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A duty to protect: How the VA is keeping veterans safe amid the pandemic. Civilians too

One quiet chat in the middle of a war thrust Dr. Jennifer MacDonald’s career into motion.

It took place 10 years ago at a troop clinic on the U.S. military base in Basra, Iraq. That day, a soldier walked in, complaining of joint pain. MacDonald, then a third-year medical student stationed on the base, decided to dig deeper into the soldier’s story. The real problem soon surfaced.

Amid her fourth combat tour, the soldier was merging long duty shifts with grueling gym sessions – all to work through some conflicting emotions. She missed her family, she said, but worried going home might be even harder. That moment marked a mental breakthrough for the soldier and an epiphany for MacDonald.

“It shaped my concept of transition for veterans and my desire to serve,” says MacDonald, who deployed to Iraq as a member of the Minnesota Army National Guard. “From a medical perspective, it shaped my desire to offer physical healing – and healing from a holistic perspective.”

Dr. Jennifer MacDonald, wearing a mask, testifying before Congress on behalf of the VA.
Dr. Jennifer MacDonald testifying before Congress on behalf of the VA. (Courtesy of Dr. Jennifer MacDonald)

Today, those same commitments still fuel MacDonald, a family medicine physician in Washington, D.C. and an executive at the U.S. Department of Veterans Affairs (VA), where she serves as chief consultant to the deputy under secretary for health.

At the VA, MacDonald spends “most of the day, every day,” she says, helping to monitor and manage the agency’s pandemic-era efforts to protect 9 million VA-enrolled veterans. (There are more than 18 million veterans in total in the U.S.) MacDonald also helps to maintain quality health care at 170 VA Medical Centers (VAMCs) and at more than 1,200 VA sites of care.

Early in the pandemic, at the height of uncertainty over COVID-19, MacDonald and other VA leaders, including senior executives at the VA Office of Information and Technology, began collaborating with industry partners to address new and existing challenges highlighted by the national emergency. One of those partners, Microsoft, was called upon to help transform key VA business processes and accelerate modernization efforts already underway across the agency.

Now, to track and react to active COVID-19 cases among veterans, as well as current bed space at VA hospitals, MacDonald and other VA leaders rely on a series of cloud-based dashboards, built with Microsoft’s Power BI, Bing Maps Platform and Azure App Service. The dashboards offer a first-hand view at near real-time data across the largest integrated health care system in America.

A woman in a lab coat and a mask looks into a microscope.
A VA health care employee at work during the pandemic. (Courtesy of the VA)

An executive-level dashboard provides VA leaders with situational awareness of COVID-19 cases and virus impacts in an aggregate view across the entire department. Another dashboard delivers mission-critical information to health care system leaders who manage the 170 local VAMCs. The final dashboard summarizes what is known about the status of COVID-19 patients who have been tested or treated at VA facilities.

These tools access a single, authoritative VA data source built on Microsoft’s SQL Server technology. The system harmonizes VA data on patient information, system capacity, staffing and inventory.

“It gives us a common operating picture and decisional information in near real time,” MacDonald says. “Our early planning and the early development of tools like these have enabled us to keep veterans safe. Veteran safety has been the true north of our response.”

The pandemic also prompted the department to activate its crucial but little-known “Fourth Mission.” During national emergencies, the VA can be activated to provide support to national, state and local efforts spanning emergency management, public health, safety and homeland security.

“VA is committed to helping the nation in this effort to combat COVID-19,” VA Secretary Robert Wilkie said earlier this year. “Helping veterans is our first mission, but in many locations across the country we’re helping states and local communities. VA is in this fight not only for the millions of veterans we serve each day; we’re in the fight for the people of the United States.”

A U.S. soldier in Army fatigues stands on a stage flanked by three Iraqi people on each side, all of them signing together.
MacDonald, center, sings with Iraqi people. During her tour of duty in Iraq, she performed music to help boost troop morale. (Courtesy of Dr. MacDonald)

The executive-level dashboard is a key tool in that fight, MacDonald says. In addition to offering an interactive map of current coronavirus cases at each VA Medical Center, the tool shows supply-chain and hospital-capacity metrics at every facility. Equipped with that data, the VA can shift resources as needed.

“That near-real-time information from the COVID-19 dashboard enables us to make decisions as we look cohesively at the COVID-positive patients we have hospitalized in a specific location, the number of beds there, our staffing and our inventory of ventilators and personal protective equipment (PPE),” MacDonald says.

“As we see COVID-19 take root in more areas, we have requests from states to hold open beds for potential civilian cases,” she adds. “As community hospitals reach capacity and need to transition civilian patients to our system to free up more capacity, we have been able to meet those needs.”

In Florida, for example, the VA recently dispatched 15 clinical support teams to assist 82 long-term care facilities with an estimated 8,863 patients.

A Department of Veterans Affairs sign outside a building in Washington, D.C.
VA headquarters in Washington, D.C. (Photo by Kiyoshi Tanno, iStock/Getty Images Plus)

As of Nov. 5, the VA had provided more than 870,000 pieces of PPE, including gowns, gloves, masks and face shields. It also has supplied respirators to civilian medical facilities. And VA Medical Centers have admitted 345 non-veteran civilians for care.

Meanwhile, the VA also is working to help individual veterans and their families remain healthy and to provide them timely information.

“At the end of the day, it’s about enabling processes and allowing VA to provide benefits to veterans,” James Gfrerer, the VA’s assistant secretary for information and technology, and chief information officer (CIO), recently told MeriTalk. “I have the benefit of being a veteran myself … and really know what the challenges are.”

As part of that effort, the agency launched a public-facing coronavirus chatbot that offers a symptom checker and gives around-the-clock responses to questions like, “If I need to leave my house, how do I stay safe?”

The chatbot was built in less than a month by leveraging the Microsoft Healthcare Bot service on Microsoft Azure, the company’s cloud computing service. The chatbot also answers queries about COVID-19 testing, stimulus payments and how to get a prescription refill.

These tools serve as a first-line safety valve for patients, providing them with a sense of security – a critical value to health providers, says Dr. Michael Uohara, who advises Microsoft’s federal health care initiatives.

A veteran undergoes an eye exam at a VA medical facility.
A veteran undergoes an eye exam at a VA medical facility. (Courtesy of the VA)

“Early in the pandemic response, the provider community was challenged to uncover approaches that provided support and care, while keeping patients socially distanced,” says Uohara, who previously worked in general surgery and clinical research.

“The adoption of the coronavirus chatbot by the VA was one of the techniques that served this purpose. To that effect, the VA, and a few early adopters like the CDC (U.S. Centers for Disease Control and Prevention), foreshadowed the use of these technologies. The Microsoft Healthcare Bot has now been embraced by dozens of large provider organizations, and there are now over 2,000 healthcare bots with tens of millions of users,” Uohara adds.

From an employee perspective, the most pivotal piece of all social-distancing efforts involves the ability to work from home. To help enable that shift within the department, the VA deployed Microsoft Teams and Windows Virtual Desktop.

Before the pandemic, on any given workday, about 60,000 VA employees performed their jobs remotely, according to Gfrerer.

During one spring weekend, the VA launched “the largest single-day deployment of Microsoft Teams,” bringing about 400,000 users onto the platform, Gfrerer has said.

The number of Teams users within the VA now exceeds 500,000 users, who hold video conferences, share documents and collaborate from the safety of their homes.

“When it comes to telework and our business model,” Gfrerer told the Federal News Network in September, “the theme is very similar to what you hear across (the) commercial sector and certainly around the rest of the federal government … it’s a new day, we’re not going back.”

Top photo: A veteran speaks with his doctors from home via a telemedicine call. (Photo by adamkaz/Getty Images)