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IT Everything

A witness to history in healthcare information technology.
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By Joseph Conn

Blog: VA's mobile tech strategy worth watching

Private-sector healthcare leaders developing mobile health technologies should keep an eye on what's happening at the Veterans Affairs Department.

In April 2011, the VA and the Defense Department launched a stand-alone mobile application called PTSD Coach, a self-assessment tool and guide for people who have or who suspect they might have post-traumatic stress disorder. In its first 20 months, the app has been downloaded more than 90,000 times worldwide.

At the strong recommendation of a focus group of patients, PTSD Coach was designed to run without links to an electronic health-record system, with the idea being that more veterans and military personnel would seek treatment if, initially, they could anonymously download and use the tool for self-diagnosis.

Early next year, the VA will open up an armory of new mobile-health applications. Twenty-six are in development now. By VA policy, all of these new apps will be connected in some way to clinician record-keeping systems.

"You're not allowed to create apps to collect data from patients if you don't have a complimentary app for it to be shared with clinicians," according to Kathleen Frisbee, director of the VA's Web and mobile solutions initiative and co-director of its Connected Health office.

The first of the new batch, an app for veterans and their family care givers, will begin pilot testing in January or February, Frisbee said. Mobile tools for providers are also in the works.

This comprehensive development effort for connected mobile apps began at the VA in 2011 with a project—not to design the next killer app—but "to first explore the security issues of bringing mobile devices onto our network," Frisbee said. "Then we started building out the infrastructure and building apps."

That's refreshing.

For too long, security in healthcare IT has been a backwater—witness the 511 major security breaches on the "wall of shame" at HHS' Office for Civil Rights. Four of those breaches were at VA facilities. Three occurred from the loss or misplacement of paper records, but a fourth resulted from a stolen laptop.

In addition to security, the VA is addressing other common challenges in mobile healthcare.

In reporting for a story introducing our 2012 list of Most Important Mobile Applications, I spoke with industry experts who said the hard part won't be in building slick mobile apps but in sorting out the clinically useful nuggets of information from a landslide of data that mobile devices are expected to generate and then integrating the good stuff effectively into an organization's clinical workflow.

Frisbee agrees. "We're developing ways to reduce the data so we don't overwhelm the providers," she said.

At the VA, the data-analysis and segregation capabilities will be built app by app, but creating the basic architecture that will enable meaningful data delivery to clinicians was part of a $5 million development effort that included infrastructure updates and security measures.

The VA also created an in-house testing and certification process for mobile apps to "bring order and management to this app world," she said. It includes a clinical review process to assist in the design of decision support functions.

The VA has long been a national leader in health IT. While it's not first out of the starting blocks in mobile technology, it should be worth watching to see how the VA executes its mobile strategy in 2013. I plan to keep an eye on them. You should, too.

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