VA leverages IT to fix scheduling deficiencies

Pilot program for appointment request app shows promise, as the agency takes several approaches to reduce wait times for vet care.

A survey conducted by The Joint Commission finds that the Department of Veterans Affairs is making progress in improving access to healthcare for veterans, including the use of emerging technology such as a new smartphone app and enhanced website, according to the VA.

“The Joint Commission is one of the most widely respected healthcare organizations in the industry,” said David Shulkin, MD, the VA’s Under Secretary for Health. “Their analysis shows that VA as national healthcare leader is making progress in improving the care we provide to our veterans. This affirms our commitment to providing both excellent healthcare and an exceptional experience of care to all veterans served.”

According to Shulkin, the VA is modernizing its culture, processes and technological capabilities through the MyVA initiative to “put veterans first.” Earlier this year, the VA’s Veterans Health Administration established and launched MyVA Access to ensure that veterans gain more control of how they receive healthcare.

On the technology front, the Veteran Appointment Request app, which has been developed and is currently being piloted by the VA, will enable users to directly schedule or request primary care appointments, request mental health appointments, as well as view appointment details, track the status of requests, send messages about the requested appointments, get notifications about appointments, and cancel appointments. The app is slated to be available to all veterans by early 2017.

Shulkin told a Senate committee in late June that the VA is testing the Veteran Appointment Request app at two facilities—the VA Connecticut Healthcare System (West Haven) and the VA Boston Healthcare System (Jamaica Plain)—and that they are showing “positive” results.

In addition, improvements to the VA website are in the works that will enable veterans to check wait times in real time, including a new, easy-to-use scheduling software program. The program is also being piloted at 10 sites and is expected to reduce scheduling errors and enhance VA’s ability to measure and track supply, demand and usage.

However, these digital tools can’t come soon enough for the VA, which for years has struggled to provide timely healthcare to veterans and has been plagued by instances in which facilities inaccurately recorded the required dates for appointments and inconsistently tracked patients waiting for outpatient medical appointments. In some cases, the delays in care or VA’s failure to provide care have resulted in harm to veterans and even deaths.

The good news, according to the VA, is that the department is moving to incorporate same-day access to primary care and mental health services for veterans when it is medically necessary; currently, 39 VA facilities offer same-day appointments.

VA also points to the fact that it recently held two “Access Stand Downs” to assess and give priority to those patients with the most urgent healthcare needs. According to the VA, “during a nationwide Access Stand Down that took place on February 27, 2016, the one-day event resulted in VA reviewing the records of more than 80,000 veterans to get those waiting for urgent care off wait lists; 93 percent of veterans waiting for urgent care were contacted, with many receiving earlier appointments.”

Further, the VA contends that the department completed nationally more than 57.8 million appointments from July 1, 2015 through June 30, 2016, an increase of 1.1 million appointments over the same time period in 2014-2015.

“We commend VA for being proactive by requesting The Joint Commission to conduct unannounced site visits at all their medical centers to review and evaluate their efforts to improve access and quality of care,” said Mark Chassin, MD, president and CEO of The Joint Commission. “VA was the first system ever to request an assessment with an important focus on access so that deficiencies could be identified and rapidly addressed. The Joint Commission will track and report on the extent to which improvements were sustained, when the same facilities undergo their triennial accreditation surveys. To date, results from 57 hospitals that have undergone full accreditation are promising. We are pleased with VA’s ongoing commitment to quality improvement and patient safety.”

Nonetheless, The Joint Commission’s report concluded that: “Many [VA] organizations continue to face challenges in providing all patient appointments in 30 days. However, improved efforts of leadership teams in utilizing data to better understand where particular bottlenecks may be and then taking corrective actions were observed. Staffing continued to be a major challenge in this area, but as new staff were hired, the waiting times for appointments were being more effectively addressed.”

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