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 Veteran with lower limb prostheses participates in Ironman Triathalon race
VA provides care for more than 45,000 Veterans with major limb loss, including those with amputations secondary to combat. In the past, the process of prosthetic limb care at VA has been laborious, inconsistent, and unclear.
To address these challenges, a team of VA staff in VISN 20 including physicians, prosthetists, purchasing, contracting, and administrative staff worked together to understand the process and potential areas for improvement. In 2017, they launched FLOW3.
The original design team, led by Dr. Jeff Heckman, now medical director at the Southeastern Regional Amputation Center at the James A. Haley Veterans Hospital and Clinics in Tampa, FL, this novel workflow optimized the prosthetic limb care process, improving timeliness in care, employee satisfaction, and Veteran customer experience.
Innovating in Prosthetic Care
FLOW3 centralizes all components of the prosthesis ordering process for Veterans and VA prosthetic limb care teams, allowing VA clinicians to view prescription details, comments, and purchase activity all in one location. FLOW3 also notifies providers as orders move throughout the process, allowing for timely, improved follow-up care.
With support from Diffusion of Excellence as a 2017 VHA Shark Tank Competition winner, the FLOW3 team, including Jeff Bott and Wayne Biggs, expanded the practice to VISN 12 and started their journey to implement on a national scale. By 2021, FLOW3 was an enterprise-wide solution; implemented in 157 facilities and benefiting over 17,600 Veterans.
Launched in September 2023, FLOW4 seeks to expand the workflow capabilities beyond prosthetic care, offers seamless integration into VA’s new electronic health record (EHR) system, and allows Veterans to track device orders like they track online purchases with real-time notifications and delivery updates. FLOW4 is currently piloting at 16 VA sites with the practice fully active at six sites that have implemented the new EHR system.
Learn More
Read more about the work of FLOW3 in a recent study published by Dr. Heckman and team, in collaboration with VHA Quality Enhancement Research Initiative and VA Rehabilitation and Prosthetics Services.
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eScreening is a cutting-edge web-based software developed by VA innovators. Designed to streamline access to care for Veterans, eScreening administers clinical screenings and provides guidance based on their individual responses, aiming to offer targeted support for mental health, housing, or food-related concerns.
The software was developed by innovators James Pittman, Elizabeth Floto, and Niloofar Afari at the San Diego VA Healthcare System and designed to facilitate comprehensive patient screenings, offer diagnostics, feedback, and alerts for various medical concerns. eScreening is also used in primary care to satisfy clinical reminders, and in research projects as well.
“The screening tool takes information provided by a Veteran and determines if they may be at risk for suicide, homelessness, or food insecurity,” said James Pittman, Director and Co-Inventor of the eScreening Program at the VA Center of Excellence for Stress and Mental Health in San Diego. “We can then use that information to triage and identify the type and level of service that may be needed and provide support based on the urgency of that need.”
eScreening has been implemented at 31 VA facilities with 38 more in progress, and is now being used to revolutionize health care beyond VA. Total Orbit, a company specializing in health care solutions, recently licensed rights to the technology through VA’s Technology Transfer process. This strategic licensing agreement is set to enhance patient information accessibility and education across the broader health care landscape. VA has more than 800 technologies interested entrepreneurs can license. Click here to browse these innovations.
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 VA is committed to leveraging cutting edge technology to improve the health care of our nation’s Veterans.
In this episode of the podcast series New Horizons in Health, VA Under Secretary for Health Dr. Shereef Elnahal leads a discussion about a very important advancement in Veteran care: 3D printing.
Elnahal is joined by an Air Force Veteran, a rehabilitation engineer and an assistive technology program coordinator, as well as members of VHA's Office of Advanced Manufacturing, a program within VHA's Office of Healthcare Innovation and Learning.
Regaining independence
Air Force Veteran Jeff Larson shares his story of the accident that left him paralyzed, his rehabilitation journey and how 3D printing is helping him regain his independence and quality of life.
“In surgery, they took my bicep and wrapped it around and connected it to my tricep. Fortunately, I met some amazing people and Seth, and he introduced me to some of the VA 3D printing,” Larson shared.
Rehabilitation engineer Seth Hills works with Larson to create customized attachments for his prosthetic brace.
“We work closely with the Veteran to help them to become independent. There’s a lot of technology out there, but not all of it will meet the needs of every individual Veteran. So that’s a great spot for VA 3D printing to come in,” Hills said.
Melissa Oliver, program coordinator for assistive technology at Richmond VA, rounds out the panel with an overview of the birth of VHA’ s Office of Advanced Manufacturing. “We don’t want to be limited by the supply chain or what we could buy from vendors. If we couldn’t buy it, we want to create it,” Oliver said.
VA has used 3D printing in the clinical environment for over 10 years and has been a pioneer in establishing point-of-care advanced manufacturing labs, bringing medical device fabrication to the hospital campus.
Learn more on New Horizons in Health episode 3 by listening here.
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The VHA Innovator's Network Greenhouse Initiative offers an opportunity for early stage innovative solutions to collaborate with frontline health care providers at VA facilities to conduct end-user testing and ideation, share early stage product designs for feedback, and conduct small scale product feasibility testing.
XanderGlasses, smartglasses that use augmented reality technology to display real-time captions, are one such Greenhouse collaboration. The glasses allow people who are hard of hearing to clearly understand who is speaking to them, whether at home, at work, or in a noisy public venue. Noise canceling microphones capture speech and the audio goes through a speech-to-text processor that formulates sentences in the right context and with proper grammar and punctuation, so it makes sense to the user. Those captions are projected into the lenses for the user to read with only a one second speech-to-text delay.
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Since 2021, Xander has been collaborating with iNET sites, including VA Pittsburgh Healthcare System, VA Palo Alto Health Care System, Charlie Norwood VA Medical Center in Augusta, GA, VA New Jersey, and Orlando VA Medical Center. Leveraging principles of human-centered design, Xander worked VA employees and Veterans to solicit feedback on the early stage product designs allowed Xander to refine their prototypes, ensuring they met Veteran needs in a way that improved their experience and restored their ability to communicate in real-time.
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Last week, XanderGlasses were featured on NBC's Today Show as one of the many innovative products recently on display at CES, or Consumer Electronics show. Today Show host Craig Melvin and tech expert Katie Linendoll demoed the product, showcasing its ability to close-caption conversations in real time with impressive accuracy. View the Today Show segment here!
Now, Xander Glasses are available for pre-order on the VA Intrapreneurial Product Marketplace (VAIPM), a website launched by iNET to make purchasing VA employee-designed products easier. It also features products from Greenhouse Initiative, solutions from outside VA that employees helped design and test.
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Veterans with low or no vision face an average wait time of 4-6 weeks to receive their prescription eyeglasses from a specialty optical lab. Many Veterans are unable to independently travel to have glasses fitted, leading to the glasses going unused or not working effectively. To address these issues, Sean Wrubel, a Blind Rehabilitation Specialist at Louis Stokes Cleveland VA medical center (VAMC), created Blind Rehab In-house Eyeglass Fabrication (BRIEF). Also known as the Specialty Optical Lab, this practice reduces processing time for Veterans’ eyeglass orders by making the eyeglasses in-house as opposed to outsourcing.
BRIEF enables Veterans to receive eyeglasses during their stay at a VA blind rehab facility and reduces wait time to less than one week. The program also provides the same service to outpatient low-vision clinics, reducing the amount of travel for Veterans to obtain their glasses. BRIEF has reached over 3,500 Veterans and received a 100% Veteran satisfaction rating.
BRIEF began in 2021 and has expanded to Charlie Norwood VAMC, Clement J. Zablocki VAMC and Community-Based Outpatient Clinics, Doris Miller VAMC, Edward Hines Junior Hospital, John D. Dingell VAMC, and Richard L. Roudebush VAMC. The practice was recognized as a 2022 VHA Shark Tank Competition winner and was recently implemented at Biloxi VAMC. BRIEF is currently implementing at four additional VA facilities.
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The MIT Catalyst Fellowship is one of VHA Innovation Ecosystem's three Innovation Fellowship opportunities, bringing together the US Department of Veterans Affairs, VHA Innovation Ecosystem, the Institute for Medical Engineering and Science, and the MIT Office of Innovation. The program stands out for enabling innovative projects with substantial health improvement potential to transcend the confines of a single lab or organization. The participating cohort, which is made up of equal numbers of VA and non-VA Fellows, immerses themselves in a dynamic, team-based, multidisciplinary environment.
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Previous cohorts have launched new businesses, carved out novel research paths, and ventured into diverse professional trajectories. Participants benefit from mentorship provided by leading private sector and academic professionals. The program also leverages the proven MIT linQ Innovation Method, specifically designed to amplify the impact of real-world medical innovation opportunities.
The MIT Catalyst Fellowship is thrilled to announce the selection of eight VA fellows for the Spring 2024 Cohort:
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Thomas Beachkofsky, MD, Director of Dermatology Laser Surgery and Cutaneous Rehabilitation Clinic from the James A. Haley Veterans Hospital in Tampa, Florida
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Rinu Daniel, Clinical Rehabilitation Engineer from the James A. Haley Veterans Hospital in Tampa, Florida
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Danielle Hallman, DNP, RN, NE-BC, Assistant Chief Nurse of Mental Health from Bay Pines VA Healthcare System
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Amit Kalia, MD, Chief of Imaging and Section Chief of Interventional Radiology at the Bruce W. Carter VA Medical Center in Miami
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Amit Kalia, MD, Chief of Imaging and Section Chief of Interventional Radiology at the Bruce W. Carter VA Medical Center in Miami
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Sarah Carbone, a Research Health Science Specialist at the Louis Stokes Cleveland VA Medical Center
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David Lawrence, MD, FASAM, Medical Director at Downtown Los Angeles Substance Use Disorder Clinic, VA Greater Los Angeles Health System
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Javier Nazario-Larrieu, MD, Staff Interventional Radiologist at the VA Caribbean Healthcare System in San Juan, Puerto Rico
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