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Veteran Engagement
with Electronic Health Technologies
MARCH 12, 2014
Neil C. Evans, MD
Co-Director, Connected Health
Offi...
2
3
4
5
VETERANS HEALTH ADMINISTRATION
About VA
6
VETERANS HEALTH ADMINISTRATION
8.93 Million VA Health Care System Enrollees***
6.84 Million VA Supervised & Administered L...
VETERANS HEALTH ADMINISTRATION
Hospital System to Health System
In 1996, VA began the creation of Veterans Integrated
Serv...
VETERANS HEALTH ADMINISTRATION
Vision:
VHA will continue to be the benchmark of excellence and
value in health care and be...
VETERANS HEALTH ADMINISTRATION
VHA Principles
10
VHA’s principles are the philosophical pillars that are
embedded in VHA’s...
VETERANS HEALTH ADMINISTRATION
VHA’s Current Priorities
• Patient Aligned Care Teams (PACT)
• Connected Health Care
• Acce...
VETERANS HEALTH ADMINISTRATION
Connected Health
• VA: Connected Health is defined as extending the reach of healthcare, em...
14
VETERANS HEALTH ADMINISTRATION
VA Connected Health
VA is aligning virtual care technologies to create a seamless, unified
...
VETERANS HEALTH ADMINISTRATION
VA Connected Health (Virtual Care)
3
VETERANS HEALTH ADMINISTRATION
Connected Health Technologies Year Started Estimated Veterans
Served in 2013
Home Telehealt...
VETERANS HEALTH ADMINISTRATION
Scope of VA Telehealth Services
19
Clinical Video Telehealth (CVT)
Real-time video consulta...
VETERANS HEALTH ADMINISTRATION
VHA Telehealth Services: Outcomes
20
Reductions in Utilization FY 2012
Home Telehealth - re...
My HealtheVet (www.myhealth.va.gov)
VETERANS HEALTH ADMINISTRATION
My HealtheVet
A personal My HealtheVet account provides
Veterans with 24/7 online access to...
VETERANS HEALTH ADMINISTRATION 23
www.myhealth.va.gov
• More than 107 million visits
• Over 2.5 million registered users
•...
VETERANS HEALTH ADMINISTRATION
• VA Prescription Refill(s)
• VA Prescription Refill History
• Self-entered medication(s),
...
VETERANS HEALTH ADMINISTRATION
VA Blue Button
®
: Download Results
26
SecureMessaging
Patients and providers are able to communicate securely
online through VA’s Secure Messaging accessible th...
VETERANS HEALTH ADMINISTRATION 2
VA Connected Health (Virtual Care)
Where is VA Going?
VETERANS HEALTH ADMINISTRATION
VA Mobile / mHealth
32
VETERANS HEALTH ADMINISTRATION
Is there interest in mHealth?
34
6.8 BILLION MOBILE-CELLULAR SUBSCRIPTIONS
VETERANS HEALTH ADMINISTRATION
Goals of VA Mobile Health
• Focus on health by engaging patients and Caregivers outside
of ...
VETERANS HEALTH ADMINISTRATION 37
PTSD* Coach
*Post-Traumatic Stress Disorder
More 80,000 downloads in 70 countries
VA’s O...
VETERANS HEALTH ADMINISTRATION
VA Mental Health Apps
38
VA Mental Health Apps
38
Available on iTunes
Apps are native and d...
VETERANS HEALTH ADMINISTRATION
Washington, DC VA Medical Center Pilot
Summary of Care App – Lab Results
• Significant desi...
VETERANS HEALTH ADMINISTRATION
VA Mobile Strategy Timeline
2011 2012 2013
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
PROVIDER/STA...
VETERANS HEALTH ADMINISTRATION
VA Mobile Framework
41
VETERANS HEALTH ADMINISTRATION
Mobile Application Environment
• Standardizing
Apps and their
development;
Reducing Costs
•...
VETERANS HEALTH ADMINISTRATION
VA Mobile App Certification Process
Requirements
 Business Ownership Commitment
 Aligned ...
VETERANS HEALTH ADMINISTRATION
Mobile Health Development Strategy
44
Build Apps at HTML5 so they will work on mobile brows...
VETERANS HEALTH ADMINISTRATION
VA Mobile Health Staff Apps
45
VETERANS HEALTH ADMINISTRATION
Clinicians Interested in Using Mobile Apps
• 89 percent of primary care and internal
medici...
47
VETERANS HEALTH ADMINISTRATION
VA Health Care-Team Facing Apps in
Development
• Patient Viewer App
(Data review, Note Entr...
VETERANS HEALTH ADMINISTRATION
VA Mobile Health Provider
Program
49
Photographs from Washington, DC
VAMC Distribution
VETERANS HEALTH ADMINISTRATION
VA Mobile Health Veteran Apps
50
VETERANS HEALTH ADMINISTRATION
Does someone in your family
have a working cell phone?
Do you use the Internet?
Do you acce...
Expert Care and Self Care
Information Sharing
Transactions
Communications
VETERANS HEALTH ADMINISTRATION
Veteran-Facing VA Mobile Apps
In Pilot Testing
• Family Caregiver Suite of Apps
• Veteran A...
VETERANS HEALTH ADMINISTRATION
Family Caregiver Mobile Health Pilot
• Cohort: Seriously Injured post-9/11
Veterans and the...
VETERANS HEALTH ADMINISTRATION
Family Caregiver Apps
56
1) Pain Coach – Supports Pain Management
2) Care4Caregiver – Suppo...
VETERANS HEALTH ADMINISTRATION
Login
• Uses Department of
Defense LogOn (DS
LogOn) credentials.
• Delegation App will
allo...
VETERANS HEALTH ADMINISTRATION
VA Mobile Launchpad (iOS Version)
58
VETERANS HEALTH ADMINISTRATION
• Medications
• Labs
• Problem List
• Radiology Reports
• Progress Notes
• Demographics
• V...
VETERANS HEALTH ADMINISTRATION
• Vitals
• Exercise
• Diet
• Mood
• Communications
Journal App
60
VETERANS HEALTH ADMINISTRATION
RxRefill App
61
• Allows Veterans
to request
prescription
refills
VETERANS HEALTH ADMINISTRATION
How Caregivers are Supported
• Training
–Quick Start Guide
–Videos
• Help Desk
• Newsletter...
VETERANS HEALTH ADMINISTRATION
Family Caregiver Mobile Health
Evaluation Study
Primary Quasi-Experimental Study
• Caregive...
VETERANS HEALTH ADMINISTRATION
VA Family Caregiver Pilot
Characteristics of iPad Recipients
• 879 iPads distributed
• Aver...
VETERANS HEALTH ADMINISTRATION
VA Family Caregiver Pilot – Baseline
Caregiver Strain
65
Average: 5.54 STD: 3.68 Median: 5
VETERANS HEALTH ADMINISTRATION
Unique Users by Month by App
66
0
200
400
600
800
1000
1200
1400
1600
630 Caregiver/Veteran...
VETERANS HEALTH ADMINISTRATION
Family Caregiver Pilot App Utilization
67
0
100
200
300
400
500
600
700
Jun Jul Aug Sep
Num...
VETERANS HEALTH ADMINISTRATION
Percentage of Reported Reasons for Non-Use
of Family Caregiver Apps
68
DS Login Issues
App ...
VETERANS HEALTH ADMINISTRATION
VA Family Caregiver Pilot –
Preliminary analysis
Significant Predictors of Mobile Health Ap...
VETERANS HEALTH ADMINISTRATION
Veteran Appointment Request App
• Allows Veterans to request
appointments for primary
care ...
VETERANS HEALTH ADMINISTRATION 71
MyStory App (Personal Health Inventory)
• Allows Veterans to identify
what is most impor...
VETERANS HEALTH ADMINISTRATION
Mobile Blue Button
72
VETERANS HEALTH ADMINISTRATION
New Veteran-Facing Mobile Apps in
Development
• Text Messaging Program (Annie)
• Patient Pe...
VETERANS HEALTH ADMINISTRATION
What we have Learned
• Barriers to Use
–Low computer literacy
–Access problems with credent...
VETERANS HEALTH ADMINISTRATION
Critical Factors for Success
• Senior leadership commitment to “care at a distance”
• Intel...
VETERANS HEALTH ADMINISTRATION
Contact Information
76
Neil C. Evans, MD
Co-Director, Connected Health (Clinical Director)
...
77
Veterans engagement with electronic health technologies  jhu -evans 3.12.14 v final
Veterans engagement with electronic health technologies  jhu -evans 3.12.14 v final
Veterans engagement with electronic health technologies  jhu -evans 3.12.14 v final
Veterans engagement with electronic health technologies  jhu -evans 3.12.14 v final
Veterans engagement with electronic health technologies  jhu -evans 3.12.14 v final
Veterans engagement with electronic health technologies  jhu -evans 3.12.14 v final
Veterans engagement with electronic health technologies  jhu -evans 3.12.14 v final
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Veterans engagement with electronic health technologies jhu -evans 3.12.14 v final

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Veterans engagement with electronic health technologies jhu -evans 3.12.14 v final

  1. 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
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  6. 6. VETERANS HEALTH ADMINISTRATION About VA 6
  7. 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. 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. 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. 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. 11. VETERANS HEALTH ADMINISTRATION VHA’s Current Priorities • Patient Aligned Care Teams (PACT) • Connected Health Care • Access • Homelessness • Mental Health Care • Standardization 11
  12. 12. 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.
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  14. 14. 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
  15. 15. VETERANS HEALTH ADMINISTRATION VA Connected Health (Virtual Care) 3
  16. 16. 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
  17. 17. 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.
  18. 18. 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
  19. 19. My HealtheVet (www.myhealth.va.gov)
  20. 20. 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
  21. 21. 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)
  22. 22. 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
  23. 23. VETERANS HEALTH ADMINISTRATION VA Blue Button ® : Download Results 26
  24. 24. SecureMessaging Patients and providers are able to communicate securely online through VA’s Secure Messaging accessible through My HealtheVet.
  25. 25. VETERANS HEALTH ADMINISTRATION 2 VA Connected Health (Virtual Care) Where is VA Going?
  26. 26. VETERANS HEALTH ADMINISTRATION VA Mobile / mHealth 32
  27. 27. VETERANS HEALTH ADMINISTRATION Is there interest in mHealth?
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  29. 29. 6.8 BILLION MOBILE-CELLULAR SUBSCRIPTIONS
  30. 30. 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
  31. 31. 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
  32. 32. 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
  33. 33. 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
  34. 34. 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
  35. 35. VETERANS HEALTH ADMINISTRATION VA Mobile Framework 41
  36. 36. 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
  37. 37. 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
  38. 38. 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
  39. 39. VETERANS HEALTH ADMINISTRATION VA Mobile Health Staff Apps 45
  40. 40. 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
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  42. 42. VETERANS HEALTH ADMINISTRATION VA Health Care-Team Facing Apps in Development • Patient Viewer App (Data review, Note Entry, Order Entry) • Immunization App • Warfarin Monitoring • VA Mobile Imaging • Caring for Women Vets • Pre-Conception Care • Pregnancy • Chronic Kidney Disease App • Safe Women Prescribing • Maternity Care Coordinator • Scheduling Calendar View • Secure Messaging • Joint VA-DOD Patient Viewer • Launchpad • Mobile ECG Viewer 48
  43. 43. VETERANS HEALTH ADMINISTRATION VA Mobile Health Provider Program 49 Photographs from Washington, DC VAMC Distribution
  44. 44. VETERANS HEALTH ADMINISTRATION VA Mobile Health Veteran Apps 50
  45. 45. 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
  46. 46. Expert Care and Self Care Information Sharing Transactions Communications
  47. 47. 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
  48. 48. 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
  49. 49. 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
  50. 50. 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
  51. 51. VETERANS HEALTH ADMINISTRATION VA Mobile Launchpad (iOS Version) 58
  52. 52. VETERANS HEALTH ADMINISTRATION • Medications • Labs • Problem List • Radiology Reports • Progress Notes • Demographics • Vitals Summary of Care App Displays EHR Data 59
  53. 53. VETERANS HEALTH ADMINISTRATION • Vitals • Exercise • Diet • Mood • Communications Journal App 60
  54. 54. VETERANS HEALTH ADMINISTRATION RxRefill App 61 • Allows Veterans to request prescription refills
  55. 55. VETERANS HEALTH ADMINISTRATION How Caregivers are Supported • Training –Quick Start Guide –Videos • Help Desk • Newsletter 62
  56. 56. 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
  57. 57. 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
  58. 58. VETERANS HEALTH ADMINISTRATION VA Family Caregiver Pilot – Baseline Caregiver Strain 65 Average: 5.54 STD: 3.68 Median: 5
  59. 59. 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.
  60. 60. 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
  61. 61. VETERANS HEALTH ADMINISTRATION Percentage of Reported Reasons for Non-Use of Family Caregiver Apps 68 DS Login Issues App Issues Usability 219 Non-Users
  62. 62. 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
  63. 63. 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
  64. 64. 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
  65. 65. VETERANS HEALTH ADMINISTRATION Mobile Blue Button 72
  66. 66. 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
  67. 67. 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
  68. 68. 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
  69. 69. 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
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