VA Connected Care: Enhancing Veteran Access and Experience

Transcription

1 VA Cnnected Care: Enhancing Veteran Access and Experience Sessin #135, February 21, 2017 Neil C. Evans, MD, Chief Officer, Office f Cnnected Care, U.S. Department f Veterans Affairs 1

2 Speaker Intrductin Neil C. Evans, MD Chief Officer, Office f Cnnected Care Veterans Health Administratin, U.S. Department f Veterans Affairs 2

3 Cnflict f Interest Neil C. Evans, MD Chief Officer, Office f Cnnected Care Veterans Health Administratin, U.S. Department f Veterans Affairs Has n real r apparent cnflicts f interest t reprt. 3

4 Agenda Learning Objectives & STEPS Cnnected Care at VA Three Fundamentals f Apprach Lessns Learned Q&A 4

5 Learning Objectives Distinguish the attributes that make up an effective patientfacing digital strategy acrss a natinal/reginal health enterprise Identify pprtunities and pitfalls fr prvider and patient technlgy adptin Explre hw patients respnd t accessing infrmatin in their electrnic health recrd (EHR) (e.g., VA Open Ntes) Apply best practices in scaling digital technlgies acrss a health system 5

6 Hw Benefits Were Realized VA Cnnected Care has realized benefits in all STEPS areas. Key Highlights: Mre than 12 percent f Veterans served by VA receive at least a prtin f their care yearly thrugh ne f VA s telehealth mdalities 55.8 millin visits / 502 millin page views t VA s persnal health prtal, My HealtheVet, in FY16 Access t care, bth primary and specialty care, is significantly imprved acrss the vast gegraphy that VA serves Very high patient satisfactin levels acrss all VA Cnnected Care mdalities Realizing the Value f Health IT Health IT creates five kinds f value f benefit t patients, healthcare prviders and cmmunities S T E P S Satisfactin Treatment/Clinical Electrnic Secure Data Patient Engagement and Ppulatin Management Savings 6

7 Veterans Health Administratin Largest integrated health care system in U.S. 144 Medical Centers 1,221 Outpatient Clinics 130 Cmmunity Living Centers 103 Dmiciliaries 300 Vet Centers Phts f happy veterans 33% f Veteran patients live in rural America 21 Millin Veterans living in U.S. Mre than 9 millin enrlled, 6 millin receiving care 305,000 VHA emplyees _glance_06_04_16.pdf 7

8 Transfrmatin VA is underging a radical transfrmatin t imprve ur relatinship with ur Veterans. This relatinship is the crnerstne fr all that VA des... The fundatin f that relatinship is built n trust and respect. It must be built t last a lifetime. -- VA Secretary Bb McDnald ( ) Five Brad Strategies Imprving the Veteran experience Imprving the emplyee experience Achieving supprt services excellence Establishing a culture f cntinuus perfrmance imprvement Enhancing strategic partnerships 8

9 VA s Cnnected Care Strategy Visin Access and the Veteran experience will be enhanced by health infrmatin technlgies that effectively integrate int the daily activities f Veterans and VA staff Missin T deliver high-quality, Veteran-centered care; ptimize individual and ppulatin health; advance health care that is persnalized and practive; and enhance the health care experience thrugh virtual mdalities f care 9

10 VA Cnnected Care Prducts/Services My HealtheVet Prescriptin Refill and Tracking VA Blue Buttn (Dwnlad my Health Recrds, including VA Open Ntes) Veterans Health Library Appintments VA Mbile mbile.va.gv/appstre Apps fr Veterans Apps fr VA Staff VA Beta App Stre Telehealth 10 Clinical Vide Telehealth, VA Vide Cnnect Stre and Frward (Asynchrnus) Telehealth Remte Hme Mnitring Reginal/Natinal Telehealth Hubs Tele-ICU VHA Innvatin Emplyee Innvatin Cmpetitins (2,000+ ideas in FY2016) Examples: Rx Tracking, One-VA Pharmacy, E-Screening, Hearing Aid Distance Fitting Applicatin (HADFA)

11 User Adptin f VA Cnnected Care Technlgies 11

12 Three Fundamentals f VA s Apprach Access t Trusted Relatinships Access t Trusted Health Infrmatin Imprving the Care Experience fr Veterans, Caregivers and Health Care teams 12

13 Access t Trusted Relatinships Cnnecting Veterans With Their VA Care Teams 13

14 VA Telehealth Services 12 percent (677,000) f Veteran patients enrlled in VA care accessed thrugh telehealth 2.14 millin visits in FY16 Hme Telehealth: 156,000 Veterans Reductin in bed days f care 59% Reductin in hspital admissins 31% Patient satisfactin 88% Vide Telehealth: 307,000 Veterans Clinical Vide Telemental Health Reductin Acute Psychiatric care 39% Patient satisfactin 92% Stre & Frward Telehealth: 304,000 Veterans Patient satisfactin 94% 14 *Statistics as f September 2016

15 Clinical Vide Telehealth (>45 Clinical Specialties) 15

16 16

17 Episdes f Care Episdes f Care VA Vide Cnnect Mving Vide Visits t Veterans Persnal 900,000 Devices 800, , , , , , , , , , , , , , , ,000 3,648 3,660 4,890 6,945 11,023 20,447 31,279 39,453 0 FY 09 FY 10 FY 11 FY 12 FY 13 FY 14 FY 15 FY 16 All CVT 149,172188,082249,262387,529542,661659,650758,011837,851 CVT t hme 3,648 3,660 4,890 6,945 11,023 20,447 31,279 39,453 17

18 Realizing the Benefits 18

19 An Example: VA s Tele-Genmic Medicine Service Centralized Genmic Medicine and Cunseling service started in 2012 Reaches areas f the cuntry where genetic services are generally unavailable Prvides direct patient cunseling and supprt t lcal clinicians Care delivered thrugh cmmunity-based utpatient clients (CBOCs) as well as VA Medical Centers (VAMCs) t reach Veterans in their cmmunities Nw reaches 80 VAMCs 19

20 Anther Example: Tele-ICU Minneaplis V23 Sub-Hub Active Affiliate In Develpment JIF site (USAF MTF) Cincinnati Sub-Hub Active Affiliate In Develpment JIF site (Navy prpsed) 20

21 21

22 Frm Accessibility t System Capacity An Example: Reginal Telemental Health Hubs 22

23 My HealtheVet Secure Messaging Research Findings Increases access and satisfactin Increases cnvenience and efficiency Enhances patient/prvider relatinships Patients want t use with all f their prviders Timely respnse is critical Nazi, KM. The Persnal Health Recrd Paradx: Health Care Prfessinals Perspectives and the Infrmatin Eclgy f Persnal Health Recrd Systems in Organizatinal and Clinical Settings. J Med Internet Res 2013;15(4):e70 Natinal Oct-16 Nv-16 Dec-16 Ttal Unique Patient Senders 211, , ,100 Inbund Messages 521, , ,241 1,539,582 Escalated Messages 25,427 23,901 22,700 72,028 % Escalated 4.90% 4.60% 4.50% 4.66% Average Business Days t Cmplete Ttal Cmpleted Messages 520, , ,953 1,537,226 Messages Cmpleted by Triage Members 112, , , ,723 Messages Cmpleted by Clinical Members 285, , , ,522 Messages Cmpleted By Prviders 122, , , ,981 Outbund Team Member Messages , , ,187 1,636,609

24 Benefits f Secure Shimada et.al study fund that the use f secure reduced the rate f urgent care visits in VA Kaiser 2010 study fund that the use f secure was assciated with imprvements in HEDIS measures, including HbA1c, chlesterl and bld pressure cntrl Grup Health Cperative study evaluated the impact f managing depressin care using secure and fund the grup using secure had > 50% lwer rates f depressin cmpared with the cntrl VA studies have shwn that the use f secure imprves the prvider-patient relatinship and imprves patient engagement 24

25 Realizing the Benefits 25

26 Access t Trusted Health Infrmatin Cnnecting Veterans With Their Health Infrmatin 26

27 My HealtheVet Registrants: 3,817,629 Identity Prfed VA Patients: 2,255,495 Patients Opted-in fr Secure Messaging: 1,885,724 Rx Refill Requests: 14 millin per year VA Blue Buttn Dwnlad My Data: mre than 1.55 millin unique users Web Data: 55.8 millin visits/502 millin page views in % f all f VA.gv Web traffic Cnsistently the 4 th mst visited site in Federal Gvernment 27

28 Brn in

29 VA Open Ntes Launched in January 2013 All VA patients can access their clinical ntes using the VA Blue Buttn n My HealtheVet: Requires a Premium (authenticated) accunt Includes primary care, specialty care, mental health, scial wrk, nursing and Secure Messaging ntes, cnsult result ntes, and nte addendums Ntes frm January 1, 2013 frward available 29

30 VA Open Ntes Experience Abut the Survey 22 JUN 2013 t 15 SEP % randm sample f website visitrs wh navigated 4 r mre pages during their visit N=37,103 (62% survey cmpletin rate) Data filtered t remve ptential duplicates and fcus n patients receiving VA care (N=29,191) Research Team: Kim Nazi, Carlyn Turvey, Dawn Klein, Timthy Hgan, and Susan Wds 30

31 Knwledge and Use f VA Open Ntes 34% knew that VA Ntes culd be viewed 24% viewed their VA Ntes at least nce VA Open Ntes users (N=6861): were predminantly male (90%) and aged years ld (87%) tended t have mre educatin and mre frequent VA use tended t be mre frequent My HealtheVet users VA Open Ntes use was nt significantly assciated with gender r self-rated health status Mre than half f bth users and nn-users had previusly requested paper medical recrds VA Open Ntes users were asked additinal questins abut their experience 31

32 Summary f Key Findings (VA Open Ntes Users) Patients wh viewed their ntes anticipated cnsiderable benefits frm having access t clinical ntes similar t VA Open Ntes study, including: ding a better jb f taking medicatins as prescribed (80%) being better prepared fr clinic visits (89%) feeling mre in cntrl f their health care (91%) taking better care f themselves (91%) understanding their cnditins better (92%) being better able t remember the plan fr their care (92%) 32

33 Summary f Key Findings (cntinued) Althugh sme users may nt have understd all f the infrmatin cntained in their ntes, verall satisfactin with access t VA Open Ntes was generally rated high (and significantly higher if users did understand the infrmatin) The majrity f users reprted that they felt n need t cntact their prvider. Thse wh did (r planned t) mstly wanted t learn mre abut a health issue, medicatin r test result 33

34 VA Open Ntes Subsequent Findings Use: Veterans using VA Open Ntes are still minrity, but are mre engaged in VA services Open Ntes + Secure Messaging (SM): Accessing VA Open Ntes des nt seem t result in increased use f SM. But, Veterans wh have increased their SM use are mre likely t use VA Open Ntes Visits: Accessing VA Open Ntes des seem t be assciated with an increase in primary care visits Physician Behavir: Veterans access t VA Open Ntes des nt change dcumentatin behavir f primary care prviders 34

35 The Brader Open Ntes Stry 35

36 Realizing the Benefits 36

37 Imprving the Care Experience Fr Veterans, Caregivers and Health Care teams 37

38 Vice f the Veteran - Key Themes Transactins Make it easy fr me t take care f simple health-related tasks nline and n my mbile device Cmmunicatin Make it easy fr me t cmmunicate with my health care team when I need t d s Infrmatin Sharing Make it easy fr me t see my health care recrds, give me cntrl f my health care data, and let me share health-related data with yu Expert Care Make it easy fr me t access VA expertise when and where I need it. Prvide me with tls I can trust when it s my health n the line Wds SS, et al. J Am Med Infrm Assc 2016;0: di: /jamia/cv199, Perspective

39 Vice f the Prvider - Key Themes Wrkflw Integratin Make it easy fr me t deliver care virtually. Seamless electrnic health recrd integratin wuld be great Technlgy Make it easy fr me t use any VA Cnnected Care technlgies. Set-up shuld be simple and training needs minimal Wrklad / Cmpensatin Cnnected Care (virtual care) shuld be valued equal t face-t-face care. Recgnitin f this added wrklad is critical Patient Supprt Make it easy fr the patient t get the supprt they need t access and use virtual care tls Patient-Generated Data Patient-generated data is valuable and supprts patient self-care, but needs t be thughtfully integrated int wrkflw and care Wds SS, et al. J Am Med Infrm Assc 2016;0: di: /jamia/cv199, Perspective

40 VA Mbile 32 VA mbile apps Natinal Release 21 Field Testing - 11 Links t cmmercial apps stres and direct links t mbile and web apps Training materials App feedback 40

41 Messaging Enabled Self-Care A mbile messaging system that prmtes self-care fr Veterans. Annie sends regular, autmated text message reminders t Veterans t help them track health infrmatin requested by their VA care teams. Annie can als can send Veterans reminders and messages frm their lcal VA facility Named after Lt. Annie G. Fx First wman t receive Purple Heart fr cmbat 41

42 Annie PGD data is Available t the Clinical Team 42

43 Realizing the Benefits 43

44 Lessns Learned When building an enterprise VA Cnnected Care prgram, technlgy shuld nt be the primary fcus Quality care Ease f use Wrkflw / life integratin Adequate technical supprt Maintaining brand / reputatin Preserving relatinship Scaling requires mre resurces than yu think Active spnsrship by yur executive team Clinical leadership buy-in Cmmunities f practice Standardizatin f practice Training (multi-channel) Dedicated custmer supprt, fr bth patients and health care teams Assurance f quality Perseverance and partnerships! 44

45 Lessns Learned (cntinued) Design fr yur entire patient ppulatin. Beware f the digital divide Persnas can be very helpful It s k t have mre than ne digital slutin accmplishing the same thing Multiple channels (telephne, SMS, web, mbile, vide, etc.) Tailred user supprt and training VA Cnnected Care wn t market itself Recmmended t a patient by a trusted staff member is by far the best ptin Helping health care team members understand the advantages f VA Cnnected Care, and the cnvenience it affrds fr patients shuld be a primary gal Be sure virtual wrk is adequately recgnized. Health care team staff members are yur mst capable marketing team Careful user-centered design f nline and mbile sites is critical 45

46 Value f Health IT S High patient satisfactin strng acrss Cnnected Care prgrams Hme Telehealth 88% Stre-and-Frward Telehealth 94% Clinical Vide Telehealth 92% My HealtheVet Out f mre than 120,000 surveys - sat scre f 76 / 100 T E Treatment efficiencies realized fr all stakehlders (patients, prviders, & the health system) Significant utilizatin by Veterans f secure access t their data help with understanding/managing care Travel savings / Decreased barriers t access / Patient cnvenience Leveraging scale f the VA Health Care System 1.4 millin VA Blue Buttn feature users 15.7 millin VA Blue Buttn file dwnlads 46

47 Value f Health IT P Patient Engagement is a primary gal f all Cnnected Care technlgies 1.7 millin VA patients pted in t use Secure Messaging 81 millin VA prescriptin refills since August 2005 S Operatinal, Business and ther savings can be realized trugh enterprise planning fr cnnected care Hme Telehealth reduced bed days f care 59% Hme Telehealth reduced hspital admissins 31% 47

48 Questins? Neil C. Evans, MD Twitter: 48