Gail Graham, Deputy Chief Officer, Health Information Management, Office of Health Information at VHA, appeared before the House Committee on Veterans Affairs and the Health Subcommittee to discuss how the future expansion of wireless technologies will help veterans in rural communities. Graham sees the potential use of wireless to target veterans with TBI, PTSD, or visual impairments.
The VA has initiated plans to develop and deploy a nationwide program to use wireless networking that is separate from the VA wireless LANs to use at VA healthcare facilities. Veterans and their families will be able to use this technology for communications, email, and therapeutic activity during patient stays at VA facilities.
VHA recently established a Program Office dedicated to using Real Time Location Systems (RTLS) to locate and track equipment, clinical staff, patients, and patient or staff movements. This information will also help improve the quality and efficiency of healthcare delivery to veterans by improving workflow. RTLS uses wireless LAN, RFID, Infrared, and other technologies. Future plans include developing requirements, standards, and overseeing the broader RTLS deployment.
Joseph M. Smith, M.D., PhD, Chief Medical and Science Officer at the West Wireless Health Institute in La Jolla, suggested that the VA in their Care Coordination/Home Telehealth (CCHT) program needs to take the next step and incorporate innovations beyond traditional telehealth equipment.
Plans should be made to evaluate and implement wireless health solutions to further extend the reach of the CCHT program. The technology should include wireless biometric sensors to monitor highly relevant physiologic parameters to track disease activity on a continuous basis and then be able to transmit the information to the patient’s healthcare provider.
Currently, the West Wireless Health Institute is exploring a VA demonstration research project in San Diego that is working with a small cohort of recently diagnosed PTSD patients. The demonstration project incorporates a mobile device with video conferencing capabilities to enhance crisis management, provides for regular “check-ins”, and biofeedback therapies. The plans are to increase access to real-time support for veterans with PTSD so that hospital admissions and acute events will decrease.
Dr. Smith thinks that the VA with the new $80 million VA Innovation Initiative (VAi2) will certainly improve veterans care but he wants to encourage a program such as VAi2 to accelerate wireless health solutions to enable home and mobile monitoring for symptoms and biometrics to enable remote therapies for a wide range of chronic and acute care needs.
According to Colonel Ronald Poropatich M.D., Deputy Director TATRC, the Army has developed, deployed, and is evaluating a mobile telephone-based secure messaging system called “mCare”. As of June 2, 2010, “mCare” has delivered over 18,500 messages to over 300 warriors assigned to Community-Based Warrior in Transition Units.
As the Colonel explained, there have been a number of challenges to overcome to achieve success with “mCare”. Today, the personal cell phones that patients use come in a wide variety of phone models and wireless carriers and as a result, these needs must be accommodated. Each wireless carrier has separate testing and certification processes that require specific devices that have different installation processes. This has resulted in a complex technological process for clinical teams to navigate.
Developing a streamlined simple process to be used by the care team while negotiating with each wireless carrier to enable accessibility to patients at no cost, is a time consuming process and is still ongoing. Also, full integration with the PHR is not currently part of the “mCare” model however, the feasibility and the cost to incorporate the PHR is being explored.
Colonel Poropatich discussed how the Army is specifically trying to help in the treatment of diabetes. The Army is exploring an important wireless application by examining the impact of a video cell phone reminder system to help in glycemic control in patients with diabetes mellitus. The evidence shows that the positive impact of Self Monitoring of Blood Glucose (SMBG) is important so that more patients can reach appropriate goals for glycemic control. However, SMBG remains suboptimal and one-third of patients with diabetes are not adhering to their medications.
Preliminary results show that AIC improves more in patients who are provided with video reminders as compared to those who did not receive them. Using reminders delivered via the cell phones appears to be an effective way to improve glycemic control and long term outcomes.
Currently, the Army Research and Development Command (RDECOM) is evaluating commercial handheld solutions and how they can work in a tactical setting. RDECOM has developed numerous handheld command and control solutions and is supporting the development and transition of “MilSpac”, to operate in a social networking environment.
As Colonel Poropatich stated, “The challenges that need to be addressed include integrating legacy information systems with mobile applications. As mobile phones evolve from simple communication tools into complex physiological data gathering devices, the line between cell phone and a medical device will blur. From a practical perspective, it is important to avoid overloading already busy clinicians with more information than they are able to use.