NAVAHCS Requirements on MMC.pdf

Under the Veterans Health Administration, the Northern Arizona Veterans Affairs Health Care System serves more than 34,000 Veterans across a largely rural area of 65,000 square miles, where patients encounter major barriers to accessing the care they earned. Rural clinics are often severely understaffed due to chronic recruitment and retention challenges, as remote locations and inadequate housing fail to attract the providers they need. There are significant provider-scaling issues, as more providers and specialists are required to serve patients, and the maldistribution of clinics by specialty and geography drives the most severe imbalance in rural areas. This directly impacts essential primary care and preventative services. For example, women who live hours away from the nearest imaging center face time-consuming, costly travel just to have a routine mammogram.

Mobile Health Clinics (MHCs), along with companion telehealth services, have proven effective in overcoming these barriers by bringing mobile health events and providers to patients, right where they live. However, the vehicle must meet specific requirements to successfully navigate the landscape, operate reliability in the environment, and effectively meet the patient population’s unique needs. For the NAVAHCS service area, this includes high elevations, long stretches of unpaved roads, and vast areas with no cellular access. It also requires personalized, flexible support for mobile events, as well as VHA-experienced, culturally competent staff.

MHC Specifications for Successful Operations in Rural Northern Arizona

For the NAVAHCS service area, mobile clinic vehicles must have the ability to travel and operate with full clinical capacity at elevations up to 9,000 feet. They must be equipped with sustainable power, and redundant power sources are essential for daylong events.

This includes solar, lithium ion back up battery capability, shore power capability, as well as generator to run the MHC. Vehicles and drivers must have demonstrated experience navigating rural and unpaved roads.

Two exam rooms are necessary to maximize utilization by enabling concurrent services such as primary care, telehealth, screenings, and lab draws; optimizing patient flow;

increasing number of patients seen; and reducing wait times. They also ensure patient privacy for confidential discussions, physical exams, and treatments in accordance with Health Insurance Portability and Accountability Act (HIPAA) regulations.

MHCs also must comply with the Americans with Disabilities Act (ADA), including an 800lb wheelchair lift. Clinical Laboratory Improvement Amendments (CLIA) waived capabilities are required, including the ability to monitor and keep instruments operating without temperature extremes. Temperature inside the MHC must be maintained at 70-75 degrees in exam spaces for clinical stability, such as vaccination refrigeration, biologic and laboratory sample storage, and maintenance of supplies. Mobile mammography capabilities are required, including high-quality 3D imaging, 24-hour results, and transfer to the VHA health record.

Additionally, MHCs must be telehealth-tested with VHA equipment and remote electronic health record (EHR) access. Clinical Video Telehealth capability (CVT) is required for specialty collaboration with patient care, and MHCs must deliver consistent connectivity for virtual appointments using satellite and cellular connections with at least one back-up connection.

Other Considerations for Successful Operations

MHC management and support personnel must have recent experience working with VHA, either as a direct employee or for a VHA contract to demonstrate currency with VHA systems and processes. MHC providers and support staff must complete Veteran and Tribal cultural competency training annually to maintain currency in delivering culturally competent care.

Finally, MCH’s must offer flexible scheduling to accommodate the needs of each location where mobile clinic events are held, with routing prioritized by key factors like wait times, patient volumes, and the severity and type of disease states. Key personnel must provide personalized support for MHC events with in-person representation, onsite event management, and facilitation of Veteran engagement, not only to ensure smooth operations, but also to foster trust, partnerships, and relationships within the tribal and rural communities.

Recommendation

To ensure reliable delivery of care, MHC’s must be equipped with the stated specifications to successfully navigate high elevations, handle rough terrain, and operate in austere environments in the NAVAHCS service area. Management, scheduling, and support for mobile operations must be tailored to meet the unique NAVAHCS mission and the needs of every patient it serves.