The VA is testing iPads to improve home care for war-wounded veterans
by Todd R. Weiss
Created Apr 19 2013 - 1:49pm
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
"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
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
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."
Todd R. Weiss is an award-winning technology journalist and freelance
writer. Read Todd R.'s bio
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