The U.S. Department of veterans affairs has been making major investments in innovating its technology and infrastructure in recent years.
There’s the massive electronic health record modernization, of course, but also everything from a new National Artificial Intelligence Institute to an Apple Health Records rollout to a project focused on tablet-based telehealth.
Indeed, telehealth continues to be a major priority for the VA. It’s already responsible for the biggest telemedicine infrastructure in the nation, and use of its telehealth services is surging. The sprawling provider network continues to seek new ways to deliver better care to its members where they live, in their communities and their homes.
At HIMSS20, Dr. Neil C. Evans, chief officer in the VA’s Office Of Connected Care, will speak about some lessons learned as the department, a longtime health IT leader, works to make more progress with its connected care initiatives.
With more than 325,000 employees at 150 VA Medical Centers and 1,400 community-based clinical settings, and caring more than 9 million veterans each year, the challenges and opportunities for technology-enabled care delivery at VA are clear.
In Orlando on March 10, Evans will describe how the agency is embracing its mandate to broaden access to telehealth and make community care available to more veterans. He’ll show how VA is reconfiguring its systems to increase patient engagement across its network, and will offer some perspective on what’s worked – and what hasn’t – in its care innovations.
Evans recently answered some questions from Healthcare IT News about how technology is helping VA make big improvements in patient access, engagement and experience.
Q. What has VA’s recent prioritization of telehealth enabled for the care veterans can receive?
A. Telehealth allows VA to bring health care to veterans where they live when that’s their desire, making care more accessible and more convenient. In addition, telehealth allows the VA to more efficiently provide clinical expertise across the entire health care system. Finally, a veteran’s geographic location should not limit their access to quality care. VA is committed to increasing access to care for all enrolled veterans and has placed special emphasis on those in rural and remote locations.
Q. Similarly, how has technology-enabled patient engagement improved across the VA in recent years?
A. VA was an early adopter of digital health tools and remains a leader within US health care in leveraging technology to enhance patient engagement. My HealtheVet, VA’s online patient portal now has more than 5 million registered users and typically sees 1.1 million veterans interacting with the site, including their personal health data, every month.
VA helped launch the Blue Button initiative and we’ve now seen 38 million Blue Button downloads by veterans since August 2010. The most recent feature launched on VA’s portal allows veterans to download their full imaging files, including the opportunity to burn a disc with their DICOM (Digital Imaging and Communications in Medicine) files and a DICOM viewer.
“These digital tools are allowing veterans to more actively understand their health data, to better communicate with VA clinical teams and to engage more productively as they navigate their individual health journeys.”
Neil C. Evans, VA Office Of Connected Care
Beyond the portal, over the last several years, VA has dramatically expanded the digital tools it offers veterans. For example, the Annie App – an automated protocol-based two-way text messaging system allows for personalized texts that help veterans with self-care. VA is piloting a health chat feature as well. And VA’s mobile app store now has 45 apps available to help veterans monitor and manage numerous health issues, to include smoking cessation, patient management, mental health care, and more.
These digital tools are allowing veterans to more actively understand their health data, to better communicate with VA clinical teams and to engage more productively as they navigate their individual health journeys.
Q. Do you have any numbers indicating how many more veterans are using tech to connect with their providers?
A. In FY19, VA provided more than 2.6 million telehealth episodes of care, such as a video appointment or a store and forward telehealth exchange, to more than 900,000 veterans. For example, more than 490,000 veterans utilized VA’s video telehealth capabilities last year, and 50 percent of those veterans lived in rural communities.
Our patient portal, My HealtheVet, continues to grow, now with more than 5 million registered users. In FY19, there were more than 20.6 million Rx refill requests. Since its inception in June of 2008, more than 86 million VA Secure Messages have been initiated by VA patients or their care teams.
Q. How does the VA’s ongoing electronic health record modernization play into these new advancements?
A. Connected care technologies enhance the ability for veterans to connect with their health care providers, synchronously or asynchronously. The most effective interventions enhance or extend a traditional health care relationship. For health care providers, the electronic health record is their go-to application for getting work done. It’s where the data is and where most workflows and health care transactions play out.
Accordingly, provider adoption of telehealth and connected care is enhanced when better integrated with the electronic health record. As part of VA’s EHR modernization efforts, efforts are underway to deeply integrate and build VA’s connected care technologies directly into the new record, in support of a better veteran and provider experience and further expansion of virtual care delivery.
Q. Your presentation description mentions strategies that “worked and didn’t work” along the way. What have been some lessons learned?
A. Without giving too much of my presentation away, I’ll say that there are a few key takeaways.
First, for health systems to be successful, Connected Care / Telehealth needs to be someone’s job. To make the technology successful, VA has focused on ensuring that implementation experts and technology managers are available to train providers and patients alike and to help integrate these technologies as a natural part of a provider’s and patient’s workflow.
Second, the digital divide is a real concern and must be addressed. Equitable access to virtual care services is critical.
And third, well … come to my HIMSS20 presentation and let’s discuss!
Q. VA seems to be pioneering a model of care that many say will soon become much more common across the US: where hospitals are only for the most acute cases, and the majority of care is delivered remotely in the home. Do you agree?
A. Regardless of technology, healthcare will always be about the relationship between patients and their care teams. Where and how these relationships, focused on helping patients improve their health, develop and play out is in flux. More and more is happening virtually (secure messaging, telephone, chat, video, mHealth apps, and more) and I think this trend will only continue. But not to the exclusion of in-person care, which will always be necessary.
Q. Any closing thoughts or hoped-for takeaways for those who attend this session?
A. Connected Care is part of VA’s DNA, a mission-critical capability of the overall health care system; it’s increasing the accessibility of care, the efficiency of care delivery in our national health care system, the quality of care, and the veteran experience of care. I certainly hope that some of what VA has learned will prove helpful for other health care systems who are also advancing these capabilities
Dr. Neil C. Evans will describe VA’s telehealth and patient engagement initiatives in his HIMSS20 session, “Connected Care As an Access and Patient Engagement Strategy.” It’s scheduled for Tuesday, March 10, from 1:30-2:30 p.m. in room W311E.
Healthcare IT News is a publication of HIMSS Media.