VA Innovators Network: Accelerator Innovation Proposals for 2017

The following is a list of the Innovation Proposals for VA Innovators Network 2017 Portfolio. (Find the source of these proposal here. Learn more about VA Innovators Network here.)

Improving Veterans’ Experiences

3D Printing as Art Therapy and Voc Rehab: WRJ/Chillicothe Combined Application (White River Junction Seed Proposal) — The overall objective of this concept is to integrate various aspects of 3D printing as integral parts of the recreational therapy and vocational rehab programs. Desk-top manufacturing offers a unique approach to translate one’s imagination into a physical form; be for a leisure activity or for marketing, and quickly cultivates an excitement and interest. This program thus may also create a post-treatment leisure activity aiding in continuous progress, and may even offer gainful employment to Veterans. POC: Brynn Cole, Innovation Specialist and Brooke Robinson Drew, M.S. Creative Arts Therapist.

3D Printing Foot Orthosis Outcome Testing (3DP Foot) (Puget Sound Seed Proposal) — We have assembled a multi-specialty and interdisciplinary team of experts who focus on prevention of amputation in Veterans with diabetes and peripheral neuropathy and 3D printing in order to develop a system for creating custom diabetic foot orthoses using advanced technology. We envision an in-house, same day, semi-automated system to create, customize and produce accommodative foot orthoses that will be high quality, cost-effective and result in an efficient process leading to high Veteran satisfaction. POC: Jeffrey Heckman.

A Multimodal Approach to Enhancing Veterans’ Sexual Health and Wellness (Hines Spark Proposal) — To enhance Veterans’ sexual health and wellness through a multimodal approach including: 1) completion of specialty training in sexual health and functioning for select mental health providers 2) development of targeted in-house sexual health training for primary care and mental health providers 2) development of a multidisciplinary sexual health education class for Veterans and their supporters. POC: Jamie Mathews.

AM-PAC Outcome Measure (Albany Spread Proposal) — The Stratton VAMC currently does not utilize an outcome measurement tool that can track patient outcomes across the continuum of care. Implementing the Activity Measure for Post-Acute Care™(AM PAC) measurement tool into each physical and occupational therapists practice would allow for enhanced patient engagement along with “quality improvement, outcomes monitoring, and research activities in inpatient and outpatient rehabilitation, home care, nursing homes and long-term acute care settings.” POC: Daniel Gecewicz, PT.

Aptitude-Based Hiring for the San Francisco VAMC (San Francisco Spark Proposal) — A proof of concept trial to test and validate aptitude-based hiring as a basis for identifying, screening and hiring US military Veterans with demonstrated potential (but not otherwise qualified by virtue of experience) to succeed as Medical Support Assistants (MSAs). MSAs were selected for this trial because 1) the entry-level nature of their roles lends itself to hiring for aptitude, 2) the relatively high turnover offers greater opportunity to examine the effects of the proposed hiring program, and 3) a large proportion of MSA candidates are Veterans, meaning that the project has the potential to benefit Veterans directly through employment and indirectly through improved operations in the SFVAHCS. POC: Jia Lee (SFVAHCS), John Reynolds (Veterans2Work), and Angela Waldrop (SFVAHCS).

Better Living Through Drumming (Grand Junction Spark Proposal) — To use drumming and drum circles to improve the overall health of veterans. POC: Douglas Walker.

Brave Stitches (Milwaukee Spark Proposal) — Brave Stitches will use the quilting process as a route to guide Veterans with chronic health issues out of a helpless mindset to a healthy self-help mentality and to enhance their healing. This will be accomplished by introducing Veterans to other therapeutic activities available at the VA or in the community with each quilt block they make. In the future, they can look at their quilt and remember the helpful activities that are available and how to participate. POC: Julie Rieder, CMA (AAMA).

Cane Clip to Improve Patient Safety on Mobility Scooter (Richmond Seed Proposal) — A prototype was developed for clipping a walking cane to the front handle of a Golden Companion scooter, which otherwise only allows a patient to stow a cane behind the scooter’s backrest. This innovation will improve the fall risk for patients with limited mobility. POC: John Miller, MS, Biomedical engineering.

Cellphone Switch for Paralyzed Veterans (Richmond Spark Proposal — A low cost switch interface that would plug in-line with a cellphone headset cable (or lightning plug adapter) making it possible to answer/hang up and access Siri/Google using your choice of switch, reducing caregiver burden. POC: Seth Hills, ME, CPO, Clinical Rehabilitation Engineer.

Center for Integrated Wellness (Boston Spread Proposal) — Our proposed innovation is to spread and diffuse the Center for Integrated Wellness (CIW) across the VA Health Care System to enhance the Veterans and employee experience. Veterans, particularly those living with mental illnesses, benefit greatly from innovative, non- traditional and less stigmatizing modalities of care. CIW conducted a program evaluation and found the program to be cost effective, it additionally indicated a statistical difference in increasing self-esteem, increasing coping mechanics, and decreasing symptoms associated with addictions and trauma. One innovative aspect of the program is “Veteran designed care”. Veterans co-own the program and assist in all aspects from ordering supplies to treatment options. Nothing about us without us” is the guiding principle for the CIW. POC: Grishelda Hogan.

Community Care Prescription Responsiveness (Tuscaloosa Spread Proposal) — Submitted to the Diffusion of Excellence Hub — Expand the systems redesign project to other departments at the medical center and other VA’s to address the increased time associated with Veterans discharging from the local hospitals and then facing increased wait times for their discharge prescriptions to be filled at the VAMC pharmacies. POC: Kimberly Sawyer, RN.

Develop Beneficiary Travel Software to Automate Claims Paid to Veterans (Richmond Seed Proposal) — Software enhancement to the current Beneficiary Travel Kiosk software to allow for automation of “clean” Beneficiary Travel claims. Claims that met all requirements would automatically print to the fiscal office and would not require a review by travel assistance prior to processing by fiscal. POC: Christina Hubble, MHA.

EMS 37 Tasks (Boston Spark Proposal) — Identify 37 basic Housekeeper Aide job tasks. Collaborate with local community college staff to produce videos of each of these tasks (using housekeeping staff) Upload videos to YOUTUBE site. Publicize and assign these videos to EMS staff for initial and ongoing training purposes. POC: Brian Oleary.

Enhancing Acute Inpatient Care of the Veteran Living with Dementia: Incorporating A Mobile Multisensory Environment (Milwaukee Seed Proposal) — Our innovation project will incorporate proven sensory stimulation techniques into the acute care setting to enhance the quality of life for Veterans living with dementia. Through appropriate sensory stimulation — delivered via a convenient mobile unit — multiple factors prolonging hospitalization may be reduced, such as anxiety, agitation, disruptive behavior, and falls. POC: Molly Hendricks, MS, RN, CNS-BC and Valerie Kolmer, MSN, RN, ACNS-BC.

Facility Directory Kiosk (Lebanon Spark Proposal) — My proposed innovation project is a Facility Directory Kiosk for veterans who may have appointments and/or would like assistance in a certain area but are uncertain as to where to go within the facility. It would be a visual touchscreen, take them on a virtual tour as to where their destination is and then have a final print out with directions. This will also provide advertisement of activities/specials throughout the facility. POC: Amber Reesman.

Full Disclosure Initiative (Jackson Spark Proposal) — Full Disclosure Initiative is a program that will prepare Veterans for navigating the medical center by doing the following: send easy to follow directions with Veteran’s appointment letters, improve way finding at the medical center by incorporating design aspects that reach multiple generations, and develop short micro videos that will increase the communication between the medical center and our Veteran population. POC: Stratton Brown, Biomedical Engineer.

Impact of Active Participation in Blind Rehabilitation Training on Longer Term Physical Activity Levels (Hines Spark Proposal) — We will investigate to what magnitude a comprehensive inpatient blind rehabilitation training impacts an individuals’ at home (post-discharge) physical activity within and outside the home. We will use an individuals’ pre-admission physical activity as a baseline, from which to compare rehabilitation and post-rehabilitation activity levels. POC: Charles Brancheau.

Improved Design of Prosthetic Sockets (San Antonio Spark Proposal) — Utilize weight-bearing, ultra-low dose CT to visualize residual limb anatomy in Veteran amputees suffering from long-standing prosthesis pain. This will utilize 3D printing techniques to rapidly prototype solutions. POC: Craig Caya.

Improving and Combining Cognitive Behavioral Treatment for Chronic Pain and PTSD (Albuquerque Spark Proposal) — PTSD and chronic pain are highly co-morbid, and poor management of one condition can negatively impact treatment outcomes for the other. This project represents a necessary precursor to developing treatments that simultaneously target both conditions. POC: Madeleine Goodkind and Zachary Schmidt.

InFuSE program (San Antonio Seed Proposal) — Weekly outpatient cohort program that will promote physical activity, group exercise, executive function, social interacts and community engagement for Veteran suffering from TBI/PTSD. POC: Rebecca Tapia (San Antonio), Derrick Mason (San Antonio), Shane Chanpimol (Washington DC).

Intimate Partner Violence (IPV) Outreach Website (Loma Linda Spark Proposal) — Among Veterans, 13–58% report being affected by intimate partner violence and it has been found that PTSD symptoms and other factors related to military service are associated with greater incidence of IPV; however, information on IPV among Veterans is not readily available online, the preferred source of information for people affected by stigmatized health issues. This project will entail the creation of a VA website where Veterans, family members, and providers can learn more about IPV in the Veteran population, assess whether they are affected by IPV, and learn more about those IPV treatments and complementary services available thru their local VA and in the community. The website will be developed in collaboration with Veterans and will focus on the engagement of Veterans in the prevention and elimination of intimate partner violence thru recognition of the unique challenges and strengths of our Veterans. POC: Kristen Runge.

iRest Yoga Nidra Meditation (Albany Spread Proposal) — Albany Stratton VAMC’s use of yoga-based interventions is currently limited to behavioral health in the area of PTSD management by only 1 provider. The proposed innovation project involves training of key geriatric staff members in the research-based transformative practice of deep relaxation and meditation: iRest Yoga Nidra Meditation. This practice is being utilized within VHA, DOD and within community programs “to reduce the symptoms of PTDS, depression, anxiety, insomnia, chronic pain, while increasing heal, resiliency and well-being.” See link attached for additional details on this practice and the Integrative Restoration Institute (IRI). https://www.irest.us/projects/veterans. POC: Sandra Osborne, RN.

Just In Time Hearing Aid Fittings (Loma Linda Seed Proposal) — This proof of concept project aims to increase patient satisfaction and improve the patient experience by reducing the number of required return appointments and incurring travel costs by providing same day access or “Just In Time” Hearing Aid Fittings. POC: Crystal Mata, Au.D., M.S.

Locking Medication Boxes the Key to Saving Thousands (Lexington Seed Proposal) — Our innovation concept will drastically reduce thousands of dollars in medication waste each year with the installation of a locking medication box in each patient room for storage of patient home and inpatient medications. POC: Mary Ann Wick, Respiratory Therapist.

Low Vision Button Kit to Improve Abilities for Veterans With Vision Limitations (Richmond Seed Proposal) — This proposal is to continue development of an ability switch for Veterans with vision deficits, upper extremity limitations, and/or cognitive impairment. It solves an unmet need for this population while maintaining a cost far below similar products. Veterans with conditions such as Spinal Cord Injury (SCI), Multiple Sclerosis (MS), essential tremor, or vision loss often require adaptive access to devices like cellphones, computers, lights, home entertainment, hospital beds, communication devices, and power wheelchairs. A popular access method is the utilization of ability switches, which come in many shapes, sizes, and configurations. POC: Brian Burkhardt, MS, ATP.

‘MISSION: THRIVE’ Treatment Program for Co-Morbid PTSD and Chronic Pain (Richmond Spark Proposal) — Mission: Thrive is an innovative treatment for the co-morbid problems of PTSD and chronic pain that combines traditional cognitive-behavioral therapy approaches with experiential therapies such as mindfulness meditation, walking, and yoga. It is a group psychotherapy program comprised of three phases encompassing 22 sessions, each lasting 90 minutes. Mission: Thrive promises to provide integrated holistic treatment for co-morbid trauma

and pain in multiple service lines (mental health, physical medicine and rehabilitation, and primary care) that may help reduce the total amount of time Veterans spend in treatment and assist in reducing the Veteran suicide rate, since both pain and PTSD are significant contributors to Veteran suicides. POC: Brian Meyer, PhD, Clinical Psychologist.

Mobile Desktop (Loma Linda Seed Proposal) — This innovation pilot project allows healthcare providers to move between rooms and clinical locations with an active desktop. This mobile desktop allows providers to quickly disconnect from a computer session in one location leaving applications open and reconnect seamlessly at another location to the same session, exactly where it was left in the previous location with all applications still running and no additional application or computer log-ins necessary. POC: John M. Byrne, DO.

MyVA Way App Development (Albuquerque Spark Proposal) — To create a new electronic mobile application which will provide turn-by-turn indoor and outdoor map navigation of our facility, and continuous interaction through the continuum of care for our Veterans, family members, visitors, and staff. POC: Jennifer Dewinne and Polly Oetting.

MyVA Way Mapping (Albuquerque Spark Proposal) — To create a new electronic mobile application which will provide turn-by-turn indoor and outdoor map navigation of our facility, and continuous interaction through the continuum of care for our Veterans, family members, visitors, and staff. POC: Jennifer Dewinne and Polly Oetting.

Patient Appointment List Redesign (Lebanon Spark Proposal) — Redesign the Patient Appointment List that we provide our Veterans while in our Medical Center to direct them to their future appointments. The List we currently provide them with includes more irrelevant information than it does relevant — such as Provider #, vague department descriptions, odd acronyms, and each print out requires clerical staff to remove/cover patient identifiable information (an unnecessary step). The redesign will include only relevant information to the patient, no patient identifiable information, and easily directs patients to the facility, building, and floor of their future appointments. POC: Jason Smeltz.

Patient Centered Reduction of CNS Polypharmacy (San Antonio Seed Proposal) — Development phase of a pilot program aimed at reducing psychotropic polypharmacy through patient education, Pharmacy consult, and integrated communication strategies based on patient-centered goals of function and symptom control. POC: Rebecca Tapia. Note: This proposal is also listed under Suicide Prevention.

Patient Centered Flow Design in Dialysis (Richmond Spark Proposal) — The proposed innovation project is to create a patient-centered flow design that can improve in managing our dialysis patients prior to the start of dialysis and during the dialysis treatment which in turns will improve patient satisfaction and the communication between staff and our veterans. The proposed innovation project is to create an electronic patient flow system that assigns specific times to patients, who arrive for routine dialysis treatment and their placement in a dialysis chair. This project has the potential to expand into other areas of renal disease such as data-driven decision making along with coordination of care. POC: Lisa Meade, RN, MHSA, BSN, Renal Clinical Coordinator and Christina Aguilar, BSN, RN, CNN.

Patient Navigation in Primary Care (Cleveland Seed Proposal) — We propose to pilot a patient navigation program within our primary care clinic. We propose this role will be assumed by our peer support specialist. The patient navigator will be a flexible role that can accommodate the needs of the patient and be a point person that will connect them to the many resources we have and guide, explain and streamline their healthcare. POC: Melissa Klein, MD.

Pharmacy Compounding Committee (Boston Seed Proposal) — The specific focus of this committee is the standardization and review of all compounded medication recipes used at VA Boston Healthcare System (VABHS). The main goal is to increase the availability, preparation standards, and homogeneity of compounding recipes. This committee not only improves workflow across all VABHS pharmacy campuses, it increase the quality of compounded medication provided to our veterans. POC: Jameson Wood.

Polytrauma 3D Printing (San Antonio Spread Proposal) — Development phase to assess role of 3D printing technology in the Polytrauma TBI and amputee population via training, collaboration, and human centered design processes. POC: Blessen Eapen and Rebecca Tapia.

Safety Seat Ejector (Albany Spark Proposal) — We propose to develop a portable seat ejector with flip down arms and a safety lock device. Currently there is currently no device on the market that has the safety features or flip down arms that we intend to incorporate into our design. This idea will have clinical utility, clinical value, societal value and customer value. It will allow for veterans with mobility issues to be more functional in the community environment, decrease caregiver burden and increase safety during sit to stand transfers. Veterans who could potentially benefit from this device would include those impacted on by debility, peripheral neuropathy, and acquired proximal muscle weakness secondary to such common issues as age related sarcopenia. POC: Andrew Dubin, MD.

Sensory Therapy (Gulf Coast Seed Proposal) — The proposed concept would be to create a multi-sensory environment in every resident’s room. The environment will be especially beneficial for residents who are not able to participate in established recreational activities, crafts, and socialization due to their physical and/or mental limitations. This multi-sensory environment will provide unlimited access to a relaxing and personal environment offering stimulation and meaningful interactions for all residents, especially those with cognitive impairments. POC: Jaime Hathorn, MSN, RN, CNL.

The Bike Share Entrepreneur Project (Chillicothe Seed Proposal) — The “Bike Share Entrepreneur Project” has a twofold objective benefiting both the Veteran and the VA employee. Those benefits are summarized:

1) Partnering with the Small Business Administration, The Ohio State University South Development Centers, VA Center for Innovation and Chillicothe VA Medical Center, Veterans are provided an opportunity to engage and receive formal entrepreneurial instructions about how to set up and run their own business while receiving practical experience managing a bicycle share program at the Chillicothe VA Medical Center. 2) VA employees are provided an opportunity to engage in an alternative form of transportation, bicycle riding traveling from building to building while on the 308 acre VA campus, and also an opportunity to engage in bicycle riding for exercise, stress reduction and relaxation. POC: Elizabeth Bellman LISW-S and Ashley McGuire, Vocational Rehabilitation Supervisor.

Therapeutic Design for Dementia Neighborhood (Chillicothe Spark Proposal) — The Chillicothe VAMC would like to honor America’s heroes with dementia by enhancing the quality of life for our residents who call our long-term care neighborhoods home, in our project called, Therapeutic Design for Dementia Neighborhood. Our goal is to improve sensory stimulation experiences, offer animal assisted therapy, and one-on-one interventions, while also reducing caregiver burnout. POC: Beth Abele RN, MSN, CNL.

Transplant Education (Hines Spark Proposal) — The aim of this project make improvements in health literacy (i.e., the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions) among patients in the pre-transplant process, improve phase 1 education materials, and to disseminate a standardized model of pre-transplant education at Hines VA and to other Phase 1 transplant sites within the VISN. . POC: Courtney Cornick.

Using standardized patients to improve health coaching in primary care (Puget Sound Spark Proposal) — We propose to use standardized patients to provide ongoing training and feedback to both nurse care managers and peer health coaches in motivational interviewing and patient centered counseling skills to improve patient centered care, communication skills, and self-management support for patients with common chronic medical conditions. Our innovation is in utilizing standardized patients to provide a structured training and assessment for front line primary care staff, including both nurse care managers and veteran peer health coaches. Standardized patients allow for structured audit and feedback of specific competencies which traditional workshops and didactics cannot address. In addition, the model is consistent with leading concepts in adult learning and best-practice continuing education. POC: Karin Nelson.

Using Virtual Reality to Improve PTSD Treatment at the Jackson VAMC (Jackson Spark Proposal) — Posttraumatic Stress Disorder is a serious mental health condition facing approximately 1 in 5 Veterans. Prolonged Exposure therapy is a gold standard treatment for PTSD and involves helping Veterans gradually face feared situations (e.g., crowds, driving) as they move towards recovery. However, innovative strategies are required to make this therapy more effective, efficient and engaging. The aim of the current project is to improve Veteran engagement in PTSD treatment through the use of Virtual Reality (VR) technologies. As an immersive, fully sensory experience, VR offers a unique opportunity to help Veterans practice facing feared situations in a safe, supportive environment. POC: Elizabeth Nosen, PhD.

Veteran Discharge Education Process (Chillicothe Seed Proposal) — Create a multidisciplinary approach to Veteran Discharge that empowers providers and Veterans to collaborate in the construction of a Veteran centered discharge plan (Human Center Design Approach) with detailed, personalized discharge instructions resulting in improved outcomes and satisfaction. We are incorporating some of the RED (Re-engineered Discharge) project principles while remaining within small facility constraints. This is accomplished by reorganizing roles and responsibilities throughout the discharge process. Removing manual rework through the utilization of a research-based software tool promotes process consistency. The resulting documentation facilitates continuity of care communication to the VA primary care teams. This will help standardize and build a best practice discharge that is comprehensive, individualized, and consistent for every Veteran. The goal is to empower Veterans with the necessary tools to achieve success after discharge while narrowing the gap between inpatient and outpatient care. POC: Megan Kessler, RN, MSN, CNL & Sue Howard, RN, MSN-I.

Veteran Emergency Response Program (Tuscaloosa Spark Proposal) — Our goal is to work with local law enforcement and emergency responders to develop a communication tool to better connect us with the Veteran and ensure we’re addressing the underlying issue that caused them to come into contact with the law enforcement and emergency responders . POC: Jay Moyer.

Voucher Based Reinforcement Program — Contingency Management Principle (Tuscaloosa Spark Proposal) — Involves a closet located on the unit that contains basic necessities for apartments/homes (i.e. Towels, Cookware,

Sheets, etc.) that Veterans could “earn” as they complete steps of the RRTP program. “Incentives for Sobriety.” POC: Yolanda Johnson, RN.

Waiting Room Wellness (Milwaukee Spark Proposal) — Our project will leverage wasted Primary Care waiting room time by showcasing site-specific health and wellness programming, public service announcements, and demonstrations on DVDs playing in the waiting room while patients wait for clinic visits. The programming will not only convey pertinent health messages, but also fulfill patients’ requests for more information about local VA programs and how to participate. POC: Jessica Long, MS, RDN.

Whole Health for Life (Atlanta Seed Proposal) — We plan to offer a 2 hour Whole Health workshop during which Veterans will have an interactive introduction to the Circle of Health, complete their Personal Health Inventory and start their Personal Health Plan. After the workshop each Veteran will be asked to enroll in one Integrative Health Class in each of the following three areas; Nutrition, Exercise and Stress Management and attend a follow-up Whole Health session. Appointments are made for the Whole Health workshop and all Integrative Health classes, thus making these appointments eligible for travel pay. We are planning to work with the Tele-Health program to develop a Virtual Whole Health workshop for patients unable to attend in person. POC: Stephanie Brown-Johnson.

Women Veterans Comic Anthology (White River Junction Spark Proposal) — The Center for Cartoon Studies and the WRJ VA have formed a unique collaborative relationship in recent years. In 2015, the two entities came together to create and publish a Comic Anthology called When I Returned, which captures the experiences of Veterans who are coming home from war in cartoon format. Of note, no women Veterans were interviewed for this project, thus the experiences of women were not captured in cartoon form, and were not published. It became a priority and mission for several artists and the WRJ VA Women Veterans Program Manager to collaborate on a second volume, with the purpose being solely to capture the experiences of women Veterans. POC: Carey Russ, LCSW, Women Veterans Program Manager.

Improving Access to Care

Adaptive Polysomnography Lab (San Antonio Seed Proposal) — Adapting the SCI transitional apartment room to allow for onsite sleep studies. POC: Keith Burau.

A toolkit for the spread of lung cancer screening and lung nodule tracking (Portland Seed Proposal) — Many Veterans are at high risk for lung cancer, which is more treatable if found when it is small. Several sites within the VA have established programs with the goal of identifying early cancers, through 1) tracking incidentally found lung nodules and 2) proactively looking for nodules via lung cancer screening for high-risk patients. These sites use centralized processes to ensure that identified nodules are followed up appropriately; this includes ensuring timely follow-up, preventing excessive CT scans and procedures, and referring for consultation or evaluation as indicated. Other sites within the VA frequently ask for assistance from established programs in setting up local programs for nodule tracking or lung cancer screening — two complementary but different processes. We propose to develop a toolkit to assist sites with adapting a lung nodule tracking or lung cancer screening program to function within their local environment, including staff education, necessary resources, and troubleshooting. POC: Anne Melzer, MD.

Clinic Access Tool Snapshot (CATS) is a tool used to calculate supply and demand for the Lexington VA Medical Center (Lexington Spread Proposal) — Clinic Access Tool Snapshot (CATS) is a tool used at the Lexington VAMC to calculate clinic supply/demand. We have incorporated Consults, Recall, EWL, Pending Appointments, Missed Opportunity Rates (demand), etc. by clinical specialty along with how many slots (supply) is available in that clinical specialty by a given timeframe on a one page document. You can view access at a glance, see where you have opportunities for improvement and be proactive in meeting Veteran needs as it relates to access to care. POC: Phillip Branham, Ambulatory Care Operations Director — Group Practice Manager.

Developing a Sleep Medicine Clinic in the VA Virtual Medical Center (San Antonio Spread Proposal) — This project will enhance access to sleep medicine services by providing veterans with an online alternative to complete their first appointment. Veterans will visit the VA Virtual Sleep Medicine Clinic in the VA Virtual Medical Center (www.VAVMC.com), an online environment that provides access to a variety of health education and information services. Veterans referred for Sleep Medicine services will be able to complete a Sleep History Questionnaire online at a time of their own choosing and convenience, and also participate in on online education class concerning sleep and sleep disorders. POC: Paul Ingmundson.

Disseminating Effective Intervention Choice for PTSD to Primary Care (Atlanta Seed Proposal) — Piloting training and implementation of Brief Prolonged Exposure for Primary Care (PE-PC) in a Primary Care Mental Health Integration (PCMHI) team at Atlanta VAMC to establish feasibility and effectiveness in VA. Plan is for dissemination of this model to other PCMHI teams in VHA. POC: Sheila Rauch. Jonathan Merken.

Improving Access to Transitional Work for Veterans Living in Rural Communities (Hines Spark Proposal) — Propose to subsidize a portion of a community-based transitional work contract. Targeted communities would be rural businesses near either LaSalle or Kankakee, which are furthest from the nearest VA Medical Center (Hines VA). This subsidy will encourage businesses outside of VA Medical Centers to participate in the Transitional Work Experience program and increase job opportunities for rural veterans with barriers to employment and limited access to Transitional Work Experience services at Hines VA. POC: Julie Zook, MS, CRC, LCPC and Sarah Lemp, MS, CRC.

Increase Access to Mental Health Services via Telehealth (Cleveland Seed Proposal) — This proposal will address issues to access to a full complement of Mental Health Groups from Veterans through the development of a database that is searchable by any Mental Health Provider via a SharePoint with information relating to group, and group via Tele Video, which a committee of trained Mental Health Providers will approve the appropriateness of the group. POC: David Chmielewski, MBA.

Leveraging Technology to Improve Smoking Cessation Treatment Access and Engagement: An Interactive, Personalized Mobile Application for Veterans (San Francisco Seed Proposal) — The overall goal of this project is to redesign an existing VA smoking cessation mobile application (app), Stay Quit Coach (SQC, https://mobile.va.gov/app/stay-quit-coach), into an appealing, interactive, and personalized format based on direct feedback from Veterans and VA clinicians. Young combat Veterans who served in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom, OIF and Operation New Dawn, OND), and those with mental health conditions such as posttraumatic stress disorder (PTSD), have an unacceptably high prevalence of smoking, low quit rates, and poor rates of treatment engagement in VA smoking cessation clinics. It is urgent to develop novel, scalable treatment approaches to support quit attempts, reduce barriers, and promote engagement in these Veterans. POC: Ellen Herbst.

Mobile Clinic Hearing Aid Services (Tuscaloosa Spark Proposal) — Audiology has presented a potential expansion of services in performing mobile clinic and home based repairs and fittings as well as device management whereas devices can be replaced once out dated or unrepairable. The initial conversation with the Lead suggests this could be a significant number of Veterans and could create a significant impact on their quality of life. POC: Kristi Dowdle, Au.D.

Mobile Health Dementia Assessments: Reaching Veteran Families at Home (San Francisco Seed Proposal) — Subsequent to unmet needs centering on access to dementia care for Veterans, we propose to improve access to care through piloting in-home dementia care consultations using video telehealth and customized mHealth devices. If successful, this pilot may represent an approach to home-based dementia care that can be pragmatically translated to practice. POC: Blake Scanlon, MD (Palo Alto VAHCS) and Thomas Neylan, MD (SFVAHCS).

Moral Reconation Therapy for Intimate Partner Violence: Can Milwaukee’s Success Be Replicated? (Milwaukee Seed Proposal) — This project will further develop our ‘proof of concept’ that Moral Reconation Therapy (MRT) for Intimate Partner Violence (IPV) successfully reduces IPV recidivism rates in Veteran populations. Our unique MRT for IPV program at the Milwaukee VA Medical Center (VAMC) has graduated 58 Veterans since 2012 with, to the best of our knowledge, no post-completion recidivism for IPV-related offenses. Milwaukee may be a unique case; in order to test if MRT for IPV is a viable candidate for ‘spread’ to multiple VAs, we will replicate and evaluate the program at two sites in Wisconsin and one site in Illinois: The Community Based Outpatient Clinics (CBOCs) in Appleton and Green Bay, and the Jesse Brown VA Medical Center in Chicago. POC: Lisa Tiso, LCSW, MSW, SAC, ACSW.

MOREaccess (Missed Opportunities Reduction Expanding Access (Cleveland Seed Proposal) — A proposal to expand the use of a dynamic data-based algorithm to facilitate strategic overbooking of patients with high no-show probability to increase access and slot utilization (SmartBooks). The approach is team-based and tailored to the needs of the Veteran patient and providers. A single team’s 3-month pilot result showed a 69% success rate using the algorithm as a decision support tool within the weekly huddle. This project will operationalize and expand to all primary care teams. POC: Corinna Galck-ytter, MD.

Primary Care Musculoskeletal Clinic Replication (San Diego Spread Proposal) — We propose to spread the curriculum we created for the Musculoskeletal Mini-residency to train interested primary care providers in musculoskeletal evaluation and procedures in order to create primary care musculoskeletal clinics at their local VA sites. Providing musculoskeletal care and joint injections in primary care, especially in CBOCS, will improve access for veterans with musculoskeletal pain, improve non-opiate pain treatment options, and decrease referrals for joint injections from impacted specialty care clinics. POC: Michal Kalli Hose and Anna Quan.

Psychosocial Intervention Team (Lebanon Spark Proposal) — Our proposed project includes the development of an ad hoc clinical team of subject matter experts to formulate and implement short-term, solution-focused interventions to address complex psychosocial needs of Veterans. We hope to not only identify creative approaches to providing Veteran-centric care, but to develop a process that will effectively include diverse clinical perspectives, increase collaboration, and allow employees to further develop their clinical skills. POC: Joseph Getway, LCSW.

Shared Medical Appointments for Weight-Loss Medication Management (San Diego Spark Proposal) — The VA San Diego MOVE! Weight Control Program serves veterans with obesity through a variety of opportunities, including pharmacotherapy for weight loss. However, there is a mismatch between increasing patient demand for weight loss medications and an inadequate supply of prescribing providers, resulting in decreased patient access to necessary appointments. Thus, the proposed innovation project is the implementation of a co-designed group clinic for obese and overweight veterans using the weight loss medication orlistat, which is the first line pharmacotherapy for weight loss available at the VA. POC: Kelley Hagerich.

Smartphone-Enabled, Home-Based Cardiac Rehabilitation (Atlanta Spread Proposal) — The expanded use of a smartphone-based platform for cardiac rehabilitation may transform delivery through increased access and improved outcomes for Veterans with cardiovascular disease. We have demonstrated the feasibility of deploying such a platform at a single VA medical center with strong Veteran participation and a significant increase in CR participation, and now propose to determine the potential to scale the program through a multi-site expansion. POC: Amit Shah, MD.

Synchronous Tele-Medicine Rheumatology Follow-up Care to a Rural VISN Site (Grand Junction Spark Proposal) — Telehealth has the potential to address significant workforce shortages and overcome numerous barriers to health care access in many rural areas of the country. The delivery of telehealth, however, requires systematic implementation that leverages economical and innovative approaches to acquire data that traditionally has been gathered in an inefficient and ad-hoc manner during face-to-face visits. We propose to examine the feasibility of utilizing cheap temperature probes (laser-based surface thermography performed by non-physician telehealth technicians) to replace in-person joint counts by rheumatologists in order to demonstrate the potential of novel telehealth approaches as a test case for the delivery of care in a critically underserved medical condition (inflammatory arthritis). POC: Patrick Wood.

TECS Spread and Tele-Glaucoma (Atlanta Spread Proposal) — This spread proposal increases the infrastructure at the pre-existing TECS sites. Funding for 4 Humphrey visual field analyzers will allow TECS to begin tele-glaucoma services and provide a supplement to the current glaucoma care offered by the Atlanta VA Eye Clinic. Continued investment in the TECS program will help the VA address growing needs for eye care services and chronic outpatient disease monitoring in a more cost-effective manner. POC: April Maa, MD. Associate Professor, Emory Eye Center. Director of TECS and Staff Ophthalmologist, Atlanta VAMC Eye Clinic.

Text Message Appointment Reminder (Loma Linda Spread Proposal) — The goal of this innovation is to increase patient attendance at appointments and reduce the no-show rate by sending patients text message reminders about their appointments. Text message appointment reminders have been shown in many studies to be effective and are widely used in the private sector. Our text messaging system has several advantages, including low cost and an automated way for patients to cancel an appointment through the text messaging system. POC: Shane M. Elliott, MBA.

The Universal Symbol for Mental Health: Providing a Pathway to Access Care (Jackson Seed Proposal) — The proposed innovation is a branding campaign for mental health so that even as the system and resources shift and change, Veterans and staff will always know how to connect with mental health services; a universal symbol indicating staff, offices, or units that can help a Veteran on their pathway to mental health. POC: Kelly Buckholdt, PhD.

Utilization of Technology to Improve the Quality of Field-Based Care (MHICM) (Hines Spark Proposal) — Providers in the Mental Health Intensive Case Management program spend most of their time working in the community without access to their patients’ medical records or means to locate resources. This is a request for tablets with internet and remote data access to be used by MHICM case managers to provide access to patients’ medical records and to allow case managers to access community resources for patients they see while working in the community. POC: Alexandra Morocco.

Wound Pad (Boston Spark Proposal) — With the use of an IPAD/tablet the clinician/providers can use an IPAD/tablet to track and monitor the progress of wounds that are seen in the Vascular Clinic. With current APPs available and the additional demographic protocol, the IPAD/tablet input could be made avail in real time in the patient’s electronic record, allowing for a streamline process of improved quality of care. POC: Marion Tinsley.

Wound Treatment Network (Grand Junction Spark Proposal) — The Wound Treatment Associate Network would link wound care providers in the VA with home health, community nursing home and assisted living facility staff to improve continuity of care for those high-risk veterans that need wound care. This would decrease the amount of time required to heal wounds as well as reduce the risk for amputation. This would also assist in the PAVE (Preventing Amputations in Veterans Everywhere) initiative. POC: Rachael Tombleson.

Unburdening the Clinician/Clinician Efficiency

3D Cricothyrotomy (Puget Sound Seed Proposal) — We hypothesize that 3D printed cricothyrotomy task-trainer models utilized in a blended-learning simulation curriculum and the newly-completed EES Difficult Airway and Rescue Cricothyrotomy (DAARC) 3-D virtual reality serious game will improve physician performance in critical difficult airway and rescue cricothyrotomy cognitive and psychomotor skills. In this pilot study we will quantify the amount by which this novel trainer improves airway management decisions made by physicians completing the EES Difficult Airway and Rescue Cricothyrotomy (DAARC) 3-D virtual reality serious game and decreases training costs versus traditional classroom training. POC: Arthur French.

A Safe, Secure and Efficient Wound Image Capture and Storage Solution (San Diego Seed Proposal) — To create a wound image management system that enables simple and effective wound image capture, storage and retrieval as well as improving the inefficient, burdensome and outdated protocols for securely uploading to VISTA Imaging. This system will be deployed across the many clinical sites where Spinal Cord Injured patients are treated within the health care continuum to include outpatient clinics, inpatient wards, operating rooms, and in homes. The deployment of this wound imaging system and process will adhere to applicable societal values by protecting patient Privacy and avoiding Medico-legal liabilities with HIPAA compliance, while improving wound care monitoring as part of the overall quality of patient care. POC: Kevin Broder and Richard Bodor.

Improving Patient Care and Reducing Provider Alert Fatigue through Precision Medicine Outpatient Reference Intervals (Albuquerque Spark Proposal) — We aim to reduce the alerts and notifications burden and burnout of VA providers by developing precision medicine outpatient laboratory reference intervals POC: Peter Woodbridge.

Cancer Surveillance and Survivorship Tracker (Albuquerque Seed Proposal) — We will pilot an existing manual prototype system that facilitates case management of Veterans with cancer by automating the system throughout the course of their disease: from diagnosis through remission and chronic disease status. The system will ensure: 1) that Veterans with cancer are not to follow-up during their long and complex course of care and 2) that their care is delivered in accordance to the National Comprehensive Cancer Network (NCCN) guidelines. POC: Janice Schwartz.

Clinical Use of Portable Technology to Ease and Improve Workflow, and Enhance Patient-Provider Interaction Within the Emergency Department (Hines Spark Proposal) — The Emergency Department at Hines VA Hospital is visited by over 2000 patients monthly. We propose to implement the use of IPads within the Emergency Department to assist providers with clinical care of the patient during their visit and also to improve the patient experience. POC: Annestine Weinberg.

Communication Enhancement to Bed Management System (BMS) Boards (Richmond Seed Proposal) — Utilize BMS boards to their fullest potential to enhance effective communication. There is a need to integrate CPRS and BMS boards to create immediate visual notification of new orders. Nurses will not have to open a specific chart — the BMS board, which may be on every computer, provides a unit overview of all new orders. The board should also provide alerts related to readiness of transfusion products and MEWS (Modified Early Warning Score) scores allowing for improvement in the quality and safety of care (innovations.ahrq.gov). POC: Janice Carter-Wesley, RN, BSN, MSN, NE-BC.

I-Interpret: Automated Computer Analysis of Fundus Images (Atlanta Spark Proposal) — The goal of this innovation is to test a Google -develop a computer algorithm that is capable of “reading” fundus photographs and detect common eye disease such as glaucoma, diabetic retinopathy, and macular degeneration, compared to a human reader. This particular spark project, however, has a very narrow focus. This spark project is requesting funds to support VA IT and informatics time to develop the necessary pathway to identify images of interest from the VISTA Imaging archive unit at the VA and de-identify the photos so they can be safely transferred to Google. Google will then provide a computer “read” on the images and the results will be compared to the physician read. POC: April Maa, MD. Associate Professor, Emory Eye Center. Director of TECS and Staff Ophthalmologist, Atlanta VAMC.

Innovations in Cross Coverage (Albuquerque Spark Proposal) — The proposed innovation project is designed to provide cross covering Residents, and specifically new Interns, with an app that can be readily accessed at any location, to guide management of common and emergent conditions among hospitalized veterans when their primary inpatient team is not available. POC: Caroline Castillo.

Insulin Drip Calculator (Boston Spark Proposal) — Using Microsoft Excel I have developed a Portland Protocol calculator which automates hourly insulin drip rate calculations. POC: Andrew Kelley.

Liver Lesion Tracking Dashboard: An Innovative Management Tool to Increase Efficiency in Population Health Management (Cleveland Seed Proposal) — The numerous advances in technology and the widespread utilization of imaging studies, has led to an increase in the detection of liver lesions making diagnosis and management a priority for hepatology/gastroenterology providers. Given the large volume of patients who are at risk for an increased rate of Hepatocellular Carcinoma (HCC) and the importance of a timely diagnosis, innovations are needed to manage the populations at risk for this disease. We seek to apply a standardized, multidisciplinary approach to liver lesion diagnosis and management that is supported by an innovative electronic tool designed to ensure that patients have timely diagnosis and management of liver lesions. POC: Tina Vonhaz, CNP.

Unburdening the Clinician/Clinician Efficiency — Continued

Medication Management Program (Cleveland Seed Proposal) — Collaboration between the Cleveland VAMC intensive management teams and Columbus intensive management and outreach teams are proposing a medication management program that will provide long term assistance with refills, organization and management of complex prescription regimens for high risk veterans. POC: Melissa Klein, MD.

Maximizing Nurses’ Time At the Bedside Through Dictation Technology (Richmond Spread Proposal) — Utilize Dragon system to maximize nurses’ time at the bedside and minimize time spent at the keyboard documenting with voice recognition dictation documentation for nurses. POC: Janice Carter-Wesley, RN, BSN, MSN, NE-BC.

Navigation of CKD Services Within the VA (Grand Junction Seed Proposal) — We have ~ 500 patients receiving fee-based dialysis throughout VISN 19, and ~ 30,000 patients (as an estimate) with CKD throughout the VISN who do not have access to local renal subspecialty care. Due to the geographic size care of these patients can be fragmented and the providers (some of whom are not VA providers) don’t know how to negotiate our VA ‘system’. Therefore providers spend an inordinate amount of time trying to care for patients with CKD who need non-formulary CKD medications, CKD procedures (e.g., interventional radiology procedures or vascular surgery procedures), help with kidney transplant referral, advice regarding CKDu003C and dialysis, and education regarding CKD, dialysis and transplant. Due to the difficulty negotiating our ‘system’ Veteran care can be delayed (or in the worst case not provided at all). The Veterans therefore have to either drive to Denver which is the worst option in winter. POC: Sara Combs.

Patient Follow-up/Tracking Tool (Tuscaloosa Spark Proposal) — Create software that interfaces with CPRS to manage and track alerts, test results and provide care management within clinics. POC: Erica Bettis, RN.

VIVED: Visit Information Visualization for the Emergency Department (Boston Spark Proposal) — We aim to develop a visualization tool for emergency department (ED) census data to aid in the identification of bottlenecks and operational patterns that disrupt emergency care flow at a particular site. POC: Haley Hunter-Zinck.

Patient Centered Electronic Health Questionnaire for SCI Patients (eScreening!) (San Antonio Spark Proposal) — Provide SCI patients with a touchscreen device to answer health screening questions during their annual exam. The device will import answers directly into CPRS. POC: Seth Chandler.

Swallowed Optical Coherence Tomography Capsule for Office-Based Non-Endoscopic Screening of Barrett’s Esophagus (Boston Seed Proposal) — Rapid office-based screening for Barrett’s esophagus and dysplasia using novel swallowed capsule optical coherence tomography without need for moderate sedation and endoscopy in patients with reflux disease and other risk factors for esophageal adenocarcinoma. POC: Hiroshi Mashimo.

View Alert Support System (San Diego Spark Proposal) — We are trying to improve the communication of abnormal radiology findings to providers by creating a support system that will generate automatic emails and/or web pages to radiologists when a view alert is not created for their findings in CPRS/VISTA. POC: Amilcare Gentili.

Care in the Community

GERI-VET Home Visits (Cleveland Seed Proposal) — In recent years, an emphasis has been placed on the acute care of older adults presenting to the emergency department (ED) given their specialized needs and risks associated

with hospitalization. In an attempt to facilitate safe discharges from the ED, we propose utilizing former military medics to perform home visits for older adults at high risk of functional decline after discharge from the ED. Our

geriatric-trained medics will execute a comprehensive care plan developed at the index ED visit and tailor the plan as appropriate based on an in-home assessment of the older adult’s living conditions and functional status, working to bridge care between the ED and primary care follow-up POC: Jill Huded, MD.

Measuring Blood Pressure (BP) in the Home Environment (Cleveland Spark Proposal) — We propose to develop a wearable health prototype for continuous BP estimation. The wearable health devices that acquire electrocardiogram (ECG) and photoplethysmography (PPG) data simultaneously can provide a non-invasive, continuous, and user-friendly estimation of BP, without interfering with a patient’s daily routine. POC: Frank Jacono, MD.

PLIE: An Integrative Movement Program for Veterans with Dementia and Caregivers (San Francisco Spread Proposal) — Using a Human Centered Design approach, we have developed an innovative group movement program for people with dementia and their caregivers called PLIÉ (Preventing Loss of Independence through Exercise). Our VA-funded research suggests that PLIÉ can improve function and quality of life in affected individuals and reduce stress in caregivers, but the program has only been available to research study participants. This VA Innovators proposal will enable us to begin to scale the program for dissemination by 1) identifying new VA and community partners who want to offer PLIÉ classes; 2) training VA employees to teach PLIÉ classes and 3) using technology such as PLIÉ videos to support home-based practice. POC: Deborah Barnes.

Spread of retail-based urgent care clinics to Lexington, KY VAMC (Lexington Spread Proposal) — To spread Palo Alto VA’s Diffusion of Excellence best practice of utilizing retail-based urgent care clinics for after-hours treatment of urgent minor illnesses/injuries to central Kentucky. We are proposing allowing Veterans to utilize retail-based or free-standing urgent care centers, which are more readily available than VA clinics or hospitals in our primarily rural catchment area. POC: Domonic Hopson, Chief, Care in the Community.

VA SmartHome Project- Tampa VA (Richmond Seed Proposal in Collaboration with Tampa) — The VA SmartHome Project seeks to maximize independence of the Veteran, reduce caregiver burden and improve quality of life through the use of a mobile application. This application provides prompts and reminders, schedule and medication management, activity monitoring, as well as reporting features. POC: Steven Scott, MD (Tampa) and Melissa Oliver, MS, OTR/L (Richmond).

Chronic Kidney Disease

APOL1 Genetic Testing in African American Veterans with Hypertension (San Francisco Seed Proposal) — Having a high- risk Apolipoprotein (APOL1) genotype predisposes African-American patients with hypertension to a very high likelihood of kidney disease. Our goal is to identify these high-risk Veterans who can eventually be targeted for more intensive and personalized preventive treatments to reduce the burden of kidney disease in the VA. For APOL1 genetic testing to be integrated in routine management, educational and workflow tools need to be developed to make this a feasible process at the VA. In this study we propose to use Veteran and primary care physician interviews and surveys to develop these innovative tools. POC: Farrukh Koraishy, MD (St. Louis VAHCS) and Carmen Peralta, MD (San Francisco VAHCS).

CKD Snapshot (Cleveland Spark Proposal) — Many guidelines exist to optimize the care of patients with CKD, but the implementation of these guidelines is highly variable and often poor. We propose the development of an online, easily accessible clinical decision support system (CDSS) called CKD Snapshot. CKD Snapshot will provide

individualized patient management support based on existing CKD guidelines, in real time, to both primary care providers and nephrologists caring for patients with CKD. POC: Niraj Desai, MD.

CKICC — Chronic Kidney Disease Identification, Care & Communication Tool (Puget Sound Spark Proposal) — Adapt an existing functional electronic tool that is integrated with VistA/CPRS to provide a consistent, tailored data set for chronic kidney disease (CKD) care and disease management efforts. The tool will optimize the identification of veterans with CKD as well as any significant co-morbid medical conditions, and catalyze communication between clinical providers, kidney specialists and patients so as to facilitate appropriate care pathways for these patients. POC: Jonathan Medverd, MD, Acting Chief, Radiology, VA PSHCS Chronic Kidney Disease.

Healthier Kidneys Through Your Kitchen: Earlier Nutrition Intervention for CKD (Lexington Spark Proposal) -Initiate earlier nutrition intervention (at stage 3b) for Chronic Kidney Disease (CKD) through a nutrition class featuring healthy teaching kitchen demonstrations. This class would offer follow-up options through Clinical Video Telehealth (CVT) visits with a registered dietitian (RD), in-person nutrition consultation, the MOVE weight management program, and/or phone call follow-up from a RD. The American Journal of Kidney Disease states “We recommend that individuals with CKD receive expert dietary advice and information in the context of an education program, tailored to severity of CKD and the need to intervene on salt, phosphate, potassium, and protein intake where indicated.” (Am J Dis. 201; 63 (5):713–735). Having a RD involved is vital because misinformation from others who cannot provide medical nutrition therapy can cause harm [for example “overly restrictive dietary prescriptions may diminish total caloric intake, markedly reduce protein intake, and result in mal-nutrition” (Am J Dis. 201; 63 (5):713–735).] The goal is to improve quality of life for these Veterans and prevent/delay the need for dialysis or a kidney transplant. Another goal is to save the VA costs associated with later stages of CKD (medications, complications resulting in hospitalizations/surgeries, dialysis /dialysis contracts), and earn more reimbursement through increased use of Medical Nutrition Therapy codes by Registered Dietitians. POC: Rebecca Schlueter, Clinical Nutrition Manager.

Improving Support for Informal Caregivers of Veterans on Home Dialysis (Hines Spark Proposal) — Although home dialysis is the optimal way to deliver dialysis compared to in-center dialysis, it is largely underutilized. Informal caregivers play an essential role in patients’ adoption and sustainment of home dialysis. However, caregivers experience considerable challenges in assisting patients on home dialysis including time, financial burdens, and burnout. Little is known about strategies to address these concerns. The proposed innovation project aims to identify ways to support informal caregivers of Veterans with end-stage renal disease (ESRD) on home dialysis. POC: Michael Fischer, MD.

Increasing Statin Utilization in CKD Patient (Hines Seed Proposal) — E-DYNAMIC- Enhanced Dynamic Reminder System will enhance the existing lipid management clinical reminder system (CRS) for primary care providers. The project will link the CRS with the existing VISN12 Data Warehouse PACT Risk Calculation, a dynamic VA web-site which tracks cardiovascular disease risk, statin use and adherence in clinic patients, to improve cardiovascular disease prevention in Veterans with chronic kidney disease (CKD). POC: Nicolas Burge.

Increasing Access to VA Home Dialysis via Home Tele-Health (Lebanon Seed Proposal) — Access to VA-provided home dialysis for patients with end-stage renal disease (ESRD) is limited. In VISN 4, the VA Pittsburgh Healthcare System is the only facility with a home dialysis program; Veterans with ESRD at other VA facilities desiring home dialysis need to receive this therapy as contracted non-VA care. We propose to use in-home video telehealth

technology to facilitate the provision of home dialysis services from a central hub, thereby increasing access to care and reducing expenditures for non-VA care. POC: Paul Palevsky, MD, Chief, Renal Section.

Sodium Tracker App (Richmond Spark Proposal) — Sodium restricted diet is recommended for a multitude of medical conditions including chronic kidney disease, hypertension, liver disease, and congestive heart failure. It is proposed to develop an app “Sodium Tracker” to improve compliance with sodium restricted diet to improve Veterans’ health and increase engagement. POC: Monika Aggarwal, MD, MS, FASN. Staff Physician & Director of Dialysis.

Spreading CKD ECHO (Puget Sound Seed Proposal) — Chronic kidney disease (CKD) affects approximately 15–30% of Veterans, and is associated with high morbidity, mortality, and cost to the Department of Veterans Affairs (VA). CKD Specialty Care Access Networks/ Extension of Community Health Care (SCAN-ECHO) is a telehealth program that was implemented at 5 sites within VA to improve kidney disease care by partnering with primary care providers (PCPs) to increase access to nephrology specialty care. We propose a novel evaluation of the implementation of CKD SCAN-ECHO nationally using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework as a Seed Pilot program to determine the best CKD SCAN-ECHO program, and will use the information gathered to develop an implementation program for a VA Innovations Spread project of an improved CKD-ECHO program at other VA sites, which will target PCPs and Patient Aligned Care Teams (PACTs) to improve CKD outcomes nationally within VA. This project was originally proposed as a Spread level proposal and has been edited to a Seed level from which a potential Spread will be developed and applied for in the future. POC: Bessie Young Mielcarek.

Telehealth for home dialysis patients (Hines Spark Proposal) — To monitor adequacy of home dialysis and manage all aspects of end stage kidney disease, patients are assessed by an interdisciplinary team of nephrologist, peritoneal dialysis (PD) nurse, PharmD, dietician and social worker during a face-to-face visit on a monthly basis. Several of our home dialysis veterans live in rural areas, more than 30 miles away from parent facility and travel long distance for this visit. In this project, we want to assess the feasibility of tele-nephrology for monitoring (face to face comprehensive visit) home dialysis patients thereby improving access to care, decrease commute, time and financial burden, improve quality of life and potentially increase utilization of home dialysis modality. POC: Anuradha Wadhwa, MD.

Diabetes

Improving Diabetes Care Among Hispanic and Native American Veterans in New Mexico (Albuquerque Spark Proposal) — A proposal to develop a behavioral training curriculum for medical residents treating diabetic New Mexican Hispanic and Native American Veterans in diabetes clinics. POC: Anayansi Lombardero.

Project Engage Diabetes (Albuquerque Seed Proposal) — This project evaluates a new procedure for engaging high-risk veterans with chronically uncontrolled diabetes in behavioral health treatment. Two key aspects of this procedure are 1) use of informatics to identify at high risk veterans with uncontrolled diabetes (A1C over 9) and 2) proactive engagement of veterans in behavioral health care at their PCP appointments. POC: Melissa Falkenstern.

Hiring and Human Resources

Application process (Lebanon Spark Proposal) — Improve the application process by reformatting the VA forms (10–2850a, 10–2850c) electronically through usajobs.gov. POC: Ashley Klick, MSN, MHA, RN.

Opioid

Cash for your stash: an opioid buyback program (White River Junction Seed Proposal) — Prescription opioid misuse and abuse are preventable public health problems that affect all ages, all walks of life, and all genders. Our overall objective is to motivate patients to return unused prescription opioid pain pills to remove them from the community. POC: Jean Liu, MD, MS, FACS, General Surgery.

Multidisciplinary Approach to Harm Reduction Education (Lexington Seed Proposal) — The project is aimed to educate VA hospital staff on harm reduction methods and resources in order to provide better care for those Kentucky Veterans engaged in opioid use. The project will follow a “train the trainer” model so that frontline staff can educate Veterans on the availability of harm reduction resources. POC: Sean Lockwood, Chief, Hospitalist.

Opioid/Benzodiazepine Taper — Interdisciplinary Consultation Project (Albuquerque Spark Proposal) — Reduce the rate of veteran overdose by a targeted interdisciplinary program targeted at those veterans on high risk combination pharmacotherapy. POC: Katherine Belon.

Reducing Serious Adverse Events for Veterans on Chronic Opioid Therapy through More Effective Drug Screening and Interpretation (Albuquerque Spark Proposal) — We propose to combine Time of Flight Mass Spectroscopy (TOF MS) drug screening with interpretive aids to reduce the number of serious adverse events in Veterans on chronic opioid therapy at the New Mexico VA Health Care System (NMVAHCS). POC: Peter Woodbridge.

Rural Health

Teleguidance of Point of Care Cardiac Ultrasound — Establishing a Sustainable and Efficient Training Method (White River Junction Seed Proposal) — Access to specialty care and technology for Veterans living in rural areas remains an important issue and the dissemination of cardiac ultrasound relies on proper and efficient training. We propose to use screen mirroring and teleconferencing to remotely train and guide medical residents in the application of handheld cardiac ultrasound in patients admitted to the hospital with chief complaints for which focused cardiac ultrasound is beneficial in directing patient management. POC: Daniel ORourke, MD, MS, MEd, Chief of Cardiology.

Virtual Clinic Location (Gulf Coast Spark Proposal) — To increase rural Veterans’ access to healthcare, Gulf Coast Veterans Health Care System (GCVHCS) proposes a partnership with local CVS or Walgreen pharmacies to establish Virtual locality VA clinics while we purchase a care event. With potential pilot sites in catchment areas for both facilities, we will be working in collaboration with North Florida/South Georgia Veterans Health System (NF/SG) to develop this concept. Virtual VA locality clinics would reduce Veterans’ travel and wait times to receive healthcare. This would also increase the overall customer service and reduction in Care in the Community expenses (formerly known as Non-VA Care or Choice dollars). POC: Marthena Gethers, MLS (ASCP) cm, Assistant Chief of Pathology and Laboratory Medicine Service.

Suicide Prevention

Clinically reducing suicidality by addressing insomnia (Cleveland Seed Proposal) — There is a strong relationship between chronic insomnia and suicidal ideation based on over 20 publications. However there is no solution to this problem currently. We have a case series of 20 patients in whom a change in medications to low-dose Mirtazapine improved sleep quality (subjectively) and both active/passive suicidal ideation. Based on this observation, we propose to develop a protocol and test its feasibility through an electronic device (actigraphy) that measures movement to confirm this novel clinical observation; in terms of innovative technological approaches we plan to use actigraphy (fit bit) to illustrate that improving sleep consolidation will reduce suicidality. The actigraphy will be worn by the subject while they are asleep to confirm that they are not awake. By improving sleep consolidation with low dose mirtazapine and confirming the sleep time with actigraphy we plan to show the medication with the electronic device will help navigate the treatment plan of suicidal ideation and have promising results in decreasing suicidal ideation. POC: Kamal Gandotra, MD.

Family and Couples Services at Atlanta VAMC: A Pilot of the Family Integration Team Model (Atlanta Seed Proposal) — Our proposed innovation project is to pilot a family/couples mental health services program at the Atlanta VAMC, entitled the Family Integration Team, or FIT. FIT is both a centralized and de-centralized model of care designed to meet the family/couples services needs of our Veterans at the VAMC and some of the outlying clinics and CBOCs. POC: Kara Snead, PhD and Regina Koepp, PsyD, ABPP.

Grand Junction VHCS Suicide Prevention Program for Veterans Experiencing Chronic and Complex Pain (Grand Junction Spark Proposal) — This innovative project will infuse a specific suicide prevention program into the management and care of Veterans experiencing chronic or complex pain. This program will support the development of procedures to identify Veterans with high risk for suicide and support proper assessment; monitoring, education, and follow up care of Veterans upon consult to the pain management service. POC: Elizabeth Roten.

Mental Health Link Team (Atlanta Seed Proposal) — The Mental Health Link Team will provide same day and brief assessment and treatment for Veterans currently at the margins of care. In particular, this project takes aim at addressing the complex needs of Veterans unassigned or unengaged in mental health treatment presenting with non-emergent suicidal ideation or elevated risk for adverse outcomes to sites of care focused on high risk Veterans, including the Emergency Department, the Suicide Prevention Program, REACH VET, and our same day access clinic. The principle guiding this team will be the provision of enhancements and evidence-based resources to at risk Veterans who need flexible treatment options, including brief treatment, walk-in services, connection to resources, or care coordination. The scope of this project will include: formation of a treatment team to provide therapy and care coordination for at-risk Veterans, training for providers in motivational interviewing and suicide-specific assessment and treatment, assessment of existing suicide prevention resources and treatment engagement processes, and re-design of patient flow to ensure the team is able to deploy care resources on demand in ways that enhance treatment engagement and continuity of care for high risk Veterans. POC: Christina Wilson, PhD, Erik Adolphson, LCSW.

Patient Centered Reduction of CNS Polypharmacy (San Antonio Seed Proposal) — Development phase of a pilot program aimed at reducing psychotropic polypharmacy through patient education, PharmD consult, and integrated communication strategies based on patient-centered goals of function and symptom control. POC: Rebecca Tapia. Note: This proposal is also listed under Improving the Veteran Experience.

Suicide Prevention for Rural Veterans with Enhanced Outpatient Group Programing (White River Junction Spread Proposal) -A Veteran’s highest risk of suicide is the time immediately after discharge from an inpatient psychiatric unit. We propose an enhanced multidisciplinary outpatient group program which begins after discharge from the inpatient unit that serves to support Veterans during this high-risk time with the goal of reinforcing skills developed on the inpatient unit and helping to transition the Veteran back to outpatient care. POC: Robert Scott, MD, PhD. Medical Director, Inpatient Psychiatry.

Suicide Awareness of Veterans Exiting the CLC (SAVE-CLC) (Tuscaloosa Spark Proposal) — Partnership with Salem VA to create program to address suicidality among recently discharge CLC Veterans (unique suicide risk population). POC: Michelle Hilgeman, PhD Psychologist.

Training Home-Based Primary Care (HBPC) Teams to Improve Suicide Prevention Practices (Boston Spark Proposal) — In order to help HBPC team member’s better address suicide prevention for Veterans enrolled in HBPC, we propose to develop an educational toolkit and a model SOP addressing the unique needs of this population. We plan to pilot these products with a few HBPC teams, and then spread them to the national VA HBPC community (435 teams nationally, 156 VAMC and 279 CBOC-based). This project is part of ongoing quality improvement project by a group of HBPC mental health professionals representing six HBPC teams across the country. POC: Michelle Mlinac.

VA Crisis Line Awareness for those who do not use the VA (Milwaukee Spark Proposal) — Our proposal is to disseminate existing crisis line signage and printed resources throughout off-campus sites in an effort to reach Veterans who do not use the VA for their healthcare. Sites will include places like public restrooms and community bulletin boards, and will provide additional resource presence to all who need the assistance. POC: Christa Holland, PSA.

Improving Employee Experiences

All In One HR (Lexington Seed Proposal) — We are interested in working with a high level Tele-communication / Computer Specialist / Designer to design an ‘All in One’ system that speaks or connects to all of our systems. We would like to provide a central information hub for HR. This would include detailed employee records, reporting library, employee self-service, manager self-service, salary and job listing, track training, phone support, and benefit tracking. POC: Kirtrina Campbell, Administrative Officer, HRMS.

Connecting Employees to Self-Care through CIH (Lexington Spark Proposal) — The Complementary and Integrative Health (CIH) workgroup would like to partner with VA Medical Center employees who are certified in Complementary and Alternative Medicine (CAM) Modalities to engage employees in self-care activities. Self-care is associated with decreased stress, improved employee engagement, and improved attendance. POC: Christy Taulbee, Health Promotion Disease Prevention (HPDP) Program Manager.

Consult Management Registry (Portland Spark Proposal) — This project will create a platform to support a reliable and consistent approach for timely management of consults and waitlists. The team will develop a web-based registry that displays information to direct schedulers to address consults due for action, track scheduling attempts, and Veterans Choice List (VCL)/Electronic Waitlist (EWL) entries in a way that allows them to work efficiently while prioritizing the work based on the clinically indicated date (CID) and national mandates for consult management. In addition to identifying and tracking Veterans for action on consults and waitlists, the registry will also be a hub for education/training materials for consult management, assuring that the staff and leadership can always locate the most up-to-date consult management requirements for communication to Veterans and for staff training. POC: Amber Laing, RN.

Customizable Housing for Laryngectomy Patients with Irregular Stomas (Richmond Spark Proposal) — This proposal addresses the provision of customizable housing for laryngectomy patients that have large stomas or irregular contours to their neck due to extensive surgeries. This innovative solution will allow Veterans the ability to verbally communicate effectively and safely. POC: Stacy Gross, MS, CCC-SLP.

Decon Touchscreen Paperless Documentation (Milwaukee Spark Proposal) — We will develop a software program for a touchscreen kiosk that will replace the paper forms currently used for documentation in the decontamination (decon) area of sterile processing services. This will eliminate paper waste, decrease errors, and prevent costly recalls of reusable medical equipment due to damaged or unrecognizable paperwork (the high level of moisture in the decon area damages paper). Use of electronic documentation will also eliminate the time required of staff to complete paper forms, straighten up binders, and look for missing paperwork. POC: Mary Anderson, MT.

Emergent Transfer Coordination and Communication (White River Junction Seed Proposal) — The current transfer of urgent and emergent patients relies heavily on physicians completing administrative tasks. By implementing a multidisciplinary team of experts involved in the process and having one central communication hub, the plan is to cut down the amount of physician work and cut the amount of time it takes to transfer a patient. POC: Teresa Stearns, MSN, RN, VHA-CM, Associate Chief Nurse –Quality & Performance.

Employee Integrative Health and Wellness Program (Atlanta Spark Proposal) — Dr. David J. Shulkin, Undersecretary for Health, identified “Increased Employee Engagement” as one of his top five priorities and urged the VHA staff to identify ways to improve employee engagement by creatively addressing workforce challenges that hinder the “employee experience”. Our proof of concept design will explore the feasibility of utilizing a structured and comprehensive Employee Integrative Health and Wellness (e-IHAW) Program to improve employee experience and engagement by leveraging human capital resources, improving communication skills, sharing good news, celebrating excellent service and creating a work environment that promotes wellness, civility, psychological safety, collaboration, innovation and servant-leadership. POC: Yanire Nieves, MD, MBA and Sandra Waller, RN.

Tuscaloosa VA Innovation Center (Tuscaloosa Seed Proposal) — Transform old, unused space, into a state-of-the-art Innovation Lab that will serve as a space for teams to innovate, create and train (HCD, Entrepreneurship, making). POC: April Jones.

VA Boston Maker Program (Boston Spark Proposal) — Creating a Maker Program at the VA Boston Healthcare System to unleash and harness the creativity and problem solving skills of our employees and Veterans. POC: John Dadamo.

Other

Veteran Radiation Dose Tracking Program (Jackson Seed Proposal) — The radiation dose tracking program will include five fluoroscopy devices that are major contributors to Veteran radiation exposure at the G.V. (Sonny) Montgomery VA Medical Center. Based on FY15 procedures, documenting radiation dosage using dose tracking software rather than manually completed spreadsheets could result in a savings of 0.8 FTE annually while increasing regulatory compliance and data accuracy. Extrapolated over all 22 x-ray creating devices at this facility, there is a potential savings of an additional 3.15 FTE annually. There are currently 8 other facilities in VISN 16 that would benefit from similar or greater savings. POC: Stratton Brown, Biomedical Engineer and Mike Smith, Health Physicist.

3D Printing for Pre-Surgical Planning (Puget Sound Seed Proposal) — We hypothesize that 3D printed patient-specific models will facilitate a more comprehensive understanding of medical imaging data. In this pilot study, we will quantify the amount by which 3D printed models improve treatment decisions made by surgeons, as well as improve Veterans’ satisfaction with the informed consent process. POC: Beth Ripley.

A Self-Leveling Walker for Safe Stairclimbing (Cleveland Spread Proposal) — Currently available walking aids (rolling walkers) are inadequate for safely ascending or descending stairs and ramps, and conventional rehabilitation techniques to teach such maneuvers often require excessive physical effort or expensive home modifications — and failure to master the mobility maneuvers can lead to premature admissions to skilled nursing

facilities. This project addresses these pressing needs by professionally engineering and producing new, robust and reliable walkers with the ability to automatically adjust the lengths of the front and rear legs and remain

stable on steps and slopes, thus improving patient independent mobility and increasing the effectiveness of rehabilitative treatment after amputation, orthopedic surgery or neuro-musculoskeletal dysfunction. We will

construct three clinical grade self-leveling walkers and distribute them to collaborating VA sites for formal evaluation and assessment by patients and care providers. POC: Ronald Triolo, PhD.

Actigraphy for Veterans (White River Junction Spark Proposal) — The use of wrist actigraphy (device worn like a watch on the non-dominant wrist) in Veterans as a non-invasive and cost effective means to help in the diagnosis and treatment of sleep disorders such as insomnia, circadian rhythm sleep disorders, and sleep disruptions due to mental health illness such as Posttraumatic Stress Disorder and depression. The use of actigraphy will provide a more objective measure of sleep duration, will help guide clinical treatment for sleep disorders, and will help determine how treatment affects mental health symptoms in Veterans. POC: Jessica Oehlke, MD. Psychiatry Resident, Burlington Lakeside Clinic.

Data-Driven Operating Room Scheduling: A New Paradigm (Boston Spread Proposal) — Presently, the operating room (OR) schedule is written based on surgeon block scheduling. This project proposes that organizing the schedule around the anticipated length of stay for a given surgery will reduce length of stay by avoiding an anticipated weekend discharge, which is frequently delayed until the next weekday. Implementing data-driven operating room scheduling will increase hospital capacity and reduce the costs associated with recovery from surgery. POC: Jessica Shanahan.

Development of Cycling Program for Patients with SCI (Cleveland Seed Proposal) — Overground biking has several real advantages over commercially available stationary trainers utilizing functional electrical stimulation (FES), including enhanced reconditioning and a sense of personal freedom and mobility. The problem to be solved is that access to over ground biking with electrical stimulation is still restricted to an extremely small number of recipients of implanted stimulation systems who happen to be enrolled in ongoing research projects. This innovation project will expand upon of our already existing cycling program at the Advanced Platform Technology Center at the LSCVAMC, which won the gold medal in the FES Bike race at the 2016 Cybathlon (http://www.cybathlon.ethz.ch/en/cybathlon-news/cybathlon-results/fes-results.html) in Zurich, Switzerland using our experimental implanted technology. In this project we will extend access to over ground biking to a wider population and expand the biking program beyond the handful of implant recipients by adding the option for surface stimulation so that any disabled veteran with a spinal cord injury (SCI) can take advantage of it. We will explore the relative benefits of surface and implanted stimulation, and ultimately develop a surface stimulation based adapted exercise program locally here at the LSCVAMC to allow SCI patients undergoing rehabilitation the chance to ride the bike and train to get valuable exercise to live healthier lives. POC: Kevin Foglyano, BSE.

Enhancing Sleep and Mood in an Inpatient Medical Setting Through the Use of Nonpharmaceutical Interventions (light box, spa sound machine, and sleep mask) (Hines Spark Proposal) — We seek to address the problem of irregular or poor sleep in the hospital setting (specifically within the spinal cord injury/disorders [SCI/D] program), with the hope of improving mood, quality of life, energy, participation in treatment, and overall wellbeing. POC: Azadeh Ghaffari.

eTracking (Albany Seed Proposal) — eTracking is an electronic specimen tracking list that facilitates barcode label scanning of patient specimens. Using a secure, shared network folder, authorized personnel access a highly

customized Excel spreadsheet. This spreadsheet provides a user-friendly interface that organizes/automates tasks such as network file location, filenames, date/time stamping, and creation of daily, custom tracking lists using VBA scripting. This project utilizes assets already in place in the VA system. POC: Michael Pracht, MT.

Fall Sensor (Cleveland Spark Proposal) — We propose to develop a mesh (synchronized) network of Inertial Measurement Units (IMUs) using an existing wearable sensor development platform, initially focused on dynamically estimating body position and automatic fall detection. Real-time dynamic detection of body posture has wide-ranging applications, including fall sensors for the elderly, closed-loop feedback systems for nerve stimulation (e.g. for paraplegic patients), physiotherapy (e.g. guided

Other — Continued

postural changes for chronic back pain), and many more. (IMUs) combine an accelerometer and gyroscope to accurately track changes in velocity and angle. POC: Frank Jacono, MD.

Foundation Training, Posterior Chain Strength and Chronic Low Back Pain (San Antonio Spark Proposal) — Use an existing space at the VA to teach a Foundation Training class to Veterans with an AM and PM class to accommodate as many schedules as possible. POC: Dillon Bomer.

GEOspatial COMmunity and Patient ASsessment Strategy for Veteran Adherence (GeoCOMPASS-VA) (Loma Linda Seed Proposal) — The goal of this project is to design and test interventions to improve Veterans adherence to medical advice. Our premise is that where you live influences your beliefs and behaviors, including those related to health. GeoCOMPASS-VA first identifies Veterans “at risk” for non-adherence based on individual traits derived from VA data (CDW) (e.g. history of no-show, co-morbidities). Next, the community or “neighborhood” in which the Veteran lives, and the traits of that neighborhood, are identified using Geospatial Information System (GIS) and geodemographic segmentation software. This software and approach is widely used by retail business companies to target and market to consumers. Finally, point-of-care interventions are designed to proactively “market adherence to medical advice” to Veterans who are at risk for non-compliance. POC: Susan Hall, MD, PhD, MPH.

Precision Medicine: Genetic Screening before Prescribing at the VA (Albuquerque Spark Proposal) — My proposed innovation project will establish a simple protocol based on well-established treatment regimens to order appropriate genetic tests before medications are prescribed for veterans, thereby decreasing adverse events associated with medications, subsequent medical visits or hospitalizations associated with this, decreasing future problems with metabolism through the liver and kidney, and subsequent morbidity and mortality. This will increase patient/provider satisfaction and outcomes. Proof of concept will begin with one medication, Plavix (clopidogrel) which should demonstrate that adopting this strategy will be beneficial not only to veterans, but also to our entire healthcare system. POC: Nguyen Park.

Smart foot position sensor to prevent power wheelchair user foot and leg injuries (Cleveland Seed Proposal) — Power wheelchairs (PWC) provide freedom to move and better quality of life for many Veterans with decreased strength and sensation, such as SCI/D. Sadly, while PWCs improve such Veteran’s mobility, injuries occur when the Veteran’s foot is malpositioned on the PWC footplate. We are developing a smart wireless footplate pressure and position sensor (FoPPS) to warn users when their foot is not in the right position on their PWC footplate, this will allow them to reposition their foot before a lower limb (LL) injury occurs. POC: M. Kristi Henzel, MD, PhD.

Stop the Bleed (Puget Sound Seed Proposal) — Improve education, access to treatment and options for preventable death related to blood loss in multiple casualty events like mass shootings, terrorist attacks and natural disasters. Significant external bleeding can also result from everyday events such as crashes, industrial accidents and construction. Innovation Project goal is to establish easily accessible “stop the bleed kits” and providing training opportunities empowering employees, veterans and caregivers. POC: Frank Smith.

Upper Extremity Patients Orthotics (Albuquerque Spark Proposal) — This spark project will explore the feasibility of 3D printing some upper extremity (UE) patient orthotics in an effort to increase patient compliance with wearing their orthotics. It will evaluate which UE orthotics could best benefit from digital design & fabrication, what clinical workflows might work best for therapists & patients and what potential cost saving there might be. POC: Benjamin Salatin.

ZZZZs Without Zolpidem (Albuquerque Spark Proposal) — A large proportion of NMVAHCS patients who are prescribed zolpidem are prescribed a dose and/or dosing frequency higher than recommended by the FDA. To address this problem, we will enroll long-term nightly zolpidem users in a cognitive behavioral therapy program for the treatment of insomnia (CBT-I). POC: Linda Macdonald.


Learn more about VA Center for Innovation here.

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