Himanshu S. Singh, M.D. joined DSS, Inc. as the Director of Medical Informatics in April of 2018. He had worked in the VA for over 18 years, with his last 8 years in a senior leadership role. The following conversation took place in April and has been edited for length.

Q: Please describe your background

You could say I was indoctrinated into the VA’s mission from childhood. My father did his residency at the Wilkes-Barre VA Medical Center, and I accompanied him some weekends when he was on duty. We moved to Dublin, Georgia when I was a teenager, and I started volunteering at the VA Medical Center where my father worked. It brought me up close and personal to the VA’s mission of providing care for those that serve and protect us.

Q: What evolutions in Veteran care have you seen at the VA?

What we were always focused on was how to better prepare Veterans for the services we provided. Many Veterans have multiple chronic conditions and sometimes get enrolled into the VA later in life which createscomplexity in the management of their Healthcare. VA has been driving transformations in Healthcare through initiatives like the Joint Incentive Fund (JIF), working with DoD in helping with transition of care; Patient Aligned Care Team (PACT), which follows a Medical Home Model; Integration of Primary Care and Mental Health and Whole Health, which is an alternative approach to patient care and patient empowerment. All of these, and many other initiatives, help realign our mission in serving our Veteran needs.

The VA also started to take a hard look at serious issues like traumatic brain injury and PTSD, which benefit from an integrated and cohesive view. The VA has done a lot to move from a siloed approach to an integrated approach to care.

One such initiative was the PCMHI. With the increase in Behavioral health patients in the VA, Healthcare became proactive by adding Mental Health staff within the PACT clinics in Primary Care.  The goal was to address Veterans’ behavioral health issues in real-time instead of requiring another appointment.

Q: What challenges still remain at the VA?

As a learning organization, you must examine how to constantly improve and lead or to be part of a change agent. One area that we need to continue to improve is the Coordination of Care. We must do a better job managing our Veterans in an outpatient setting once they are discharged from hospital. There needs to be better integration of patient management within different areas of Healthcare – for example in Specialty Care, Primary Care, Pharmacy, Tele-Care, etc. – to improve our care for Veterans. We also need to constantly look at organizational re-alignments, with the Veteran at the center, to improve our care and outcome.

Q: Can you explain how the VA is addressing Socio-Economic factors in Veteran care?

VA has made great strides to research, and understand socio-economic and behavioral challenges and has led a number of strategic initiatives to address this. In the last 5 to 10 years, the VA has tried to tackle issues like homelessness, Vocational Rehab, and Compensated Work Therapy (CWT). There is also the Hud-Vash program which helps homeless or socio challenged Veterans with temporary housing integrate back into society.

VA continues to make strides in addressing Veterans substance abuse and opioid addiction using an integrated approach to addiction that continues after in-patient care. The VA has set up group counseling, a Big Brother system where Veterans are connected with others from the same branch of the armed forces. There is also residential rehab treatment, where individualized Veteran needs can be focused on.

Finally, the VA established the Veteran Justice Outreach program (VJO) which allows for certain Veterans with misdemeanors and first offenses, to be forgiven as long as they follow and complete a court ordered treatment program as a way to give Veterans a second chance.

Q: How can DSS solutions assist the VA mission?

It’s important to realize that DSS is a Veteran-owned business. The connection to the mission comes from the very top of the organization from our own CEO. DSS’ main focus has been working with our customers at the Medical center in bringing efficiency in patient care through innovative technology and solutions.

We work at the grassroots level, defining the clinical pathway and workflow leading to efficiencies in patient care for our customers and integrate different solutions to create interoperability. This may involve taking an antiquated “roll and scroll” user experience and modernizing it to a web and our GUI based solution.

Some our innovation in the last few years within the VA are:

Consult Tracking Manager (CTM) – Paper-based or non-integrated systems and solutions make it nearly impossible to efficiently and accurately coordinate consult management activities and require care teams to perform double entry of data. Currently, manual workflows make consult management inefficient and create a risk of long wait times.

Consult Tracking Manager is a VistA-integrated web-based solution that streamlines workflows, provides easy administrative oversight, and helps to ensure patients are called and scheduled in a timely manner. It improves overall outcomes for administrators and consult managers, providers and patients alike.

PeriOP Manager – Combining the functionality of LiveData with DSS’ VistA integration, PeriOp Manager is a comprehensive and cost-effective solution for managing, documenting, analyzing and improving every step of the perioperative process, from pre-operative patient assessments, through surgery, to discharge to the recovery room. Three Dimensions of Benefits: Patient Safety; Surgical Throughput, Utilization and Efficiency; Surgical Quality of Care

Suicide Prevention Manager (SPM), powered by Iconic Data’s Patient Case Manager (PCM), is a hospital information system integrated care coordination platform that injects real time data into key suicide prevention workflows to improve the quality of care and increase situational awareness.  SPM monitors and surveils compliance and outcomes and its dashboard puts real-time data in to the hands of facility, VISN, and VACO leadership.

Q: What is the concept of Whole Health?

Whole Health is an approach to Healthcare that empowers and equips each individual to take charge of their health and well-being, and to live their life to the fullest. VA facilities have been exploring what it takes to shift from a system designed around points of medical care – primarily focused on disease management – to one that is based in a partnership across time – focused on whole health.

Three components of Whole Health:

Empower: The Pathway – In a partnership with peers, Veterans and their family explore their mission, aspiration, and purpose, and begin their overarching personal health plan.

Equip: Well-being Programs – With a focus on self-care, skill building and support, these programs are not diagnosis or disease based but support the personal health plan of each individual. Services include proactive, complementary and integrative health (CIH) approaches.

Treat: Whole Health Clinical Care – In the VA, community, or both, clinicians are trained in Whole Health and incorporate CIH approaches, as well as self-management support and shared decision-making, based on that Veteran’s personal health plan, grounded in the healing relationship.

About Dr. Singh

Dr. Singh joined the Department of Veterans Affairs with a background in Medicine and technology in 2001. He began his VA Career in Clinical Informatics. Himanshu has served in several leadership roles including Assistant Director at the Ralph H Johnson VAMC, Acting Associate Director at the Ralph H. Johnson VAMC, COO/Associate Director at Ann Arbor Health Care System and West Palm Beach VAMC.  Most recently in January 2015 he served as the Acting CEO/Director VA Northern Indiana Healthcare System and in January of 2016 as the Acting CEO/Director at the Saginaw VA Medical Center.  He oversaw daily operations of a level 2 and level 3 complex medical centers.

About DSS

With over 25 years of experience, DSS is a leading a health information software development and systems integration company, providing services and solutions used daily by thousands of clinicians and administrative staff nationwide, to reduce costs, streamline workflows and improve patient care. For more information about DSS, visit www.dssinc.com.

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