can allow you to provide

them with visual means of receiving information.

In order to share your screen, you would do the following:

Navigate to the bottom of the VVC meeting screen once you are in the Virtual Medical

Room (VMR) to the Screenshare button.

Click on the Screenshare button to start screensharing.

A verification message will show so that you can decide on what screen to share

Select the option that you would like to share with the Veteran and/or Caregiver and

then select the Share button at the bottom

A preview of what you are sharing will pop up in the VVC visit window

In order to stop sharing your screen, navigate to the bottom of the window and click on

Stop Sharing

Where can visits occur

VA Video Connect allows providers to contact the Veteran/caregiver at any location that

has access to Wi-Fi. The Veteran/caregiver should be in a private and safe location.

The VA healthcare provider must be located in a place where they can attend to the

meeting without distractions.

Security and Privacy

It is important to be in a location that has the appropriate level of security and privacy for

the visit. Because of the video and audio, it is important that others cannot see or hear

the visit to maintain confidentiality.

Joining the Visit

There are 2 ways to join your VVC video visit:

• Joining through Virtual Care Manager

• Joining through email

To join through the Virtual Care Manager, complete the following steps

1. Log into Virtual Care Manager

2. Select your Site and Division, then click Continue

3. In the “Staff View”, navigate to the area on the left-hand side of your screen,

there is a section marked “Video Visits”

4. Click on the appropriate Visit:

5. Click on Start Video Visit

VVC Visit will open in the Google Chrome Browser

To join the VA Video Connect visit through the provider email, complete the

following steps

1. In the provider email from Mobile Health, navigate to the hyperlink to join the

appointment:

2. Click on the link to open the VVC Visit

3. When VVC opens in the Google Chrome Browser, you will be able to set your

sound and video settings

Identifying who is present in the Virtual Medical Room

Identify that you are speaking to the correct participants through active verification

(asking the full name and date of birth/last 4 of the SSN). It is also important to identify

if there are any other people in the room with the caregiver and/or Veteran (family

members, etc.). Before starting the visit, if there are children in the room, this is a good

time to talk with the participant about the nature of the conversation and that the

exposure of children to the clinical conversation may be emotionally damaging to them.

Identify any other people in the room with you (interns, other CSC staff, etc.).

Preventing and Handling Emergencies

General Rules

• Always start with CAPS-Lock.

• Ask Veteran/caregiver if they use 911 in their community

• Ask for a local emergency contact number

• If they do not have a local 911 number, then you can use the E911 system in

case of an emergency

In an Emergency

• Stay on the VVC call with the caregiver/Veteran

• If possible, caregiver or Veteran should place the call to local 911

o If they can’t place the call, using your office phone, call the number for

local emergency services (if you have one) OR call e911

• Stay on the VVC call until local emergency services arrive

E911 (Emergency Call Relay Center)

• Service that connects to the traditional 911 operator. The E911 operator is used

to connect a provider with the appropriate emergency service for a Veteran

located in their community

• Provider dials the E911 at 267-908-6605 and relays the Veteran/caregiver’s

location

• E911 operator will connect you to the dyads local emergency response service

E911 Calls

• Call E911 Center (Emergency Call Relay Center) at 267-908-6605.

• Identify emergency

• Relay dyads physical location (including the street address, city, state, and ZIP

code) to the E911 operator

• E911 operator initiates connection with the appropriate local first response team

through the Public Safety Answering Point (PSAP)

• Provider remains on the line

• Call is now established- when confirmed, provider gives report (along with

Veteran’s and or caregiver’s name and location) to local first response team

• Follow instructions from local first response team

CAPS-Lock

At the beginning of every VVC session, it is important to discuss and document the

CAPS-Lock. The steps to this process are as follows:

C – Consent – Discuss consent to have the visit completed in the telehealth format for

all participants. While this is a one-time requirement for your service, it is appropriate to

confirm that the consent to have the visit completed via VVC is still active.

A – Address – Verify the address for each participant. This allows you to verify that they

have 911 services available in the event of an emergency.

To verify an address, you can complete the following steps in the VVC Visit:

Navigate to the top left of the screen in order to click on the Options Menu:

Next, select the e911 option from the menu

Click on each participant in the “participants list”

Fill in the information to pre-validate the address of the Veteran and/or caregiver (below

address is not a Veteran’s address).

Select Pre-validate Address button at the bottom.

You should get a notification if the address is validated correctly

Close the e911 box

The address is NOT SAVED past this session. It can be re-entered for each session.

P – Phone Numbers – Collect the Veteran’s and/or caregiver’s correct phone number

and the phone number of an emergency contact. These numbers can be used in the

event of technical failure of the Video Session (disconnection) or for use in an

emergency.

S – Survey – Visually look at the environment and identify each of the participants in the

area.

Lock – Lock the VMR once all participants have joined the meeting. To do this you will

complete the following steps:

Navigate to the top left of the screen in order to click on the Options Menu:

Click on Lock Conference.

You will notice that there is a keyhole symbol on the right-hand side of the screen, as

well as one near the VA logo on the top right-hand side of the screen.

You can unlock the conference by completing the same steps, with the exception of

clicking on Unlock Conference in the Options Menu.

Resources:

Telehealth Services Site for VA Video Connect

Telehealth Services Site for VA Video Connect for Schedulers

VA App Store Page for VA Video Connect

Virtual Care Manager – Telehealth Intranet Site

VA App Store Page for Virtual Care Manager

Module 9 – Documenting VA Video Connect Visits

Documenting Visits

To document visits for VA Video Connect (VVC) you must complete the following:

Enter the Computerized Patient Record System (CPRS)

Enter the patient chart that you need to complete documentation in.

Navigate to the “Notes” tab at the bottom of the screen

Click on “New Note” to start a new note:

If appointment was scheduled, complete the following when the pop-up menu appears:

Click on clinic appointment that the VVC Note is associated with:

Once you click on the correct appointment, it should be reflected in the Encounter

Location box at the top of this popup menu:

Click on OK on the pop-up menu:

If the appointment was not scheduled in advance, complete the following when the pop-

up menu appears:

Click on the “New Visit” tab:

Enter your visit location:

Enter Date/Time of Visit (PLEASE NOTE: Do not leave to default of “NOW” for the date

and time. This will create an encounter issue that is difficult to close. Change to the

Date/Time of the Visit)

Click “OK” to save Date/Time:

You should see the appointment information in “now” reflected in the Encounter

Location box:

Click on “OK” to close the pop-up menu:

The next pop-up menu that you will get is the Progress Note Properties box:

Select the note title that matches the note that you are completing in CPRS.

Remember, that VA Video Connect notes in the Caregiver Support Program are not

currently permitted for Initial and Annual Assessments.

Click on “OK” to close the pop-up menu:

Complete Documentation in the note template that pops up.

Document CAPS Lock information in the note as well. Information about CAPS Lock

can be found in Module 8 Conducting a VVC Visit.

Resources:

Telehealth Services Site for VA Video Connect

Telehealth Services Site for VA Video Connect for Schedulers

VA App Store Page for VA Video Connect

Virtual Care Manager – Telehealth Intranet Site

VA App Store Page for Virtual Care Manager

Module 10 – VA Video Connect Troubleshooting

This section will cover the most common issues with completion of a VA Video Connect

visit. This is not an exhaustive guide. However, these are the issues one would most

likely encounter.

Troubleshooting Initial Setup

A common problem is setting up the appointment.

If you have not received or cannot find your email with the appointment link, then

complete the following steps:

1. Try using the search function in your email to search for the email (all emails for

VVC come from “Mobile Health”)

2. Check your Spam or Junk folder to see if the email was delivered to that folder

3. Verify that the correct email address was used in order to send the appointment

email (for both you and the Veteran/caregiver)

4. If the email cannot be found, resend the scheduled appointment email. This can

also be used if the Veteran/caregiver did not receive the email or if they cannot

find it

5. If the visit was scheduled through a scheduler, they can resend the email

6. If the visit was scheduled through Virtual Care Manager, you can follow the steps

below in order to resend the invitation:

a. Go to Virtual Care Manager.

b. Click on the appointment for the Veteran that was scheduled.

c. The appointments will show on the Video Visit Details on the right side

d. Scroll down on the Visit details and you will find the Resend Notifications

button

Troubleshooting Technology Failure

There may be an error when loading the Virtual Medical Room for a variety of reasons.

1. The link to the VVC session is invalid or does not open. If this happens

complete the following:

a. Verify the date and time of the appointment

b. If the appointment was scheduled through your FTC, this can be done by

contacting the FTC to verify the date/time of the appointment

c. If the appointment was scheduled through Virtual Care Manager, you can

verify the appointment date and time by logging into Virtual Care Manager

and looking at the appointment:

d. Verify the session link in the web browser

e. If you copied and pasted the link, verify that the web address was

transferred correctly

f. There may be an issue with the web browser. If you can, copy and paste

the link to an alternative internet browser (such as Google Chrome)

g. If you are using Safari on an iOS device, verify that you have the VA Video

Connect Application on your device

If you complete all of the steps and do not resolve the issues, you can complete the

following:

o Create and send a new VA Video Connect link for immediate use.

o Contact the National Telehealth Technology Help Desk at the following

Email: [email protected]

Phone: 866-651-3180

703-234-4483

Troubleshooting Poor Connectivity

Poor connectivity may result in audio or video delay, pixelated video, or even the

connection dropping.

Below are some steps to improve signal strength:

• An Ethernet connection (“hard wire” – connect the device directly to the Internet)

will provide the most reliable connectivity

• When using Cellular or Mobile Data:

o Make sure that at least 2 “bars” (4G) are showing for device connectivity

strength

o Try moving to a new area to increase the signal strength, i.e. sitting near a

window

• When using WiFi, move closer to the router if possible

o If WiFi connection is poor, try switching to cellular or mobile data, if

available, by disabling WiFi

Resources:

Telehealth Services Site for VA Video Connect

National Telehealth Technology Help Desk

VA Video Connect Troubleshooting Guide for Providers

Module 11 – Groups

VA Video Connect also has the capacity to be used in group format. Prior to offering

group VVC visits, staff must have permission from local VA leadership. It is

recommended that staff reach out to the Facility Telehealth Coordinator to make them

aware of the group you provide and receive written permission and/or clarification of the

policy for the provision of telehealth services.

Selecting Group Participants

Caregivers using VVC for monitoring assessments are excellent candidates for video

support groups. They are likely comfortable with the technology and have an

understanding of how it works. CSCs should, however, use their clinical judgment and

discretion when creating the group. It is important to consider size, length of group,

number of group members, personalities, frequency of group sessions, and type of

group (support, psychoeducational, therapeutic, etc.).

Telehealth Agreement and Informed Consent

Caregivers must acknowledge and accept the terms of engagement prior to their first

group visit, and providers must document this acknowledgement in the medical record.

VHA Telehealth Services has created a document for national use. It is helpful to email

or mail this document to the caregiver for review prior to the first group.

It is recommended that the provider state in the document that they have discussed the

Telehealth Agreement and Informed Consent with the participant and document the

receipt of the signed Telehealth Agreement and Informed Consent in the participants

CPRS record.

Creating Group Video Visits

1. Ensure you have a group clinic. VVC CG GROUP SW (or similar) with

primary stop code of 192 and secondary stop code 720

2. On the left-hand side of screen, click create unenrolled group video visit

3. Select radio button for group of Veterans (caregivers)

4. Enter date, time, duration

5. Ensure provider information is correct

6. Enter name of group

7. Select edit group

8. Add Veterans/caregivers by searching for their name

9. Select correct Veteran/caregiver

10. Ensure Veteran/caregiver email is correct

11. Select add/update Veteran button

12. Continue to search and add Veteran/caregivers until you have composed

complete list of all attendees (where it is noted that the VVC can have up to

30 participants, it may be best to follow clinical practice guidelines on group

size)

13. Click update at the bottom of the screen

14. Click create

An email will arrive with the video group visit information. You may join the visit through

the email link as you do for individual video visits.

Once all participants have entered, be sure to lock the virtual medical room.

Documentation

Be sure to use correct procedure codes for group face to face (97150 or S9446).

IMPORTANT: Document informed consent of using telehealth in the caregiver’s

collateral record.

How to handle an emergency in a telehealth/VVC group

Terminate the group. Provide support to the participant in need by following the steps

from Module 8 (as above).

Ending the Group Visit

Upon the completion of the group video visit, terminate the session in the same manner

you would in an individual video visit by selecting the red phone button and confirming

you would like to leave the visit.

Resources:

https://vaww.telehealth.va.gov/pgm/vvc/groups/index.asp

Module 12 – Conclusion

You will discover that VA Video Connect (VVC) is a modality that can simplify your day

to make your job easier. You will save time by reducing travel and effort for yourself.

You will save the Veteran/caregiver time and stress of others entering the home for a

visit. It is also easy to schedule appointments and complete your documentation.

By using VVC, you are creating an encounter that will be more personal and more

informative for you as a clinician. You will observe more information from your Veterans

and/or caregiver using visual cues captured during each encounter that you would not

be able to observe from a telephone check-in, such as:

• The affect of both Veteran and caregiver such as restlessness, fidgeting,

repetitive movements, flat affect, facial expressions and more

• Attention to personal hygiene

• Signs indicating health status (appearance of skin, skin color, physical signs of

injury or illness)

• Gaze of eyes (looking away from camera, looking down, eye avoidance)

• Volume of speech, pace of speech

• Weight changes

• Sleep indicators (do your caregivers/Veterans look tired?)

• Level of engagement and willingness to connect with clinician

• Veteran/caregiver living conditions and environment (clutter, cleanliness, safety)

• You can ask about the Veteran’s medications and can get a visual of all

medications and nutritional supplements if you have a concern

• You can ask about prosthetic devices and what is helping to promote safety and

independent functioning (are devices being utilized, are they in good condition,

are there devices that might be needed?)

As a front-line clinician, you may be influential in helping Veterans feel comfortable

requesting VVC for other clinical services. Leadership listens to the “voice of the

customer.” When Veterans advocate for services, they increase the likelihood of getting

the right care at the right time, in a convenient place. This is especially true for

Veterans and caregivers:

• Who live in Rural areas

• Who must travel a long distance to get their medical care

• Who are elderly and have problems with mobility or cognition

• Who have medically complex or catastrophically disabled conditions

• Who work full time

• Who are Caregivers to their parents, their spouse or their child and cannot leave

them

We are at the forefront of using VVC and have the ability to expand our reach and

services to meet the needs of our Veteran/caregiver dyads while still providing

exceptional care.

Resource:

https://www.va.gov/anywheretoanywhere/docs/Telehealth_Services_factsheet.PDF

VA Telehealth Services. Retrieved January 14, 2020

Created By:

Hollie-Lyn James, Workgroup Lead

Gulf Coast VA HCS

Pamela Wright, KDM Executive Champion

CSP National Office

Marren Grant, Consultant

Office of Rural Health

Rebecca Bixler, Caregiver Support Coordinator

Sioux Falls VAMC

Lizzette Grecia, Caregiver Support Coordinator

Perry Point VAMC

Christy Pargeter, Caregiver Support Coordinator

Oklahoma City VAMC

Additional Contributors:

Jamie Da Pos, Caregiver Support Coordinator

Pittsburgh VAMC

Teresa Lanier, Caregiver Support Coordinator

Gulf Coast VA HCS

Lashanta Dorsey, Caregiver Support Coordinator

Houston VAMC

Bret Hicken, Consultant

Office of Rural Health

Christopher Turner, Consultant

Office of Rural Health