Reaching Out to All Who Served Through Technology & Innovation

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1 Reaching Out to All Who Served Through Technology & Innovation Luke Steinbach MS RD Joann Houge Clinical Dietitian Facility Telehealth Coordinator St. Cloud VA Medical Center

2 St. Cloud VA Health Care System Enrolled Veterans 32,675 Medical Center located in St. Cloud Community Based Outpatient Clinics (CBOCS) Brainerd Montevideo Alexandria

3 Population Density 2010 Brainerd Alexandria St. Cloud Montevideo

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7 Rural Veterans In Minnesota there are 14,781 Veterans who are enrolled in VA care that are greater than an hour away from a medical center or CBOC. Distance is barrier for treatment Greater than 15 miles Within 5 miles from facility are most likely to use services Rural Veterans make up 36% of all enrolled Veterans nationwide. 1 Rural Veterans have more physical ailments and score lower on quality of life assessments than their urban counterparts. 1 1 Soc Sci Med Jun;50(12): Is travel distance a barrier to veterans' use of VA hospitals for medical surgical care? Mooney C, Zwanziger J, Phibbs CS, Schmitt S.

8 Meeting Veteran Needs Mobile Clinic Audiology Van Technology Secure Messaging Store and Forward Clinical Video Telehealth Home Telehealth

9 Mobile Clinic Able to provide same services as traditional clinic setting Hearing aid fittings Hearing evaluations Compensation and pension exams Device repair Services are provided at all three CBOC locations Cost savings Veterans do not need to travel to St. Cloud for Specialty care.

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11 Technology Secure Messaging Encrypted messaging system allows Veterans to communicate with entire care team. Send and receive attachments of all kinds. Telehealth Using advancements in technology to bring specialized care to the Veteran in their own clinic or home. ensure the patient gets the right care, in the right place, at the right time.

12 Store and Forward Images or Videos are captured at the Veteran s primary clinic and then transmitted to a specialist to review and report their findings. Dermatology, retinal eye exam, electrocardiogram, and pulmonary function test are the major uses for store and forward technology. Results are uploaded via the equipment to a secure location where the interpreting provider can access them at anytime.

13 Clinical Video Telehealth (CVT) CVT is the use of real-time interactive video conferencing that links a Veteran in the clinic to a provider in another site. Telehealth Clinic Technician (TCT) on both sides of video visit to assist with video connection, troubleshooting, and clinical tasks as requested by the provider. Instrument attachments can be used for diagnosis if applicable Stethoscope, handheld camera with tongue depressor, otoscope etc.

14 Clinical Video Telehealth (CVT) Vast network of VA health care providers allow for specialized treatment in rural areas. Genetic medicine, Oncology, Mental Health, Surgery, Nutrition, Physical Therapy, etc. Limits travel Cost savings for both Veteran and facility Expanding from clinic operation to in home use.

15 Clinical Video Telehealth to Home Same concept as traditional CVT but done from Veteran s personal computer. No need to leave home or travel to attend appointments. Can connect with VA staff either in their clinic, to specialized providers in different VA clinics anywhere, or even to employee who telecommute. Follow up visits, patient education, and specialized services are all targets for this area of growth. First St. Cloud CVT to home appointment was in April 2014.

16 Home Telehealth Monitor and measure Veteran health data through daily use of Home Telehealth equipment. Scale, blood pressure cuff, glucometer, pulse oximeter Veterans are asked a series of branching health assessment questions based on the diseases being monitored. Education can also be delivered to the Veteran through this modality.

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19 Home Telehealth Responses to questions and health data are analyzed daily by care coordinators (nurses, registered dietitians, or social workers) Conditions Monitored with Home Telehealth DIABETES CONGESTIVE HEART FAILURE WIEIGHT MANAGEMENT (MOVE!) HYPERTENSION CHRONIC OBSTRUCTIVE PULMONARY DISEASE DEPRESSION POST TRAUMATIC STRESS DISEASE SUBSTANCE ABUSE SCHIZOPHRENIA BIPOLAR DEMENTIA TOBACCO CESSATION

20 Encounters Overall Telehealth Growth in St. Cloud FY12 FY13 FY14

21 Home Telehealth

22 MOVE Home Telehealth 82 day cycle Questions Nutrition and health related to assess education need. Education provided three ways. Weigh-in Direct (audible and written from monitor) Handbook Call from care coordinator Done daily to track progress. Veteran is alerted to change in status from previous day.

23 Identifying Veterans MOVE screening completed at nursing intake BMI greater than 25 and under 70 years of age. Given information about MOVE options including MOVE Home Telehealth Provider referral Could be Veterans outside of MOVE criteria who wish to lose weight. Nutrition clinic Veterans interested after individual appointments or group classes. Veteran initiates contact, provider referral not required.

24 Monitoring Veteran Data Alerts can arise from questions and weights. Triage for potential interventions. Green: no intervention. Yellow: possible intervention. Red: intervention likely required.

25 Red Alert: Call Veteran

26 Potential Mental Health Referral

27 Weight Gain: Short Period of Time

28 Weight Gain: Following Vacation

29 Weight Loss: Encouragement and Support

30 Outcomes and Tracking Results after 3 months Average pounds lost: 10.4 pounds Average percent loss: 4.42% Better response rate more weight loss Weight loss 30+ pounds in 10% of Veterans 5-10% weight loss has been scientifically shown to significantly improve cardiovascular health, reduce risk for developing type 2 diabetes and reduce healthcare costs.

31 Weight Loss 7.00% Percent Weight Loss After 3 Months 6.00% 5.00% 4.00% 3.00% 2.00% 1.00% 0.00% Below 60% 70-79% 80-89% 90-99% 100% Response Rate

32 Veterans MOVE Home Telehealth Growth

33 Questions Contact Information: Luke Steinbach MS RD Clinical Dietitian Address: St Cloud VA Health Care System 4801 Veterans Drive Bldg. 4 Rm. 120J St. Cloud, MN Office: , ext Mobile: Contact Information: Joann Houge Facility Telehealth Coordinator Address: St Cloud VA Health Care System Office: , ext

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