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1 Hosted Monthly on the 3 rd Tuesday 3 :00PM EST Registration is Free 0

2 Vista Mobile Health Wyatt Smith, AbleVets LLC, Agilex March 17, 2015

3 AbleVets Happy St. Patrick s Day! 2

4 Why Mobility Now? Opportunity to Better serve our constituents Enhance mission systems Embrace innovation Leverage COTS products in a sustainable manner 1970 s 1980 s 1990 s 2000 s 2010 s Mainframe Mini- Computers Personal Compu3ng Desktop Internet Mobile Internet 3

5 Chronic Disease Trends Are Shaping Healthcare Redesign Chronic disease spending comprises 80% of $2 trillion spent on health care 80% of chronic disease morbidity could be reduced by changes in behavior (WHO estimate) 30-50% of patients with chronic disease do not adhere to prescribed medications (WHO estimate) 41% of American adults projected to be obese in 2015 Diabetes: 14M in 1995 à 35M in 2015 à 47M in

6 Wearable wireless sensor market Predicted to grow to > 400 million devices annually by 2015 Wearable Wireless Body Sensor Device Shipments, World Market: 2009 to

7 Mobile Health An Engagement Model of Healthcare Delivery Veterans Impacted 20+ Million 8 Million 5 Million < 1 Million Outpatient Care Traditional Telehealth Institutionalized care 6

8 VA Mobile Health: Expanding Care for Veterans Personalized Convenient Coordinated!" Accessible 7

9 A New Engagement Model The average number of minutes with a provider per year 100 Minutes 8

10 A New Engagement Model There are 525,600 minutes in a year 9

11 A New Engagement Model The blue dot represents the time our healthcare system has to observe, treat, and change behavior for a healthier life The Army spends $13 BILLION/yr on the blue dot How do we affect the other 99.9% of a person s life? 10

12 Mobility Vision Appropriately reduce utilization Improve Caregiver/Veteran/ Clinician interaction, access to information, and benefits Embrace innovation 11

13 VA Mobile Roadmap Security and Accreditation Mobile Device Management Wi-Fi Availability VA Mobile Framework and Common Services Mobile Application Environment App Development Application Testing & Certification App Deployment/Distribution App Portfolio Management and Governance 12

14 Security Authorization External users accessing internal systems Devices Data Securing physical devices through MDM Encrypting data at rest and in transit (FIPS certified) Minimizing/eliminating local storage of sensitive data Data sensitivity/delivery channel considerations ( , SMS, in-app only) Environment Isolating user groups through architecture (Staff vs. Veteran enclaves) Internal (Staff) vs. External (Veterans/Service Members) Network Access Environment reviews/authority to Operate 13

15 Mobile Device Management Functional Evaluation and Testing Implementation & Configuration Policy Development Complex Profile Schema Development Management Architecture Definition Feature Upgrades and Maintenance MDM Vendors AbleVets/Agilex Proprietary 14

16 Security Validation Device provisioning & configuration Configuration & profile testing Asset management Policy enforcement Threat modeling 15

17 Agile So>ware Development Methodology Daily Scrum Mee3ng Design Code Integrate Test Product Backlog - PrioriCzed by Product Owners Sprint Backlog - Daily Tasks managed by the team PRODUCT DemonstraCon and RetrospecCve 16

18 Enterprise Mobile Architecture Develop web-services based architectures to securely transmit data housed in legacy backend systems to and from mobile devices 17

19 Mobile Application Environment Project Registration Security Tools Development Certificates App Dev Guidance Source Code Repository Continuous Integration Application Lifecycle Management Tools MDM Security Monitoring Development Tools Deployment Environment Native Cross Platform Build Test Integrate Run & Manage Native Cross Platform Hybrid Validation, Verification & Certification Hybrid Code Reuse Library APIs GOVERNANCE PROCESS - SECURITY Developer Workstations VA Mobile Users AbleVets/Agilex Proprietary 18

20 Technology Choice Native or Web-based? Native (ios, Android, Windows) (+) Better access to device hardware (-) Maintenance of different application baselines (-) Commercial app store review processes (-) Frequent ios updates; disparate Android baselines Web-based (e.g. Backbone.js & AngularJS) (+) Build once (+) More seamless updates to apps (-) Requires connectivity/hybridized application for offline access (-) Hosting cost 19

21 User Interface Responsive/adaptive design Need to support multiple, ever-growing form factors/ resolutions Need to optimize content for amount of real-estate 508 Compliance Assistive technology for native apps vs. mobile browsers Browser support Define the device/browser combinations supported/ validated Developing standard look and feel Framework choices Design standard input controls Standard labeling 20

22 Need for Enterprise Data Sources Disparate sources of data based on end user and data domain Not always easily accessible Source systems Ancillary systems Data warehouses Data caches Some apps require access to multiple sources of data based on users/needs 21

23 Need for Enterprise Services Authentication/Authorization Patient search Patient correlation Context management User management (session state) Data storage standardization (e.g. PGD) Metrics Clinical data write-back, to include business rules 22

24 Access/Usage Rights End-user license agreements Protect the organization from unintended consequences Staff usage disclaimers Informs the staff of appropriate usage of the applications Veteran right of access agreements Consent related to data storage 23

25 VA Mobile App Certification Process ü ü ü Required Reviews: Business Ownership Commitment (Governance) Aligned with VA Business Objectives (Governance) Sustainment Plan (Governance) ü Usability Testing (OIA) ü VA Branding (OPIA) ü Data and Terminology Standards Compliance (OIA) ü Security (OIT) ü Privacy (OIA) ü System Performance Impact Assessment (ESE) ü Patient Safety Assessment (OIA) ü 508 Accessibility (OIT) ü Clinical Review for Medical Apps (VHA) ü Help Screens (OIA) ü Software Independent Verification & Validation (OIT) ALL VA Apps must be certified before posting on App stores 24

26 Managing Apps Managing Apps Launchpad concept Commercial App Stores MDM Push/pull capabilities (Staff) Veteran Enterprise App Store 25

27 Veteran Enterprise Application Store Design Private App Stores Single Sign-On Role-based Access Control Customize COTS App Stores Integration with MAE Auditable Installs and Usage Metrics 26

28 Initial Pilot at the DCVAMC smith! 27

29 Impact on Healthcare Delivery Your& produc+vity& Ability&to&share& informa+on&with&the& pa+ent& Ability&to& communicate&with& the&pa+ent& Ability&to&review& important&pa+ent& informa+on& Ability&to& communicate&with& other&providers&in&a & Large&posi+ve&impact& Moderate&posi+ve& impact& Neutral&impact&(neither& posi+ve&or&nega+ve)& Somewhat&dissa+sfied& Very&dissa+sfied& Ability&to&deliver& healthcare& 0%& 10%& 20%& 30%& 40%& 50%& 60%& 70%& 28

30 Apps EHR Extensions 29

31 Next Webinar pophealth This open source software integrates with EHRs and automates the reporting of Meaningful Use quality measures. Dr. Bush will demonstrate how it provides actionable clinical information and performance monitoring across providers. Registration is free April 21, :00 PM EST 0

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