The VA is testing iPads to improve home care for war-wounded veterans

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The U.S. Veterans Administration is embarking on a one-year pilot project to loan some 1,120 iPads to the home-based caregivers of severely injured war veterans in an effort to streamline and improve the flow of health information from patients back to the VA.

The iPads will replace detailed patient reports that are now done by caregivers via telephone, through a secure website, or through handwritten notes turned in during patient visits to their doctors, said Dr. Neil Evans, associate chief of staff for informatics at the VA Medical Center in Washington, D.C.  The iPads are loaded with nine specially built health care apps that will be used to report patient information to the agency, including overall health assessments, pain reports, necessary prescription refills and more.

"These are people who have high health care needs and who can't get treatment in traditional ways," Evans told CITEworld. "So how do we help them? By creating technologies that give a better sense of connection with their health care teams."

Part of an improved care program for vets

The VA Mobile Health Family Caregiver Pilot project is part of a program announced in 2012 that aims to make it easier for seriously injured post-9/11 veterans and their caregivers to get improved support and assistance from the VA

The veterans who are receiving the in-home care under the program suffered severe injuries in post- 9/11 conflicts, such as multiple amputations, devastating brain injuries, and Post Traumatic Stress Disorder due to weapons fire, improvised explosive devices, and other warfare attacks, said Evans.

"We are getting these devices into the hands of families so they can care for their veterans," he said. Funding for the pilot project is coming from the Caregivers and Veterans Omnibus Health Services Act of 2010, which authorized more money to help injured veterans.

Much of the care of these veterans is done in-home after they are released from hospitals so they can continue their healing and recoveries.

"Family member caregivers are providing a huge chunk of healthcare in this country," said Evans. "This program allows those caregivers to receive monthly stipends from the VA to manage their care and to provide training, counseling, and respite support for the caregivers."

At least 4,000 veterans and their caregivers were given the option to join the iPad pilot project, and some 1,120 volunteered to participate. The iPads are being shipped to patients and caregivers starting April 22 and the pilot is to get underway in May.

Using the iPads, the health care details for patients will be reported more quickly, and because they are electronic rather than paper-based, that information will then be available to a much wider group of health care professionals who are providing the care, said Evans. Even more critically, the mobile iPad apps will directly tie into back-end systems and apps at the VA, removing the inefficiencies and potential errors of paper and phone-based reporting.

"They'll be better connected with their care providers," he said. "Our mission is to provide holistic health care to those entrusted to us. I like to say that health care occurs not just in the clinics and in the hospital, but also in patients' living spaces.

Ensuring patient privacy

One key issue to solve before getting the pilot underway was to ensure that the medical information being reported through the mobile apps would remain secure and confidential, said Evans.

A similar remote reporting technology initiative was undertaken back in 2011 by what is now the VA Center for Innovation, and lessons learned from that program were used to build the latest iPad project. That project, however, was aimed at providing mobile patient management capabilities to doctors and other healthcare providers inside VA hospitals and other care facilities.

"We spent an entire year working through security issues, such as how to secure the devices, what mobile device management software to use, and coming up with policies for data, architecture and for which devices to use," said Evans. "We created an app, the VA Patient Viewer App, which allowed people to view data about the patients on a mobile device."

Following the initial success of that project, leaders inside the VA realized it would be a great idea to come up with a similar mobile reporting program that could be used by in-home caregivers for direct patient care, said Evans.

One problem that did crop up was the need for digital authentication of caregivers as legal representatives for the patients due to medical records privacy laws, said Evans. To do that, a special log-in method was adopted that met the needs of both caregivers and the government records systems. "It's not been our standard means of authentication, so we had to work through memos of understanding to do it with various agencies. It was a definite challenge that we had to work through."

The iPads were chosen over other devices such as Android machines, according to Evans, because they share a single manufacturer, rather than being built by a wide range of makers in various models. By minimizing the number of models to one, support and service are streamlined and simplified, he said. "I don't think we would have gotten to where we are now if we hadn't chosen this."

Better security was another key to the iPads being selected. The VA did look at Android devices, he said, and the agency will likely have to plan for them in the future.

"We will have to eventually come up with a system that is platform-agnostic, because patients and caregivers want to use different devices," but to start, the decision was made to use a single platform, said Evans. "It's hard to swim across the ocean before being able to swim across the swimming pool in your backyard.

Program could be extended to all veterans

So far, in testing over the last year, the VA has received lots of helpful feedback from small groups of caregivers who have been using early devices, he said. "We've learned a lot of lessons and it will help us in terms of future development."

The iPad pilot program is potentially being viewed by the VA as a future means of dramatically improving in-home care of severely-injured war veterans across the nation, said Evans. "This is a way to really support and empower care in the home right where people are. It's really exciting."

Eventually, the results of the year-long pilot will be evaluated, and compared with the experiences of caregivers who opted to continue with other reporting methods. After those comparisons and evaluations, the VA will determine whether it should deploy the iPad program to all families.

Eventually, the apps that will be used on the iPads also could also be made available to any of the six million veterans who receive health care services from the VA each year, said Evans. 

"Many of these applications would be really useful for any patients to use – and that would be our vision – to eventually release them for consumption on personal mobile devices for our patients at large."

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