11/23/2015

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A REVIEW: COMPREHENSIVE TBI EVALUATION

11/19/15

Adobe Connect Link: https://pittrstce.adobeconnect.com/vatbimeet/

Conference Call-in Number is 866-236-9258

The telephones will be muted during the presentation and will open to the audience for discussion, questions, and answers during the last ½ hour.

Please make sure you mute the microphones if you are listening from your computer.

Type in comments or questions in the chat box any time during the session.

Resource Materials and Handouts may be downloaded.

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Clinical Champions

Presenters

• Joel Scholten, MD

Physiatrist and TBI Specialist, Washington DC VAMC

Special Projects, Physical Medicine and Rehabilitation, VA Central Office

Physician Lead, CTBIE Teleconsultation Pilot

e-mail: Joel.Scholten@va.gov

• Nan Musson, M.A., CCC-SLP, BC-ANCDS

Speech Language Pathologist, North Florida/South Georgia VHS

Speech Pathology Discipline Lead

Rehabilitation & Prosthetics Services, VA Central Office

Project Lead, CTBIE Teleconsultation Pilot

e-mail: nan.musson2@va.gov

Overall objectives for the conference call:

• Brief Background

• Review Standardized CTBIE Utilizing Telehealth Technology

• Business, Administrative, and Workload Capture

• Building a Telehealth Team

• Education/Training Available

• Outcomes and Lessons Learned

• The Future: Connected Care

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BACKGROUND

In February 2012, Rural Health Funding was awarded to develop a Comprehensive Traumatic Brain Injury Evaluation utilizing Telehealth Technology

> Develop a standardized procedure for the TBI specialist and the Telepresenter

> Improve access to care for Veterans in rural settings

> Increase overall percentage of Comprehensive TBI Evaluation completion within timelines

> Increase the number of telehealth visits provided by TBI specialists

COMPREHENSIVE TBI EVALUATION

TELEHEALTH PILOT

Funding from the

Office of Health Care Transformation

Support by

Specialty Care Transformation

Leadership and Coordination by

Rehabilitation and Prosthetics Services

Collaboration with

Telehealth Service

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Advisory Board

• Nan Musson, Project Lead

• Joel Scholten, MD Lead

• Doug Bidelspach, PM&R Office

• David Cifu, Director PM&R

• Ronald Riechers, Neurologist

• Bryan Merritt, Physiatrist

• Lisa McPeak, Physiatrist

• Belisla Vasquez, Physiatrist

• Jack Dryden, PM&R FAB

• Patricia Ryan, Telehealth Services

• Michelle Winslow, CVT Telehealth Lead

• Rod Miles, FTC Bridget Smith, TBI Queri

• Robin Hurley, ACOS Research & Ed

• Kathy Walker, PNS and Telerehab Lead

• Brian Shenal, Neuropsychologist

• Betty Dameron, OEF/OIF

Special Thanks to:

University of Pittsburgh (“Pitt Crew”) :

• Mark R. Schmeler

• Richard M. Schein

• Andi Saptono

• Joseph Ruffing

• Bambang Parmanto

Telehealth Services:

• Pat Ryan

Associate Chief Consultant

Washington DC

• John Peters

Clinical Video Telehealth Program Manager

Washington DC

• Rhonda Johnston

Director, Clinical Video Telehealth National

Training Center, Denver, CO

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In May 2012, the Advisory Board met at the

Bay Pines VAMC Hosted by VISN 8 Telehealth staff

Objectives included:

• Develop a consensus standardized Comprehensive TBI Evaluation to be delivered via Telehealth (including the TBI Specialist and TCT Roles)

• Review and Select Telehealth Equipment

• Recommend Training Modules

• Identify Outcomes for the Project

• Develop an Application Process for Potential Pilot Sites

TBI/Polytrauma System of Care

TBI Screen

All Veterans separating from DoD after September 11, 2001 complete a 4

question screen to identify potential TBI/concussion

CTBIE

Veterans with a positive screen are referred for a Comprehensive TBI

Evaluation by a TBI Specialist

Historically approximately 20% of Veterans screen positive and about

75% have completed a comprehensive evaluation.

Clinical Video Telehealth (CVT)

Clinic Based Telehealth (CBT) from a Medical Center to an Out-Patient or Community

Based Clinic

Real -Time Video

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VIRTUAL TELEHEALTH TEAM

Specialist and Telepresenter (TCT):

TBI Specialist:

- Neurologist

- Physiatrist

- Neurosurgeon

- Neuro-psychiatrist

Telepresenter:

Any discipline

TBI Speclialist and Telepresenter Responsibilities:

Before the Teleconsultation

During the Teleconsultation

After the Teleconsultation

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Before the Teleconsultation

Telepresenter

• Provide the patient with Screening Tools to be completed in the waiting area (clip board and pen):

• Neurobehavioral Symptom Inventory (NSI)

• Post-Traumatic Stress Disorder Checklist-Military (PCL-M)

• Patient Health Questionnaire (PHQ)

• Prep room if necessary (set-up of telehealth equipment and peripherals)

• Verbal consent for telehealth visit

• Obtain Pt.’s main complaint

• Vitals (i.e. height, weight, pain level)

TBI Specialist

• Review history in CPRS

• Ensure that Veteran had + TBI screen if using Comprehensive TBI Evaluation (CTBIE) template

• Check telehealth equipment and peripherals

WAITING ROOM…

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While the Pt. is completing the forms the TelePresenter and

Provider are preparing the Telehealth equipment

During the Teleconsultation

Telepresenter

• Review of Screening Results (relay results of question 9 directly to TBI specialist) and vitals

• Olfactory Testing (Brief smell inventory)

• Montreal Cognitive Assessment (MOCA)

• Pain Module (if needed at the end of the evaluation)

• Tandem Romberg

• Assists with the handouts and brochures

TBI Specialist

• Review of telehealth ‘consent’

• Complete Interview

• Complete Telehealth Examination

• General Appearance and Observation (speech, distractibility/attention, thought process)

• Cranial Nerves (EOM, grimace, tongue protrusion, hearing intact to conversational volume)

• Motor and Coordination (finger to nose, Luria motor sequencing, Rapid Alternating

movements, seated heel to shin, pronator drift)

• Gait

• AND completes Pain or Musculoskeletal module if warranted

• Discuss observations, diagnosis, prognosis, and recommendations with Veteran

• Provide Education regarding symptom management

INTRODUCTION AND INTERVIEW

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Montreal Cognitive Assessment Dr Z. Nasreddine 2003 to 2014, The Montreal Cognitive Assessment - MoCA©

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Brief Identification Smell Test – Version AAuthor: Richard L. Doty, Ph.D., Sensonics, Inc

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PAIN MODULE CHECKLIST

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Pain Module…

Criteria: The Pain Module will be completed by the Telepresenter (TCT)

under observation of the TBI specialist and should be considered if the

following:

1. Veteran reports a pain score >4

2. Specific symptom complaint

a. Headache score of 3 or 4 on NSI

b. Balance score of 3 or 4 on NSI

3. TBI specialist determination based on interview

Pain Module Checklist Continued…

Reflexes

• Biceps

• Triceps

• Brachioradialis

• Patella

• Achilles

Pain Module Checklist Continued…

Sensory Exam

• Light touch

• Pinprick

• Vibration

• Proprioception

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Pain Module Checklist Continued…

Range of Motion

• Cervical

• Lumbar

• Shoulder

• Knee/Ankle

Pain Module Checklist Continued…

Cranial Nerve

Balance and Coordination

• Rhomberg

• Tandem Gait

• Observational Gait

SUMMARY AND RECOMMENDATIONS

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Patient Education

MIRECC, HOUSTON VAMC

HTTP://WWW.MIRECC.VA.GOV/VISN16/PROVIDERS/TUFF.ASP

Back to School: Guide to Academic Success

After Traumatic Brain Injury

Academic Skills

Cognitive Skills

Healthy Sleeping

Managing Headaches

Mood Management

Stress Management

Fill out VISN

Fill Out Facility

Fill Out Date

Inform the Veteran to fill

in bubbles. Tell them that

checkmarks, x’s, circling

the answer, etc. are not

acceptable

Inform the Veteran to only

write in comments inside of

the box. Any answers

outside do not scan

Specialty Clinic,

Telerehabilitation

Telepresenter provides the Telehealth Satisfaction Survey…

After the Teleconsultation

Telepresenter

• Patient Satisfaction (national form)

• Progress Note/Encounter

TBI Specialist

• Complete CTBIE template

(including NSI, PCL-M, PHQ)

• Submits orders/consults

• Complete the Encounter

• If appropriate, initiate the “Interdisciplinary Rehabilitation and Community

Reintegration (IRCR) Care Plan”

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Example: Diagnostic and Procedure Codes

TBI CVT Polytrauma – (9:00 a.m.)

TBI Specialist

Diagnostic Code:

854.01

Procedure Code:

99204

Helpful Hint: Attach the Progress Note to this appointment

TBI CVT Polytrauma (8:45 a.m.)

Telepresenter

Diagnostic Code:

854.01 (same diagnostic code)

Procedure Code:

Q3014

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The IRCR Care Plan should be completed for EVERY individual who is being discharged from inpatient rehabilitation or receives outpatient rehabilitation services and meets the all of the following criteria:

• Diagnosed with TBI/Polytrauma;

• Referred to the TBI/Polytrauma team for assessment and treatment;

• Required and received interdisciplinary rehabilitation assessment including medical, case management PLUS at least one of the following; PT, OT, SLP, Psych, RT, KT, Voc, Blind Rehab;

• Determined to benefit from rehabilitation treatments for functional disabilities related to TBI/polytrauma;

• Rehabilitation treatments require intervention by interdisciplinary specialists including medical, case management PLUS at least one of the following: PT, OT, SLP, Psych, RT, KT, Voc, Blind Rehab.

Individualized Rehabilitation and Community

Reintegration (IRCR) Care Plan

Interdisciplinary Rehabilitation and Community Reintegration (IRCR) Care Plan

The following training modules were developed for the pilot:http://www.rstce.pitt.edu/VA_TBI/VATBI.html

Overview of TBI Diagnosis and Co-Morbidities

Demonstration of MoCA Administration

Demonstration of Brief Smell Test A

Demonstration of Neuromuscular Pain Module

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Additional virtual trainings were developed for the pilot:http://www.rstce.pitt.edu/VA_TBI/VA_TBI_2013videos.html

Introduction to CTBIE Evaluation utilizing Telehealth Technology

Review of Business/Administrative Aspects

Demonstration of the entire Comprehensive Traumatic Brain

Injury Evaluation Teleconsultation Visit/Documentation

Telehealth “Hot Topics”: CTBIE (available on TMS)

Telehealth Equipment

Space and Furniture

Office EquipmentSupplies

Clinic Profiles

Provider:

Space and Telehealth Equipment

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Telepresenter (patient site):

Room, Telehealth Equipment, Chair

Peripheral Telehealth Equipment:

Document Reader, Exam Camera, Head Phones

Document Reader

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Recommended

Provider

- Desk Top EX90 (remote control)

- Document Reader or Fax Machine

- VA Desktop Computer

- CPRS

- My Healthe Vet

- PM&R SharePoint

- Microsoft Lync Communicator

- Telephone or Cell Phone

Telepresenter

- Education or Global Med Cart (Exam Camera)

- Document Reader or Fax Machine

- VA Desktop Computer

- CPRS

- My Healthe Vet

- PM&R or Local SharePoint

- Microsoft Lync Communicator

- Telephone or Cell Phone

- Chair (no rolling chairs)

- Table or Desk space

Supplies to support Teleconsultation

(Telepresenter)

Supplies for the Telepresenter

• Screening Forms (PDF, clip board, pen)

– Neurobehavioral Symptom Inventory (NSI)

– Post-Traumatic Stress Disorder Checklist-Military (PCL-M)

– Patient Health Questionnaire (PHQ)

• Montreal Cognitive Screening (MoCA)

• *Brief Identification Smell Test - A and #2 pencil

• *Reflex Hammer and sharp/pin

• Education Handouts (link, PDF or SharePoint)

• Telehealth Patient Satisfaction

* Sent by snail mail to the TBI Specialist

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Clinic Appointments

Telehealth visits require 2 appointments:

1) Provider site (actual time for the telehealth visit)

2) Patient site (1 – 15 minutes between the appointments)

Recommendation for the CTBIE Teleconsultation appointments/letters:

a) Schedule the patient appointment 15 minutes prior to the Telehealth visit

b) Include a sentence asking the patient to arrive 15 minutes prior to

the appointment in the clinic appointment letter

Allows ample time for the patient to complete the screening forms and for the

telepresenter to obtain the vital signs prior to the Teleconsultation.

Special Note: During FY’16 Telehealth Services will be introducing a new

Telehealth Service Scheduling package.

Stop Codes and 4CHAR Codes

• Primary Stop Code/Polytrauma: 197

• Secondary Stop Code/Telehealth: 690 or 692/693

• 4CHAR Code: PLTV (added to designate CTIBE)

Example:

• Patient Site: 197690 PLTV

• Provider site: 197692 PLTV

Emergency Procedures:

• Provider telephone numbers

• Telepresenter telephone numbers

• OPC/CBOC telephone numbers

• Medical Emergency procedures

• Crisis procedures

• Patient/Family contact information

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Prepare:

• Service Agreements

• Memorandum of Understanding

• Review Credentialing and Privileging

• Review State Licensure

• Competencies (Telehealth Equipment, Discipline Specific)

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Pilot Site Project:

• FY12 – 16 sites selected and began clinics in FY13

• FY13 - 15 sites selected to begin clinics in FY14

• FY14 - 10 Polytrauma Rehab Centers (PRC) and

Polytrauma Network Sites (PNS) will be

included

By Q4 FY14 all PRCs, PNSs, and all VISNs had multiple options to complete

Comprehensive TBI Evaluation Teleconsultations

TBI Telehealth Pilot Sites

Phase I - 16 Pilot Sites

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TBI Telehealth Pilot Sites

In FY13, 15 additional Pilot Sites were selected and

In FY14, 10 PRC/PNS expand the network across all VISNs

WORKLOAD, OUTCOMES, AND RESEARCH

CTBIE Telehealth Pilot Codes: 197 + Telehealth (600 series) + PLTV

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Encounters Unique Patients

FY13 FY14 FY15 (thru August) FY13 FY14 FY15 (thru August)

All Divisions 417 864 731 310 641 549

(V05) (688) WASHINGTON VA MEDICAL CENTER 185 325 280 108 168 157

(V07) (508) ATLANTA VA MEDICAL CENTER 34 38 10 30 38 10

(V07) (521) BIRMINGHAM VA MEDICAL CENTER 7 9 7 9

(V08) (516) C.W. BILL YOUNG DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER 23 3 22 3

(V08) (673) JAMES A. HALEY VETERANS' HOSPITAL 17 21 14 16

(V10) (541) LOUIS STOKES CLEVELAND DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER 10 19 12 10 18 12

(V12) (578) EDWARD HINES JUNIOR HOSPITAL 5 7 5 7

(V16) (586) G.V. (SONNY) MONTGOMERY DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER 6 49 6 39

(V16) (598) JOHN L. MCCLELLAN MEMORIAL VETERANS' HOSPITAL 22 63 60 22 61 57

(V16) (623) JACK C. MONTGOMERY DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER 9 6 9 6

(V16) (629) NEW ORLEANS VA CLINIC 27 27

(V17) (549) DALLAS VA MEDICAL CENTER 80 126 105 71 104 81

(V17) (671) AUDIE L. MURPHY MEMORIAL VETERANS' HOSPITAL 3 8 3 8

(V18) (519) GEORGE H. O'BRIEN, JR., DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER 15 2 1 15 2 1

(V18) (678) TUCSON VA MEDICAL CENTER 22 20 7 20 18 7

(V20) (663) SEATTLE VA MEDICAL CENTER 8 22 18 8 22 18

(V21) (459) SPARK M. MATSUNAGA DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER 21 85 40 20 57 26

(V21) (612) MARTINEZ VA COMMUNITY LIVING CENTER 9 53 38 9 47 35

(V22) (600) LONG BEACH VA MEDICAL CENTER 3 3

(V22) (691) WEST LOS ANGELES VA MEDICAL CENTER 20 23 20 23

(V23) (636) OMAHA VA MEDICAL CENTER 11 21 4 11 21 4

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Pilot Project Outcomes Data

(Spread Sheet)

•Provider Location (Text)

•Provider Zip Code (5 digit number)

•TCT Location (Text)

•TCT Zip Code (5 digit number)

•Positive TBI Screen (MM/DD/YYYY)

•TBI Teleconsultation (MM/DD/YYYY)

•Did the TBI Specialist recommend a face-to-face visit to complete the exam (Yes/No)

•Referrals after the TBI evaluation:

•OT (Yes/No)

•PT (Yes/No)

•Speech Pathology (Yes/No)

•Neuropsychology (Yes/No)

•Interdisciplinary Care Plan initiated (Yes/No)

•Comment (open text)

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SLP = 54

PT = 86

Neuropsych = 48

Audiology = 44

Mental Health = 71

Optometry = 30

Referrals After Exam

OT SLP PT Neuropsych Audiology Mental Health Optometry

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Research

“Examining Telehealth Applications for Evaluation of

Mild Traumatic Brain Injury”

Bridget Smith, Principal Investigator

•Aim 1:

Characterize approaches to using telehealth to provide CTBIEs.

•Aim 2:

Examine the association between patient characteristics and use of telehealth to

perform the CTBIE and outcomes associated with telehealth.

•Aim 3:

Convene an expert panel and develop recommendations to facilitate the

implementation of telehealth strategies to provide comprehensive TBI evaluations.

•Aim 4:

Conduct a preliminary cost analysis.

Principal Findings:Responses indicated that there are far more advantages to utilizing CVT—including travel

convenience, cost-effectiveness, and patient satisfaction—than there are disadvantages.

The top challenges :

- challenges with scheduling (e.g.,

coordinating the schedules between

two different sites)

- setting up the clinic (e.g., space and

equipment requests)

- TBI Specialist learning to rely upon

the TCT to be their hands

Strategies utilized to improve the visit:

- establish good relationships and

communication with telehealth staff

and providers

- TBI specialists learning to establish

personal connection and rapport

with patients via telehealth

technology

- assuring resources are accessible

to the telepresenters/patients and

providers

VIRTUAL CAREThe possibilities are endless…..

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VIRTUAL CARE = “CONNECTED CARE”

Healthcare is moving to a virtual care delivery system.

•Movement of care goes beyond the hospital and clinics into the day-to-day lives of patients.

•The goal is to achieve “connected health,” which puts patients at the center of holistic care, beyond a symptom or disease focus.

•Creates and connects relationships between/among providers and between patients and their providers.

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Connected Care…

Home Telehealth (HT): Monitors patients and manages diseases through video into the home and use of mobile devices for acute and chronic management and health promotion/disease prevention.

Clinical Video Telehealth (CVT): Real-time videoconferencing between VA medical centers and CBOCs that replicates face-to-face consultations between patient and provider, or provider top provider. Uses include specialty consultations and delivery of mental health services.

Store and Forward Telehealth (SFT): Acquisition, storage, and forwarding of clinical images to experts for review.

Secure Messaging: Enables timely and secure text-based communication with patients via mobile phones.

Mobile Health: Smart phone applications for self-management of health conditions 24/7.

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Connected Care

My Healthe Vet

E-consult

Interfacility Consult

Concussion Coach

2) CVT to Clinic

Desktop and Education Cart

3) CVTHm (demo jabber

software/anywhere scheduler)

4) CVT Patient Tablets (issued via

DALC/ROES)

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TELEHEALTH NETWORK: PROVIDING CARE AND CONNECTING WITH SUBJECT MATTER EXPERTS

TBI Telehealth NetworkTeleconferencing with DoD, Families and Receiving Facilities

TBI Telehealth Pilot Sites

THE BIG PICTURE:

Networking, Follow-up, SME expertise and Mentoring

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TBI Telehealth Pilot Sites

THE BIG PICTURE: Follow-up Care

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Assistive Technology Labs:

7 Core Areas:

•Adaptive Computer Access

•Adaptive Driving

•Adaptive Sports

•Augmentative & Alternative Communication

•Electronic Aids to Daily Living

•Electronic Cognitive Devices

•Powered Mobility/Seating

Implementation of an Virtual Team:

Interfacility Consultation with CVT Teleconsultation Telina Caudill, Deborah Drewes, Tampa VAMC

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Transportable Exam Station (TES)

The “Suit Case”

• Located at many VISNs (approximately 198 nationally)

• A mobile tablet (6 hrs. battery life)

• CPRS access

• Peripherals (e.g., exam camera, pulse O2)

• Telehealth presenter or nurse may take into

the home or work setting

Group Education or Treatment

(multiple clinics at the same time)

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Home Telehealth Care Coordination for Chronic Conditions

mTBI Disease Management ProtocolScript developed for mTBI and the patient responds to the questions for a 28 day cycle.

Still available via Home Telehealth Services.

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CVTHm

• http://vaww.telehealth.va.gov/

• JABBER software on the patient’s home computer

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CVT Patient Tablets

http://vaww.infoshare.va.gov/sites/telehelpdesk/CVT%20Patient%20Tablet/SitePages/Home.aspx

Patient Training Video: CVT Patient Tablet-Veteran Orientation

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Simple Tablet Connection

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Sample Worksheet:

Selecting Home Telehealth Equipment

Telehealth Device Advantages Challenges “Wish List”Technology Needed

TES (suitcase) Mobile/Move around home

Telehealth/ Nursing staff needed and provide support

Peripherals available

Still pictures of the homeVPN Access

Big case

Battery lifeConnectivity inconsistent

Audio inconsistent

Movement/Picture Breaks E-mail information to TCT

Weather may impact signal

FocusHome lighting/shadows

Video clips for training

Education materials

Pictures of DME

Printer (blue tooth)

Hand held manual muscle device

Body worn movement monitors

Possible Apps:

PT – shoulders, neck, backManhattan Physical Therapy

Smart Move

Metronome (gait speed/VOR)Stop watch (time stretches and

exercises)

2 cameras

Videoclips (MyHealthy Vet)

Peripheral: Pulse O2

CVT Patient Tablet (HAT) Device in the home

Verizon ConnectionPeripherals available

MyHealthy Vet

Can load free apps/VA storeSpeech really likes for voice tx

Limited Devices available

Plug into outlet (not mobile)Verizon Connection

Size of the screen

Enlarge screenHearing loss/headphones

CVT Patient Tablet

(Sony/Mobile)

Mobile Device in the home

MyHealthy VetCan load apps free/VA store

Not yet available

Video phones Phone line No longer on contract

CVTHm on Pt. Computer Always available in the home

MyHealthy Vet

Patient computer

Internet connection paid by veteran

Camera paid by veteran

Less reliable than CVT Tablets

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My Healthe Vet

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Not just the provider perspective but, the Veteran’s perspective

More than Messages:

Strategies incorporating My HealtheVet into the treatment plan

Specific Examples:

• Send a message with an attachment to the patient

• Patient sends an attachment (word, PDF, or photo)

to the provider

• Calendars and Appointments

• Journal treatments/compliance

• Add vendors or non-VA providers to lists

• Medications

MyHealthe Vet Resources

Secure Messaging:

• http://vaww.va.gov/myhealthevet/docs/brochures/MHV_SM_HCT_InfoBrochure_I

n-Person_Prof_print_color.pdf

Chemistry/Hematology:

• http://vaww.va.gov/myhealthevet/docs/brochures/MHV_Chem_PT_InfoBrochure_

In-Person_Prof_print_color.pdf

Open Notes:

http://vaww.va.gov/MYHEALTHEVET/docs/promo_comm/MHV_OpenNotes_FactS

heet_LocalPrint_06_2013.pdf

All MHV Promotional Material:

• http://vaww.va.gov/MYHEALTHEVET/promotion_communication.asp

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Applications

Concussion Coach Overview

Concussion Coach is a mobile phone

application for Veterans and Service

members who experience symptoms that

may be related to brain injury.

The goals of this App are to:

• Educate users about concussion, related

symptoms, and treatments

• Allow users to assess and measure

symptoms

• Provide resources for managing

symptoms

• Present planning tools to build resilience

• Provide access to crisis resources,

personal support contacts, or

professional healthcare.

Available for mobile Apple devices:

https://itunes.apple.com/us/app/concussion-

coach/id713590872?ls=1&mt=8

Home Screen

• From the home screen

users can choose from the

five main actions of the App

• “Settings” allows users to

personalize the App with

media from their phone

• “About” provides users with

information about the App

and access to the team that

built it

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Concussion Coach Downloads

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VA App Store

https://mobile.va.gov/appstore

VA Mobile App Examples

• Patient Facing

• Summary of Care

• Mobile Blue Button

• Secure Messaging

• Mission Health

• Veteran Appt Request

• Teledermatology

• Annie App (Veterans)

• PTSD Coach

• Care4Caregivers

• MyVAHealth

• Wellness Check

• VA FitHeart

• Mobile eKidney

• VA Virtual 311

• MOVE! Coach Mobile

• VA Moms

• RxRefill

• SyncMyData (HealthKit Integration)

• More…

• Health Care Team• Patient Viewer

• Nursing Shift Companion

• Secure Messaging

• Teledermatology Image Capture

• My Mobile Desktop

• Caring for Women Veterans

• Maternity Care Coordinator

• GRECC App

• Post Falls App

• Imaging Viewing Solution

• Scheduling Manager

• Antibiogram App

• Immunization Campaign App

• Annie App for Providers

• Warfarin Monitoring

• Nursing Action Tracking

• Environmental Exposure App

• Cardiac Rehab Provider Facing

• More…

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Utilizing Combined Virtual Care

Case Example:

28 yr. old male with mild TBI, PTSD, chronic headache and insomnia

Challenge: Accessing VA care at CBOC 75 miles from medical center

Virtual Care Options:

- CTBIE via telehealth

- CVTHm (home computer/jabber) to review sleep, headache log, medication

- Smart Phone demonstration to include apps for cognitive aid

- Concussion Coach, review sleep module

- Secure messaging to send cognitive strategies

- Recreation therapy invites to community activity (group secure messaging)

Rehabilitation and Prosthetics Services

Total Encounters from 2008 – Q2 FY15

0

5000

10000

15000

20000

25000

30000

35000

40000

725916

1694

4329

12640

24273

36319

262632008

2009

2010

2011

2012

2013

2014

2015

Telehealth Encounters per Discipline (FY’15)(special note: some disciplines have specific funding for telehealth activities)

PolyT5%

PM&R2% Speech

12%

Audiology47%

PT22%

OT4%

Blind2%

Amputation6%

PolyT

PM&R

Speech

Audiology

PT

OT

Blind

Amputation

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Virtual Care: New Options to Expand Access to Specialized

Rehabilitation Care

Telehealth

Standardized TBI evaluation protocol for Telehealth o Virtual training modules completed and available

through TMSo More than 1,500 unique Veterans have been were

seen for an initial TBI Teleconsultation since 2013.

Clinical Video Telehealth to Clinics

60% increase in number of overall encounters in FY’14

Clinical Video Telehealth to Home Evaluate possible TBI

47 sites using telehealth to connect to patient’s home

Secure Messaging o 80% of VAMCs have SM triage rehab team

E-consults o Specialist consultation may reduce need for additional

patient visit.

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Rehabilitation and Prosthetics Services

National Telehealth Pilot Projects Underway

• TBI Team Evaluation (CTIBE, CVT across VISNs)

Joel Scholten, Project Lead

Washington DC to Atlanta and Augusta, GA

• Home Evaluation and Rehabilitation in the Home (Rural Health, HBPC)

Mark Havran, Nan Musson, Deborah Voydetich, Discipline Leads

Des Moines, Iowa

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TBI References and Training http://vaww.rehab.va.gov/PMR/Polytrauma_TBI_Intranet.asp

• VHA Directive 2010-012, Screening and Evaluation of Possible TBI in OEF/OIF Veterans, March 8, 2010

• VHA Handbook 1172.04, Physical Medicine and Rehabilitation: Individualized Rehabilitation and Community Reintegration Care Plan, May 3, 2010

• VHA Handbook 1172.01, Polytrauma System of Care, March 20, 2013

• VA/DoD Clinical Practice Guideline: Management of Concussion/mTBI, April 2009. http://www.healthquality.va.gov/mtbi/concussion_mtbi_full_1_0.pdf

• VHI: Traumatic Brain Injury available on TMS or www.publichealth.va.gov/vethealthinitiative

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Telerehabilitation Manuals:http://vaww.telehealth.va.gov/clinic/rehab

Clinical Video Telehealth National Training Center

Rhonda Johnston, PhD, BC-FNP, BC-ANP, CNS

Education Specialist

Director, Clinical Video Telehealth National Training Center: Denver

Veteran's Administration Central Office, Office of Telehealth Services.

4100 E. Mississippi Ave., Suite 825 RM 805

Glendale, CO 80246

Telephone: (303) 303 372 7808

Fax: (303) 639-7001

E-mail: rhonda.johnston@va.gov

Telehealth Services Resource Materials

• Telehealth Terminologyhttp://vaww.infoshare.va.gov/sites/telehealth/docs/tele-terms.docx

• VHA Telehealth Services http://vaww.telehealth.va.gov/telehealth/cvt/index.asp

• Clinic Based Telehealth Operations Manualhttp://vaww.infoshare.va.gov/sites/telehealth/docs/cbt-ops-manual.docx

• Credentialing & Privileging Memorandum of Understandinghttp://vaww.infoshare.va.gov/sites/telehealth/docs/cvt-cp-mou.docx

• Telehealth Service Agreementhttp://vaww.infoshare.va.gov/sites/telehealth/docs/serv_agr.docx

• Conditions of Participation Core: http://vaww.infoshare.va.gov/sites/telehealth/docs/Core-CCT_CoP.doc

CVT: http://vaww.infoshare.va.gov/sites/telehealth/docs/CVT_CoP.doc

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