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INDUSTRY INSIGHT

Real-time intelligent software can help the VA save lives

The Department of Veterans Affairs understands the importance of employee morale and engagement. The VA is dedicated to creating an “organizational culture in which all people inspire and support each other to deliver world-class services to Veterans and all their loved ones.”

The VA has made progress in recent years on this front, according to several employee surveys.  These efforts are critical and must be continued, particularly those that equip VA staff with the tools to operationalize the agency’s policies, while supporting the best employee experience. 

However, policies that cannot be realistically executed by VA employees become simple aspiration. They can also lead to a demoralized workforce, high burnout and increased turnover rates that impair the VA’s ability to achieve its mission and objectives. Thankfully, software powered by clinical and administrative business intelligence can help. Real-time technologies that allow proactive monitoring and timely action are increasingly commonplace in health care. 

When VA employees have to depend dashboards and reporting tools that rely on 24- to 48-hours old data, such as those that run off the VA’s corporate data warehouse, veterans can be at risk.  All too often, when health care reporting tools are not real-time, staff members must comb through patient charts in the medical records system, looking for new information and issues.  

This is an enormous task that is akin to trying to find needles in a haystack and are a setup for potential failure. Human-only approaches are not a good way to build a health care system, if the goal is the delivery of highly reliable care. No staff member can be perfect every day, no matter how committed they are to caring for their patients.

A recent inspector general’s report highlights this disconnect between aspirational policy and the reality of execution challenges at scale, despite the best efforts by VA employees.

The report found that the proscribed steps were not followed in discharging a veteran from the Harry S. Truman Memorial Veterans’ Hospital in Columbia, Mo. Inpatient staff did not include the Columbia Vet Center staff in discharge planning and did not complete the Veterans Health Administration-required comprehensive suicide risk evaluation (CSRE) before the patient’s discharge. The veteran committed suicide three days after discharge.

Real-time monitoring technology focused on this potential vulnerability would have been invaluable. The technology could have notified facility staff of the missing CSRE following the patient’s positive suicide screening so someone could proactively intervene and make sure the CSRE was completed. 

Without the proper tools, VA employees cannot deliver on their mission. The sad reality is that not all VA Medical Centers have been equipped with real-time suicide prevention process management tools available today. What good is a massive database of patient information in the nation’s largest integrated health care system if it cannot be leveraged to make the care delivered to veterans consistently superior?

Care is dramatically improved when such tools are in place, as illustrated by how some VA medical centers protected and treated veterans during the COVID-19 pandemic. When the national emergency was declared, 45 VA medical centers had in place a sophisticated real-time data mining tool for clinical decision support.

The software was rapidly updated to automate the tracking and monitoring of a large volume of inpatients and outpatients tested for COVID-19.  An intelligent methodology, with knowledge of Centers for Disease Control and Prevention guidelines, was developed and deployed in the 45 centers aiding with the tracking of patients with particular presenting symptoms and diagnostic test results. Clinicians were able to receive real-time alerts via email, and patient test results could be viewed in the user interface concurrently alongside patient demographics, risk factors and other current clinical data.

This system provided the real-time visibility needed to power planning, care coordination, risk management and prioritization of interventions. Such software could also improve performance of VA suicide prevention teams, especially those with large caseloads battling the veteran suicide challenge by tapping into real-time data, pushing care notifications and allowing read-write access.

Far too many staff members at VA facilities today are operating blind, with no real-time situational awareness into the state of care for veterans at high-risk for suicide. No amount of superhuman effort can offset the absence of software providing real-time insights and the capability to visualize opportunities to improve proactively.

In the modern world, software with real-time care monitoring capabilities and clinical and administrative business intelligence will consistently connect policies and procedures. Leadership should ensure all VA employees at every facility have the tools veterans deserve and VA facilities need to excel. With such tools, VA staff can deliver on the promise of timely, appropriate and highly reliable care for all veterans.

About the Author

David LaBorde, M.D., is CEO of Iconic Data Inc. and senior advisor with DSS Inc.

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