The document discusses Veteran engagement with electronic health technologies at the Veterans Health Administration (VHA). It provides an overview of VHA's use of connected health technologies like telehealth, My HealtheVet, and mobile apps to improve care delivery and patient engagement. It outlines VHA's goals of expanding the use of these technologies through new mobile and web-based tools that allow real-time access to health information and communication with providers.
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Veterans engagement with electronic health technologies jhu -evans 3.12.14 v final
1. Veteran Engagement
with Electronic Health Technologies
MARCH 12, 2014
Neil C. Evans, MD
Co-Director, Connected Health
Office of Informatics and Analytics, Veterans Health Administration
7. VETERANS HEALTH ADMINISTRATION
8.93 Million VA Health Care System Enrollees***
6.84 Million VA Supervised & Administered Life Insurance Policies* *
3.66 Million Veterans Receiving VA Disability Compensation * *
3.31 Million VA Maintained Gravesites * **
1.87 Million Active VA Home Loan Participants * *
950,000 VA Education Beneficiaries * *
300,000 Veterans Receiving VA Pension * *
300,000
VA Vital Statistics
7
131
VA National
Cemeteries
56
VBA
Regional
Offices
1,600+
VA Health
Care Sites *As of FY 2012
**As of 6/30/13
***As of FY 2013
Veteran family members receiving care
through VA health care programs***
8. VETERANS HEALTH ADMINISTRATION
Hospital System to Health System
In 1996, VA began the creation of Veterans Integrated
Service Networks (VISNs) to transform VA Health Care
from a “Hospital System” to a “Health System.”
VHA currently has 21 VISNs.
•135 Community Living Centers
•300 Vet Centers
•151 Medical Centers
•985 Outpatient Clinics
820 Community-Based
151 Hospital-Based
8 Mobile
6 Independent
•103 Domiciliary Residential
Rehabilitation Programs
8
•70 Mobile Vet Centers
Source: FY 2012-2013 End-of-Year Pocket Card
9. VETERANS HEALTH ADMINISTRATION
Vision:
VHA will continue to be the benchmark of excellence and
value in health care and benefits by providing exemplary
services that are both patient-centered and evidence-based.
This care will be delivered by engaged, collaborative teams
in an integrated environment that supports learning,
discovery and continuous improvement.
It will emphasize prevention and population health and
contribute to the Nation’s well-being through education,
research and service in national emergencies.
VHA’s Mission and Vision
9
Mission:
Honor America’s Veterans by providing exceptional
health care that improves their health and well-being.
10. VETERANS HEALTH ADMINISTRATION
VHA Principles
10
VHA’s principles are the philosophical pillars that are
embedded in VHA’s vision. They are embodied in our
goals, objectives, and every initiative undertaken.
Data-Driven/Evidence Based
Patient Centered
Providing Value
Continuously Improving
Team Based
Prevention/Population Health
11. VETERANS HEALTH ADMINISTRATION
VHA’s Current Priorities
• Patient Aligned Care Teams (PACT)
• Connected Health Care
• Access
• Homelessness
• Mental Health Care
• Standardization
11
12.
13. VETERANS HEALTH ADMINISTRATION
Connected Health
• VA: Connected Health is defined as extending the reach of healthcare, empowering
patients, and supporting healthcare teams through virtual systems of care
• Connected Health is powered by consumer health technologies that engage
patients and connect them to their health care teams, enabling the extension of
the health care relationship beyond the traditional in-person synchronous
encounters that for so long have been the centerpiece of patient/provider
interactions.
• Wikipedia: Connected health is a model for healthcare delivery that uses
technology to provide healthcare remotely. Connected health aims to maximize
healthcare resources and provide increased, flexible opportunities for consumers to
engage with clinicians and better self-manage their care. It uses technology – often
leveraging readily available consumer technologies – to deliver patient care
outside of the hospital or doctor's office. Connected health encompasses programs
in telehealth, remote care (such as home care) and disease and lifestyle
management, often leverages existing technologies such as connected devices
using existing cellular networks and is associated with efforts to improve chronic
care.
15. VETERANS HEALTH ADMINISTRATION
VA Connected Health
VA is aligning virtual care technologies to create a seamless, unified
experience for Veterans.
VA’s virtual care technologies include:
• Clinical Video Telehealth
• Home Telehealth
• Store and Forward Telehealth
• Telemental Health
• Mobile Health
• My HealtheVet
• Secure Messaging
• SCAN-ECHO
• Mobile Apps
• VA Point of Service Kiosks
17. VETERANS HEALTH ADMINISTRATION
Connected Health Technologies Year Started Estimated Veterans
Served in 2013
Home Telehealth 2003 144,250
Clinical Video Telehealth 2002 202,823
Store & Forward Telehealth 2000 311,369
eConsults 2010 257,949
SCAN-ECHO 2011 1,632
My HealtheVet 2003 2,487,000
Blue Button 2010 881,000
Secure Messaging 2008 795,000
Veteran Mobile Apps 2013 Field testing
Staff Mobile Apps 2013 Field testing
Veteran Point of Service Kiosks 2010 >4M transactions
VA Connected Health
18.
19. VETERANS HEALTH ADMINISTRATION
Scope of VA Telehealth Services
19
Clinical Video Telehealth (CVT)
Real-time video consultation that covers 44 clinical specialties including: Tele-
Intensive Care, TeleMental Health, TeleCardiology, TeleNeurology, TeleSurgery,
Women’s Telehealth, Tele-Primary Care, TeleSCI care, TeleAmputation Care,
TeleAudiology, Remote Nursing Home Consultation, TelePathology, etc.
Home Telehealth (HT)
Care and case management of chronic conditions and provision of non-institutional
care support to patients. Uses in-home and mobile technologies to manage
diabetes, chronic heart failure, hypertension, obesity , head injury, depression, etc.
Store and Forward Telehealth (SFT)
TeleRetinal Imaging, TeleDermatology, TeleWound Care, TeleSpirometry, Tele-Sleep
Studies TeleCardiology.
20. VETERANS HEALTH ADMINISTRATION
VHA Telehealth Services: Outcomes
20
Reductions in Utilization FY 2012
Home Telehealth - reduces bed days of care – 58%
Home Telehealth – reduces hospital admissions – 38%
Clinical Video Telehealth – reduces bed days of care 56% for mental health care
Patient Satisfaction
Home Telehealth - 85% mean score
Store-and-Forward Telehealth –96% mean score
Clinical Video Telehealth - 93% mean score
Travel Reduction Savings
Clinical Video Telehealth – $34.45 per consultation
Store and Forward Telehealth - $38.81 per consultation
Home Telehealth Savings
$1,999 per annum per patient
22. VETERANS HEALTH ADMINISTRATION
My HealtheVet
A personal My HealtheVet account provides
Veterans with 24/7 online access to a variety of
tools to manage their health care.
Communicate with
Participating Patient
Aligned Care Team
Members
View Appointments
and Health
Information
Refill Prescriptions Download and Share
Personal Health
Record
22
www.myhealth.va.gov
23. VETERANS HEALTH ADMINISTRATION 23
www.myhealth.va.gov
• More than 107 million visits
• Over 2.5 million registered users
• More than 1.3 million users have a
Premium (authenticated) account
• Over 47.3 million VA prescription
refills since August 2005
• More than 918,000 unique VA
Blue Button users since August 2010
• More than 5.2 million VA Blue
Button file downloads
• More than 843,000 VA patients
opted in to use Secure Messaging
My HealtheVet Statistics
(as of November 2013)
24. VETERANS HEALTH ADMINISTRATION
• VA Prescription Refill(s)
• VA Prescription Refill History
• Self-entered medication(s),
herbal(s), over-the-counters
(OTCs) and supplement(s)
• VA Medication(s) List*
• My Complete Medications
List (VA and self-entered)*
More than 47.3 million VA prescription
refill requests since launched in August
2005
Encouraging VA patients to play an
active role in the medication
reconciliation process
*Requires Advanced account.
My HealtheVet: Pharmacy
Veterans’ Top Request for Online Services
24
36. VETERANS HEALTH ADMINISTRATION
Goals of VA Mobile Health
• Focus on health by engaging patients and Caregivers outside
of traditional health care visits
• Improve data sharing to increase the value of communication
• Increase health care provider efficiency and satisfaction
36
37. VETERANS HEALTH ADMINISTRATION 37
PTSD* Coach
*Post-Traumatic Stress Disorder
More 80,000 downloads in 70 countries
VA’s Office of Mental Health began VA Mobile App
development with “stand alone” apps
VA’s Mobile Health Program Office focuses on Mobile Apps
that connect into VA data systems
38. VETERANS HEALTH ADMINISTRATION
VA Mental Health Apps
38
VA Mental Health Apps
38
Available on iTunes
Apps are native and do not connect to VA
39. VETERANS HEALTH ADMINISTRATION
Washington, DC VA Medical Center Pilot
Summary of Care App – Lab Results
• Significant desire
for access to a
robust set of
clinical data
• High levels of
enthusiasm for
mobile tools
• Usability/security
issues
• No lack of ideas for
customized
workflow-focused
Apps
39
40. VETERANS HEALTH ADMINISTRATION
VA Mobile Strategy Timeline
2011 2012 2013
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
PROVIDER/STAFF MOBILE CAPABILITIES
VETERAN FACING MOBILE APPLICATIONS
CENTRAL MOBILE DEVICE MANAGEMENT AND CLOUD HOSTING
New Cloud MDM
Begin VA Mobile - Interim MDM - Initial Cap 1500 Mobile Devices
Mobile
Validation
Field Enterprise App Library
Dedicated Cloud Environment Hosting – FISMA High Impact Certified
Mobile App Development Environment
Security Test and Certification Authority to Operate (ATO)
Certification and Governance
Veteran Mobile Credentialing Services
Delegation Authorization
Family Caregiver Pilot
Caregiver Evaluation Study
More Apps
Provider
Mobile Pilot Mobile Display of Patient Data
Mobile Imaging
Nursing Apps
Mobile Browser Pilot
Scheduling App
40
42. VETERANS HEALTH ADMINISTRATION
Mobile Application Environment
• Standardizing
Apps and their
development;
Reducing Costs
• Common Dev
Tools
• Common Services
& Software
Library
• Dev Knowledge
Base
• Development &
Production
Environments
42
43. VETERANS HEALTH ADMINISTRATION
VA Mobile App Certification Process
Requirements
Business Ownership Commitment
Aligned with VA Business Objectives
Sustainment Plan
Usability Testing
VA Branding
Data and Terminology Standards Compliance
Security
Privacy
System Performance Impact Assessment
Patient Safety Assessment & Functional Testing
508 Accessibility
Clinical Review for Medical Apps
Help Screens
Software Quality Assurance
ALL VA Apps must be
certified before posting
on App stores
43
44. VETERANS HEALTH ADMINISTRATION
Mobile Health Development Strategy
44
Build Apps at HTML5 so they will work on mobile browsers across
platforms and on desktop browsers
46. VETERANS HEALTH ADMINISTRATION
Clinicians Interested in Using Mobile Apps
• 89 percent of primary care and internal
medicine physicians use smartphones to
communicate with other hospital staff
• 51 percent of clinicians use smartphones
to reference health information
• 83 percent of clinicians would immediately
utilize mobile EHR Apps to update patient
charts, check labs and order medications if
their current EHR vendor made those
features available for mobile
– Only eight percent currently use a
mobile device for these functionalities
46
Source: Black Book Rankings, May 2013
Source: HIT Consultant
51. VETERANS HEALTH ADMINISTRATION
Does someone in your family
have a working cell phone?
Do you use the Internet?
Do you access the Internet
through a Cellular Network?
Have you downloaded
Health-related information
to your phone?
0
10
20
30
40
50
60
70
80
90
100 91
65
21
10
92
73
30
12
92
76
40
11
Veterans enrolled in VA
Veterans not enrolled in VA
Non-Veterans
Veteran Mobile Device Access
51
2012 Health Information National Trends Survey
52.
53. Expert Care and Self Care
Information Sharing
Transactions
Communications
54. VETERANS HEALTH ADMINISTRATION
Veteran-Facing VA Mobile Apps
In Pilot Testing
• Family Caregiver Suite of Apps
• Veteran Appointment Request App
• My Story
• Mobile Blue Button
Soon-to-be Released
• Summary of Care
• Mobile Blue Button
• LaunchPad
54
55. VETERANS HEALTH ADMINISTRATION
Family Caregiver Mobile Health Pilot
• Cohort: Seriously Injured post-9/11
Veterans and their Family
Caregivers in the VA’s Family
Caregiver Program
• Suite of Apps designed based on
needs of Caregivers and Veterans
• iPads loaded with Apps loaned to
Caregivers for one year
August
2012
Mailing to Notify of
Selection, Request
Loaner
Agreement, Invite into
Study
1,200 Caregivers
Responded “Yes”
Distribute 800+
iPads
Mailing to
4,000+ Caregivers
September
2012
November
2012
May
2013
Timeline
55
56. VETERANS HEALTH ADMINISTRATION
Family Caregiver Apps
56
1) Pain Coach – Supports Pain Management
2) Care4Caregiver – Supports Caregiver Stress
3) Journal – Record Vitals/Exercise/Food/Contacts
4) RxRefill – Refill Prescriptions
5) Summary of Care – Display Data from HER
6) PTSD Coach – Supports PTSD management
7) Health Advocate – Allows Veteran to Designate a Health Advocate
8) Notifications and Reminders – Sets Medication Reminders and
Receive Notifications from Health Care Team
57. VETERANS HEALTH ADMINISTRATION
Login
• Uses Department of
Defense LogOn (DS
LogOn) credentials.
• Delegation App will
allow Veterans to
authorize sharing of
their VA clinical data
with Family
Caregivers using DS
LogOn credentials.
57
59. VETERANS HEALTH ADMINISTRATION
• Medications
• Labs
• Problem List
• Radiology Reports
• Progress Notes
• Demographics
• Vitals
Summary of Care App Displays EHR Data
59
63. VETERANS HEALTH ADMINISTRATION
Family Caregiver Mobile Health
Evaluation Study
Primary Quasi-Experimental Study
• Caregiver burden levels and Veterans Health Care utilization
Longitudinal Cohort Study
• How does exposure to apps relate to outcomes
• Statistical model to predict utilization of apps
Qualitative Study
• Phone interview with high and low app users
63
64. VETERANS HEALTH ADMINISTRATION
VA Family Caregiver Pilot
Characteristics of iPad Recipients
• 879 iPads distributed
• Average age (of both Caregivers and Veterans) – 40 years old
• 95% of caregivers are female
• 90% are spouses of the Veterans
• Majority of Veterans are rated with a service-connected
disability of 80% or greater
– PTSD
– Nerve/Fracture related injuries
– TBI
• 60% Urban, 40% Rural
64
66. VETERANS HEALTH ADMINISTRATION
Unique Users by Month by App
66
0
200
400
600
800
1000
1200
1400
1600
630 Caregiver/Veteran diads (72%) have used
at least one of the ten apps in the suite.
67. VETERANS HEALTH ADMINISTRATION
Family Caregiver Pilot App Utilization
67
0
100
200
300
400
500
600
700
Jun Jul Aug Sep
Number of Unique Users per Month
69. VETERANS HEALTH ADMINISTRATION
VA Family Caregiver Pilot –
Preliminary analysis
Significant Predictors of Mobile Health App use include the
following
• Veteran Age – Mobile Health App use decreases with
increases in the age of the Veteran.
• Caregiver-Veteran relationship – Odds of use increase if
caregiver is a spouse of the Veteran.
• Urban/Rural – Odds of use increase if the Veteran lives in a
rural location.
• Mental Health Diagnosis – Odds of use increase of if the
Veteran has a mental health diagnosis.
69
70. VETERANS HEALTH ADMINISTRATION
Veteran Appointment Request App
• Allows Veterans to request
appointments for primary
care and mental health care
using a Mobile App
– Includes Mobile App-
specific to both the
Veterans and Appointment
Clerk’s needs
– Mobile Web App can be
used on multiple mobile
devices or from desktop
– Pilot includes more than
600 Veterans at
Washington, DC and Palo
Alto VAMCs
70
71. VETERANS HEALTH ADMINISTRATION 71
MyStory App (Personal Health Inventory)
• Allows Veterans to identify
what is most important to
them in terms of life and
wellness goals to achieve
those goals
– Provides ability for Veterans to
share information with their
support teams (e.g., VA health
care team, family and friends,
life coach, support group,
personal trainer, etc.)
– Three-month pilot includes 30
Veterans at North Chicago, East
Orange, Fayetteville (NC),
Denver, West Los Angeles,
Salisbury and Columbia VAMCs
73. VETERANS HEALTH ADMINISTRATION
New Veteran-Facing Mobile Apps in
Development
• Text Messaging Program (Annie)
• Patient Personal Health Plan
• Women’s Health
• Mission Health (Gaming App)
• Wellness Check (Bio-surveillance Reporting)
• Pre-visit Agenda and Post-Visit Plan
• Cardiac Rehabilitation
• Chronic Kidney Disease
• VA Benefits App
73For more information, visit http://mobilehealth.va.gov
74. VETERANS HEALTH ADMINISTRATION
What we have Learned
• Barriers to Use
–Low computer literacy
–Access problems with credentials
• Facilitators to Use
– Availability of support
– Easy to use interface
– Knowledge that Healthcare Team is involved
– Trusted Invitation to Participate
74
75. VETERANS HEALTH ADMINISTRATION
Critical Factors for Success
• Senior leadership commitment to “care at a distance”
• Intelligent design and implementation
– User-centered development and design
– Ease of use!!!
– Integration with core IT systems and data
– Accounts for provider and patient workflows
– Informed by pilots, with rapid-cycle corrections
– Adequately resourced implementation
• Effective Communication to patients about the value of these technologies
– Extension of the relationship
– Personal invitation to participate
• Accessible user support and low barrier to entry
75
76. VETERANS HEALTH ADMINISTRATION
Contact Information
76
Neil C. Evans, MD
Co-Director, Connected Health (Clinical Director)
Department of Veterans Affairs
Washington, D.C., USA
Neil.Evans@va.gov
VA Mobile Health Website
http://mobilehealth.va.gov
As the nation braced itself for the final throes of the Civil War, thousands of spectators gathered on a muddy Pennsylvania Avenue near the U.S. Capitol to hear President Lincoln’s second inaugural address. It was March 4, 1865, a time of great uneasiness. In just over one month, the war would end and the president would be assassinated. President Lincoln framed his speech on the moral and religious implications of the war; rhetorically questioning how a just God could unleash such a terrible war upon the nation. “If we shall suppose that American slavery is one of those offenses in the providence of God, ... and that He gives to both North and South this terrible war as the woe due to those by whom the offenses came.” With its deep philosophical insights, critics have hailed the speech as one of Lincoln’s best. As the speech progressed, President Lincoln turned from the divisive bitterness at the war’s roots to the unifying task of reconciliation and reconstruction. In the speech’s final paragraph, the president delivered his prescription for the nation’s recovery: “With malice toward none, with charity for all, with firmness in the right as God gives us to see the right, let us strive on to finish the work we are in, to bind up the nation’s wounds, to care for him who shall have borne the battle and for his widow, and his orphan, to do all which may achieve and cherish a just and lasting peace among ourselves and with all nations.” With the words, “To care for him who shall have borne the battle and for his widow, and his orphan,”President Lincoln affirmed the government’s obligation to care for those injured during the war and to provide for the families of those who perished on the battlefield. Today, a pair of metal plaques bearing those words flank the entrance to the Washington, D.C. headquarters of the Department of Veterans Affairs (VA). VA is the federal agency responsible for serving the needs of veterans by providing health care, disability compensation and rehabilitation, education assistance, home loans, burial in a national cemetery, and other benefits and services. Lincoln’s immortal words became the VA motto in 1959, when the plaques were installed, and can be traced to Sumner G. Whittier, administrator of what was then called the Veterans Administration. A document on VA medical history prepared for the congressional Committee on Veterans’ Affairs and titled, “To care for him who shall have borne the battle,” details how the words became VA’s motto. “He (Whittier) worked no employee longer or harder than himself to make his personal credo the mission of the agency. What was that credo? Simply the words of Abraham Lincoln, to care for him who shall have borne the battle and for his widow, and his orphan. To indicate the mission of his agency’s employees, Mr. Whittier had plaques installed on either side of the main entrance.” President Lincoln’s words have stood the test of time, and stand today as a solemn reminder of VA’s commitment to care for those injured in our nation’s defense and the families of those killed in its service.
ID:04Created 11/4/13Source: http://www.va.gov/vetdata/docs/Quickfacts/Stats_at_a_glance_06_30_13.pdf http://www.va.gov/vetdata/docs/Quickfacts/Summer_13_sharepoint.pdfAdded Veteran family members on 12/19/13 with info from 10NA Updated Enrollees on 1/9/14 to reflect FY 2013 4th Quarter pocket card: http://vaww.va.gov/VHAOPP/vast3.asp
ID:07Created for VHA Overview Version 1.6/13/2011Updated 1/9/2013 to reflect FY 2013 4th Quarter pocket card: http://vaww.va.gov/VHAOPP/vast3.asp(rounded to nearest tenths place)Approximately 3.1 million Veterans enrolled in VA health care live in rural areas.
ID:24Created 11/4/13
ID:25Created for VHA Overview Version 2.7/18/2011Edited 1/10/2013 Modified 11/4/13
ID:27Created by LGaegler on 9/30/13
VA: Connected Health is defined as extending the reach of healthcare and empowering patients and supporting healthcare teams through virtual systems of careAlternate: Consumer health technologies that empower patients and connect them to their health care teams, enabling the extension of the health care relationship beyond the traditional in-person synchronous encounters that for so long have been the centerpiece of patient/provider interactions.Wikipedia: Connected health is a model for healthcare delivery that uses technology to provide healthcare remotely. Connected health aims to maximize healthcare resources and provide increased, flexible opportunities for consumers to engage with clinicians and better self-manage their care. It uses technology – often leveraging readily available consumer technologies – to deliver patient care outside of the hospital or doctor's office. Connected health encompasses programs in telehealth, remote care (such as home care) and disease and lifestyle management, often leverages existing technologies such as connected devices using existing cellular networks and is associated with efforts to improve chronic care.
The collection of technologies that enable the extension of the health care relationship beyond the traditional in-person synchronous encounters that for so long have been the centerpiece of patient/provider interactions.Connected Health technologies include telehealth, telemedicine, patient portals, mobile health applications (mHealth), wearable monitoring devices and other technologies that connect patients to their health care team or health resources.
William Osler – ““To know what has to be done, then do it, comprises the whole philosophy of practical life.”Some Future Planned CapabilitiesUniversal easy access to patient-facing applications for Veterans and CaregiversAllow Veterans to request appointments over the InternetEnable video visit capabilitiesImprove VA’s secure messaging capabilityCreate text messaging capability for disease management supportContinue development of patient-facing disease management support appsSupport Veteran self-care through data collection and sharing from monitoring devicesDevelop a pre-visit agenda and post-visit plan applicationDevelop a personal health profile and plan Establish a standardized process for collecting and storing patient-entered dataEstablish a standardized process for sharing patient-generated dataCreate a virtual health portal for staffDevelop staff-facing web/mobile apps Establish an infrastructure to support distributed app development Foster the development of innovation with internal and external stakeholdersCreate an outreach and communications strategy for partnering with internal and external communities and stakeholders
Forty-five percent of these patients lived in rural areas, and may otherwise have had limited access to VA health care; the number of Veterans receiving care via VA’s telehealthservices is growing approximately 22% annually.In FY2013, 144,520 Veterans enrolled for VA home telehealth services, 41,430 of those patients were supported by Home Telehealth to live independently in their own homes, patients who otherwise would have needed long-term institutional care.
Reductions and Satisfaction data from FY12 Telehealth Services’ Report Card in FY12, for 1,439 TMH patients, There was a 30% reduction in admissions in home telemental health in their first six months of care when reviewed to a comparative period of time before enrollment. This resulted in a 56% reduction (-3,026 days) bed days of care (BDOC). Source routine VA HT outcome data. Travel reductions savings and HT savings calculated by ARC
82 million+ visits2 million+ registered users686,000 Veterans have downloaded data569,000 Veterans use Secure Messaging36 million prescription refills
ID:34Created for VHA Overview Version 1.6/13/2011Updated with url on 12/27/13
Veterans served in FY2013: 801,849In FY 2013, VA expanded its use of Secure Messaging in:Primary CareSpecialty CareSurgical CareIn FY 2013, VA launched Secure Messaging in:Mental HealthDentistryRehabilitationProsthetic Services
VA Mobile aims to improve the health of Veterans by expanding care beyond traditional settings. VA mobile applications (Apps) deliver evidence-based tools and connections to health data and VA care teams while on-the-go. Patient-Centered Care: Providing Veterans with additional opportunities to become active partners in their health care. Data Mobility: Providing opportunities for VA’s health care teams to more easily engage with and empower Veterans and Caregivers in the management of their health and well-being. Pilot programs are used to evaluate how Apps increase convenient access to health care, improve patient engagement and strengthen communication among Veterans, Caregivers and VA clinicians. The Apps support a range of health care management tools, facilitate day-to-day administrative tasks and expand education and communication. Pilot programs allow VA to gather user feedback, allowing for corrections and enhancements. For more information, visit mobilehealth.va.gov.
Empower Veterans to have more control over their personal and medical information and gives them the capability to ensure their information is current and accurate.Allow Veterans to view upcoming appointments, update personal information, review insurance information and check their account balances.Increase convenience and improve the check-in process.
Scan-Echo: Specialty Care Access Networks-Extension for Community Healthcare OutcomesIn many rural and remote areas, Veterans and their primary care providers do not have easy access to specialty care services and expertise. VA is using video teleconferencing to increase access to specialty care for Veterans in rural and medically underserved areas. SCAN-ECHO links several primary care providers, many of whom are in different rural communities, simultaneously enabling rural primary care clinicians to gain the knowledge needed to provide care that was not previously available in their communities. It also enables Veterans with chronic conditions requiring complex care to get the medical care they need. In FY 2013, SCAN-ECHO served more than 1,600 Veterans.
Inform Me (Inform and Attract) Engage Me (Retain and Interact) Empower Me (Partner Efficiently) Partner with Me (Create Synergy and Extend Reach) Support my e-Community.William Osler – ““The search for static security – in the law and elsewhere – is misguided. The fact is security can only be achieved through constant change, adapting old ideas that have outlived their usefulness to current facts.”William Osler – ““The good physician treats the disease; the great physician treats the patient who has the disease.”New Blue Button Features in 2013More timely access to information (reduced ‘hold periods’ for several VA data classes from 7 calendar days to 3 calendar days). These changes were also made to the VA CCD in the My HealtheVet 12.5.1 Release on July 2, 2013Expansion of the types of self-reported information that all registered users can include in their VA Blue Button: My Goals (Current Goals/Completed Goals)Improved performance for the Blue Button data refresh processEnhanced data refresh status message with link to a user friendly description to enhance understandingEnhanced user interface which includes information about business rules for VA data classesImproved user message when no records match selection criteriaMinor formatting improvements for Blue Button output(See the release notes and sample files posted on our Resources page)
External organizations are deploying Connected Health technologies of varying maturities across four different categories
Mobile Apps will be using the DOD DS Log On credentials.
Primary Quasi-Experimental Study:Changes in Caregiver burden Levels extracted from chart reviewsVA collects Caregiver burden levels quarterly during home visits using Zarit Burden InventoryChanges in Veteran Healthcare Utilization VA Hospital Admission RatesVA Emergency Department Visit RatesVA Provider Visit RatesOutpatient Appointment No-show RatesLongitudinal Cohort Study:How does exposure to apps relate to changes in Caregiver Preparedness & Burden LevelsCaregiver and Veteran Factors predicting App Frequency of UseQualitative Study:Phone interviews with High and Low App Users to find out why use variedWhy is this important? The pilot evaluations inform next steps in VA’s roll out of a suite of Mobile Health resources and ensures that all technologies developed best meet the needs of Veterans, Caregivers and clinicians.
Characteristics of iPad Recipients The VA distributed 879 iPads to Caregivers in the VA’s Family Caregiver Program. The average age of both the Caregivers and Veteran recipients is 40 years old. The majority of the Caregivers are female (95%) and spouses of the Veterans (90%). The majority of the Veterans are rated with a service-connected disability of 80% or greater and the most common conditions are PTSD, Nerve/Fracture related injuries and TBI. The recipients are split pretty evenly between urban locations (60%) and Rural locations (40%). VA Mobile App Use The VA created a suite of ten apps for the Family Caregiver mobile health pilot. Seven of these apps were designed to support patients and Caregivers in the self-management of their health. 630 Caregiver/Veteran diads (72%) have used at least one of the ten apps in the suite. The most commonly used app is the Summary of Care app, which displays information from the VA’s electronic medical record. Preliminary analysis shows that significant predictors of Mobile Health App use include: Veteran Age, Caregiver-Veteran relationship, Urban/Rural living location and a Veteran Mental Health diagnosis. Specifically …The odds of using a Mobile Health App increases if the Caregiver is a spouse of the Veteran, if the Veteran lives in a rural location and if the Veteran has a mental health diagnosis. Mobile Health App use decreases with increases in the age of the Veteran.More analysis will be forthcoming on the impact of the suite of VA mobile health apps on Caregiver burden and Veteran healthcare utilization.
630 Caregiver/Veteran diads (72%) have used at least one of the ten apps in the suite.