Presentation on theme: "Connected Health at the Department of Veterans Affairs"— Presentation transcript:
1Connected Health at the Department of Veterans Affairs Kathleen L. Frisbee, PhDc, MPH Co-Director, Connected Health Office Office of Informatics and Analytics Veterans Health Administration
2Hospital 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.151 Medical Centers985 Outpatient Clinics Community-Based Hospital-Based Mobile Independent300 Vet CentersID:07Created for VHA Overview Version 1.6/13/2011Updated 1/9/2013 to reflect FY th Quarter pocket card:(rounded to nearest tenths place)70 Mobile Vet Centers103 Domiciliary Residential Rehabilitation Programs135 Community Living CentersSource: FY End-of-Year Pocket Card
3Estimated Collections: Advanced Appropriations: VHA Budget Summary$55.1 B$57.5 B$53.1 B$50.7 BEstimated Collections:$2.93BAdvanced Appropriations:$54.6BID:08Created for VHA Overview Version 10/07/2011Updated 12/19/13 with info from 10A3NOTE: Table includes funding transferred to Joint VA/DoD Medical Care Special Programs in 2011 and 2012.
4FY 2013 End-of-Year TotalsEnrollees……………………………………………………………… Million Unique Patients Treated………………………………… Million Outpatient Visits……………………………………… Million Outpatient Surgeries…………………………………………………..….292,600 Inpatient Admissions…………………………………………….……….694,700 Lab Tests (Inpatient & Outpatient)………………………….…266 Million Prescriptions Dispensed (30-Day Equivalent)…… Million Prosthetics Services Performed……………………..……… MillionID:09Created for VHA Overview Version 1.7/18/2011Updated 1/9/2013 to reflect FY th Quarter pocket card:(rounded to nearest tenths place)Source: FY End-of-Year Pocket Card
5VHA’s Mission and Vision Honor America’s Veterans by providing exceptional health care that improves their health and well-being.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.ID:24Created 11/4/13
6Next 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:Provide Veterans personalized, proactive, patient-driven health careAchieve measureable improvements in health outcomesAlign resources to deliver sustained value to VeteransID:26Created by LGaegler on 9/30/13
7VA’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 EmployeesID:12Created for VHA Overview Version 1.6/13/2011Updated 11/05/13 with FY13 data from HTM.
8VHA’s Current Priorities Patient Aligned Care Teams (PACT)Connected Health CareAccessHomelessnessMental Health CareStandardizationID:27Created by LGaegler on 9/30/138
9VA Connected HealthAligning virtual care technologies to create a seamless, unified experience for Veterans9
10Importance of Connected Health Technologies Remote MonitoringMobile HealthVideo VisitsGlobal market for Video Visits is expected to increase tenfold by 2018, expanding into a $13.7 billion market50% reduction in readmissions with Video visits/monitoring, a study foundForecasted savings from remote patient monitoring 36 billion over the next five years22 million households are expected to use virtual care solutions in 2018, up from one million in 2013By 2018 mHealth is forecasted to increase by 61% to be a $26 billion marketText appointment reminders reduced no-shows by 20-90%
11Estimated Veterans Served in 2013 VA Connected HealthConnected Health TechnologiesYear StartedEstimated Veterans Served in 2013Home Telehealth2003144,250Clinical Video Telehealth2002202,823Store & Forward Telehealth2000311,369eConsults2010257,949SCAN-ECHO20111,632My HealtheVet2,487,000Blue Button881,000Secure Messaging2008795,000Veteran Mobile Apps2013Field testingStaff Mobile AppsVeteran Point of Service Kiosks>4M transactions
12VA Telehealth Services Provided care to 608,900 patients… …amounting to 1,793,496 telehealth episodes of careHome 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.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.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 theirown homes, patients who otherwise would have needed long-term institutional care.Recognized as an international leader in telehealth development/implementationProvided care from 151 VA Medical Centers (VAMCs) and over 705 Community Based Outpatient Clinics (CBOCs) to 608,900 patients…amounting to 1,793,496 telehealthepisodes of careReductions in Utilization FY 2012Home 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 carePatient SatisfactionHome Telehealth % mean scoreStore-and-Forward Telehealth –96% mean scoreClinical Video Telehealth - 93% mean scoreTravel Reduction SavingsClinical Video Telehealth – $34.45 per consultationStore and Forward Telehealth - $38.81 per consultationHome Telehealth Savings$1,999 per annum per patientReductions and Satisfaction data from FY12 Telehealth Services’ Report CardIn 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
13My HealtheVet (www.myhealth.va.gov) 107 million+ visits2.5 million+ registered users843,000 opted-in to use Secure MessagingVeteran’s Personal Health RecordSelf-Service Prescription RefillAccess to Labs, Appointments and Secure MessagingAbility to download Physician Notes and other content from EHRMore than 107 million visitsOver 2.5 million registered usersMore than 1.3 million users have a Premium (authenticated) accountOver 47.3 million VA prescription refills since August 2005More than 918,000 unique VA Blue Button users since August 2010More than 5.2 million VA Blue Button file downloadsMore than 843,000 VA patients opted in to use Secure Messaging
14VA Blue Button Enhances Access to Personal Health Information Fosters Patient EngagementSupports Patient-Centered CareEnhances Veteran access to personal health information from the VA Electronic Health Record and other key data sourcesFosters patient engagementEncourages activationSupports patient-centered careAs of FY 2013, more than 880,000 users. Established in 2010.
15Secure MessagingVeterans 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 ServicesPatients and providers are able to communicate securely online through VA’s Secure Messaging accessible through My HealtheVet.
16Patient-Centered Care VA MobileVA 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.VA mobile applications (Apps) deliver evidence-based tools and connections to health data and VA care teams while on-the-go.Patient-Centered CareData Mobility
17Veterans Point of Service Kiosks Kiosks have been shown to save hospitals up to $7 per check-inUtilization of kiosks has been shown to increase patient satisfaction by reducing waits and offering greater convenienceEmpower 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.In FY2013, 4 million+ transactions; established in 201017
18SCAN-ECHOUse of videoconferencing technology to seek expertise from specialists located miles awayScan-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.
19My HealtheVet – VA’s Personal Health Record Secure with ProvidersDownload Health Data (Blue Button)Health Education LibraryRefill PrescriptionsView AppointmentsEnter Patient Generated Data (PGD)
20Growth in My HealtheVet Adoption by VA Patients Registered Users (38.9%)Premium Users (26.8%)Secure Messaging (16.4%)
21My 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 pressure6.9 – 11.1% increase in HEDIS measures for patients with hypertension, diabetes or both20 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 PHR21
22Efforts to Align and Increase My HealtheVet Use New Architecture and cloud hostingRedesign of interface based on Veteran feedbackRefocus on doing high demand functions wellConsolidate 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 proofingSign up Veterans for My HealtheVet when they enrollEstablish delegation capability22
24Foundation Building Mobile Apps Development/Production Environment Mobile ArchitectureMobile Device Management SoftwareMobile GovernanceMobile Certification ProcessMobile BrandingVeteran App LibraryPatient Generated Data Architecture and PoliciesMobile Device Support Contract
25Mobile Application Environment Standardizing Apps and their development; Reducing CostsCommon Dev ToolsCommon Services and Software LibraryEnvironments:DevelopmentIntegrationPre-ProdProduction
30VA-DoD Stand Alone Apps VA Mental Health AppsAvailable on iTunesApps are native and do not connect to the VA network.
31VA Mobile Health Veteran Apps Veteran-Facing Apps
32Veteran-Facing VA Mobile Apps In Field TestingFamily Caregiver Suite of AppsVeteran Appointment RequestMy StorySoon-to-be ReleasedSummary of CareMobile Blue ButtonVA Launchpad
33VA Family Caregiver Mobile Health Pilot TimelineCohort: Seriously Injured post-9/11 Veterans and their Family Caregivers in the VA’s Family Caregiver ProgramSuite of Apps designed based on needs of Caregivers and VeteransiPads loaded with Apps loaned to Caregivers for one yearMailing to 4,000+ CaregiversAugust 20121,200 Caregivers Responded “Yes”September 2012Mailing to Notify of Selection, Request Loaner Agreement, Invite into StudyNovember 2012May 2013Distribute 800+ iPads
34Family Caregiver Suite of Apps Pain Coach – Supports pain managementCare4Caregiver – Supports Caregiver stressJournal – Allows for the recording of vitals, exercise, meals, contactsRxRefill – Assists with refilling VA prescriptionsSummary of Care – Displays data from electronic health record (EHR)PTSD Coach – Supports PTSD managementHealth Advocate – Allows Veteran to designate a health advocateHealth Assessment – Provides Veteran with a convenient way to take various health self-assessmentsNotifications and Reminders – Sets medication reminders and receive notifications from VA care team
36What We Learned from Family Caregiver Mobile Health Pilot Access: Individuals living in rural areas are more likely to use than urban areasAge: 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 credentialsMental Health: Caregivers caring for Veterans suffering from mental health-related issues, other than PTSD, are higher usersPolytrauma: Caregivers caring for Veterans receiving polytrauma care are less likely to use the Apps and this appears related to Caregiver’s lack of timeCaregiver Preparedness: The less prepared the Caregiver feels to provide care, the more likely he/she is to use Mobile AppsCaregiver Computer Skills: The higher the self-reported computer skills, the greater the use of the Apps
37Veteran-Facing Mobile Apps in Development Text 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 App37
38Annie – VA’s Disease Management Text Messaging Program Modeled After Successful NHS England Program – Flo named after Florence NightingaleVA 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.
39Annie 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 messagesTailored/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.”
40High Level Process for Messaging in Annie Clinical Staff: Creates a Protocol and sends document via to Clinical Administrator GroupClinical Administrator: Creates a Messaging Template for the ProtocolClinical Staff: Assigns Messaging Template for the Protocol to a PatientStep 1Step 2Step 3
41Benefits for Text Messaging Study found test messaging resulted in 66% increase in medication adherenceNumerous studies have shown large decreases in appointment no-showsIncrease healthy behaviors and health managementSmoking cessationBlood Glucose ControlWeight LossAsthma control
42VA Mobile Health Staff Apps Health Care Team-Facing Apps42
43VA Mobile Health Provider Program Distributing up to 11,000 mobile devices (tablets) at 18 VA Medical Centers for use in clinical care85% are iPad MinisPhase 1: Commercial Apps – Require DISA Reviews before adding to VA App StorePhase 2: VA Developed AppsAccompanied by a mobile device service contract for help desk, break/fix, provisioning43
44VA Mobile Health Provider Pilot Sites Initial Pilot Sites:NashvilleOrlandoWashington, DCPilot Sites:PittsburghDenverSeattleSt. CloudLas VegasMiamiMartinsburgWhite River JunctionColumbus, OhioPotential five additional sites:Palo AltoAlbuquerqueDurhamTomahCheyenne
45VA Mobile Health Provider Program March 2014 distribution at Washington, DC VAMC
54VA Health Care Team-Facing Apps in Development Patient Viewer (Data Review, Note Entry, Order Entry)ImmunizationWarfarin MonitoringVA Mobile ImagingCaring for Women VetsPre-Conception CarePregnancyChronic Kidney DiseaseSafe Women PrescribingMaternity Care CoordinatorScheduling Calendar ViewSecure MessagingJoint VA-DOD Patient ViewerLaunchpadMobile ECG Viewer
55Contact InformationKathleen L. Frisbee, PhDc, MPH Co-Director (Program Lead) Connected Health Office, Office of Informatics and AnalyticsDepartment of Veterans Affairs Washington, D.C., USANeil C. Evans, MD Co-Director (Clinical Lead) Connected Health Office, Office of Informatics and AnalyticsVA Mobile Health Website