For the Innovation program, which loaned devices (netbooks or iPads) and connectivity (mobile broadband Internet access) to veterans who needed them, the role of PTC expanded to become a technology concierge, helping to set up and manage all mobile telecommunication devices. The PTC phoned veterans when they received their device and provided a virtual tour, helped familiarize them with the technology by using test calls, and guided them in the use of relevant mobile applications installed on the device. During treatment, the PTC called enrolled veterans to follow up and to answer additional questions. The PTC also provided assistance to veterans interested in enrolling in the patient online portal My HealtheVet to access health information, communicate with providers, and request medication refills.
The VAPORHCS received institutional review board approval to present HBTMH pilot research data and program evaluation data for Innovation (as a quality improvement project). An initial evaluation of the position was completed through review of PTC workload and productivity, informal feedback from telehealth providers, and veteran and provider surveys during and after treatment.
Results
From March 2010 through April 2012, the PTC logged more than 2,500 hours of volunteer service on behalf of the HBTMH pilot (before the Innovation expansion). The dropout rate due to nonclinical reasons for veterans enrolled in the HBTMH pilot was 11%.3 During the HBTMH pilot, 78% of veterans reported that they had enough technical support (ie, from the volunteer PTC), whereas among veterans receiving clinic-based videoconferencing sessions, 61% reported having adequate technical support (ie, from telehealth clinical technicians employed by the VA).3
During 2013 to 2014, veterans and providers were surveyed during and after Innovation program treatment. Eighty percent of participants stated that the PTC was prompt in resolving any issues (20% reported “neutral”). One hundred percent of providers indicated that the PTC was able to resolve the technical issues and that they were “very likely” to continue participating in HBTMH if the PTC was involved. Eighty-nine percent of veterans reported they felt there was enough technical support, and 11% responded “neutral” to this question. Table 2 describes typical PTC services provided during the Innovation program.
Informal summary observations from the PTC confirmed that the most frequent interventions were device and software orientation, assessment of audio and/or video disruptions during sessions, and software log-in configuration and support. Common technical issues included audio and video bandwidth limitations and the need to clean up veterans’ personal computers to restore functionality or improve performance (eg, problems due to malware and viruses; e-mail communication, various dates, William Cannon).
Troubleshooting was performed immediately during a session about half the time (vs between sessions) and initiated by veterans about half the time (vs by providers on their behalf) according to informal observations. The average length of a technical support appointment was about 30 minutes for veterans who were comfortable with technology; in contrast, appointments with veterans who were unfamiliar with technology averaged about 90 minutes.
The task logs recorded instances where flexibility and availability were needed for optimal task completion. Although many tasks seemed to be routine, others showed considerable use of the PTC’s time or direct participation during a session.
One PTC noted, “Client called around 9:30 and had me put [provider’s name] info into Jabber. Also Jabber had an issue of being stuck but forced a call and issue cleared up. 15 min. Stayed online with client to ensure appointment connection went well. 5 min.”
Malware, although not the most common issue, seemed to be time consuming. A task that required 4 hours for resolution of multiple issues was described as “requested outside assist due to drivers. Troubleshooting discovered 240 plus malware and numerous Trojan [horses].”
Another time-consuming issue involved software or updates to existing software interfering with the videoconferencing program, with the following example logged for 90 minutes: “Jabber will not store contacts. Updated IOS. Deleted games. Deleted and reinstalled Jabber. Re-updated Jabber. Problem finally resolved” (December 19, 2014). Other patients simply needed more time to familiarize themselves with the technology, as in this example: “2.5 hours of training and using the iPad” (November 25, 2014).
Informal feedback from providers as well as formal feedback from a program audit indicated appreciation for the PTC’s ability to facilitate engagement and surmount technical hurdles. One provider reflected on a particular instance in which the PTC worked with both the veteran and the provider over the phone and webchat to teach them to use the equipment. “[Veteran] and the peer technician developed a friendly rapport and [veteran] expressed gratitude for the team’s efforts to deliver treatment that he would not have had otherwise.” Another provider commented, “The [National] Help Desk is almost too general. You have to explain who you are each time, and never get to explain who [the] veteran is. … They are aware of national problems. Otherwise, they can’t help out much.”
