Friday's resignation by Department of Veterans Affairs Secretary Eric Shinseki is only the first of many steps the beleaguered agency must take to fix its treatment of America's military, bolster its tattered reputation, and attract the talented professionals it needs for the future.
The department -- which has about 312,481 full-time employees and a 2014 budget of $153.8 billion -- is bulky and well funded. Neither understaffing nor money lies behind its failures. Instead, culture, a dearth of checks and balances, and a history of unpunished transgressions helped create a department that allowed wait times to last for months or erase veterans from lists entirely, according to published reports. Forty members of the Armed Forces, who waited for 21 months to get care at a VA hospital, may have died as a result of this negligence, a whistleblower charged. As more employees come forward, media and government officials are turning their attention to previously published reports by departments such as the U.S. Government Accountability Office, which in March 2013 found "inconsistent implementation of certain elements of [Veteran's Health Administration's] scheduling policy that impedes VHA from scheduling timely medical appointments."
At that time, the GAO determined the VA was implementing various technologies to improve wait times and service. In light of recent revelations, it's imperative for the VA to use these tools as part of its major overhaul. These are only tools, of course. The VA itself requires much more than technology to once again become worthy of veterans' trust. But by installing technologies for transparency, communication, and visibility, the VA can demonstrate it is moving in the right direction.
- Waiting Room Apps: A number of healthcare organizations, looking to enhance efficiency and patient satisfaction, use apps to reduce or even eliminate waiting room times. No matter who's providing care, 90% of patients were aggravated by doctors' wait times, according to a 2013 study by reviews website Software Advice. Sitting around in an uncomfortable room watching the news is one thing; being totally unable to see a doctor because your name is removed from a provider's calendar is another. Empowering patients to register themselves and set up appointments via text, patient portals, or other systems eliminates the now very real fear of being overlooked by VA schedulers. Automated reminders reduce missed appointments, keeping veterans healthier, patient satisfaction higher, and making clinics run smoother.
- Integrate EHRs: Since older veterans also are eligible for Medicare or Medicaid, it's vital the VA's electronic medical records integrate with the government's other large health programs. Encouraging -- or, certainly, not penalizing -- veterans to use alternate healthcare providers when it's more convenient or timelier will help clear some backlog, especially in certain regions where VA resources are harder to access.
- Telemedicine: Expand the use of telemedicine for areas such as psychiatry, monthly check-ins, and non-emergency care. Of course, there are many cases where veterans must see a physician in person. There are, however, other instances where clinicians provide equally good care via video or phone, saving patients a drive and wait and enhancing the provider's efficiency.
- Analytics: With data from 151 medical centers and 827 outpatient clinics and having served more than 6 million patients in 2013 alone, the VA should use real-time analytics not only to track diseases and treatments, but to monitor its own performance.
- Remote patient monitoring for the home: By equipping homes with sensors and alerts and working closely with families and patients, VA organizations help the nation's wounded war heroes return to normal lives. Not only does this improve veterans' quality of life; it also reduces medical expenses.
- Feedback: Given the shattered relationship between the VA and its constituents, VA administrators or an external agency should conduct frequent audits of wait times and proactively seek feedback from veterans using inexpensive polling applications, whether or not they are registered to a VA provider.
The VA must open up the toolbox and use everything -- from technology to training, from staff changes to new oversight -- to try and regain the trust it lost. When you exist only to serve the men and women who pledged their lives to save this nation (and then let them down time after time), you're lucky to have another chance to atone.
Has meeting regulatory requirements gone from high priority to the only priority for healthcare IT? Read Health IT Priorities: No Breathing Room, an InformationWeek Healthcare digital issue.