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Commentary

VA Connected Health

The term connected health refers to technologies that extend the health care relationship beyond the traditional in-person synchronous encounters that for so long have been the centerpiece of patient/provider interactions. Connected health technologies include telehealth, telemedicine, patient portals, mobile health applications (mHealth), wearable monitoring devices, and other technologies that connect patients to their health care team or health resources.

These connected health technologies are rapidly evolving, promoting a greater focus on patients and their caregivers, driving patient expectations for easier sharing of personal health information, and necessitating change in how health care teams interact. The U.S. Department of Veterans Affairs (VA) is taking advantage of these emerging technologies by developing new or enhancing existing Web, mobile, and point-of-care digital services to redefine traditional VA care delivery.

Currently, more than one in four VA patients is engaged in the use of a connected health technology. One of VA's goals is to increase participation even further, with an objective of improving the quality and experience of care for our patients and their caregivers, while simultaneously broadening access to care.

Drivers of Connected Health

Driving the accelerated adoption of connected health is the simultaneous improvement in information technology and the emergence of the increasingly engaged and empowered patient. We anticipate increased demand for connected health technologies, which will be driven by consumers' expectations that health information, knowledge, direct care, and support should be delivered virtually—when and where it is needed, with ease of access and use.¹

As part of this health care consumer revolution, connected health technologies are expected to provide enhanced patient participation in self-care through remote health tracking, disease management support systems, and simple communication tools. Consumers prefer systems with an easy-to-use interface, trustworthy source, perceived value, and effective integration with the other communication channels of the business. The ability of these self-care connected health technologies to improve patient outcomes will likely continue to be driven by individual tailoring, personalization, behavioral feedback, and clinical integration. ^2,3

More effective bi-directional exchange of health data between patients and their health care teams is a second major shift occurring as a consequence of the growth in connected health technologies. Patients are empowered by the health care system's newfound ability to make personal health data available in near real time via digital tools for their personal consumption. Increasingly, VA expects that patient-generated data, supported by powerful algorithms, will be a key ingredient used by health care organizations to personalize the patient experience. Patient-generated data will further drive the shift from the still common paradigm that patients neither own nor control their health data to the emerging concept that the data belongs to them.

The increasing demand and interest in virtual are delivery, either synchronous (example: clinical video telehealth) or asynchronous (example: secure messaging) is a third major shift being powered by connected health technologies. These virtual care delivery modalities do not replace existing health care relationships, but augment them. Virtual care delivery has the potential to reduce inefficiencies in traditional health care delivery, allowing improved access to care and a reduction in geography related disparities.

Priorities of VA's Connected Health Office

In early 2013, VA created a dedicated Connected Health Office with responsibility for overseeing the execution of a unified connected health strategy and ensuring its alignment with VA's overall strategic plan. The office's overarching goals are three-fold: (1) increasing and improving access; (2) supporting Veteran self-care; and (3) enabling VA employees to better meet Veterans' needs. These high-level goals have been further defined by the following priorities: (1) create a seamless, unified experience for Veterans across all VA patient-facing technologies; (2) expand Veteran access to care; (3) engage Veterans and their families in self-management of their health; (4) create patient-centered care through personalization of VA health care; (5) improve information sharing to increase the value of communication; (6) increase VA health care team efficiency and quality by moving relevant clinical data closer to the point of care; and (7) systematically and intentionally deliver innovations that will improve health care.

The future impact of connected health technologies will depend upon both the effectiveness of the technologies and their reach—the number and percent of Veterans with access to, adoption of, and use of the technologies. VA should adopt strategies to enhance access to these technologies for all Veterans, including at-risk populations, such as Veterans with lower income, lower health and technology literacy—and those Veterans with health issues, including traumatic brain and spinal cord injuries that can make access to technologies more challenging.

VA's Under Secretary for Health, Dr. Robert A. Petzel, has maintained that VA's goal is to put Veterans at the center of the agency's care and treat the whole person, not just symptoms or diseases. He argues that connected health technologies are a critical tool to allow us to achieve that goal and that they are rapidly changing how Veterans access the resources and information available to them. At a recent showcase of VA's leadership in connected health, Dr. Petzel remarked, "These technologies are helping us create a system of care without walls, a virtual system of care. This is where medicine is going— the virtual care delivery system."

References

1. Frist, W. H. "Connected Health and the Rise of the Patient-Consumer," Health Affairs 2014; 33(2):191-3.
2. Gibbons, M.C. et al. "Impact of Consumer Health Informatics Applications," AHRQ Publication No. 09(10)-E019, Rockville, MD, 2009.
3. Jimison, H. et al. "Barriers and Drivers of Health Information Technology Use for the Elderly, Chronically Ill, and Underserved," Evidence Report Technology Assessment 2008; 175:1-1422.