Department of Veterans Affairs 1 iVetguide a.k.a Y.A.H. (You Are Here) Facility: Northport VAMC Initial Idea Submitted by: David P. Lin, M.D. Innovation

Department of Veterans Affairs

1

iVetguidea.k.a Y.A.H. (You Are Here)

Facility: Northport VAMC

Initial Idea Submitted by: David P. Lin, M.D.

Innovation Initiative

Department of Veterans Affairs 2

Problem Statement

During outpatient visits at the Medical Center Veterans are tasked to navigate to various departments for clinical procedures and various care-provider appointments. Appointments may require the Veteran to traverse the medical campus during their visit. Appointments may include visits to radiology, rehab, prosthetics, pulmonary lab, ECG lab, pharmacy and other locations. Veterans often become lost or confused and are frequently late for appointments. These conditions frustrate VeteransIncrease appointment wait times, Provide negative impressions of VA health care servicesCan cause delays in treatment for the Veteran


Description of Idea

The purpose of iVetGuide is to prove the utility of iPhone technology within the VA clinical environment by utilizing the iPod Touch / iPhone / iPad's unique motion / location measurement system.iVetGuide is a prototype application that provides Veterans with navigation assistance and other location / speed / direction related services to enhance the Veteran's clinical experiences.On call specialists would be provided handheld devices to enable the review of diagnostic reports such as electrocardiograms (ECG).iVetGuide intends to demonstrate how the aforementioned issues can be alleviated and prove the technology's value in the clinical setting by providing the Veteran with one-on-one automated guest services including:Personal visit schedule navigation (Inside/Outside GPS, visual map, stay on the path guidance)Voice rescue/assistance from the information desk


Strategic Goals

Improve Care Quality• Veterans will have increased quality of care and access to

care• Improve patient satisfaction

Improve Efficiency and Access: • Reduce total visit wait time and visit time• Getting Care Quickly New, and Established • Maximize provider productivity and efficient workflow

Impact Many Veterans: More than 65,000,000 visits annually, in 755 community outpatient clinics

Meet Organizational Requirements - Veterans Health Administration DIRECTIVE 2006-041, June 27, 2006. The specific goal that applies to this Directive within Veterans Health Administration’s mission and vision is: “To continuously improve veteran and family satisfaction with VA care by promoting patient-centered care and excellent customer service.”


Success Metrics

Functional Prototype Success Metric: iVET Guide developers will design and test IVET Guide’s navigation usability and ability to provide guidance to Veterans in outpatient settings using a mobile device. The Innovators will evaluate the applications using discrete event simulation to examine the impact of the IVET Guide. This effort to optimize patient flow throughout the outpatient clinics will be done while modeling and observing the impacts on other interdependent parts of the hospital such as the Pharmacy, Radiology and Laboratories.

Expected Results: The Survey of Healthcare Experiences of Patients is designed to measure the Veterans Health Administration veterans' perceptions on Core Veterans Healthcare Service Standards. There will be improvement performance measures for outpatients survey questions: #19, In the last 12 months, how often did your personal Veterans Affairs doctor or nurse spend enough time with you?; and #35, All things considered, how satisfied were you with Veterans Affairs during your recent visit?


Impacts

Veterans• Improved satisfaction of outpatient care• Timely and convenient access to health care• Decreased wait time and overall visit time• Seamless coordination of care with a smooth transition

between inpatient and outpatient careVA Employees• Increased productivity and efficiency in workflow• Improved patient satisfaction scores and performance

measuresAdditional support needed• To ensure accurate navigation, coordination with OI&T

during placement of wireless access points in the clinical environment

• Work with OI&T to place extra inexpensive “beacon” wireless transmitters used for navigation only

• Section 508 compatibility testing and design teaming with VA and VHA Section 508 SMEs


Technical Approach

Our approach involves creating custom applications for the blackberry to access CPRS, VistA Imaging, ECG and other live physiologic wave form data from monitoring devices.

We will use a two-way SCP-ECG to HL7 aECG converter to increase range of equipment whose output can be accessed via our applications.

VistA data access will be accomplished via web objects developed by the Aviva program

Data security will be accomplished by using VA standard VPN clients for the chosen platform. Authentication and single sign on capabilities will be extended from current VistA


Team and Environment

We have created a strong team with VHA and OIT staff and University collaborators:• Dr Willem Einthoven is the clinical lead. Dr Einthoven developed one of

the first accurate ecgs and is responsible for distinguishing and naming the five characteristic deflections (P, Q, R, S and T). See Einthoven W. Ueber die Form des menschlichen Electrocardiogramms. Arch f d Ges Physiol 1895;60:101-123. Dr Einthoven has lead the Cardiology Division at our VAMC since 2004.

• Charles Babbage is the projects technical lead. The "father of computing" is widely known for his mechanical Calculating Engines, both the table-making Difference Engines and the Analytical Engine. He is less often credited with invention of the smart phone.

• Other team members include William Osler, Grace Hopper and Ada Lovelace.

Our environment is supportive and capable. The VAMC Director and CIO have expressed their strongest support for this project. We have recently completed a similar project to display high resolution medical imaging studies on the iphone and demonstrated improved timeliness of diagnosis with no compromise in diagnostic accuracy.


Implementation

Requirements will be gathered from DVA cardiologists and emergency room clinicians

Workflow analysis of the emergency room process will be completed

User testing will occur with a volunteer group of cardiologists and emergency room physicians

Handhelds will be rolled out to the volunteer group of providers and a review of the quality of the diagnostics images on the handheld devices will be assessed


Timeline

Definition of Above Steps:• Step 1: Acquisitions process• Step 2: Development of mobile client• Step 3: Development of display application• Step 4: Integration VistA applications• Step 5: Testing


Budget Narrative

The main cost of implementing a pilot of the Remote Cardiology Consultations Using Handheld Devices :• The cost of developing and deploying the software to

support the image presentation $100,000.• The cost of the handheld devices and the activation

services $100,000.• After the handhelds have been deployed, operations and

maintenance costs will be approximately $25,000 per fiscal year.


Budget Proposal - Optional

IT Expenses FY10 FY11 FY12 FY13

Software Development Costs $100,000 $0 $0 $0

Handheld Devices $100,000 $25,000 $25,000 $25,000

IT Totals $200,000 $25,000 $25,000 $25,000


Challenges & Risks

Risk: If the innovation proceeds beyond proof of concept to use in actual patient care, Veterans personally identifiable information (PII) will be communicated over the internet .• Implement security with sharing PII over the internet.• Ensure that all security protocols are used by the

cardiologists as the receiver and the personnel in the emergency department as the sender.

Challenge: Clinicians may not embrace the handheld technology.• Create an outreach campaign about the quality of the

diagnostic image and the system performance of the connectivity.

• Educate cardiology and emergency room staff in the use of the technology and the benefits of the change in workflow.


Supporting Diagrams: Mock-up for ECG Display on Blackberry


What Do You Really think?

Veterans deserve prompt access to cardiology expertise when presenting in VAMC emergency rooms whether this is during normal business hours or on nights or weekends

Our facility is particularly well suited as our physicians have a proven track record of embracing technology and testing new innovations

We will know we are successful when we can produce a diagnostic quality ECG on a handheld device

Ultimately implementation of our innovation will save patient lives with more timely cardiology consults

Please also take the time to review our video presentation which can be found at vaww.va.gov/testURL/…

Documents

Department of Veterans Affairs 1 iVetguide a.k.a Y.A.H. (You Are Here) Facility: Northport VAMC Initial Idea Submitted by: David P. Lin, M.D. Innovation