Rural Veterans Health Care: A Case for a Human-Centered Technology Approach

Imagine for a moment that you are a Veteran living in rural Northern Minnesota, and you have just received an organ transplant. You are due for a check-up but the nearest clinic that has your health records is more than 100 miles away. How do you get there? What if you have a complication on the way? How do you pay for your hotel for what may be an overnight visit?

These are the questions that plague rural Veterans on a daily basis; and the above is a real life example encountered by Jonathon Guyer, a Veteran Health Information Exchange (VHIE) Coordinator at the St. Cloud VA Medical Center in Minnesota and many other VHIE Coordinators across the United States.

Atlas Research and Information Innovators, Inc. (Triple-i) Veteran Health Information Exchange Coordinators (VHIECs) are a part of the Virtual Lifetime Electronic Record (VLER) program that shares parts of a Veteran’s VA medical record electronically, safely, and privately with his or her community-based health care facility. Prior to the start of the VLER program, it was difficult for rural Veterans to access their medical records and have them transferred from one facility to another. The burden usually fell on the Veterans themselves, requiring them to track down and create paper copies of their medical records. The VLER program and its associated technology have played a role in providing higher-quality care to rural Veterans. The technological advancements, however, are only half of the story.

While technology is an incredibly valuable asset, technology is only helpful if its users understand how to leverage it. The same holds true for electronic health records. For this reason, Mr. Guyer and other VHIE Coordinators are an integral component of this new, technologically-driven, health care program. VA’s Office of Rural Health funds an effort that provides VHIECs at 56 rural VA Medical Centers, where they provide support services and outreach to help Veterans learn how to use VLER and other technology-related programs.

Mr. Guyer has taken it a step further by expanding the program at the St. Cloud VA Medical Center to cover far more than just VLER. He sees himself as a “navigator,” helping Veterans not only learn about the VLER program and sign appropriate authorization documents, but also connecting them with other services and resources. When his position began in October 2014, Mr. Guyer realized that there was not a central physical location for Veterans to ask questions, set up online accounts, and learn about the important benefits available to them.

At the end of 2014, the Health Hub at the St. Cloud VA Medical Center opened. Mr. Guyer describes the Health Hub as a one-stop shop to connect Veterans with the resources and tools they need; a “friend within VA” where they can come to access information and ask important questions. Mr. Guyer acts as the human intermediary between Veterans and the electronic system, and speaks with 160 to 170 Veterans a week in order to help them learn and leverage this technology. The Veterans often meet face-to-face with Mr. Guyer who walks them through each step of the enrollment process. Before the Veterans leave the Health Hub, he provides each Veteran with his phone number just in case they have additional questions or need further assistance.

The Health Hub helps Veterans through the enrollment process for both VLER and My HealtheVet. While VLER connects providers with medical records and information, My HealtheVet connects Veterans with an online portal that enables them to navigate through their health care records. By educating Veterans about this system and providing access to services in a single location, Mr. Guyer and other VHIECs are helping people make more informed decisions which should minimize complications that might arise in the future.

Mr. Guyer works on site at the Health Hub in the St. Cloud VA Medical Center on behalf of Atlas Research, a management consulting firm in Washington, D.C. that works extensively with VA. Both Atlas and Mr. Guyer have specialized experience working with VA to help people use and apply IT solutions that improve overall care and service. This expertise is what has enabled Mr. Guyer to recognize the challenge at the St. Cloud VA Medical Center, and to create the Health Hub as a solution that delivers positive results for Veterans, community providers, and VA.

The Health Hub has been met with positive feedback and has become an example for other VA Medical Centers across the country. This model has already been replicated at three facilities with five more in the process of transitioning.

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