Presentation 1: The Use of Technology with Rural Veterans at VA Pacific Islands Health Care System (VAPIHCS) The VA has been recognized as a leader and champion in developing and using technology to increase Veterans’ access to healthcare. The passing of “Anywhere to Anywhere VA Health Care Initiative” in 2018 now allows VA providers to deliver telehealth services to Veterans without the restriction of physically being in the same state. Locally, VA Pacific Islands Health Care System (VAPIHCS) established the Connected Care Service, funded by the Office of Rural Health, to use technology and innovation increase Veterans’ access to mental health, primary care and specialty services. As one of 19 Nationally Designated Clinical Resource Hubs (ND-CRH) across the nation, Connected Care has led the facility in delivering telemedicine to Veterans and their families in the most remote areas of our country, including the Hawaiian islands, Guam, Northern Mariana Islands, and American Samoa. In addition to serving our local community, Connected Care now serves clinics in our regional Veterans Integrated Service Network (VISN) that includes California and Nevada.
This symposium will introduce recent VA initiatives and policies that support the use of technology to reduce Veterans’ barriers to healthcare. We will give an overview on medical and psychiatric telehealth services offered by VAPIHCS. We will differentiate between synchronous (real-time or Clinical Video Telehealth) versus asynchronous (or “store and forward” telehealth) methods of telehealth. Through three specialty programs in Connected Care, we will showcase how technology is used to deliver a range of services for medical and psychiatric conditions. Special attention will be given to addressing day-to-day challenges and offering solutions related to technology, connectivity, and rurality.
“Overcoming Challenges of Delivering Evidence-based Psychotherapies (EBP) via Telehealth”
Graciete Lo, PhD, Clinical Psychologist
Veterans who reside in remote regions of the country often do not have sufficient access to specialty behavioral health services compared to those who live in metropolitan areas as a result of multiple barriers. VA Video Connect (VVC) technology was developed to eliminate some of these barriers and is now being widely used to allow for the delivery of evidence-based psychotherapies (EBP) into a Veteran’s home. Presenting on recent literature, we will compare the clinical effectiveness of delivering EBPs in-person versus telehealth. A main focus of this talk will be on tackling common challenges of delivering EBPs and working with high-risk populations via telehealth. Strategies to adhere to a treatment protocol will be discussed, when providers face connectivity issues, clinical interruptions, and other barriers. We will conduct live demonstration of VA mobile technology (VVC, VA Smart phone apps) and consider how its technology can augment a therapist’ service delivery.
“How to Use Technology to Support a Virtual Multidisciplinary Pain Team”
Monica Thompson, PsyD, LPC, Clinical Psychologist
In light of the opioid crisis and the pervasiveness of chronic pain conditions in servicemembers, VAs across the country are especially committed to developing comprehensive pain management programs. We will introduce VA’s first virtual pain team consisting of experts from psychology, nursing, social work and medicine. Based on a biopsychosocial model of pain, the pain program delivers a range of services to assess and treat Veterans with chronic pain and offers expert consultation with Primary Care teams. We will introduce the use of GlobalMedia Telemedicine cart that allows providers to conduct physical exams remotely and the delivery of patient health education, psychosocial interventions (CBT for Chronic Pain, Motivational Interviewing) and Complementary and Integrative Health (e.g., chair yoga, meditation) in a virtual manner. We will also discuss strategies and approaches to support a team of professionals who reside on different islands.
“Remote Patient Monitoring Through Telehealth: Innovation in Care Management”
Sheryl A. Rivera, RN, BSN, Lead Care Coordinator Home Telehealth
VA’s Home Telehealth Nursing program uses a team of care coordinators to assist Veterans in monitoring medical conditions (e.g., COPD, diabetes, hypertension) and specific vital signs from home. These data are reviewed by registered nurses on a daily basis in order to support the Veteran’s health and to promote early identification of symptom changes. Another goal is to help Veterans take better control of their health so that that they can make healthier decisions about their lifestyle and to increase their engagement with their medical conditions. We will introduce various types of technology and devices that are used for daily monitoring of blood glucose, weight, and blood pressure.
Learning Objectives: - Review updated policies and telehealth services across the VA
- Introduce three specific services at VA Pacific Islands Health Care System that use technology to support healthcare delivery
- Discuss overcoming barriers and challenges of implementing telehealth services in rural settings to address various medical and mental health conditions
Presentation 2: Implementing Evidence-Based Care in a Large Healthcare System: Lessons LearnedMillard Brown, MD, Chief, Department of Behavioral Health, Tripler Army Medical Center
Army Medicine had to rebuild its Behavioral health system after years of military operations stressed the original system. Starting in 2010, the Ay Behavioral Health System was created to standardize program offerings, structure and funding. A key component was the building of the Behavioral Health Data Portal, a web-based standardized data collection system to inform diagnostic assessment and track treatment outcomes. This presentation will detail implementation lessons learned and initial data findings after 7 years and 5 million encounters.
Learning Objectives:- Be able to identify key implementation principles for implementing measurement based behavioral healthcare technology.
- Be able to identify the degree to which therapeutic alliance, session numbers and other factors influence outcomes.
