Good Morning.
I'm really excited to be able to introduce you to the Vet Links kiosks.
I'm also very proud of the team that have worked for a number of years to develop the
product to where we are today and I'm glad to have the opportunity to share this with
you and be proud of my team, they are excellent people.
Beyond beyond the actual activities and tasks of getting care time with the doctor at your
appointments your check out your follow-ups your lab test and other diagnostics there's
a whole slew of activities that veterans need to do in order to maintain and manage the
relationship with VA, the relationship with their provider as well as their health and
the kiosk allows the veteran to do many of those activities when they are at the medical
center.
A little bit of background.
Several years ago, a number of VA medical centers had begun to experiment
with your own kiosks.
They recognize the value of knowing veterans to perform self-service transactions this
was clearly a trend and VHA took notice and realized it was time to look at this from
the central perspective to see what's working well what's not working well what were the
lessons learned and how can we leverage all these lessons learned all the wonderful experience
provided truly great product for veterans across the country.
There were two facilities that really stood out among the rest.
The first is the Portland VA medical center very innovative place.
They developed a homegrown solution, which they called APHID and their champion was a
clinician or team of clinicians.
Pittsburg also stood out with their use of kiosks and there champion was doing kiosks
because of its administrative benefits.
Put the two together we have an excellent brain trust there.
The two people who really should be getting credit Dr. Bretzel Routh, who led the APHID
research and development and Mike Moreland, who was then VA Pittsburg director and now
VISN 4 director.
The program was launched in 2009, we sought to standardize across the whole country so
that Veterans who go to one VA to another VA will have the same experience, it would
be more predictable and manageable for them.
In 2010 we started a pilot at four medical centers each of them receiving ten kiosks
and learn from there.
And the mission was to make sure that these devices work easy-to-use, effective and efficient
As I mentioned, we wanted to standardize the patient facing activities but we also want
to make sure that we align with all the other innovations and wonderful programs that you're
seeing today.
We want to align, we don't want to conflict we don't want to contradict we don't want
to duplicate we want to enhance as such we do to talk, we do communicate forms like these
demonstrates just how we are working together and slowly over time begin to cross-pollination
and synergize.
One important guiding principle of ours is that we will provide all veterans with an
equal or near equal quality of experience regardless of any dependence and any assistive
technologies.
Veterans who uses assistive technologies likely need them because the service they provided
to our country.
We want to make sure that they can use our technology.
There are a number of benefits of kiosks.
There are saving of time, savings of money, cost reduction, cost avoidance but a lot of
the benefits are the softer benefits.
Veteran is more control of their time.
Veteran is more in control of their information.
The Veteran can more actively engage with their doctor.
The Veteran shows up for an appointment, they want to update their address, they don't need
to find the right clerk to talk to.
If they want to update their address and then update their insurance information they don't
have to go from clerk to clerk to clerk.
There for they are in more control of information, they are more in control of their time idea.
The information that VA gets from them is more up-to-date so if the veteran provides
us with new insurance information that makes insurance collection much more efficient.
If the Veteran provides us with an updated address, the moment they have an updated address,
well they receive all their information more timely.
We have less return mail.
We have less lost prescriptions that are mailed out to them and so on.
When the Veteran has time, at their leisure, in the medical center while waiting for an
appointment, while waiting for their doctor to review their medications, well that prompts
them to ask questions, to understand more about the medications that they are taking.
To remember that they had a comment or question about a medication for their provider, in
taking this it is keeping me up a night.
Taking this and I stop eating.
You're seeing today information about a number of VA innovations.
And Vet Link is certainly one of those.
And we provide the self service within the medical center.
When the Veteran is outside the medical center, they have a number of options.
At home, My HealtheVet is a wonderful option for them.
When they are on the go anywhere in the world, My HealtheVet and mobile apps are available
to them.
When they in the medical center and transitioning from, I don't have direct business for my
care today with the VA too, I'm in the medical center and I have face-to-face care.
This is where we come in.
We help them transition from the outside to the inside and the inside to the outside.
We allow them to check in, to update their information, to review their information questions
that they need to ask and maybe learn a little more about the VA.
Where are we now?
We are now live in 16 medical centers, 754 Kiosks, over 1.4 million interactions with
the Kiosks so far.
We ask the Veterans if they find the kiosks easy to use and over ninety percent has said
yes.
As I mentioned before, our guiding principal, we very proudly debuted our kiosks at the
Blinded Veterans Association Conference last year and we achieved great results, great
feedback.
Our kiosks, I believe, are the first in the world if not for all kiosks, then certainly
the health kiosks to be fully 508 compliant, fully accessible, and usable by blinded veterans.
We also partnered with the office of prosthetics to make sure any Veteran dependent on prosthesis
is able to use our touch screen technology as well and as you can see we have been very
successful.
This is where we are currently located.
Next month actually we go full steam ahead on our nation wide deployment.
By the end of this year we expect to have 3000 kiosks in the field.
If you're located in any of these areas and are interested in perhaps seeing the kiosks
and use, please contact VA and we'll be more than happy to arrange a visit for you.
The devices themselves are stand alone, free standing as is like the one in the corner.
They are also available as a wall mount, a table top and tablets.
The staffs are able to access all the information, they are able to see everything that's going
on in the kiosks through a browser based app from their workstations and are able to use
that same app to communicate internally between staff and clinicians and front office and
back office and so on.
And the most popular is the free standing What does the kiosks mean in the VA?
This is what it looks like.
Let's go down a level and technical.
The kiosks themselves can be regarded as think clients, which means there is no direct information
stored in the kiosks itself.
If somebody has this wonderful idea of taking home a seventy two pound free standing kiosks,
they won't have any PII, Personal Identifiable Information, or personal health information
on it.
They all go straight to the server.
The server is the hub which allows the kiosk to communicate anywhere that we need it to
communicate internally through VistA as well as anything the facility needs.
If the facility has printing needs, it'll print it.
If we need to access other data respirators, we can access the other data respirators.
All for a seamless experience for the Veteran and for the staff.
And clinicians are able to access the output of the kiosk through the CPRS and VistA
Currently it takes about 90 seconds, but we usually see it less for Veteran to log in
review race, ethnicity, their demographic, insurance, next of kin, check into their appointment,
view upcoming appointment, print their co-pay, get a canteen coupon, and learn about some
other programs in the VA. 90 seconds through the kiosk, and the rest of the time they are
waiting is their time.
They can rest, they can go grab a cup of coffee, they can go talk to some of their buddies,
it their time.
For the future capabilities, medication and allergy review, was a big one that we are
investing in this year.
Medication reconciliation is very important to provide the Veteran the opportunity to
review something that we are going to be investing a lot of time in.
And there are a number of others that are being developed as you can see on this list.
Medication and allergy review is important.
We are leveraging the self service approach that was pioneered by Dr. Lesselroth and the
Portland medical center.
Allowing the Veteran the ability for medication review will reduce adverse drug events.
Oh course it saves lives and saves money.
When we catch adverse drug events earlier on, or if we prevent them entirely, theres
no fixing, we save a lot of money that way.
We treat and retreat.
We improve patient outcomes and we also increase the patient engagement.
When Veterans come in and check in, and they are asked about what meds you are taking,
I don't remember.
So we ask them to bring in bottles of their meds so that we look at it with them, and
they come in with shopping bags.
And it's still very confusing.
Veterans come in with their care givers, their spouses who are their primary care givers
and they these back and forth discussions about "Was it the red one?
Was it the Green one?
Is it the round one?"
Through kiosks they can see, they get a visual, and as you can see, this is a screen that
a Veteran will see.
You see an image, a picture of the prescription to scale, a name, the dosage, the instructions,
are you taking this as written?
Are you not?
Are you unsure?
You have a commentator question that you would like to ask your healthcare provider.
It records it.
And it sends it to the healthcare provider.
Anything else about it?
Do you need a refill?
Does it make you feel sick?
Tell us.
We need to know.
And it's also very important for the Veterans to let their doctors know if they are taking
anything from outside of the VA.
Do they have to go to a community care provider and get a prescription there?
Are they taking herbals?
Are they taking other over the counter medicines?
This is a chance for them to let us know.
User friendly and again the patient is in control of his or hers time.
They are relaxed and can go back and forth as needed.
And medication review can happen in a number of different scenarios.
At check in, while they are checking in, they can use the kiosks once and they are done.
While they are in the waiting room, they can capitalize on the waiting time.
Many Veterans show up early, many Veterans stay late.
Between appointments that waiting time can be used very effectively.
It can be used as part of a suite of screening questioners in addition to medication and
allergy review.
We have other screenings.
Maybe the Veteran wants to take a depression screening that day.
Maybe the Veteran needs to do some other screening that day.
All of this can be done at the comfort at their pace.
When they are with the staff getting their vitals taken, well that provides an opportunity
to dialogue and ask questions.
With the staffer there and they are looking at the pictures of the meds, names of the
meds, with the patient right there, they recall the benefits and the Veteran can ask questions
right then and there.
And then the same thing in the exam room.
If they are doing the medication review in the exam room with the clinician or if they
are waiting for the clinician to arrive, and they are doing the review right there, it's
another effective use of their time and increases the opportunity for dialogue and questions
and engagement.
It's a challenge building it but we believe that it's worth the investment.
The architecture is going to be very important and needs something that needs to scale to
VA's size.
VA's huge, 156 medical centers, 800+ outpatient clinics, it needs to scale.
And then having all of these information compiled, makes other things possible.
We are able to look at all the data nationally and identify trends, which medications have
higher adherence rates, which medications don't.
And then we begin to ask the questions why.
We can now provide this visibility.
The medication image library is another innovation of VA.
It will be kept updated in almost real time and this will provide many uses not just for
medication review but other programs that need to be leveraged it as well.
Our architecture as I said needs to scale.
We don't want to bring the VA network down while people are using kiosks and while millions
of people are accessing the data simultaneously.
We will ensure accessibility as it is our guiding principal.