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Implementation of VHRC Tool in GetWell System

Abdulelah Albukhari

University of San Diego

Capstone project

Dr. Brenda Boone

August 2022
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Abstract

The Virtual Health Resource Center (VHRC) in the Veteran’s Administration Hospital

(VA) in San Diego educates veterans on how to use virtual tools available to them, which can

help veterans who struggle with using the available digital health features. As the VHRC

progresses, the center team is trying to reach more veterans to help them use available resources

and implement a more modern and innovative solution to increase their knowledge. One

promising solution is implementing a new tool through the GetWell Network (GWN) system in

the in-patient rooms GWN system which is available in all the in-patient rooms at the San Diego

VA hospital. The tool will allow the team to provide center services to patients in the in-patient

rooms. This project will include a statement of the current status and an extensive literature

review providing evidence based on how many veterans they need for digital education. In

addition to the goal and purpose of the project, scope of work, and plan of action for the project

process.

Furthermore, in this capstone paper there will be a description of the deliverables of the

project. The capstone project will provide the next steps of this implementation related to the

VHRC. The VHRC team will ensure the success of the implementation. Finally, it will provide

the stakeholders with adequate and precise data so the management can decide to implement the

project in all in-patient units.

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Implementation of VHRC Tool in GetWell System

The project’s objective is to implement new tools through the GetWell Network (GWN)

system in the in-patient GWN system. GWN is the inpatient engagement software solution for

hospitals. The new icon will appear on the inpatient TV system in the main menu and as a pop-

up to educate the patients about the Virtual Health Resource Center (VHRC) in the Veteran’s

Hospital VA in San Diego. The GetWell system fully equips the inpatient rooms.

The system empowers veterans to self-manage education and equips staff with the

insights needed to deliver excellent service and higher quality care. GWN aims to improve

patient satisfaction and provide a more robust patient entertainment system (GetWell Inpatient,

2022). GWN also empowers patients and families to be active participants in their care, engages

patients through any modality, and prepares patients for a successful discharge (GetWell

Inpatient, 2022). Prior to discharge, many patients do not know what VHRC can provide to

them, or they do not know about it at all. The main objective of this project is to improve the

patient’s knowledge about VHRC and the benefits they can get from its services. So, the

question is, “Do the patients know about VHRC?”

The VHRC has health technology experts. They provide guidance, hands-on support,

training, troubleshooting, and other information on virtual care tools, such as VA Video Connect,

My HealtheVet, health apps, and devices.

The project is to help patients who do not know about those services determine which

virtual care options might be suitable for their health and lifestyle needs before discharge.
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The Digital Health and Virtual Health Resource Center in San Diego

Current State

The Department of Veterans Affairs (VA) issued a new federal rule in 2018 enabling VA

physicians, nurses, and other healthcare professionals to provide care to veterans using

telehealth, or virtual technology, regardless of where in the United States the provider or veteran

is situated (US Department of Veteran Affairs, 2018).

Currently, the VA Hospital in San Diego’s VHRC, works to educate veterans on how to

use the virtual tools available to them. Veteran health care has many applications available for

veterans, like virtual follow up and many digital health options. The VHRC team provides

guidance, hands-on support, training, help troubleshooting, and other information on virtual care

tools, such as VA Video Connect, My HealtheVet, health apps, and devices. Many patients do

not know about those services, and many veterans have difficulty using digital health tools

reference questionnaire results (see Figure 1) as done by the VHRC survey. The VHRC currently

helps the veterans by educating them about how to use all the virtual services; veteran patients

used to visit the center by walking-in or by scheduling a phone meeting with the team member.

Currently, the center serves an average of 40– 50 patients per week. However, the center team

wants to reach more patients and help them know more about how to access their electronic

healthcare portals and get benefits from them.

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Figure 1

Digital Health Literacy Questionnaire

Note. Questionnaire is done by VHRC team.

Many patients in the in-patient’s rooms do not know about the electronic health features

and the VHRC. The team figured out there is potential to reach those patients by using the GWN

system in the inpatient rooms. By implementing the VHRC tile in the system and starting to

educate patients about the available virtual and electronic portals, this implementation will help
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to increase patients’ outcomes and decrease the load for the in-person visits to the hospitals, thus

increasing patients’ satisfaction.

Patient, Intervention, Comparison, Outcome, and Time Questions for VHRC

The patient, intervention, comparison, outcome, and time (PICOT) question presented

was: For inpatient veterans with access to GWN, does adding an option to request information

about the Virtual Health Resource Center in GWN compared to those without access to GWN,

lead to an increase in the number of educational encounters provided by the VHRC within 90

days of implementation? The PICOT question will help the VHRC team determine if educating

patients during their stays would be more beneficial than visiting the center.

Literature Review

Technology has become one of the most used things today in many sectors. It has

improved performances and other things in the economic sectors. Healthcare is not left behind,

as it has benefited a lot from the use of technology. The patients and healthcare personnel have

embraced the use of technology for the improvement of activities in the hospitals. It is crucial to

understand literature on the use of technology in healthcare.

Lum et al. (2020) discussed how rural veterans who are older have experienced more

complex medical problems than their urban counterparts. Issues such as healthcare provider

shortages, long distances to the healthcare facilities, and transportation limitations hinder

healthcare. Patients in rural places have difficulty compared to those who live in urban settings.

Healthcare for older rural veterans needs some things to ease their operations. According to Lum

et al. (2020), there is a need for more healthcare providers, payers, improved healthcare systems,

and proper federal government intervention to help improve the state of older veterans.
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Smith and Magnani (2019) discussed how mobile health, or eHealth, has played a role in

the healthcare sector. The authors reported that the implementation of digital health services with

wearable and mobile devices has the potential to enhance of self-management of some chronic

conditions. Smith and Magnani (2019) continued to explain some of the negative impacts that

come as a result of some technologies. However, it is subject to debate whether such

technologies can have an improvement to cardiovascular outcomes. Ideally, everything good

sometimes comes with some negative impacts. It is essential to note that despite the negative

impact of technology, it comes with efficiency, effectiveness, and ease of working in healthcare.

According to the authors, there are a lot of laxities when it comes to technology because not

everyone has updated skills when it comes to digital health (Smith & Magnani, 2019). Such

challenges have become the limiting factors in the healthcare industry.

Birnbaum et al. (2015) discussed how digital health is growing and an alarming speed

and need people to have good knowledge on digital technologies. Birnbaum et al. (2015) argued

that digital health is an area of growing interest for physicians, patients, and technology

companies alike. It promises the ability to engage patients in their care, before, during, and after

an emergency department visit. Lack of user engagement has limited the current efforts to create,

study, and disseminate digital health (Baldwin et al., 2017). The authors outline the imperative

for engaging end-users in each phase of digital health design, and a few techniques to facilitate

better digital health design and implementation (Birnbaum et al., 2015). Ideally, one can agree

that technology is essential for healthcare.

Wray et al. (2022) gave a clear explanation of the shift in the health care systems. There

has been a great shift to the use of telemedicine and other digital tools and personal’s digital

health literacy, which has become an essential skill in all sectors. According to the research,
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Veterans Health Administration (VA) has had a great investment in providing digital health care.

It has made sure people are embracing technology to make sure everything run smoothly.

Overall, the literature review shows that technology has become one of the most

commonly used things today in many sections. Although there are challenges facing the industry,

the healthcare sector is working hard to ensure technology can be used by patients.

Purpose, Objective, Goal, and Plan of Action

The project’s purpose is to implement a new feature in the in-patient Get-Well system

menu, which allows the patient to connect with the VHRC. Furthermore, the objective of the

project is to increase the VHRC encounters. The plan is to add an alert which will fire to ask the

patient if they wish to connect with the VHRC and add the VHRC tale in the menu on the

patient’s TV in their hospital room. This project is to increase patients’ awareness of the digital

health education provided by the VHRC. VHRC currently encounters an average weekly is about

40–50/week. The team expected to increase by 10%–15% each week after implementing the

changes. In the beginning, the implementation will be in one in-patient unit like the nephrology

unit. VHRC team will measure the number of requests in that unit to measure the progress in the

first unit. Then if it is successful, it will be implemented on all the in-patients’ units in the

hospital. It will be one unit at a time, so the VHRC can be ready if there are many requests. In

addition, the VHRC will work to educate the nurses on each unit so they can help in patient

education. Finally, the center will use the questionnaire survey to determine the patient’s digital

health literacy level.

When a healthcare organization goes through any implementation process, many steps

need to take place for software integration to plan to meet end-users needs adequately. First,

there are steps for the VHRC tool implementation plan that consists of team building,
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requirements gathering, working with the Get-well team, and evaluation. Implementing the

VHRC tool in the Get-well system has a team of many different roles. The Informatics

Nurse/Telehealth Coordinator is the implementation team leader will take on many different

roles and are vital parts of the team and give leadership input to the project.

The Informatics Nurse/Telehealth Coordinator works with assistant informaticists for the

design, the needs for the implementation, and stakeholder approvals. VHRC team consists of the

VHRC supervisor, and two employees who are under the telehealth coordinator’s management,

and three volunteers working in the center. The Get-well network is a third-party company that

provides the services and operates the system of the TV screens in in-patient rooms. The VHRC

team works on the design, the approvals process, and the evaluation. Once all done by the team,

they send it to the Get-well network to work with them on it and implement it in the system.

Work Breakdown Structure and Gantt Chart

The following section introduces a visual representation of the work breakdown of

implementing the VHRC tools in the Get-Well network system. They are five phases of the

project: (a) initial phase, (b) design phase, (c) implementation phase, (d) evaluation phase, and

(e) conclusion. Each phase contains specific actions conducted by the VHRC team. In addition,

Figure 2 presents a Gantt chart with a visual representation of the specific tasks and timeline for

the implementing the VHRC tool in the Get-wall network. The Gantt chart addresses the

principal investigator and project leads assigned to their specific tasks. The Informatics

Nurse/Telehealth Coordinator is our project leader working with the supervisor of the VHRC,

and two volunteer assistants (of which this author is one) for the project.
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Figure 2

Gantt Chart

After Implementation Work Process

From their inpatient room, the veteran can control their TV by a remote or a keyboard

(see Figure 3). The system on the screen is from GWN, and is the system home screen where the

veteran can find an icon to click on for the VHRC (see Figure 3). When they click on the tile,

they will find many options like they can signing up with ID me for their health portal, they can

access my HealtheVet Portal signing up for their premium account, VA Video connect and they

can request to contact with the VHRC (see Figures 4, 5, 6, & 7). The system will fire a pop-up

prompt at 10:00 am on Admit Day #2 (see Figure 8), asking the patient if they would like to

speak with someone about the Virtual Health Tools (VHT). If they click on “Yes,” another pop-

up appears asking if they would like to speak with someone from the about VHT if they click on
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yes the system will send an email to VHRC team. If they click on “No,” the system will pop-up a

message said feel free to click on the VHRC tile on the main menu (see Figure 9).

Deliverables of VHRC Tools in the In-Patient Rooms

By the conclusion of the project implementation, the team will present three deliverables.

The first deliverable will be the training provided to the nurses about the VHRC. The training

will help participants to educate the patients about the digital and virtual resources in the VA. In

turn, participants gain better knowledge of VHRC and the available resources.

The second deliverable will be a potential increase in the encounter visitors in the VHRC.

Increasing the educated patients on the virtual tools will introduce a more efficient workflow for

the hospital when decreasing the daily in-person visits. The patients can know how to use the

virtual and video calls by educating them in the VHRC, so they can shift from in-person visits to

video visits.

The third deliverable will be increasing the use of patients’ electronic portals so that they

can follow up on their lab results, appointments, and medication. Increasing the knowledge of

the patients helps to improve the health outcomes and decrease the load of admission to the

hospital.

Conclusion and Project Next Steps

The potential future and next steps for implementing VHRC tools in the in-patient rooms

in the hospital will be based on the success of the first 30 days in the first unit. If the project

successfully meets all metrics and goals, the tool will be implemented in all in-patient units by

September 2023. The project team will then develop continuous monitoring and evaluation of the

tools and solicit feedback from the nurses, stakeholders, and patients to improve the usability and

functionality of the tool for patients and nurses. If the study fails, the project team will develop
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other potential solutions to improve patient digital health education. One potential innovative

solution is to involve the VHRC education in the discharge checklist of the patient.

This project found that many veterans and patients need digital health education. From

the literature review, many studies illustrate the patient’s needs for this service. However, many

do not know how to use it or may lack resources, especially those patients who live far away

from the hospitals or in rural areas. However, VA Health Affairs provides many good resources

to help their patients. Increasing the VHRC encounter visits will help let the patients know how

to use it and benefit from it.

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References

Baldwin, J. L., Singh, H., Sittig, D. F., & Giardina, T. D. (2017). Patient portals and

health apps: Pitfalls, promises, and what one might learn from the other. Healthcare,

5(3), 81–85. https://doi.org/10.1016/j.hjdsi.2016.08.004

Birnbaum, F., Lewis, D. M., Rosen, R., & Ranney, M. L. (2015). Patient engagement and the

design of digital health. Academic Emergency Medicine, 22(6), 754–756.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674428/

GetWell Inpatient. (2022). Why GetWell Inpatient.

https://www.getwellnetwork.com/getwell-inpatient/

Lum, H. D., Nearing, K., Pimentel, C. B., Levy, C. R., & Hung, W. W. (2020). Anywhere to

anywhere: Use of telehealth to increase health care access for older, rural veterans. Public

Policy & Aging Report, 30(1), 12–18. https://doi.org/10.1093/ppar/prz030

Smith, B., & Magnani, J. W. (2019). New technologies, new disparities: the intersection of

electronic health and digital health literacy. International Journal of Cardiology, 292,

280–282. https://doi.org/10.1016/j.ijcard.2019.05.066

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8838565/

U.S. Department of Veterans Affairs. (2018, May 11). VA expands telehealth by allowing health

care providers to treat patients across state lines.

https://www.va.gov/opa/pressrel/pressrelease.cfm?id=4054

Wray, C., Tang, J., Byers, A., & Keyhani, S. (2022). Digital health skillsets and digital

preparedness: Comparison of veterans health administration users and other veterans

nationally. JMIR Formative Research, 6(1), e32764. https://doi.org/10.2196/32764

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Figure 2

Remote and the Keyboard

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Figure 3

Home Screen Tile

Figure 4

VHRC Tile
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Figure 5

Virtual Health Resource Center

Figure 6

Virtual Resource Center Links to YouTube Video

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Figure 7

Contact Virtual Health Team Sends an Alert to Group Email and Follow-up Message
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Figure 8

Contact Virtual Health Prompt Yes Reply

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Figure 9

Contact Virtual Health Prompt No Reply

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Appendix A

Program Competencies

This capstone project met the Leadership and Systems Management competency by

creating a work breakdown structure and Gantt chart to successfully present the project's

innovative progress regarding utilizing the Get-Well network and the Virtual Health Resource

Center for helping to educate the veteran patients in the in-patient rooms in San Diego veterans’

hospital.

The Health Science Knowledge and Skills competency was met while conducting the

research through the VHRC and digital health programs. In addition, I demonstrated knowledge

of medical terminology, chronic disease follow-up, the universal roles of healthcare providers,

and the foundational concepts of healthcare informatics. In addition, leadership and systems

management competencies were met throughout the implementation; I took a leadership role in

designing the tool.

The Data and Knowledge Management competency was met as I worked with the

team to use the feature and collect the data accurately.

The Quality and Regulatory competency was met as the team worked with

stakeholders, Get-well network, and complied with the Department of Veteran Affairs

regulations.

The Systems Design and Management competency has been fulfilled by creating a

work breakdown structure, assigning tasks to my colleagues, and conducting weekly meetings to

engage in progress and communication.

Lastly, the Social Justice and Community Activism competency was met because the

project was based on helping Veterans retain and sustain a better quality of life by educating
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them on how to use the digital resource by providing the best knowledge and developing more

useful treatment applications for the patients.