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Good morning. Thank you very much Dr. Tushmit. This morning I'm going to briefly showcase
for you three new Connected Health Initiatives from the Preventive Care Program in my office.
These are the HealtheLiving Assessment, an HRA, the Veterans Health Library and MOVE
Coach, the latest version of our weight management program for our Veterans. All three of these
are still under development, although you can do a test run of some early versions of
them on the table to my left, so I don't have any great videos to show you yet but those
will be coming soon and I am excited about that.
We think that these new resources are really key components of VHA's transformation to
personalized proactive and I would add preventive care that will keep Veterans well and healthy
for the long run. I'm going to start by describing to you the
HealtheLiving Assessment. As I mentioned this is a health risk assessment, or an HRA, and
many of you may have seen HRAs in the past. You may of had the opportunity to complete
one from your employer or insurance company and typically they are paper and pencil tools,
standard set of questions everybody gets same questions and you mark your answers and often
that's the end of it. This is a much improved way of doing that
and because it's computerized online it can customize the questions that are presented
to the user, based on your previous answers no one user gets exactly the same HRA because
it depends on what you said earlier so it's very customizable and very tailored to each
user At the completion once you go through all
the questions, the user is presented with a report that provides a personalized list
of doable actions based on what you said in your HRA here's something you can do to improve
your health. And it allows the user to say "well what if
I did this? How would that improve my health? but what if I did those other things I've
been thinking about? what would I get by doing that?" so it really is a very interactive
and dynamic report. I'll show you some screenshots and you'll be able to play with it if you'd
like. And then there's the option to share that
report with your healthcare team we don't want to automatically share it because once
the user the veterans feel like this is his or hers personal information and if they don't
hear she doesn't wish to share that's okay but we think that by sharing it with your
team that really gives you a chance to dialogue with your provider and help develop your plan
for how you can continue to improve your health The tool that we have developed is very much
in line with a couple of external standards that we think are important as you may know
the Affordable Care Act requires a HRA to be part of the annual wellness visit in Medicare,
and that informs the development of a personalized prevention plan so this is very consistent
with the ACA requirements It also helps us to meet the meaningful use
standards that are required from previous acts. The Healthy Living Assessment contains
questions in a variety of different areas. Content areas that you see here.
And as you can see these are things that mostly only the veteran knows about him or herself.
These are personal things that we often don't ask certainly not routinely and standardly
of our Veterans in clinic and we know from home that literature from previous use that
all of us are a little incline to answer more honestly questions if it's putting that information
into a computer than if are having to submit something to somebody face-to-face so this
is a very nice way of collecting some sensitive information that we don't but we may not be
comfortable doing. We licensed the contents of a commercially
available tool to HRA and then modified extensively so that is consistent with our clinical policies
and procedures and terminology. The tool that we purchased that licensed came from the UK
and for example it asked about weight in stone I don't know if you know what your weight
in stone is, I don't know what that is for me so we had to translate that into American
English. We also added some content that wasn't in
this commercially available product that's particularly Veteran appropriate. We ask questions
about traumatic brain injury and so on as you see there and that will really give us
an opportunity to again routinely collect that information.
We can make sure that it has several questions that are specifically for women's health as
you see here. So to show you how this really looks let me
walk you through this with Sharon. Sharon is a Veteran who is a little concerned about
her health. She's 55 and says that she think she needs to start taking better care of herself.
She doesn't have a computer home so she goes to her local library and sits down at the
computer goes to My HealtheVet website and clicks on what will be a link to the HRA when
it's there. She'll first come to a welcome page now this
is a little boring looking and this is still in development so will make it look little
more interesting we get the final one done but there are a couple things I want to point
out here. That's your notice on the upper right, her
name is there so I'm just tool is personalized for her, the assessment realizes this is Sharon
and she's the one taking It. You'll also notice that the point that I made earlier that this
report is private and it's only for her. If she chooses to share it which we hope she
will, that would be great but she doesn't have to, this is her own report so I don't
have time to go through the whole thing but let me show you a couple of the questions
that that will show up in and just as you see as examples. So the first thing you notice
again her name is there. There's a bar at the bottom that gives her a sense of how far
she's gone, oh how much she has to go yet so that helps keep her tracked with completing
it. This particular question is what about traumatic brain injury it's the first of four
questions that will be available and the items the questions have been validated and research
so that we know that we are using the wording and the way of asking the questions that always
works best identify information that we want. Here's another question this one happens to
be about depression and this is in what is referred to as a table format, as already
mentioned many of our Veterans use assistive technologies like screen readers for computer
pages in and we've been very careful to be sure that the way these questions are presented
works very well with those kinds of assistive technologies. You'll notice that this is a
question about depression and if she answers that she has been bothered by these symptoms
frequently she'll get further questions that'll ask more about her symptoms of depression.
One of the question actually even asks if she's ever thought about hurting herself and
if she responds positively to that, the number for the Veterans crisis line will immediately
show up so right then she'll get the information that will help her and say "maybe I should
reach out to someone" and so the Veterans crisis line number will
show up right then it'll also show up again at the end of the of the assessment when she's
getting her summary reports just reminder you know you said that you were thinking about
this here's where you can get help so that's built right in.
This is the last question that she'll see and this is one that allows her to say whether
she's interested in working on any of the areas that might be appropriate for her so
she can check as few or fewer as she would like.
She'll then come to this summary page and this is what's really compelling about this
particular product we think this is a really great tool you'll notice in the upper left
it gives her health age . Now that's a calculation based on the responses that she's put into
all the questions previously. It's summarized in a concept that we are all familiar with.
What our age is? It's a summary of saying to her your health age is, if you remember
her age is 55, she's 11 years older for her health based on the things that she put into
the assessment. So that will probably get her attention and help her think about what
she might want to improve that. There's some encouragement there already says you can reduce
this by 15 years with a little icon that she can click and get more information.
If her health age came out lower than 55 or someone else's came out lower than their chronologic
age, then that means that that person is in really good health and is doing great things
and we want to encourage them to keep that up.
Under that health age is a this list of recommendations so again these are based on things that she
said that she was doing and if she were to chuck in any of those it would make some changes
in her calculated health age and I'll show you that in a minute.
In the lower right it is a list of several common diseases that she might be at risk
for. The dark blue portion of the graph at the bottom is the risk that she can't change
by virtue of her age, of her gender, family history for example. But the light blue bars
show the risk that she can change so you know her risk for diabetes by the age of 80 is
really quite high so it's almost 100%. At the top is a list of screening tests and immunizations
that she's due for, again based on the responses that she put in. If she's interested in those
or wants more information she can get that right on the little icon.
This portion of the report shows how she rates on these differences health behaviors: diet
stress physical activity and so on. You can see the slider bars are in various parts,
in various locations so her diet right now scores pretty low. On her own physical activity
is in the moderate range and her tobaccos are at the top.
If she wants more information, she can click on the section here and these are things that
she can talk with her provider and healthcare team about if she would like.
And then finally we don't want to just give her all bad news or talk about all the things
that are going wrong, we want to tell her things you're doing well and here's what those
are. So as I mentioned, Veterans can try out some
what ifs. What if I was to do this one? What if I was to change that? How would that matter?
And see how much that would improve my health. So Sharon checks this first couple of boxes,
lower blood pressure and lose some weight and then she clicks on recalculate and now
you can see her health age has come all down to 57. So those two things make a substantial
improvement in her health and she can see that. She can also see her risk for diabetes
has dropped quite a bit and so that's a real positive motivating kind of response.
As I mentioned we'll encourage veterans to share their feedback report with their teams
to help them become more actively involved in shared decision making and creating their
personal prevention plans. It's still in development as I mentioned,
we'll be doing some more user testing with Veterans on this Spring and Summer and will
be pilot testing it in the facilities in the Fall and I anticipated it'll be ready for
public launch a year from now. The second tool that I want to briefly mention
is the Veterans Health Library. This is another tool that'll be part of My HealtheVet so again
another place to go to there that will feature a comprehensive Veteran focused health information.
We purchased a commercial product from a vendor of health education information and had everything,
thoroughly reviewed by VA subject matter experts to make sure that it was the correct information
consistent with our policies and procedures and was what we wanted Veterans to hear.
It's been extensively field-tested and we anticipate launching it in really a couple
of months certainly by the end of the third quarter of this year. And then we'll be going
to work to integrate it into our electronic record so that as staffs are talking to patients
about health education they can easily document that in the record and at least meets joint
commission recognition and meaningful use requirements.
So here's a screenshot of the opening page you'll notice on the left is a list of the
major areas that can be covered. In the center it up on featured content and more resources
on the right-hand side. So let me quickly show you, if you click on the diseases and
conditions you'll see a long list of the kinds of topics that are included in the library
and you can pick any one of those and get much more information.
Here's an example of a health sheet on diabetes and the benefits of exercise. There are over
3000 health sheets in the library, half in English and half in Spanish so it's very much
accessible by our Spanish-speaking Veterans and their family members and caregivers.
You notice on the right there is Learn More that's very much related to the same topics
so Veterans can explore this kind of information to the depths of they are interested in it
Under Veterans Resources are links for more VA specific content and some of those links
go directly to the program offices own website so that they keep up their own content on
their websites and it's directly linked to the library so they don't have to try to keep
up content in two different places and provides the users with the latest most current information
Other program offices embedded their content directly into the library so here's the field
manual for foot health which is very consistent with the way that Veterans who are used to
seeing field manuals in practice and in our service and it provides a great deal of information.
There are a number of videos, about 250 videos that are part of the library again, most in
English some Spanish as well cover wide variety of topics.
In addition to some online guides that are called flipbooks or go to guides and you can
see how they work. Another interesting engaging way to present a lot of information
In summary the Veterans Health Library which you can out over here, provides information
that's tailored to Veterans that can be trusted by Veterans and their family members and by
staff. As I mentioned, it will be coming out this year.
I want to just quickly mentioned on our third featuring which is MOVE Coach. As you may
know, MOVE weight management program for veterans is our comprehensive weight management program
that we have available in every facility for individual or face-to-face encounters. We
have it available by telephone and by Telehealth. Now this is the latest version of MOVE which
is a web-based application both for web and mobile applications. You'll hear soon about
this suite of mobile applications and this will be just one of those when it gets it
gets finished. All of our MOVE content focuses on goal setting
and self-monitoring around physical activity and diet and behavior changes, includes problem-solving
you had trouble losing weight, what are some of the things you might need help with.
It includes self-management guides and in the web and mobile-based versions will interact
with our VA clinicians so they'll be able to help coach of the user through their weight
management issues So this is what the app the mobile app looks
like this. We started with developing a mobile app first then we'll developed a web-based
version of little bit later and this is what it looks like when you downloaded it. You
will be able to download it and you notice once you click on the move coach and open
it up you'll see a link to self-management guides. We've used these very successfully
in telephone care and have converted them to the web-based version. Problem solving
as I mentioned and being able to track goals and progress. That portion at the bottom will
show graphs based on a Veteran entered data .The more data you enter, the more graphs
and visualization you'll see of that. So if you click on the self-management guides,
I would see this screenshot on the left. There are actually 11 of them, 9 of them show up
here, and if you were to click that first one getting started you would go to this page
and this is similar for all the different self-management guides. There's a goal section,
homework section and a list of chapters. This is a comprehensive program that a veteran
user would work through over a 19 week period. So it's different from just the commercial
weight management app that you often find that provides some information but this is
a set program of care that the user would work through.
Here's some screenshots in Chapter 1 Getting Started. The on the left and the in the center
are short little video clips it's much more interesting to watch a short video clip and
get the information that it is than to just to read small text on the little Smartphone
so we've embedded a lot of videos to make things interesting and easier to get information.
We've incorporated number of games again to make it fun and engaging so this asks about
comparing serving size to common objects and this user got the right answer, that was great
There's a number of ways of setting goals. Some are text based, so little short entry,
some are numeric, and provide easy ways of doing all of that.
We have done some initial user testing with veterans and they found it to be very engaging
and useful and would certainly recommend it to others.
More guidance at the end of summary reports where you are now what's your goal and how
much closer you are to achieving that goal. So as a result of these interesting and engaging
new technologies we think that they will go along way to helping Veterans stay healthy
for the long-run and make good health choices. Thank you