Saturday, August 27, 2011

Upgrading Veterans Healthcare

When the Department of Veterans Affairs replaces present kiosks and installs new “Point-of-Service” self-service kiosks in all ten VISN 4’s medical centers and in most community-based outpatient clinics, veterans will be able to take better charge of their medical care.

Recently, the VA awarded a $20 million contract to Vecna Medical to implement the kiosks in VA hospitals and healthcare centers nationwide. Approximately 15,000 VPS kiosks will be installed in the U.S. plus the territories over a five year period.

Veterans will use the new kiosks to update their personal information, view their account balance, and check in for appointments, but the biggest change is that veterans will be able to update their medication and allergy records right at the kiosk. Some new self-service capabilities will not be available immediately, but will be added later this year.

When the Portland VA Medical Center in Oregon initiated self-service kiosks for clinical applications, they found that self-service kiosks are the best way to collect patient information. Dr, Blake J. Lesselroth a Portland VAMC Clinical Informaticist, is grateful that these kiosks will help to improve the accuracy of medication records. He reports that about 95 percent of veterans’ medication records are not accurate. Twenty-five to 30 percent of medications that veterans take are not recorded plus the fact that ten to fifteen percent of veterans are not taking medications that are in their records”.

Future kiosk capabilities will include complete health screening, be able to scan health insurance cards, enable credit card payments, be able to request pharmacy refills, veterans will be able to complete surveys, schedule or change appointments, and access personalized health information through “My HealtheVet”.

VA Medical Centers will take a look at the patient flow throughout the hospital to plan the location for the kiosks so that they will be located near clinic check-in clerks. Many will be placed in lobbies, but they will also have kiosks located in actual clinic waiting rooms. Concerns will be addressed by check-in clerks and proctors along with signage to direct patients to the kiosks.

Veterans will not need to worry about their private information being seen by others. The kiosks are “thin clients” meaning no actual information is stored on the device. All information is stored on a server that cannot be accessed from a kiosk. Since kiosks require the use of the VIC card to access, no personal identifying information will be used.

In another new program, the VA is working to help veterans especially in rural areas have better access to healthcare. The VA is now implementing a three year pilot program to provide healthcare services through contractual arrangements with non-VA care providers. The program called “Access Received Closer to Home” or “Project ARCH” is intended to not only help all veterans but especially help veterans in rural areas receive care closer to home.

Recently, the contract to perform the duties of the program and to provide specified healthcare services to eligible veterans in certain pilot sites was awarded to Humana Veterans Healthcare Services, a subsidiary of Human Military Healthcare Services owned by Humana Inc.

The program has established five pilot sites across the country and is offering the program in Maine, Virginia, Kansas, Arizona, and Montana. Care coordinators will work closely with contracted non-VA providers to make certain that all of the necessary clinical information from veteran’s medical records is available and up-to-date. Veterans are eligible to participate in the program if they reside in a location where a “Project ARCH” pilot site is located and if the veteran is enrolled in the VA healthcare system when the program starts.

The VA will pay a negotiated contract rate for the services provided by non-VA providers but the veterans who participate in “Project ARCH” will still have the responsibility for co-payments if applicable.

In another program, the VA’s “Center for Comprehensive Access and Delivery Research and Evaluation” (CADRE) program has 55 funded research projects to identify access barriers, develop feasible interventions to improve healthcare delivery, and to create a new model for partnership with VA operations. The focus areas include rural health, telehealth and e-health strategies, patient-centered behavioral and self-management interventions, and nursing health services research.

CADRE is actively partnering with the Veteran’s Rural Health Resource Center in the Central Region in their VISN 23 PACT Demonstration Laboratory to evaluate the effectiveness of VHA’s Patient Centered Model Home model, and the eHealth Quality Enhancement Research Initiative (QUERI).