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Amy Kilbourne, PhD, MPH, Director of QUERI

Director's Letter

Enhancing Veteran Care through Implementation, Technology, and User-Centered Design

Rarely does technology alone improve quality of care without leadership commitment, provider engagement, and patient/consumer acceptance. Without these crucial elements there can be a “valley of death” between an innovation and its application into routine practice. There is growing realization that technology has the potential to make healthcare better and more cost-efficient, but will need to be developed and implemented with the end-users in mind. In other words, it is not what technology can do for you, but how you can enhance your work through technology.

This current article features key examples of how QUERI investigators took healthcare technology to the next level, notably by developing initiatives in collaboration with VA national leaders and conducting rigorous evaluation of the impact on end-users to ensure not only successful uptake but improved quality and sustainability. Team-Based Behavioral Health QUERI, in collaboration with VA national leaders, scaled-up and spread the VA National Bipolar Disorders Telementalhealth Program, which is based on a collaborative care model (Disclosure: I helped co-develop the Life Goals program used in the VA National Bipolar Telehealth Program). Similar telehealth and collaborative care programs have been implemented by QUERI for PTSD (Virtual Specialty Care QUERI) and pain management (IMPROVE QUERI) in collaboration with Mental Health and the Office of Rural Health. To provide more flexible care options, Triple Aim QUERI, and Measurement Science QUERI developed new models of care transitions and home-based care for cardiac rehabilitation.

However, for Veterans and their providers to truly realize the benefits of technologies such as telehealth, there needs to be a roadmap that garners their input as end-users and provides a pathway for scaling-up and spreading the interventions effectively. This is often referred to as user-centered design (UCD), an approach that places end-users at the center of product creation and throughout iterative development phases. Increasingly, innovation programs at universities and medical schools are applying user-centered design, much of which has been based on companies such as IDEO. Investigators from Bridging the Care Continuum QUERI applied the Getting to Outcomes (GTO) implementation roadmap to scale-up and spread the MISSION model, and GTO includes elements of user-centered design by enabling providers to tailor the intervention to increase likelihood of sustainability.

In the future, implementation scientists might want to more formally incorporate UCD to maximize the value of technologies, so that interventions are used as intended and, ultimately, benefit Veterans. This will likely require collaboration between implementation scientists and experts in UCD to develop a common process that can test, evaluate, and, optimally, scale-up and spread best practices in routine care settings.

Amy Kilbourne, PhD, MPH
Director, Quality Enhancement Research Initiative