San Diego Union-Tribune – Advocates: VA Still Needs Work To Get Fully Wired

San Diego Union-Tribune – Advocates: VA Still Needs Work To Get Fully Wired

September 1, 2013

By: Jeanette Steele

The U.S. Department of Veterans Affairs medical system was recently named among the “Most Wired,” credited for offering webcam appointments for patients with chronic illnesses.

But what does that mean for the youngest generation of American veterans, who probably own an iPhone even if they can’t afford a car or a roof overhead?

San Diego has the second-highest number of Iraq and Afghanistan veterans getting care at a VA hospital, more than 12,600. At least 30,000 young vets reside in the region.

Veterans advocates say VA hospitals have pioneered some aspects of technology, but the VA system overall has a ways to go to serve the iPad generation.

Medical Director Dr. Robert Smith said the VA’s San Diego medical system is working on technology so that young vets can cancel and reschedule appointments on their cellphones, renew prescriptions and get appointment reminders by text. It’s as close as six months to a year away, Smith said.

Already, at some VA appointments in San Diego, patients fill out intake questionnaires on computer tablets instead of paper forms.

“A lot of what we’ve been talking about is the tip of the iceberg, and it’s clearly aimed at those folks,” Smith said.

That sounds good, but a spokesman for the Iraq and Afghanistan Veterans of America said it can’t happen soon enough.

“The hardest thing about using the VA medical system is getting an appointment in a timely manner,” said Tom Tarantino, a 35-year-old Army veteran who is policy chief for the IAVA in Washington, D.C. “You still have to call up and see if they have anything available.”

One of the biggest criticisms of the VA’s technology status is the lack of a centralized computer records system.

After enormous pressure from Congress and activists, the VA is rushing to digitize its benefits records in an effort to shorten the wait time for decisions on disability claims. More than 700,000 claims remain unresolved as of early August, with 65 percent pending for more than four months.

VA medical records have long been computerized — the federal agency was a pioneer in that regard — but those records would fall off a digital cliff when transferred to the benefits side.

Tarantino said there’s no reason he and other veterans shouldn’t have a single VA record — for medical care, disability benefits, the GI Bill, even cemetery benefits.

“And it should be totally, seamlessly interoperable with the Department of Defense. It should be just one computer system where you type in ‘Tom Tarantino’ and you see it all, on demand,” he said.

“I’m not talking about ‘Star Trek’-level stuff. This is basic stuff that we cracked the technology on a long time ago.”

Congress is pushing the VA and Defense Department to make their systems talk to each other. The two enormous federal departments have promised to achieve unfettered sharing of records between their systems by the end of this year, according to news reports.

Still, as of a July congressional hearing, lawmakers were skeptical that the effort was on the right path. They cited the Defense Department’s decision late last year to develop a new records-management system separate from the existing VA software.

Back in San Diego, four local hospital systems were named in the same 2013 “Most Wired” list published last month by the trade magazine Hospitals & Health Networks.

Rady Children’s Hospital, Sharp HealthCare San Diego and the University of California San Diego health system were also noted. Camp Pendleton Naval Hospital was mentioned in the small and rural hospitals category.

The VA’s Palo Alto medical system was called out by name, though San Diego was not.

But the San Diego VA is the pilot site for development of the agency’s next-generation electronic medical records system.

That system, according to Smith’s description, will be more like a Microsoft Outlook calendar — reminding you of appointments and anniversaries — and less like a flat repository of information.

“Shouldn’t the health system be able to say, of all the patients that Dr. Smith takes care of, here’s the five that have problem blood glucose or that need to be reminded to get colonoscopies? To reach out proactively to those people and bring them back into the system, so you are not waiting for them to come to you with a problem,” Smith said.

“It’s building those tools into the information system that make that seamless and easy that is a real paradigm shift from the existing medical record systems,” he said.

The new generation will be rolled out in bits and pieces as it is developed, Smith said. San Diego was the first site chosen for the pilot project, but other locations are now involved, he said.

Other “wired” milestones for VA-San Diego:
• More than 51,000 of its 70,000 active patients access their health information online through programs called eBenefits and My HealtheVet.
• More than 14,000 veterans use secure email messages to talk to their doctors.


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