department of veterans affairs 1 innovation initiative

Department of Veterans Affairs

1

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 can: • Frustrate Veterans• Increase appointment wait times• Provide negative impressions of VA health care servicesCan cause delays in treatment for the Veteran

Department of Veterans Affairs

Problem Statement (Video)

3


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.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 Patient Satisfaction• Veterans will have a more satisfactory experience with

less frustration and more expedience related to their outpatient encounter

Improve Efficiency and Access:• Clinic wait time measures will improve as patients are

no longer delayed by navigational issues and will arrive at clinic appointments on time.

• Less rescheduling of missed appointments resulting in an improvement on clinic access measures

• Maximize provider productivity and efficiency of workflow

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: iVetGuide developers will:• Design and test iVetGuide’s navigation usability • Use discrete event simulation to examine its impact on patient flow throughout the outpatient clinics

• Use modeling and observation to examine the impact on other interdependencies such as the Pharmacy, Radiology and Laboratories

Expected Results: The Survey of Healthcare Experiences of Patients is designed to measure the Veterans' perceptions on Core Veterans Healthcare Service Standards. There will be improvement in performance measures in outpatients surveys that that measure: • Access to care • Patient satisfaction


Impacts

Veterans• Improved satisfaction of outpatient care• Timely and convenient access to health care• Decreased wait time and overall visit time

VA Employees• Increased productivity and efficiency in workflow• Have the benefit of improved patient satisfaction and performance measures scores

• “New” employees can also better navigate the medical center

Additional support needed• To ensure accurate navigation, coordination with OI&T during placement of wireless access points in the clinical environment

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


Technical Approach

Our approach involves creating custom applications for the iPhone, iPod touch, and iPad to provide Veterans with navigation assistance and other location, speed, and direction related services to enhance the Veteran's clinical experiences.

We will rely on Apple’s Core Location Services and magnetomer / compass information for initial high-level location and direction information, and will supplement this information with additional RTLS (Real-Time Location Services) information.

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

Data security will be accomplished by using VA standard VPN system for data in motion and NIST certified FIPS 104-2 compliant OpenSSL in data storage mode for data stored. (Cert # 918)


Team and Environment

We have created a strong team with VHA and OIT staff and collaborators all across the organization from several different sites:• Dr David Lin is the clinical lead. Dr Lin is a practicing

primary care physician and the Chief Health Informatics Officer for the Northport VAMC

• Mr. Louis Soriano is the projects technical lead. He has 19 years of Biomedical experience and is presently working in the Applications section for OI&T at the Northport VAMC

• Other team members (clinical and technical) include Dr. Paul Diggs (Northport VAMC), Dr. Neil Evans (Washington D.C. VAMC), Stig Hammond (EIE), Tony Mateo (FISO, Miami VAMC) and Tom Burns, (Northport EES)

• Our technical staff have subject matter experts in software development with over 40 person years of relative platform experience.

Our environment is supportive and capable. The VAMC Director and CIO have expressed their strongest support for this project.


Implementation

Requirements will be gathered from DVA medical and clinical staff, patients and patient advocates

Medical center location information will be initially gathered from CAD floor plans developed for the Nationwide Wireless program. Building on these base maps, accurate, detailed location information will be added, incorporating additional RTLS sensors. The application will continually self-refine the internal maps by comparing historical paths to existing base maps.

User testing will occur with a volunteer group of medical and clinical staff, patients, and patient advocates

Applications will be rolled out to the volunteer group and a review of the quality of the navigation assistance and direction related services on the handheld devices will be assessed


Timeline

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


Budget Narrative

The main cost of implementing a pilot of iVetGuide :• 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: Spectrum Analysis• Nationwide wireless progra,Risk: Lost/stolen devices • Veteran leaves driver’s license as collateral (as in some museums for headphone use)

Challenge: Patient’s comfort level with the technology• Have volunteers show veterans the ease of use


Supporting Diagrams: Mock-up of iVetGuide on iPhone and iPad


Supporting Diagrams: Mock-up of iVetGuide on iPhone (Virtual

Reality)


What Do You Really think?

This innovation will actually bring the technology to the veterans themselves. ---“patient-entered approach”The VA enterprise benefits by helping the veteran first!Our facility is particularly well suited as we have all new wireless access points thru the Nationwide Wireless programWill improve patient satisfaction with the medical center visit

department of veterans affairs 1 innovation initiative

Documents