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An open source approach to Veterans Affairs medical info

For years, the VA has run the Veterans Health Information Systems and Technology Architecture (VistA), which is their Electronic Health Record (EHR) system. Turns out it was written by clinicians themselves, and has served well over years. However, the VA believes it might be time to use open source methods in a kind of public/private partnership. This is a really big deal, novel in government, which might also improve the health record systems we all use. This could become the basis of a jointly developed health records platform.

Here's the gist:

VistA’s capabilities evolved endogenously over the many years it has been in successful production, and are the result of the contributions of many innovations, including those that came from within VA itself. However, today’s health care environment – in which new models of care are continuously developed and deployed – is utterly dependent upon the accelerating technological development of new medical devices, improved IT infrastructure, services, and wireless communications. In order to sensibly benefit from these advances, VA must address fundamental structural constraints that will inhibit its ability to keep pace with health services delivery. Specifically, VA believes that a structured, deliberate, and predictable migration from our custom and proprietary EHR software to an openly architected, modular, and standards-based platform will achieve five crucial objectives:

1. It will unleash EHR innovation inside and outside VA.
2. It will release VA’s captive dependency on any particular component or service and give our clinicians access to the best available tools andsolutions.
3. It will reduce the costs and risks of reliable implementation (andintegration) of new functional modules that improve VistA’s capabilities.
4. It will measurably improve health outcomes for our nation’s Veterans.
5. It will enable other providers in the public and private health caresystem to benefit from, contribute to, and interoperate with this national asset.

Industry innovation for veterans from Veterans Affairs

Okay, the deal is to work with private industry in the spirit of "public/private innovation" and to figure out new tech to better help vets in the field, in areas including medical tech, housing for homeless vets and tools to help veteran entrepreneurs

Those were the themes of the third phase of the VA Innovation Initiative (VAi2). In one part, vendors proposed new tech for patient monitoring, mobility and wireless being a big part. The judging was performed by VA rank-and-file workers for the most part. (I was also involved, but my contributions were not significant compared to the people who really know stuff.)

Details: VA Announces Award of First Industry Innovation Competition Projects

The first award is to mVisum, Inc., based in Camden, N.J. It funds a pilot project at the Washington DC VA Medical Center that enables health care providers to wirelessly review, share, and respond to cardiology data on mobile devices, increasing the ability to respond more quickly to patient needs.

The second award, made to Agilex Technologies, Inc of Chantilly, Va., funds an alternative pilot project at the same Washington DC VA Medical Center. This pilot intends to explore the ability for extending elements of VA’s Electronic Medical Record to electronic devices. The pilot will allow patient search, demographics, laboratory data, medications, allergies, appointments, and problem lists to be displayed. Agilex will also integrate clinic schedules and secure messaging onto the device.

MedRed, LLC, based in Washington, D.C., was awarded a project that VA will implement at the McGuire VA Medical Center’s Polytrauma Clinic in Richmond, Va. The project will field test a software tool that helps healthcare providers to more easily share new and innovative treatment strategies to improve the care of Veterans being treated for traumatic brain injury.

The fourth award, made to Venture Gain, LLC of Naperville, Ill., funds a project at the George E. Wahlen VA Medical Center in Salt Lake City, Utah. The project will pilot a next generation system of wearable sensors combined with software analytics to predict and prevent complications for patients diagnosed with heart failure.

VA Blue Button moves ahead with vets health records

The Blue Button is a way for a vet to download their personal healthrecord, maybe to bring to a doctor or clinic. It's a moving target, abig step toward getting more info available and accessible. It's one of many efforts across government to provide better medical care at lowercost for everyone.

Blue Button draws mostly on data entered by the vet, but also has aconnection to health information from the Department of VeteransAffairs. DoD has one too. Because they coordinated so closely they arenearly identical. You don't see that every day in large agencies.

The deal is that Veterans Affairs has greatly accelerated the rate atwhich they serve vets, with lots more to come.

Vets can access their Blue Button records at myhealth.va.gov

It includes the following now, more to come:

• Emergency contact information
• Medications
• Allergies
• Medical conditions and personal
• medical history
• Family medical history
• Test results
• Military health history
• Health Care Providers
• Treatment Facilities
• Health Insurance
• Immunizations
• Labs and Tests
• Vitals and Readings
• Family Health History (Self and Relatives)

Again, it's a moving target, more to automation to come, which will benefit us all.

VA Improves Services Through Employee Innovation

A principle of Open Government is that workers can build solutions to real problems and get the attention of top management.

The Department of Veterans Affairs has been doing a lot of this recently, providing better customer service for Vets, and providing better return for the taxpayer dollar.

We have a new example of that, where a VA employee, Renford Patch, wrote some software which helps determine if a Vet has hearing loss, how much loss, and feeds that into the claims process. It greatly simplifies and accelerates what was a complicated paper process.

This kind of thing is fairly novel in Washington, but we’re seeing it starting to happen a lot there, particularly in those areas which have embraced Open Government. I’ll try to surface more examples of this.

For more information regarding this example, check out a VA employee-developed hearing loss calculator that has 100 percent accuracy.

"Veteran PTSD and Higher Education"

We need to stand up for people who've served our country.

Derek Neuts speaks regarding veterans' experiences way better than I ever could:

With the onset of Operation Iraqi Freedom in 2003, colleges and universities around the country are now seeing an increase in enrollment rates from the veteran population, as many soldiers are returning home to either resume their civilian lifestyles or they are in-between deployments. With economic conditions being harsh, and employment opportunities becoming more competitive, many veterans are seeking to either start or finish an education that may provide them with an edge in today's unique job market. Are universities ready for this population, and do they understand how to implement the necessary accommodations?

Check out more in his blog.

Derek served in the United States Air Force Security Forces from 2001 - 2005, experiencing one tour in the Middle East conducting security and police operations.  After having experienced a medical discharge, homelessness, and transitional barriers, he now advocates for veteran families in Oregon and abroad.  He's currently finishing is B.A. at Marylhurst University.

Better claims processing for veterans

It's really frustrating waiting for information that might take unnecessarily long to get help for a vet. The folks at Veterans Affairs report on some real progress towards improving that.

 

 

 

 

Development is the lengthiest part of the claims process, taking around 100 days. Right now, if you were to submit a claim that requires medical records from a doctor outside of the VA network it could take up to 40 days for VA to get the documents.

So, we’re banging our heads on our paper covered desks trying to figure out ways to reduce wait times for claims—a move that will, over time, break the back the of the backlog—and it occurs to us: 

DOMA, a company that specializes in electronic document management, said they can get medical records from non-VA docs in support of a Veteran’s compensation and pension claim in seven days. This is huge.

We’re piloting the process at the Jackson Regional Office and if it works—if DOMA can get the docs in seven days—we’ll roll it out to six other sites, and sort of make the company walk the walk again. Those six additional pilots will run until March 2011. We’ll know if they’re a success because VBA employees will be able to track and validate the records coming in quickly and DOMA will be giving the Regional Offices weekly reports: How many requests were made, how many requests were fulfilled and how long the fulfillment took. If it’s a success we’ll roll it out the initiative to every Regional Office.

The best part? Veterans won’t have to do anything: No more liaising with your doctors, no more worrying if your records are going to make it in a timely fashion. DOMA will get the records electronically, through a secure transmission from your doctor to VA in seven days flat.

Devon interviews Corporal Sean Stephens (Arizona National Guard)

Hey, a friend, Devon, who's nine, interviewed Sean about his experiences in Afghanistan, and here's a few excerpts. Sean's now working as the Veteran’s Service Officer for the county of Marin.

What does it mean to be “embedded” with the Afghan border police?

It means you live, sleep, and eat with them so you become one of them. There were about 200 Afghan border policemen and only 12 of us Americans. We had a lot of breaks for Chi, which is a type of very sweet tea.

 

 

What were some of the dangers you faced?

You could never tell who your enemy was because they didn’t wear any type of uniform. They looked just like everyone else and sometimes, for religious reasons, the Afghan border police wouldn’t wear a uniform either. They would come walking up to talk to us and we were not even sure if they were one of the good guys or bad guys. So you had to give the guy a chance to approach you to figure out if it is a friend or an enemy. Also we ended up having to walk or ride motorcycles a lot because our big trucks couldn’t handle the narrow mountain passes. That’s dangerous because we have less protection from an IED, an improvised explosive device. One time the motorcycle in front of me set off an IED but I didn’t get hurt because I was far enough back.

What is the most or least hopeful thing you saw there?

The most hopeful thing was seeing new schools get built. You are in fourth grade, so you’ve had a few years to learn how to read, to do math and basically how to think for yourself and solve problems. That’s what the Afghani children didn’t have before now because they grew up in a time when there were no schools. By letting them go to school we gave them the opportunity to do things for themselves and to grow as a country.

Job training for veterans via the Dept of Labor

Hey, there's a lot of help coming for veterans who need help getting jobs, though the word isn't getting out well.

Turns out the the Department of Labor has some help:

VETS and its sister Employment and Training Administration’s (ETA) Job Corps agency are partnering in a demonstration project that will provide Job Corps’ comprehensive array of career development services to eligible veterans 20 to 24 years old to prepare them for successful careers. This is a fully-funded, all-expense-paid demonstration project that is free to the veterans. The program includes transportation to and from the Job Corps center, housing, and meals, among other things. The pilot is being run at three Job Corps centers: Atterbury Job Corps Center in Edinburgh, Indiana; Earle C. Clements Job Corps Center in Morganfield, Kentucky; and Excelsior Springs Job Corps Center in Excelsior Springs, Missouri.

Secondly, VETS has begun a rural veterans outreach pilot program in Washington State that will provide veterans in rural areas with better access to employment programs and services.  VETS will utilize partnerships with state and local organizations to contact rural veterans by telephone, mail and in person to determine employment services for which they are eligible.

Finally, The U.S. Department of Labor and VETS have made available a new online toolkit to guide employers through the process for hiring veterans. The free toolkit is designed to assist and educate employers who have made the proactive decision to include veterans and wounded warriors in their recruitment and hiring initiatives.

Veterans Day 2010 from IAVA: we got your back

Let's not forget.

Here, the Iraq & Afghanistan Veterans of America remind us via their Veterans day march.

Disclosure: because of what IAVA accomplishes, I've joined their board.

"Boxes of Soxes!" for homeless vets and others via St Anthonys

Hey, St. Anthony's is best known for their food services in the Tenderloin in San Francisco, and also for their computer lab, but last week, I helped them announce that homeless vets really need socks:

This year, St. Anthony’s and the VA will reach out to homeless and low-income veterans, and others, to help connect them to services and to hand out socks and small gifts of appreciation. (Socks are a near currency among the homeless population who rarely get to rest for long enough periods in safe enough areas to take off their shoes.)

Turns out that the good folks at PlanetSox read our blogging and have helped out and contributed three hundred pairs to St Anthonys who're make good use of them.

Hey, this really feels good!