An approach to evaluating the impact of virtual specialty care: the Veterans Health Administration's clinical resource hub as case study

Objectives Telemedicine for specialty medical care is evolving from a COVID-19 pandemic-era requirement to an option for patients and clinicians alike, requiring evidence to guide optimal use of virtual specialty care. Heterogeneity across medical specialties complicates this evidence generation. To address this gap in the literature, we present an approach to evaluation of telehealth across specialties with the potential to generate findings generalizable across specialties and health systems.Materials and Methods We describe an approach to evaluation of virtual specialty care that balances widely generalizable metrics, such as patient and clinician satisfaction and avoided travel or cost, and those that are specialty-specific. We use the Veterans Health Administration (VA)'s Clinical Resource Hub program to illustrate potential applications of this approach.Results Clinical Resource Hub clinics leverage a hub-and-spoke model to deliver virtual care across many specialties, compensating for staffing shortages and expanding access to more specialized services not available at every VA site. Use cases for these clinics span the spectrum of short-term, episodic care to long-term substitution for a usual source of specialty care and offer opportunities to apply a range of evaluation metrics that generalize across telehealth use cases.Discussion Clinical Resource Hub clinics provide a variety of examples for this approach, demonstrating a path forward for virtual specialty care evaluation.Conclusion As the Clinical Resource Hub case illustrates, combining universal and specialty- or use case-specific metrics has the potential to build the evidence base for virtual specialty care. The COVID-19 pandemic accelerated the use of telemedicine, including virtual specialty care, but there is limited research on its effectiveness compared to in-person care. This perspective piece explores an approach to evaluating virtual specialty care, using the Veterans Health Administration's (VA) Clinical Resource Hub (CRH) as a case study. The CRH uses a "hub-and-spoke" model, where specialists provide remote care to patients in underserved areas, expanding access to services that may not be available locally. We propose a structured evaluation framework that includes both universal metrics, such as patient satisfaction, cost savings, and clinician experience, and specialty-specific measures tailored to different medical fields. This approach is based on the Quintuple Aim of quality of care, population health, cost reduction, clinician well-being, and health equity. By analyzing real-world examples, such as virtual cardiology, bariatric surgery, and oncology clinics within the CRH, the study demonstrates how virtual specialty care could be effectively assessed. This research provides a roadmap for future evaluations, helping healthcare systems optimize telemedicine services while maintaining high standards of care.