VA counting on telemedicine to improve, expand care to vets

Friday - 8/2/2013, 6:15am EDT

Jason Miller reports from the Connected Health Showcase sponsored by VA.

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The Veterans Affairs Department is changing the way it delivers health care to more than 8 million veterans.

It already is ahead of most health care providers in using technology to improve patient care, but now VA is deploying a host of applications to expands its reach and make it easier for veterans to get care, no matter where they live.

Robert Petzel, VA's under secretary for health, said the goal is to put veterans at the center of the agency's care and treat the whole person, not the symptoms or diseases.

"These mobile apps are rapidly changing how veterans access the resources and information that we have available to them," Petzel said Wednesday in Washington at the Connected Health Showcase sponsored by VA. "Through these apps, we can engage caregivers outside of the traditional office visit. Veterans may learn that she can receive care through our telehealth program or maybe her provider will use Scan-Echo, a technology used to gather her team together to recommend a particular treatment plan. These technologies are helping us create a system of care without walls, a virtual system of care."

Robert Petzel, VA's under secretary for health, left, talks with Sen. Bernie Sanders (I-Vt.) about the benefits of telemedicine at Wednesday's Connected Health Showcase in Washington, D.C. (Photo by Jason Miller/Federal News Radio)

Sen. Bernie Sanders (I-Vt.), the chairman of the Veterans Affairs Committee, said the rest of the country could learn from how VA is using technology to treat their patients.

VA is making a huge investment in these health technologies.

Petzel said VA is spending $500 million in 2013 alone on telehealth services, which include telemental health, telehome health and clinical consultation by video. He said the agency is spending less and less money, however, each year as the cost to develop and implement health IT goes down.

"This is where medicine is going," he said. "The virtual care delivery system."

At the event, VA showed nine different technologies currently in use or about to enter the pilot stage.

10 apps to track health stats

One of those is a mobile application to help veterans keep track of their health stats.

Shawn Hardenbrook, the director of Web and Mobile Solutions at VA, said the agency is piloting iPads with a suite of 10 apps to 1,000 post-9-11 seriously injured veterans.

"They can do things like renew medications, communicate with their provider, look at their medical record information, such as labs, progress notes, radiology reports. It's a way to integrate them directly in their medical care by having it at their finger tips," he said. "As an example, they could be at a Little League game, remember they are almost out of their medication, grab their iPad out of their car — these are cellular enabled — and reorder their medication on the spot."

Veterans using the iPad will come to the start screen where they can choose which app to launch and link to VA resources.

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"It's a very simple touch interface," Hardenbrook said. "We actually had interviews with veterans. We did focus groups to design these applications. We got rid of anything extraneous that would be confusing based on their feedback."

He said the veteran has the same medical information as their doctor or nurse sees at the VA hospital. The veteran can validate the data, including their demographic details, the medication they are taking, their allergies and a host of other medical information.

"They can look at their blood pressure and graph it out. So, if they are told they have a blood pressure problem, they can see the information logged during their visit in a graphic format," Hardenbrook said. "They can look at medications, laboratory information or they may have been in talking to the doctor about their blood sugar levels and they can't remember what the doctor said. They can go into the iPad, pull up their last glucose labs and take a look with the graph."

A second pilot on the way

VA also is preparing a pilot to give 10,000 providers iPads to use a suite of 30 apps.

Hardenbrook said VA is developing a procurement to buy the devices as part of the two-year pilot.

He added VA developed the suite of apps internally and is expanding beyond Apple's iOS to HTML 5 so that the apps can be used on any device or on any computer.

In addition to the iPad suite of apps, VA is about to launch a pilot to test the healthy living assessment program. It's still in the beta stage, and VA plans on launching it in September, said Heidi Martin, a clinical informaticist at the National Center for Health Promotion and Disease Prevention at VA.

Martin said VA borrowed the concept of a health risk assessment from the Defense Department. She said DoD has active duty members complete similar assessments on a regular basis.

Tool to make better decisions

This app is focused on giving veterans the knowledge to make better decisions and improve their quality of life.

"It's a set of questions about health history, health habits and concerns that are unique to veterans such as post-traumatic stress disorder, military sexual trauma or chemical exposures," Martin said. "When the veteran finishes the questions, what he or she will get is a summarized, personalized assessment of their current health status, their risk of major diseases, and they also will have interactive features to explore the impact of various choices to improve their health."

Martin demonstrated what would happen to a 58-year-old veteran who smokes a pack- and-a-half of cigarettes a day, is overweight and doesn't get any exercise. The app gives the biological assessment of the veteran based on the data he put in. The assessment showed the veteran is running the same risk of death as a 73-year- old man.

"We told the veteran he or she could reduce that by up to 19 years by making healthier choices," she said. "We give a list of how to do that. The list of recommendations is interactive, so the veteran can experiment with what is the impact of making healthier choices."

The assessment also calculates the risk of developing major disease, such as heart disease, stroke and diabetes.

The veteran can choose to change his or her lifestyle and recalculate the risks to see the impact those changes would have.

"Let's say our gentleman is going to quit smoking and get two-and-a-half hours a week of exercise," Martin said. "We recalculate and you can see his health age has fallen from 73 to 64, so he got nine years benefit because of these changes."

Martin said VA developed the health living assessment program in response to both veterans' and providers' desire to have more tools.

"Veterans are always asking for ways to get information and be able to have data in confidential setting," she said.

Petzel said currently, about 17 percent of all veterans are using telehealth services. He said VA believes 66 percent of all veterans could benefit from the technology services.

Find more about these apps at the VA's mobile health site.

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