SOW Attach 1 Background_CCPC.docx

OCC CONNECTED CARE PRODUCT CATALOG (CCPC)

BACKGROUND

This document contains an outline of the current state of the Office of Connected Care (OCC) as well as current program direction.

Through two major business units, Telehealth Services and Connected Health, OCC works to create an environment that empowers Veterans, and their caregivers to become active participants in the management of their own care. In support of this mission, OCC has established a connected care technology network for the distribution of health care, self-care, and related services that consists of telehealth devices, web and mobile health applications, and online health platforms. These connected care technologies expand the operations of VA’s expansive health care network by remotely connecting Veterans with health care professionals across the system who can best meet their needs and by providing tools that empower Veterans to engage actively in their own care.

My HealtheVet:

My HealtheVet is VA’s highly visible patient portal that is vital to achieving VA priorities and is designed for Veterans, active-duty service members, and their dependents and caregivers (https://www.myhealth.va.gov). My HealtheVet provides a web-based personal health record and tools for Veterans to self-monitor their care, access their health records on-demand, refill prescriptions, make informed decisions, and more easily communicate with their care teams.

OCC has achieved key successes in My HealtheVet’s product lifecycle, including high utilization and satisfaction rates among the Veteran user population. OCC can attribute this to a focus on the most important Veteran needs as well as the governance and management of value-added program services that have become the foundation for future sustainment of the growth of Veterans personal health record-based transformation strategies. Major My HealtheVet product features include:

a) VA Blue Button – Provides Veterans with access to information from their VA Electronic Health Record, including immunization records, medication history, laboratory (pathology) test results, and radiology reports as well as their current medical issues.

b) Secure Messaging – Web-based platform for encrypted communications between patients and their VA providers and other VA health professionals. The increased accessibility of treatment through Secure Messaging is one of the most tangible ways that technology has changed VA health care.

c) Prescription Refill and Tracking – Enables Veterans to refill prescriptions online, track their delivery, and view a list of VA prescriptions.

d) Manage Appointments – Provides a platform to view, schedule, and cancel VA care appointments, set up email reminders, and join video visits.

e) Research Health – Provides access to health information about common conditions and VA health programs.

f) My HealtheVet Community – Provides links to news and events, information on volunteering, VA benefits, mobile health apps, and stories on how to manage health conditions.

These tools have ensured that My HealtheVet accounts for 40% of all VA web traffic and is consistently ranked as the highest used VA website as well as in the top 5 among all federal, public-facing websites. Since 2005, Veterans have used My HealtheVet to request over 170 million prescription refills and send over 110 million secure messages to their VA care teams. In fiscal year (FY) 2020 alone, My HealtheVet facilitated 20 million prescription refill requests and 24 million secure messages.

Web and Mobile Solutions:

OCC Web and Mobile Solutions (WMS) is responsible for the development and management of VA mobile health applications (apps) that give both Veterans and VA care teams safe and secure mobile access to important health data. VA mobile apps, which are available through the VA app store (https://mobile.va.gov/appstore), are enabling new care models to better serve Veterans. VA leads federal agencies in terms of establishing a scalable web and mobile services enterprise that focuses on delivering innovative virtual care capabilities to improve access and the delivery of care to Veterans.

VA’s app portfolio includes ~50 applications that are concurrently developed, enhanced, deployed, and maintained using an Agile Continuous Integration / Continuous Deployment (CI/CD) methodology as well as Office of Information and Technology (OIT) and OCC-specific processes, such as app versioning procedure, metadata protocols, change control processes, and OIT Veteran-focused Integration Process (VIP) requirements. These apps include, but are not limited to, educational tools, tools for VA health care providers, and tools for Veterans and their caregivers, such as:

a) Virtual Care Manager (VCM) – Allows VA staff to schedule and join video visits, subscribe to and review patient-generated data, and recommend virtual care tools to patients.

b) Annie – VA’s automated text message platform that enables Veterans to receive text reminders to help manage their care through workflows tailored to specific specialties and medical conditions.

c) VA Health Chat – provides Veterans online access to chat by text or video with VA staff for answers to health questions, help scheduling an appointment, answers to medication questions and more.

d) My VA Images – Allows clinicians to request photos or short videos from patients that can assist with diagnosis and/or treatment of a variety of conditions and needs.

e) Mental Health Check Up – Allows providers to assign mental health assessments to patients and save the results in the electronic health record.

The OCC application portfolio consists of modified commercial-off-the-shelf (COTS) software as well as custom developed applications. As new apps are created and current apps sunsetted, VA intends to move towards a portfolio that consists primarily of white-listed commercial apps, modified COTS software, and apps created in low-code or no-code platforms.

To facilitate the mission of WMS, OCC has developed and implemented the VA Mobile Framework (VAMF) NextGen 2.0 to ensure that all web and mobile health apps, mobile devices, source systems, and open Application Programming Interfaces (APIs), including network services required to efficiently interact with enterprise systems, function in concert with one another in a unified architecture and infrastructure. The VAMF NextGen 2.0 is part of VA’s Mobile Applications Platform (MAP), which is hosted in the VA Enterprise Cloud (VAEC) procured from Amazon Web Services (AWS) GovCloud (MAP-VAEC-AWS). The VAMF NextGen 2.0 was developed with patient-centered design principles and integrates a shared services library, patient-generated health data (PGHD), production applications, and development tools, including an automated build system, configuration management (CM) enclave tools, and Kubernetes (K8S) container orchestration-based Paps.

The VAMF Next Gen 2.0 uses a service-oriented architecture that interacts with a number of VA enterprise systems, including the Computerized Patient Record System (CPRS), VistA, and VA source databases such as the Corporate Data Warehouse (CDW). The CCIN Contractor may also have to support integration of key mobile applications and/or their data into VA’s Electronic Health Record from Cerner. VAMF NextGen 2.0 shared services are used for data exchange between apps and any VA systems, using validated data via Representation State Transfer (RESTful) or Simple Object Access Protocol (SOAP) services, where available, as opposed to directly accessing VA systems. Some RESTful services have been developed for existing apps, others will be developed to support the new or enhanced apps. Many web and mobile medical apps operate in HTML5 browsers, including OS X Safari, Google Chrome, Mozilla Firefox, Microsoft Edge, on mobile devices and desktops. In other instances, apps are developed natively for Apple iOS and Google Android platforms.

Where OCC app and architecture solutions require data exchange, it is accomplished using Fast Healthcare Interoperability Resources (FHIR) compliant APIs, unless specifically granted exemption by the government due to clearly identified gaps in FHIR Specification or other compelling organizational needs. Data is expressed using nationally recognized reference and authoritative terminology standards such as, Logical Observation Identifiers Names and Codes (LOINC), and Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT).

Telehealth Services:

Through Telehealth Services, OCC uses technologies to provide clinical care in circumstances where distance separates those receiving services and those providing them. VA utilizes health informatics, disease management, self-management, and care/case management to facilitate access to care and improve the health of Veterans with the intent to provide trusted care anytime, anywhere.

Telehealth Services is charged with the management of telehealth care across the VA health care system and the provisioning, testing, distribution, development, and support of telehealth equipment, which includes telehealth devices, tablets, health care peripherals, telehealth carts, wearables, commercial-off-the-shelf (COTS) software, customized software, and online health platforms. Telehealth care takes place in the home, community clinics, and VA hospitals through several modalities:

a) Synchronous Telehealth – Enables Veterans to participate in video telehealth appointments with a VA healthcare provider in real time through the Clinical Enterprise Video Network (CEVN), a deployed technology system consisting of VA-owned hardware and software.

b) Asynchronous Telehealth – The use of technology to securely acquire and store clinical information (i.e., data, images, etc.) that is then securely forwarded to or retrieved by a provider at a different time for clinical evaluation. Current services in this modality include TeleDermatology, TeleWound Care, TeleEye Screening, TeleSpirometry, TeleSleep (Home Sleep Apnea Testing), TeleAudiology, TeleCardiology, TeleDentistry, TeleEEG, and My VA Images.

c) Remote Patient Monitoring / Home Telehealth (RPM/HT) – Allows VA clinicians to remotely monitor a Veteran’s vital signs or other health information to help manage a chronic condition or recovery from an acute health event.

VA has a continued need to deliver health care services to Veterans through the use of Telehealth technologies via the sustained operation of critical telehealth programs:

a) VA Video Connect (VVC) – Secure web-based video conferencing tool that is the backbone of synchronous VA telehealth appointments. It connects a Veteran with a health care provider on any networked, cellular and/or WiFi connected device, in any location.

b) Clinical Resource Hubs – Brings together primary care, mental health, and specialty care clinicians to provide increased access to health care services across veteran populations facing geographic or social barriers to care through a combination of virtual care, in-person care, and mobile teams. The services currently offered through Clinical Resource Hubs include TelePrimary Care, TeleMental Health, TeleCritical Care, Medical Specialties, Rehabilitation and Extended Care, and Surgery.

c) VA’s Loaned Tablet Program – Provides eligible Veterans with 4G-enabled tablets for telehealth as well as peripheral devices that enable data collection, such as thermometers and blood pressure cuffs.

d) Accessing Telehealth through Local Area Stations (ATLAS) – Brings telehealth care into Veterans’ communities. ATLAS sites are comfortable, private spaces established for Veterans to have video telehealth appointments with their VA providers, at partner organizations across the country such as the American Legion, Veterans of Foreign Wars, and Walmart.

VA’s connected care capabilities have become a vital part of VA’s health care system. The importance has never been more apparent than during the COVID-19 pandemic when record numbers of Veterans and VA health care professionals used virtual care for the first time to access VA care safely and virtually. From February to May 2020, week-over-week telehealth video appointments through VA Video Connect (VVC) increased by 1100%, from approximately 10,000 appointments a week in early February to more than 120,000 appointments a week in May. This rapid increase in video appointments was necessary to maintain safe clinical services during COVID-19 and was made possible by the expansion and reengineering of VA’s information technology infrastructure, rapid adoption by VA healthcare professionals, and an increase in VVC capacity to accommodate a greater number of concurrent users. In FY21, VA provided over 9.5 million documented video encounters to the home, for an average of 184,000 per week. During the month of September 2022, telehealth video appointments averaged more than 35,000 daily visits an increase of more than 1600% from February 2020.

As the burden of the pandemic eases, VA will continue to build on its success and leadership as a provider of digitally enabled care. OCC will push VA’s connected care mission to deliver high-quality Veteran-centered care, optimize individual and population health, advance health care that is personalized and proactive, and enhance the health care experience through virtual modalities.

OCC’s vision for VA connected care will leverage technology to enhance:

a) Accessibility – Bringing care to the Veteran

b) Capacity – Matching clinical supply to demand for care

c) Quality – Providing the right care at the right time

d) Veteran and Provider Experience – Increasing satisfaction with VA care delivery options and experiences

Connected care will be effectively integrated into the daily lives of both VA staff members and the Veterans they serve.

OCC’s vision is driven by three overarching goals:

a) Enhancing Veteran Digital Engagement – VA connected care technologies will be unified in a single platform through which Veterans can initiate communications to VA through a phone call, secure message, text chat, or video session; see their key health information (e.g., upcoming appointments, preventive health recommendations, health records); schedule, modify, cancel, or join their appointments (in-person or virtual), and securely message their providers. By consolidating access to connected care clinical services into one convenient web platform and an associated flagship native mobile app, VA will help Veterans navigate to the services they need.

VA will offer a continuum of self-care services that enable each Veteran to engage with VA when they want, where they want, and enable health care professionals to refer Veterans to high-intensity remote monitoring services or low-intensity programs, depending on the Veteran’s needs. In addition, health care professionals will be able to access PGHD from Veterans’ wearables and other devices. Using this data, health care professionals will be able to track specific metrics between patient visits — ensuring, for example, that medications are having their desired effect. Through these efforts, VA will support Veterans’ health care needs and goals at all times, however they choose to engage, at levels appropriate for their stage of life and personal health goals.

b) Delivering Care Without Walls – VA will reimagine its health care system to operate without walls or geographic barriers. VA services will no longer be confined to a hospital or a clinic, but move with the location of the Veteran, wherever the Veteran chooses to be. Every VA ambulatory care professional will be capable of providing services to a Veteran’s home or location of their preference. VA will continually advance its technology to deliver more comprehensive in-home services, including quality remote physical examinations using VA-issued or Veteran-owned devices. This includes touchless examination technologies that enable health care professionals to obtain biometric data, such as heart rate and respiratory rate, through standard web cameras and smartphones and without the expense and complexity of peripheral devices.

This reimagining of the health care system will enable VA to expand clinical capacity, using connected care services to ensure access to consistent, high-quality care for Veterans throughout the country. Comprehensive and specialist services that were previously impossible to deliver at a local level or at small facilities will become available to all Veterans, no matter where they live.

VA will make this new model of care possible by empowering VA’s workforce to deliver virtual care through simple, integrated connected care management tools. Through a single user interface, health care professionals will be able to schedule and initiate video appointments with Veterans, “prescribe” health care tools, securely communicate with Veterans, monitor patient-generated data, and identify consultants across the country who are available to assist them with complex medical questions any time. VA will pursue full integration of VA’s connected care capabilities with VA’s Electronic Health Record modernization efforts, developing interfaces and clinical pathways that support continuity of care during the rollout of the new Electronic Health Record. VA health care professionals will be trained through a nationally coordinated training program and by regional preceptors. As the leader in connected care, VA will work with the health care industry to establish virtual care skills, competencies, and curricula for health professional trainees and technicians.

c) Solidifying Connected Care Foundations – VA will modernize connected care technologies to establish and maintain an information technology infrastructure that supports the delivery of secure, reliable, and high-quality virtual care services. Core components of the connected care infrastructure will be monitored using advanced dashboards, artificial intelligence, and computer learning to ensure high system reliability while proactively alerting engineers when service availability or security is at risk. Enhanced technology will continue to drive connected care expansion, enhancement of the health care experience, health care professional engagement, and higher-quality outcomes with greater convenience for Veterans.

VA will analyze digital health data and the connected care program for new insights, leveraging data from Veterans, health care professionals, and the medical record to understand the impact of its connected care services on Veterans and their health. As part of its data collection, VA will maintain both Veteran and health care professional experience surveys, integrating their results in continuous improvement processes. Further, VA will support and conduct research studies that expand the knowledge base around virtual care, ensuring benefit at VA and beyond. By prioritizing data analysis, program oversight, and research, VA will help lead the U.S. health care industry in the adoption of new models of care. Stakeholders will have confidence in VA’s ability to deliver quality programs and make course corrections based on clinical data and stakeholder experience. Most importantly, Veterans will trust that their feedback, experience, and health outcomes remain the focus of VA’s connected care movement.

VA will enhance connected care operations and authorities to ensure that VA health care professionals and Veterans will be able to arrange virtual care visits with the same ease as in-person appointments. As a result, Veterans will have consistent access to health care services, health care professionals will feel enabled to optimally deliver their services, and health care administrators will have the tools they need to deliver care across their regions or the entire VA enterprise.

OCC currently receives Contractor support in the execution of its mission through the provisioning of connected care technology equipment, software, and subscriptions as well as a full suite of support services for the connected care technology program. In the face of new and unpredicted changes, Congressional and oversight priorities, and mission-critical requirements, OCC will continue to require Contractor support to achieve its mission to provide exceptional, coordinated, and connected care that enhances Veteran health and well-being.