“This week, we're just piloting the use of mobile devices—smartphones, PCs, laptops, tablets through a Web-based interface,” said Dr. Adam Darkins, VHA chief consultant for telehealth services, in a telephone interview, giving an indication of the VA's tech efforts.
The VHA operates 151 hospitals, 827 outpatient clinics and provided medical care during nearly 6.5 million patient visits in fiscal 2013.
The VA first piloted its electronic home-health monitoring program in 2002 and began rolling it out across the country in 2003. Patient-generated home-health data has long since become part of everyday care at the VA, according to Darkins. More than 144,000 veterans participated in electronic home-health monitoring in fiscal 2013, with 89,000 veterans under care at year's end on Sept. 30, Darkins said.
The results have been dramatic—a 19% drop in readmissions and a 25% reduction in bed days—for those participants, according to a Darkins' study published in 2008.
Three years ago, “as a bridge to moving to mobile devices,” the VA began using what Darkins described as an “interactive voice-response system” that let patients call in their home monitoring data and have it automatically digitized, or respond to computer-generated queries by typing into an Internet-linked home-health device called a Health Buddy.
The VA currently offers home-health monitoring to veterans at high risk of hospitalization, readmission or transfer to long-term care. Many monitored vets are elderly and 30% have multiple chronic conditions, Darkins said.
The monitoring program for high-risk patients has worked so well the VA is considering offering home monitoring services to veterans with chronic diseases that are less severe, Darkins said.
Nationwide, the use by providers of patient-generated health data remains in its early stages, despite the existence of Web-based patient portals, either free-standing or “tethered” to a provider's EHR, for more than a decade.
The VA, meanwhile, has watched it all from near the lead. Its MyHealtheVet portal, tethered to its 30-year-old-plus VistA electronic health-record system, dates back to 2003. The VA's popular PHR has 2.2 million veterans and another 370,000 non-veteran users.
Many healthcare provider organizations are only now investing in home health monitoring, prompted by patient demand and in preparation for expected changes in healthcare payments wrought by the movement to value-based purchasing and ACOs under Obamacare.
Modern Healthcare takes a deeper look at this trend in its Jan. 20 issue.
Darkins attributes the VA's success in at-home electronic patient monitoring and patient-generated health data to the consistency of VA programs, which are the same across the VA system; the tie-in of the devices to its robust EHR, which affords clinicians ready access to patient-supplied data; algorithms to help identify patients who are faltering; messaging and rapid response to those alerts; and economies of scale.
Follow Joseph Conn on Twitter: @MHJConn