Implementation of Veterans Affairs (VA) Mobile Health (Panel)
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Abstract
Panelists
Organizer: Thomas Houston, MD, MPH is the Director of the eHealth Quality Enhancement Research Initiative (QUERI) that evaluates eHealth as a model of care for augmenting efficient, safe, high-quality, continuous, coordinated delivery of evidence-based services to Veterans and their families. His research is focused on the evaluation of mobile applications that could be placed in the ‘VA App Store’.
Kathleen Frisbee, MPH, PhDc is the Director of Web and Mobile Solutions in the Veterans Health Administration. She manages a number of mobile health initiatives including the launch of the VA’s “Clinic-in-Hand†mHealth pilot, Mobile Blue Button and provider-facing mobile apps. These initiatives employ mobile technologies to exchange clinical data with Veterans and Providers.
Ron Moody, MD currently works as the Director, Clinical System Development at Agilex. He is currently working on VA Veteran facing applications under the Clinic In Hand project. He is a Board Certified Family Medicine Physician with over 15 years of experience in healthcare informatics.
Wyatt Smith, DO is the Director of Healthcare Programs for Agilex and is leading the security and operational implementation of mobile devices in VA as well as VA provider mobile applications. He is a board certified Oncologist and past Deputy CIO for the Military Health System.
Susan S. Woods MD, MPH is a consumer informaticist and champion of participatory medicine, working to bring the patient voice into the development of HIT. At the VA, she serves as lead for the patient-facing component of the Health Informatics Initiative, the VHA effort to develop the next generation of electronic medical records.
Neil Evans, MD is the Associate Chief of Staff, Informatics & Co-Chief, Primary Care Washington DC Veterans Affairs Medical Center. He is a board certified internist and leads the VA provider mobile programs, pilots, and research.
Panel Proposal
Smart mobile devices represent an important part of our daily life and an opportunity to engage patients in the management of their health and behaviors that effect health. Patient-centered care that offers remote access to electronic medical records, virtual monitoring and visits, asynchronous communication, social networking, video conferencing and remote documentation will dramatically change healthcare delivery in the US. Results of the U.S. Department of Veterans Affairs mobile programs are beginning to show large positive effects.
Veterans Affairs (VA) is responsible for 22 million Veterans. Over 9 million Veterans currently obtain healthcare from VA. VA leads US federal mobile healthcare initiatives for both patients and providers and is designing its systems around the needs of patients and associated healthcare teams. VA’s enterprise EHR (VistA) has been submitted to the open source community. The VA mobile strategy includes releasing mobile healthcare applications into the open source community. VA also intends to publish EHR and other systems application programming interfaces so interested communities will have the opportunity to develop innovative capabilities to further improve Veterans’ health.
The assembled panel will discuss aspects of patient and provider application development, clinical pilot results, security, and deployment. Key demonstrations related to patient engagement in their health and provider efficiencies will be provided. VA mobile governance and process for integrating commercial and private innovations will be discussed.
Panel Outline
• Intro to VA
U.S. Department of Veterans Affairs (VA) has been a leader in the use of health information technology for more than two decades. While the VHA's budget, staff and patient population is larger than those of the average health care organization, the administration's use of international standards for data exchange and willingness to embrace emerging health care technologies such as telehealth, consumer health IT and data analytics can be an example for many health systems.
• Rational for mHealth initiative
Wireless technologies represent an important and emerging opportunity to provide quality and patient-centered care, with promise of gaining efficiencies and cost reductions. Healthcare that offers providers and patients remote access to electronic medical records, virtual monitoring and visits, asynchronous communication, social networking, video conferencing and remote documentation are positioned to make a positive and dramatic difference in people’s lives. For patients, mHealth can enable various ‘push’ notifications, such as reminders to take medicine; easy access to individual health information; communication with healthcare teams; and mechanisms to enter data ranging from satisfaction surveys to symptoms to rating experiences with doctors, hospitals, websites, and applications. The VA mobile and wireless efforts are part of a larger effort to change the way care is delivered, by designing its systems around the needs of patients and prepared healthcare teams to improve care coordination.
• Laying the foundation for the adoption of a mobile technologies in VA
In order for VA to adopt a mobile platform it was necessary to build the mobile infrastructure. VA contracted with Agilex to complete an analysis of VA systems and make recommendations for implementing and supporting smartphone and tablet devices. This analysis considered the risks and issues associated with the implementation and management of various mobile devices within VA’s infrastructure. Recommendations included security risk mitigation strategies, management, provisioning and procurement of the devices, as well as architecture and infrastructure requirements. System and device security issues were addressed for both Veteran and Provider facing applications using a mix of IT capabilities and policy decisions. Key architecture decisions involved the adoption of user identification standards and data standards for self-entered data. Innovations to enhance the user experience included the development of single sign-on to work between apps, allowing data to be used across apps, and the LaunchPad concept as a way to weave individual VA apps together so that they will work as an integrated system within the LaunchPad container.
• Creating a Mobile Health Strategy
VA’s approach to mobile technology has been a deliberate effort to incorporate the benefits of mobile devices into an integrated information systems infrastructure. VA’s goal is to create a seamless experience for patients and providers across multiple interfaces delivering the right health information to the right person, in the right place, at the right time, and in the right (meaningful) manner. VA’s views mobile applications as just one of many modalities that are used to facilitate Veteran Health and the delivery of care. In order to prevent the risks of an array of confusing interfaces for Veterans and clinicians, VA has sought to unify its eHealth strategy by recognizing the convergence of mobile devices with ubiquitous access, the electronic health record, telehealth, personal health records and mobile applications. The following foundational elements for VA’s mobile health strategy will be discussed.
• Policies & Procedures
a. Alignment of PHR and Mobile sharing policies
b. Accommodation of delegation features
c. Separation of veteran self-entered data from clinical information systems
d. Mobile app user help desk services
e. Communications plan for initial roll-out and updates of apps
• Architecture
a. Mobile Integrated Development Environment
b. Standard information models
c. Cloud hosting environment
• Standards
a. Terminology standards
b. Information Modeling standards
c. Alignment of data sharing approaches
d. Instructional content format
• Security
a. VA App store versus Public App Store
b. Credentialing and Authentication
c. Mobile Device Management Software for government owned devices
d. Election to store protected health information on veteran owned devices
• Usability & Design
a. User centered design practices
b. Branding
c. User testing of mobile apps
d. Standardization of the display of clinical information
• Governance
a. Clinical stratification of apps for levels of clinical review
b. Stratification of apps for levels of usability review
c. Coding review
d. Standards review
• Demos of mHealth projects
The Clinic-in-Hand project establishes VA’s ability to exchange health related data with Veterans and their authorized Family Caregivers using native apps created for mobile devices. Apps have been designed to support to Veterans and their caregivers though interventions targeted at the self-management of medical conditions and to assist in those tasks associated with healthcare coordination. Through this project the Veteran and Family Caregiver can access their demographics, laboratory data, medications, allergies, appointments, problem list and communicate as well as share information with their healthcare teams.
Mobile Blue Button is a series of veteran and provider mobile apps that are built using HTML5 and are accessible across multiple mobile operating systems. Much of the functionality of the Clinic-in-Hand project is being extended to work across mobile platforms and operation systems in the Mobile Blue Button but additional functionality has been added to support providers. Provider functionality includes the display of patient clinical information, single Sign-On across applications for providers and the ability to secure email patients from mobile devices.
Provider Mobile App expansion creates native apps for mobile devices that builds additional functionality that has been requested by providers.
• Review of Mobile App Governance Process
The VA is developing a “VA App Store†to hold all of the mobile applications developed by the VA. Given that there are already many good applications available on the market, there will be a certification process for existing or planned non-VA applications to be included in the VA App Store. To assure patient safety, information security, and adequate, consistent user experience, VA will review all mobile health apps proposed for publication to the VA App Store. To support developers and accelerate innovation, all review criteria related to certification will be published in the VA development environment.
VA will complete a Governance Board review after the submission of an application for certification. The Governance Board will conduct a review that covers safety, privacy, security, engineering, the human interface, and 508 Compliance. The Governance Board review will include a content review and assessment. The review will determine if application needs further evaluation. Reviews will be tiered and commensurate with the application’s risk. Consistent with the FDA approach toward regulation of mobile medical devices, we propose a discretionary evaluation program determined based on the category of risk. An application may be assigned discretionary evaluations to assure that it satisfies functional and non-functional requirements. The results of the discretionary evaluations will be returned to the Governance Board for final approval.
• Future Goals
VA intends to leverage mobile technology to increase the frequency and quality of the interactions it has with its Veteran patients. VA is working toward decision support algorithms that combine data from the VA’s EHR with data that is self-entered on the mobile device will create personalized mobile health assistants that can be used by patients in their self-care. The increased volume and frequency of data provided by patients through their mobile devices will be managed by algorithms designed to provide tailored coaching and link with health care team by providing summarized information and notifications when appropriate. Provider-facing mobile health applications are being created to leverage the portability of information needed by health care professionals at the point of care and to enhance their ability to communicate medical information with their patients. This session will demonstrate VA’s current and future applications.
Organizer: Thomas Houston, MD, MPH is the Director of the eHealth Quality Enhancement Research Initiative (QUERI) that evaluates eHealth as a model of care for augmenting efficient, safe, high-quality, continuous, coordinated delivery of evidence-based services to Veterans and their families. His research is focused on the evaluation of mobile applications that could be placed in the ‘VA App Store’.
Kathleen Frisbee, MPH, PhDc is the Director of Web and Mobile Solutions in the Veterans Health Administration. She manages a number of mobile health initiatives including the launch of the VA’s “Clinic-in-Hand†mHealth pilot, Mobile Blue Button and provider-facing mobile apps. These initiatives employ mobile technologies to exchange clinical data with Veterans and Providers.
Ron Moody, MD currently works as the Director, Clinical System Development at Agilex. He is currently working on VA Veteran facing applications under the Clinic In Hand project. He is a Board Certified Family Medicine Physician with over 15 years of experience in healthcare informatics.
Wyatt Smith, DO is the Director of Healthcare Programs for Agilex and is leading the security and operational implementation of mobile devices in VA as well as VA provider mobile applications. He is a board certified Oncologist and past Deputy CIO for the Military Health System.
Susan S. Woods MD, MPH is a consumer informaticist and champion of participatory medicine, working to bring the patient voice into the development of HIT. At the VA, she serves as lead for the patient-facing component of the Health Informatics Initiative, the VHA effort to develop the next generation of electronic medical records.
Neil Evans, MD is the Associate Chief of Staff, Informatics & Co-Chief, Primary Care Washington DC Veterans Affairs Medical Center. He is a board certified internist and leads the VA provider mobile programs, pilots, and research.
Panel Proposal
Smart mobile devices represent an important part of our daily life and an opportunity to engage patients in the management of their health and behaviors that effect health. Patient-centered care that offers remote access to electronic medical records, virtual monitoring and visits, asynchronous communication, social networking, video conferencing and remote documentation will dramatically change healthcare delivery in the US. Results of the U.S. Department of Veterans Affairs mobile programs are beginning to show large positive effects.
Veterans Affairs (VA) is responsible for 22 million Veterans. Over 9 million Veterans currently obtain healthcare from VA. VA leads US federal mobile healthcare initiatives for both patients and providers and is designing its systems around the needs of patients and associated healthcare teams. VA’s enterprise EHR (VistA) has been submitted to the open source community. The VA mobile strategy includes releasing mobile healthcare applications into the open source community. VA also intends to publish EHR and other systems application programming interfaces so interested communities will have the opportunity to develop innovative capabilities to further improve Veterans’ health.
The assembled panel will discuss aspects of patient and provider application development, clinical pilot results, security, and deployment. Key demonstrations related to patient engagement in their health and provider efficiencies will be provided. VA mobile governance and process for integrating commercial and private innovations will be discussed.
Panel Outline
• Intro to VA
U.S. Department of Veterans Affairs (VA) has been a leader in the use of health information technology for more than two decades. While the VHA's budget, staff and patient population is larger than those of the average health care organization, the administration's use of international standards for data exchange and willingness to embrace emerging health care technologies such as telehealth, consumer health IT and data analytics can be an example for many health systems.
• Rational for mHealth initiative
Wireless technologies represent an important and emerging opportunity to provide quality and patient-centered care, with promise of gaining efficiencies and cost reductions. Healthcare that offers providers and patients remote access to electronic medical records, virtual monitoring and visits, asynchronous communication, social networking, video conferencing and remote documentation are positioned to make a positive and dramatic difference in people’s lives. For patients, mHealth can enable various ‘push’ notifications, such as reminders to take medicine; easy access to individual health information; communication with healthcare teams; and mechanisms to enter data ranging from satisfaction surveys to symptoms to rating experiences with doctors, hospitals, websites, and applications. The VA mobile and wireless efforts are part of a larger effort to change the way care is delivered, by designing its systems around the needs of patients and prepared healthcare teams to improve care coordination.
• Laying the foundation for the adoption of a mobile technologies in VA
In order for VA to adopt a mobile platform it was necessary to build the mobile infrastructure. VA contracted with Agilex to complete an analysis of VA systems and make recommendations for implementing and supporting smartphone and tablet devices. This analysis considered the risks and issues associated with the implementation and management of various mobile devices within VA’s infrastructure. Recommendations included security risk mitigation strategies, management, provisioning and procurement of the devices, as well as architecture and infrastructure requirements. System and device security issues were addressed for both Veteran and Provider facing applications using a mix of IT capabilities and policy decisions. Key architecture decisions involved the adoption of user identification standards and data standards for self-entered data. Innovations to enhance the user experience included the development of single sign-on to work between apps, allowing data to be used across apps, and the LaunchPad concept as a way to weave individual VA apps together so that they will work as an integrated system within the LaunchPad container.
• Creating a Mobile Health Strategy
VA’s approach to mobile technology has been a deliberate effort to incorporate the benefits of mobile devices into an integrated information systems infrastructure. VA’s goal is to create a seamless experience for patients and providers across multiple interfaces delivering the right health information to the right person, in the right place, at the right time, and in the right (meaningful) manner. VA’s views mobile applications as just one of many modalities that are used to facilitate Veteran Health and the delivery of care. In order to prevent the risks of an array of confusing interfaces for Veterans and clinicians, VA has sought to unify its eHealth strategy by recognizing the convergence of mobile devices with ubiquitous access, the electronic health record, telehealth, personal health records and mobile applications. The following foundational elements for VA’s mobile health strategy will be discussed.
• Policies & Procedures
a. Alignment of PHR and Mobile sharing policies
b. Accommodation of delegation features
c. Separation of veteran self-entered data from clinical information systems
d. Mobile app user help desk services
e. Communications plan for initial roll-out and updates of apps
• Architecture
a. Mobile Integrated Development Environment
b. Standard information models
c. Cloud hosting environment
• Standards
a. Terminology standards
b. Information Modeling standards
c. Alignment of data sharing approaches
d. Instructional content format
• Security
a. VA App store versus Public App Store
b. Credentialing and Authentication
c. Mobile Device Management Software for government owned devices
d. Election to store protected health information on veteran owned devices
• Usability & Design
a. User centered design practices
b. Branding
c. User testing of mobile apps
d. Standardization of the display of clinical information
• Governance
a. Clinical stratification of apps for levels of clinical review
b. Stratification of apps for levels of usability review
c. Coding review
d. Standards review
• Demos of mHealth projects
The Clinic-in-Hand project establishes VA’s ability to exchange health related data with Veterans and their authorized Family Caregivers using native apps created for mobile devices. Apps have been designed to support to Veterans and their caregivers though interventions targeted at the self-management of medical conditions and to assist in those tasks associated with healthcare coordination. Through this project the Veteran and Family Caregiver can access their demographics, laboratory data, medications, allergies, appointments, problem list and communicate as well as share information with their healthcare teams.
Mobile Blue Button is a series of veteran and provider mobile apps that are built using HTML5 and are accessible across multiple mobile operating systems. Much of the functionality of the Clinic-in-Hand project is being extended to work across mobile platforms and operation systems in the Mobile Blue Button but additional functionality has been added to support providers. Provider functionality includes the display of patient clinical information, single Sign-On across applications for providers and the ability to secure email patients from mobile devices.
Provider Mobile App expansion creates native apps for mobile devices that builds additional functionality that has been requested by providers.
• Review of Mobile App Governance Process
The VA is developing a “VA App Store†to hold all of the mobile applications developed by the VA. Given that there are already many good applications available on the market, there will be a certification process for existing or planned non-VA applications to be included in the VA App Store. To assure patient safety, information security, and adequate, consistent user experience, VA will review all mobile health apps proposed for publication to the VA App Store. To support developers and accelerate innovation, all review criteria related to certification will be published in the VA development environment.
VA will complete a Governance Board review after the submission of an application for certification. The Governance Board will conduct a review that covers safety, privacy, security, engineering, the human interface, and 508 Compliance. The Governance Board review will include a content review and assessment. The review will determine if application needs further evaluation. Reviews will be tiered and commensurate with the application’s risk. Consistent with the FDA approach toward regulation of mobile medical devices, we propose a discretionary evaluation program determined based on the category of risk. An application may be assigned discretionary evaluations to assure that it satisfies functional and non-functional requirements. The results of the discretionary evaluations will be returned to the Governance Board for final approval.
• Future Goals
VA intends to leverage mobile technology to increase the frequency and quality of the interactions it has with its Veteran patients. VA is working toward decision support algorithms that combine data from the VA’s EHR with data that is self-entered on the mobile device will create personalized mobile health assistants that can be used by patients in their self-care. The increased volume and frequency of data provided by patients through their mobile devices will be managed by algorithms designed to provide tailored coaching and link with health care team by providing summarized information and notifications when appropriate. Provider-facing mobile health applications are being created to leverage the portability of information needed by health care professionals at the point of care and to enhance their ability to communicate medical information with their patients. This session will demonstrate VA’s current and future applications.
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