Background

The national Tele-Rheumatology Enterprise-Wide Initiative (EWI), funded by the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Office of Rural Health (ORH), began in Fiscal Year (FY) 2024 to address a serious shortage of rheumatologists in rural and underserved areas. Many Veterans with arthritis and autoimmune conditions had long waits and long travel distances for specialty care.

Using advanced telehealth tools and geospatial mapping, the Tele-Rheumatology EWI brings expert rheumatology services directly to rural Veterans, helping them receive specialty care closer to home. The program is designated as a National Telehealth Hub for Tele-Rheumatology under VHA Directive 1915, which streamlines referrals and supports rapid deployment of services.

In its first year, the EWI became operational and expanded to seven facilities, with plans to add five to eight more in FY 2025. Wait times for rheumatology appointments have dropped from months to weeks, and Veterans report high satisfaction with reduced travel and faster scheduling. Patient surveys and other feedback tools are used to track program success.

Goals and Objectives

The Tele-Rheumatology EWI is guided by several core goals and objectives:

• Rapid service initiation: Start providing tele-rheumatology care quickly, especially in high-need areas.
• Shorter wait times: Reduce wait times for rheumatology visits at participating facilities.
• Strategic facility enrollment: Use geospatial data to identify and enroll facilities with high community care costs and poor access to rheumatologists.
• Cost savings: Lower spending on community care while maintaining high-quality specialty services.
• Evaluation metrics: Build a clear system of performance measures and data collection to monitor and improve the EWI.
• Teaching modules: Work with the VA Institute for Learning, Education and Development (ILEAD) to create standardized tele-rheumatology training for new staff and sites.
• Best practices: Develop and update best practices based on clinical evidence, patient feedback, and team experience.
• Workforce well-being: Improve work–life balance and reduce burnout risk for remote staff through collaboration with the AIM-HI workforce development initiative.

Methodology

The Tele-Rheumatology EWI uses a structured approach to expand and sustain services.

• Rapid launch: A dedicated implementation team uses streamlined scheduling, centralized training, and close stakeholder collaboration to start services quickly.
• Wait-time management: Efficient scheduling systems and real-time monitoring of wait times support timely adjustments in staffing and appointment slots.
• Facility enrollment: Outreach targets facilities with the highest need. A standard onboarding process and ongoing support help new sites join smoothly.
• Cost tracking: Program expenses and community care referrals are tracked and analyzed to identify savings and guide resource use.
• Patient feedback: Surveys collect information on Veteran experience. Results are reviewed regularly, and concerns are addressed promptly.
• Performance metrics: Key indicators—such as access, wait times, satisfaction, and cost—are collected and reviewed on a regular schedule.
• Training materials: Clinical and education experts work with ILEAD to produce videos, interactive modules, and written guides on technical setup and virtual examination skills.
• Best-practice review: A working group conducts literature reviews and encourages team members to suggest and test process improvements.
• AIM-HI participation: Program leaders and staff complete AIM-HI training and use a relational playbook to strengthen communication and teamwork.

Impact on Rural Veteran Health

The Tele-Rheumatology EWI has significantly improved care for rural Veterans with rheumatic diseases by expanding specialty access and reducing delays.

• Telehealth and a hub-and-spoke model connect rheumatologists at central hubs with Veterans at rural clinics, cutting wait times from months to weeks.
• Veterans in remote locations, such as Central Iowa and Fayetteville, Arkansas, can now receive expert consultations close to home, often without needing full-time local specialists.
• Shared care between tele-rheumatologists and local primary care providers improves continuity and coordination of treatment plans.
• Reduced travel saves time, lowers stress, and makes it easier for Veterans to attend follow-up visits, which supports better adherence to therapy.
• A small team of specialists can serve a wide geographic area, helping address workforce shortages and strengthening rural health care infrastructure.

Key Takeaways

• The Tele-Rheumatology EWI has greatly improved access to rheumatology care, cutting wait times from months to weeks and expanding services to 10 facilities across several Veterans Integrated Service Networks.
• Veterans report high satisfaction with reduced travel and faster scheduling, and improved access has helped increase adherence to treatment plans.
• The program reduces rural health disparities by offsetting specialist shortages and delivering care to previously underserved Veterans.
• Standardized lab and documentation protocols, efficient booking systems, and clear performance metrics have improved operational efficiency.
• Close collaboration between urban specialists and rural providers strengthens knowledge sharing and capacity across VA facilities.
• Data-driven planning—such as geospatial mapping and ongoing metric reviews—supports VA’s mission to provide high-quality care to all Veterans and highlights VA’s leadership in telehealth innovation.

Download the Printable PDF for Healthcare Providers and Researchers.

References

• VHA Directive 1915. Telehealth Resource Sharing Between Facilities. VHA Telehealth Services.
• American College of Rheumatology. 2015 Rheumatology Workforce Study: Supply and Demand Projections of Adult Rheumatology Workforce, 2015–2030.

Contact

• Program Contact: Bernard Ng, MD, Executive Director, National Rheumatology Program, Lexington VA Health Care System, Lexington, KY. Bernard.Ng@va.gov
• Funding Acknowledgement: Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, NOMAD #PRFY-00584.
• Suggested Citation: Ng, Bernard. (2025). Improving Rural Veterans’ Access to Rheumatology Care Nationwide. Department of Veterans Affairs, Veterans Health Administration. Washington, DC: Office of Rural Health.

Rural Health - Navigation

• Office of Rural Health Home page:
  https://www.ruralhealth.va.gov/index.asp
• Enterprise-Wide Initiatives (EWI) page:
  https://www.ruralhealth.va.gov/Enterprise-Wide-Initiatives-EWI.asp
• Veterans Rural Health Resource Centers (VRHRC) page:
  https://www.ruralhealth.va.gov/Veterans-Rural-Health-Resource-Center-VRHRC.asp