Reimagining Health Care in the Age of Digital Tools: Promising Models to Expand Access and Promote Equity
Webinar recording, presentations, and excerpts
The Exploration-Innovation-Technology (E.I.T.) Forum is a webinar series from the National Center on Homelessness among Veterans and the VHA Innovation Ecosystem to provide a platform to showcase and foster innovative approaches to health care for Veterans. We are grateful to the presenters and panelists listed here for sharing their expertise and reflections. If you were unable to join us on September 21, you can view the recorded program and download the presentations by clicking on the titles.
Janeen Smith, MD, Director of Tele Urgent Care for VISN 21; Telehealth Lead for the National Program Office of Emergency Medicine; Associate Professor of Medicine, UCSF
I believe, after doing this for a long time, that the default visit should be a virtual visit at the patient location, unless the patient prefers an in-person visit, and that escalation to higher level of care should be an active decision rather than a reflex. The only reason we would not see a patient virtually is if it was a clear 911 emergency. At the same time, there can be barriers of digital literacy and access. Fifteen to 24 percent of Americans lack any sort of broadband connection to the internet; probably an equal amount are not able to participate in the video visit because of a lack of digital literacy. As providers we troubleshoot these issues with our patients. It’s important, not just for health care but for almost everything they need to access. This is why digital literacy is called the super social determinant of health.
Arash Harzand, MD, MBA, Director of Digital Cardiology and Senior Innovation Fellow, VHA; Assistant Professor of Medicine, Emory University
Veterans are twice as likely to have heart disease as non-Veterans but have challenges accessing VA specialty care, including cardiology. Smart Heart is a 12-week virtual cardiac rehab program that uses a smart phone app and pairs Veterans with a coach to let them self-lead a home exercise-based program when they’re unable to access a center based cardiac rehab program because of their location or the cost of attending. We enrolled just over 300 patients out of Atlanta with good patient satisfaction and good outcomes with blood pressure control; we're seeing survival and ER admissions levels comparable to those for patients who had gone to cardiac rehab directly.
Jane Yu, MD, PhD, Digital Advisor, US Federal, Microsoft Corporation
There are tens of million people in the U.S. that lack access to broadband internet, in both rural and urban communities. Microsoft is currently investing in technologies to bridge this digital divide. One solution is the Azure Orbital Program which works with a coalition of satellite and ground station partners to connect data from practically anywhere on earth -- from your home, your car, drones, in the sky, ships at sea, or even from personal backpacks carried in rugged environments. The second program is Microsoft Airband, which partners with local broadband carriers to enable the distribution of fiber, satellite, and other communications worldwide so our healthcare applications and software capabilities can reach communities with low-cost options at the very edge of internet connectivity.
Panel
Stephen C. Hunt, MD
National Director of the VA Post-Deployment Integrated Care Initiative, VA Puget Sound Health Care System
At its foundation, quality health care is built upon the processes of connection and integration. Care depends upon creating functional and dependable connections between the clinicians and the individuals they are serving, as well as connections between clinicians with one another. And care depends upon integration: putting the pieces together to transform an array of health care services into an effective system of care. As our presenters today have described, whether we are talking about urgent care, specialty care such as cardiac care, or creating a global ecosystem of care to offer access to comprehensive care to individuals in the most rural of settings, we are discovering that digital tools do not simply “allow for care virtually”. They are creating new approaches for fostering connection and integration that are driving improvements toward health care that is more accessible and equitable for all.
Ernest Moy, MD, MPH
Executive Director, Office of Health Equity, Veterans Health Administration
There will be different groups of people who are able to use these new (virtual care) services or new mix of services better than others. It is an important thing to keep in mind as we try these new approaches and technologies to think about how different Veterans are impacted and to track that from a health equity standpoint. Virtual care also provides a lot of opportunities for us to engage our peer support specialists: Veterans trust Veterans, and Veterans can trust Veterans virtually as well and help the health care message be reinforced by people like them, experiencing the same things they are experiencing, and lead them down the pathway to better health.
For more information on the webinar, please call Nora Hunt-Johnson (215) 823-5800 x207087 or email Nora.Hunt-Johnson@va.gov.
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