Connected Health at the Department of Veterans Affairs Kathleen L. Frisbee, PhDc, MPH Co-Director,...
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Transcript of Connected Health at the Department of Veterans Affairs Kathleen L. Frisbee, PhDc, MPH Co-Director,...
Connected Health at the Department of Veterans
AffairsKathleen L. Frisbee, PhDc, MPHCo-Director, Connected Health
OfficeOffice of Informatics and Analytics
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.
Source: FY 2012-2013 End-of-Year Pocket Card
• 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
• 70 Mobile Vet Centers
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$0.0
$20.0
$40.0
$60.0
$80.0
2011 2012 2013 2014
Appropriations Collections
VHA Budget Summary
$50.7 B $53.1 B $55.1 B
NOTE: Table includes funding transferred to Joint VA/DoD Medical Care Special Programs in 2011 and 2012.
$57.5 B
Advanced Appropriations:
$54.6B
Estimated Collections:
$2.93B
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FY 2013 End-of-Year Totals
Source: FY 2012-2013 End-of-Year Pocket Card
Enrollees………………………………………………………………......8.9 MillionUnique Patients Treated…………………………………............6.5 Million
Outpatient Visits………………………………………................86.4 MillionOutpatient Surgeries…………………………………………………..….292,600Inpatient Admissions…………………………………………….……….694,700
Lab Tests (Inpatient & Outpatient)………………………….…266 MillionPrescriptions Dispensed (30-Day Equivalent)……......268.6 MillionProsthetics Services Performed……………………..………..15.9 Million
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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
Mission: Honor America’s Veterans by providing exceptional health
care that improves their health and well-being.
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Next Step in VHA’s Transformation
By 2017, VHA aims to be nationally recognized as a leader for population health, improvement strategies, personalized care,
and maximizing health outcomes in a cost-effective and sustainable manner.
VHA Strategic Goals:1. Provide Veterans personalized, proactive, patient-driven health care2. Achieve measureable improvements in health outcomes3. Align resources to deliver sustained value to Veterans
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VA’s Health Care Expertise
VA is one of the largest civilian employers in the federal government and one of the largest health care employers in the world.
288,000+ Total VHA Employees
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VHA’s Current Priorities
Patient Aligned Care Teams (PACT)
Connected Health Care
Access
Homelessness
Mental Health Care
Standardization
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VA Connected Health
Aligning virtual care
technologies to create a seamless,
unified experience for
Veterans
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Importance of Connected Health Technologies
Video Visits
Global market for Video Visits is expected to increase tenfold by 2018, expanding into a $13.7 billion market
50% reduction in readmissions with Video visits/monitoring, a study found
Mobile HealthRemote Monitoring
Forecasted savings from remote patient monitoring 36 billion over the next five years
22 million households are expected to use virtual care solutions in 2018, up from one million in 2013
By 2018 mHealth is forecasted to increase by 61% to be a $26 billion market
Text appointment reminders reduced no-shows by 20-90%
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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
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VA Telehealth Services
Provided care to 608,900 patients…
…amounting to 1,793,496 telehealth episodes of care
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My HealtheVet (www.myhealth.va.gov)
107 million+ visits
2.5 million+ registered users
843,000 opted-in to use
Secure Messaging
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VA Blue Button
Enhances Access to Personal Health
Information
Fosters Patient Engagement
Supports Patient-Centered Care
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Secure Messaging
Patients and providers are able to communicate securely online through VA’s Secure Messaging
accessible through My HealtheVet.15
VA Mobile
VA mobile applications (Apps) deliver evidence-based tools and connections to health data and VA care teams while on-the-go.
Data Mobility
Patient-Centered
Care 16
Veterans Point of Service Kiosks
Kiosks have been shown to save hospitals up to $7 per check-in
Utilization of kiosks has been shown to
increase patient satisfaction by
reducing waits and offering greater
convenience 1717
SCAN-ECHO
Use of videoconferencing
technology to seek expertise
from specialists located 100-500
miles away
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My HealtheVet – VA’s Personal Health Record
Secure Email with Providers
Download Health Data (Blue Button)
Health Education LibraryRefill PrescriptionsView AppointmentsEnter Patient Generated
Data (PGD)
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Secure Messaging (16.4%)Registered Users (38.9%)
Premium Users (26.8%)
Growth in My HealtheVet Adoption by VA Patients
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My HealtheVet Benefits
Kaiser Permanente has a 63% adoption of secure messaging, if VA is able to achieve a comparable adoption the following benefits are possible:– 2 – 6.2% increase in HEDIS measures for glycemic, cholesterol
and blood pressure– 6.9 – 11.1% increase in HEDIS measures for patients with
hypertension, diabetes or both– 20 person decrease in urgent care visits per 1,000 patients per
monthKaiser Permanente patients are 2.6 times more likely
to remain customers if they use Kaiser Permanente’s PHR 21
Efforts to Align and Increase My HealtheVet
Use New Architecture and cloud hostingRedesign of interface based on Veteran feedbackRefocus on doing high demand functions well Consolidate PGD with PGD data from other applications
(e.g., mobile) and allow providers to viewCreate the same experience across My HealtheVet and
Mobile AppsExpand to use other established credentialing systemsAllow online proofing Sign up Veterans for My HealtheVet when they enrollEstablish delegation capability
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VA Mobile Health (mHealth)
mHEALTH
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Foundation Building
Mobile Apps Development/Production Environment
Mobile ArchitectureMobile Device Management SoftwareMobile GovernanceMobile Certification ProcessMobile Branding Veteran App Library Patient Generated Data Architecture and
PoliciesMobile Device Support Contract 24
Mobile Application Environment
• Standardizing Apps and their development; Reducing Costs
• Common Dev Tools
• Common Services and Software Library
• Environments:• Development• Integration• Pre-Prod• Production
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VA Mobile Architecture
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Patient Generated Data (PGD)
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How to Summarize PGD Data
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Mobile Development Lifecycle
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VA-DoD Stand Alone Apps
VA Mental Health Apps
Available on iTunes
Apps are native and do not connect to the VA network.
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VA Mobile Health Veteran Apps
Veteran-Facing Apps
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Veteran-Facing VA Mobile Apps
In Field TestingFamily Caregiver Suite of Apps Veteran Appointment RequestMy StorySoon-to-be ReleasedSummary of CareMobile Blue ButtonVA Launchpad
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VA 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
May2013
Timeline
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Family Caregiver Suite of Apps
1) Pain Coach – Supports pain management
2) Care4Caregiver – Supports Caregiver stress
3) Journal – Allows for the recording of vitals, exercise, meals, contacts
4) RxRefill – Assists with refilling VA prescriptions
5) Summary of Care – Displays data from electronic health record (EHR)
6) PTSD Coach – Supports PTSD management
7) Health Advocate – Allows Veteran to designate a health advocate
8) Health Assessment – Provides Veteran with a convenient way to take various health self-assessments
9) Notifications and Reminders – Sets medication reminders and receive notifications from VA care team
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VA Launchpad
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What We Learned from Family Caregiver Mobile
Health Pilot Access: Individuals living in rural areas are more likely to use than
urban areas Age: Likelihood of using the Apps declines by 2% for every one year
increase in age and this appears to be related to ability to obtain DS Logon credentials
Mental Health: Caregivers caring for Veterans suffering from mental health-related issues, other than PTSD, are higher users
Polytrauma: Caregivers caring for Veterans receiving polytrauma care are less likely to use the Apps and this appears related to Caregiver’s lack of time
Caregiver Preparedness: The less prepared the Caregiver feels to provide care, the more likely he/she is to use Mobile Apps
Caregiver Computer Skills: The higher the self-reported computer skills, the greater the use of the Apps
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Veteran-Facing Mobile Apps
in DevelopmentText Messaging Program (Annie)Patient Personal Health PlanWomen’s HealthMission Health (Gaming App)Wellness Check (Bio-surveillance Reporting)Pre-Visit Agenda and Post-Visit PlanCardiac RehabilitationChronic Kidney DiseaseVA Benefits App
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Annie – VA’s Disease Management Text Messaging
Program Modeled After Successful NHS
England Program – Flo named after Florence Nightingale
VA Program – Annie – named after Annie G. Fox (August 4, 1893 – January 20, 1987) was the first woman to receive the Purple Heart for combat. She served as the chief nurse in the Army Nurse Corps at Hickman Field during the Japanese attack on Pearl Harbor, on December 7, 1941.
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Annie System Capabilities
Protocol Messaging (Bidirectional): – Rules based conversations between providers and patients via the
system (e.g., “It is 10am and we have not received your blood pressure reading yet”).
– Partnered with NHS England physicians regarding clinical protocols (they have several years experience with a similar program – Flo)
Provider Messaging (Bidirectional): – Staff to staff secure quick messages
Tailored/Broadcast Messaging (Unidirectional): – Tailored to individuals or groups (e.g., age groups, diseases, facility,
time of year, etc.)– Messages such as, “flu shots are available.”
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High Level Process for Messaging in Annie
Clinical Staff: Creates a Protocol and sends
document via email to Clinical Administrator Group
Clinical Administrator: Creates a Messaging
Template for the Protocol
Clinical Staff: Assigns Messaging Template for the
Protocol to a Patient
Step 1 Step 2 Step 3
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Benefits for Text Messaging
Study found test messaging resulted in 66% increase in medication adherence
Numerous studies have shown large decreases in appointment no-shows
Increase healthy behaviors and health management
‒ Smoking cessation‒ Blood Glucose Control‒ Weight Loss‒ Asthma control
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VA Mobile Health Staff Apps
Health Care Team-Facing
Apps42
VA Mobile Health Provider Program
Distributing up to 11,000 mobile devices (tablets) at 18 VA Medical Centers for use in clinical care– 85% are iPad Minis– Phase 1: Commercial Apps – Require DISA Reviews before adding to VA
App Store– Phase 2: VA Developed Apps
Accompanied by a mobile device service contract for help desk, break/fix, provisioning
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VA Mobile Health Provider Pilot Sites
Initial Pilot Sites: – Nashville– Orlando– Washington,
DC
Potential five additional sites: – Palo Alto– Albuquerque– Durham– Tomah– Cheyenne
Pilot Sites: – Pittsburgh– Denver– Seattle– St. Cloud– Las Vegas– Miami– Martinsburg– White River
Junction– Columbus,
Ohio
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VA Mobile Health Provider Program
March 2014 distribution at Washington, DC VAMC
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Phase 1 – Commercial Apps
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Phase 2 VA-Developed Apps
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Phase 1 Provider Feedback
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Phase 1 Provider Feedback
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Phase 1 Provider Feedback
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Phase 1 Provider Feedback
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Phase 1 Provider Feedback
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Phase 1 Provider Feedback
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VA Health Care Team-Facing Apps in Development
Patient Viewer(Data Review, Note Entry, Order Entry)
Immunization Warfarin MonitoringVA Mobile ImagingCaring for Women VetsPre-Conception CarePregnancy
Chronic Kidney Disease Safe Women PrescribingMaternity Care CoordinatorScheduling Calendar ViewSecure Messaging Joint VA-DOD Patient
Viewer LaunchpadMobile ECG Viewer
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Contact Information
Kathleen L. Frisbee, PhDc, MPHCo-Director (Program Lead)Connected Health Office, Office of Informatics and AnalyticsDepartment of Veterans AffairsWashington, D.C., [email protected]
Neil C. Evans, MDCo-Director (Clinical Lead)Connected Health Office, Office of Informatics and AnalyticsDepartment of Veterans AffairsWashington, D.C., [email protected]
VA Mobile Health Websitehttp://mobilehealth.va.gov
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