Nationwide Interdisciplinary E-Consultation on Transgender Care in the Veterans Health Administration

Background: Veteran's Health Administration (VHA) requires the provision of quality transgender care for the relatively large number of transgender veterans using VHA services. Introduction: The Office of Patient Care Services has taken a multimethod approach to improving provider knowledge and skill for transgender veteran care. However, unique patient-specific questions can arise. Thus, VHA implemented a 3-year feasibility program to determine if nationwide interdisciplinary e-consultation can offer veteran-specific consultation to providers who treat transgender veterans in VHA. Materials and Methods: Launch of this program is described along with use to date, types of questions submitted by providers, and length of time to complete a response in the veteran's electronic medical record. Results: In 17 months, the program responded to 303 e-consults, with consultation provided on the care of 230 unique veterans. Nationwide coverage was achieved 1 year after the launch of the program. Common consult questions have been about medications, including hormones ( n = 125); primary care concerns ( n = 97); mental health evaluations ( n = 63); and psychotherapy ( n = 18). Consistent with the interdisciplinary model, multiple disciplines typically responded to each consult ( x = 2.27). Average time to completion of a consult was 5.9 calendar days (range = 2.4–7.7 days). Discussion: VHA has established a nationwide interdisciplinary e-consultation program. Additional outreach about the program will be needed if funding is continued. Conclusions: E-consultation on transgender health within VHA is feasible and complements the suite of trainings offered within VHA. Other healthcare organizations may benefit from a similar program.