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Gail Graham

Gail Graham, Office of Health Information, Veterans Health Administration, Deputy Chief Officer, Health Information Management, U.S. Department of Veterans Affairs

Good morning, Mr. Chairman. Thank you for the opportunity to testify about the Department of Veterans Affairs’ (VA) efforts to deliver optimal health care to Veterans in rural areas and our use of innovative wireless health technology solutions to better serve our Veterans.  I am accompanied today by Dr. Adam Darkins, Chief Consultant for Care Coordination in the Office of Patient Care Services, and Dr. James Breeling, Deputy Executive Director, Office of Information and Technology, Department of Veterans Affairs.

As the Committee well knows, all health care providers, including VA, face significant challenges in providing optimal treatment to patients in rural and highly rural areas.  Emerging technologies and new models of care promise to improve clinical quality and reduce costs while at the same time, expand our options for delivering health care to all patients.  VA is committed to pursuing strategies that harness such technologies and models of care to enhance health care delivery.  Our aim is to ensure our rural Veterans receive the quality health care they earned through service to this country.

My testimony today will describe the latest wireless technologies VA is using, detail our plans for further expansion, and conclude by discussing a new model of care that is more Veteran-centered, results-driven, and forward-looking.

Current Use of Wireless Technologies

VA is exploring many potential applications of wireless technologies.  For example, VA has installed Very Small Aperture Terminal (VSAT) Satellites on its 50 Mobile Vet Centers, which are used primarily in rural areas by the Readjustment Counseling Service (Vet Centers) to provide outreach and readjustment counseling service to Veterans wherever it is needed.  While not located in a rural area, the Washington D.C. VA medical center is undertaking a pilot program through which physicians can access electrocardiogram (EKG) data on their BlackBerry handheld devices. 

VA uses wireless technology and services to assist our Veterans with disabilities with quick access to information and to foster opportunities to live at the highest level of functionality possible.  VA provides various critical cueing aids for our Veterans who struggle with memory loss, spatial disorientation, sensory loss and other cognitive difficulties.  Cueing aids can assist a Veteran in remembering appointments, medication schedules, and work or academic appointments—essentially helping create a better quality of life for the Veteran.  These devices include personal digital assistants (PDA), smartphones, personal pocket computers, global positioning system (GPS) devices, and the Livescribe Pulse Smart Pen.  VA’s Blind Rehabilitation Service partners with VA’s prosthetics programs on Veterans training and support through assistive devices and technologies with embedded wireless functionality, such as GPS tools or PDAs; wireless computer towers, laptops and notebooks that provide our Veterans the ability to read screen print through speech output and Braille; audible prescription reading devices; and other items, such as the K-NFB Reader, that can scan and read print aloud, function as a GPS, PDA and mobile telephone with email and internet capabilities.  These technological avenues are just part of the important work we are doing for our Veterans and their families.

In our medical facilities, we are completing Wireless Local Area Network (LAN) projects to improve the coverage and reliability of mobile devices such as Bar Code Medication Administration (BCMA) carts and laptop computers so that our clinical staff can access a Veteran’s electronic health records.  VA’s BCMA application is used to quickly document and thoroughly validate administration of medication at VA facilities through barcode applications and handheld devices.  Well ahead of many of VA’s medical counterparts in the private sector, a wireless infrastructure has been in place within each VA facility since 1999.  This wireless network has vastly improved access to critical patient information used for clinical decision making at the very point where treatment is provided.  VA uses this access and mobility of information, provided by wireless connectivity, for positive patient identification and to accurately administer the proper medications at the Veteran’s bedside using barcode scanning technology.  To date, VA has administered over 1 billion medications using this technology to ensure our Nation’s Veterans receive the correct medication, in the correct dose, at the correct time.  We are developing new projects within VA that will expand the use of wireless connectivity and barcode technology to accurately administer blood products and collect laboratory specimens for both clinical laboratory and anatomic pathology. 

VA dental providers are using wireless technology to access software designed to improve point of care decisions.  This platform is available to all VA dental providers for download onto wireless devices, and many of our providers have taken advantage of this unique opportunity.  For example, Lexi-Comp provides convenient, immediate access to time-sensitive, dentistry-specific pharmacology and clinical reference information via wireless devices.  Providers can quickly access important information about drugs and natural therapeutics, oral diseases, implants, endodontics, clinical periodontics, oral surgery, treatment of medically compromised patients and medical emergencies, to name a few examples.  This technology significantly improves medication safety by providing important drug interaction analysis and side effect profiles while increasing positive treatment outcomes through a vast knowledge base available at the provider’s fingertips.  To keep up with today’s demands, many of our providers report using this technology repeatedly throughout the day and even after hours when making determinations about patient care. 

My HealtheVet, VA’s online personal health record (PHR), is yet another area of significant progress in wireless technology for VA.  As a complement to traditional health care services, the My HealtheVet PHR provides Veterans with personal online access to VA health care, featuring patient-friendly health education information and wellness reminders for preventive care, to enhance patient engagement and informed decision making.  My HealtheVet provides our Veterans with new and innovative options to connect with our team at VA.  A Veteran who was an early adopter in the pilot program and now uses the national system has described this application’s impact by stating, “I feel more in control and aware of my choices.”  Having our Veterans as partners in their health care is essential to our success at VA.

VA has seen the use of My HealtheVet grow significantly.  To date, it serves over one million registered users, which represents 14.5 percent of VA patients receiving health care services.  The total number of visits to My HealtheVet since it was launched in November 2003 now exceeds 40 million.  Veterans have refilled more than 15 million prescriptions, at a rate of approximately 600 per hour, through My HealtheVet since VA made available online interactive ordering of prescription refills in August 2005—all from the comfort of the Veteran’s own home.  

For fiscal years (FY) 2009 and 2010, VA’s Office of Rural Health awarded a grant for $981,852 to improve access to care by engaging our Veterans in co-designing improvements to My HealtheVet.  VA conducted working sessions with Veterans in five rural communities, where Veterans suggested specific changes to My HealtheVet including the addition of features they desired in a mobile version of the application.  In the first phase, our Veterans defined core functionality for a mobile version of My HealtheVet, and VA is now extending this work by using the models generated in the initial phase to build a working prototype that will be implemented on a generic internet-enabled mobile phone as well as brand-specific versions.  The mobile prototype will be evaluated by our Veterans in a proof-of-concept environment.  This testing will focus on the user’s experience in important areas such as functionality, usability and appeal.  Phase II will also support further meetings with our Veterans for feedback on how to visually model the complete set of functions they desire in a mobile version of My HealtheVet.

Around the world, mobile and wireless devices are increasingly a primary tool for connecting people to the internet.  In early 2009, VA launched a mobile-friendly version of its internet Web site at  VA’s mobile site tailors key VA content for mobile devices and is designed to be compatible with multiple brands of cell-based internet browsers.  This site provides access for our Veterans to benefits information, facility locations, eligibility details for returning Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Servicemembers, VA news, and multimedia content.   On smartphones (such as the iPhone), users can plot VA facilities on a satellite map, perform integrated phone dialing via VA’s Facility Locator, watch VA videos on YouTube, use the mobile VA Gravesite Locator, and share articles of interest via social networking Web sites.  We want to be accessible and transparent to our Veterans and their families wherever they may be.

Future Expansions of Wireless Technologies

Looking ahead, VA’s Veterans Health Administration (VHA) has examined potential for additional innovative applications targeting specific populations of Veterans, such as those with TBI, post-traumatic stress disorder (PTSD) or visual impairments.  We further anticipate development of more resources for our clinicians.  VA has initiated plans to develop and deploy a nationwide program to use wireless networking (separate from the VA wireless LANs) for internet use at VA health care facilities.  Veterans and their families will be able to use this technology for communications, email, and otherwise therapeutic activity during patient stays at VA facilities.  VHA has recently established a Program Office dedicated to using Real Time Location Systems (RTLS) to support locating and tracking equipment, clinical staff, patients, and patient or staff movement.  This type of information will help improve the quality and efficiency of health care delivery to our Veterans by improving workflow, to cite one example.  RTSL uses wireless LAN, Radio Frequency Identification (RFID), Infrared and other technologies.  Future plans for expansion include developing requirements, standards and overseeing broader RTLS deployment.

New Model of Care

Wireless technologies are part of an overall continuum of care at VA and not a “stand alone” entity.  We are undertaking the most significant change in our model of care delivery since the rapid expansion of community-based outpatient clinics began in the 1990s.  But in many ways, this new and innovative approach is actually a continuation of the same strategy VA has always pursued:  bringing care closer to our Veterans and making it as accessible as possible.  Our mission of Veteran-Centered care engages the Veteran, family and health care team in a partnership to improve communication and assure that the needs and preferences of the patient are considered.

To support this significant effort, VA has joined the Patient-Centered Primary Care Collaborative, a national coalition of other public and private sector members dedicated to improving primary care.  We are re-designing our systems around the needs of our patients and improving care coordination and virtual access through enhanced secure messaging, social networking, telehealth, and telephone access.  An essential component of this approach is transforming our primary care programs to increase our focus on health promotion, disease prevention, and chronic disease management through multidisciplinary teams.  These changes will focus on improving the experience patients and their families have when seeking care from VA.  We will benchmark with private sector organizations such as Kaiser-Permanente and Geisinger Health System.  As always, we will seek patient input to help guide this important transformation.

The President’s FY 2011 budget submission describes this new model of care in greater detail.  VA will use the latest technology to remove barriers to our Veterans and increase access to VA services.  This important initiative will enable VA to become a national leader in transforming primary care services to a medical home model of health care delivery that improves patient satisfaction, clinical quality, safety and efficiencies.  VA Tele-Health and Home Care Model will develop a new generation of communication tools (i.e. social networking, micro-blogging, text messaging, and self management groups) that can be used to disseminate and collect critical information related to health, benefits and other VA services.

VHA’s Preventive Care Program, a component of the new model of care, will develop and implement a program to provide telephone-based health behavior counseling for Veterans with risky health behaviors, including physical inactivity, unhealthy eating, smoking, and problem alcohol use, and health behavior-related conditions such as obesity.  Using a health coaching model to assist our Veterans in making behavior changes by setting goals, developing action plans, using self-monitoring, and applying other self-management techniques, the Telephone Lifestyle Coaching (TLC) Center will increase Veterans’ access to care to keep them as healthy as we can.  We used this approach in a smaller pilot project for weight management among Veterans and found a significantly high level of patient satisfaction.

The new model of care will improve health outcomes and the care experience for our Veterans and their families.  The model will standardize health care policies, practices and infrastructure to consistently prioritize Veterans’ health care over any other factor without increasing cost or adversely affecting the quality of care.  VA looks forward to working with our critical partners in Congress to ensure these important plans become a reality for our Veterans and their families of all eras across the country.


VA sincerely appreciates the continued support of Congress in supporting rural health initiatives that enable us to focus on extending current enterprise telehealth solutions as well as developing new telehealth solutions to serve our Veterans throughout the nation for whom geographical distance from VA’s physical health care assets often presents a challenge to receiving care.  Like you, VA strives to ensure that every Veteran who qualifies has access to VA’s world class health care.

Mr. Chairman, this concludes my prepared statement. I am pleased to address any questions the Committee may have.