• Say “Yes” to Innovation

    Mar 01, 2012

    An interview with Roger Baker 

    Tablets and smartphones hold great potential to improve veterans' care, believes VA CIO Roger Baker. "As IT head, my job is to make sure we can support mobile platforms."


    Last October, Roger Baker, the CIO of the Department of Veterans Affairs (VA), authorized a pilot test of 1,000 iPads in VA hospitals and other settings. VA employees will be given permission to connect to the VA network via personal iPhones and iPads, initially with read-only permission and no storage of Veterans' personal data. Eventually, Androids and other mobile devices will be able to connect as well.

    Within two years, Baker expects to have 100,000 mobile tablets in use across VA, helping to support the delivery of evidence-based medicine.

    "I think we have issued our last desktop purchase procurement," he says, "and those will run for about five years. Longer term, we will not have any desktop computers."

    Reactions to the VA's iPad deployment vacillate between praise and concerns about veterans' information getting hijacked by cyber thieves.

    But this was not a decision made on the fly, says Baker, emphasizing VA's mission-critical stance on protecting veterans' information.

    "We probably have a 90-page analysis with specific recommendations on what we should and shouldn't do to keep veterans' information secure."

    Even so, like many management decisions, the iPad deployment was instigated by a leader's gut recognition: "About a year ago, I said, 'Stop telling me 'no,' and tell me how to say 'yes' to these devices.'"

    Forefront Advantages

    The VA is no stranger to the IT forefront. Its groundbreaking VistA electronic health record, launched about 20 years ago, is still being copied and emulated. Currently, VA is busy modernizing VistA and piloting a program that will enable veterans' medical information to be shared among public- and private-sector care providers.

    "I think there is something about VA's culture that encourages innovation to enhance patient care," says Baker. "Every employee comes to work here to try and serve veterans better."

    Baker points to one advantage of being on the leading edge: "I often tell my folks, 'If you say 'yes' early, you get to define the terms for why you say 'yes.' If you say 'yes' late, you have to give people the rules they want.' For instance," Baker continues, "when we decided to test iPads, we instituted a lot of constraints on the type of apps that could run on the devices, the type of data that could be viewed, and the type of usage. But all these constraints were greeted with a warm welcome-because we are viewed as pioneers."

    One significant constraint: VA staff cannot upload or view any veterans' information on smartphones or tablets unless they use a government-certified encryption application. That restricts the potential use of mobile devices to improve patient care delivery right now. However, the VA is in the middle of piloting a mobile version of VistA with complete encryption, which may enable VA staff to securely upload and view medical records from tablets and other mobile platforms.

    App Inspiration

    The use of tablets instead of computers has the potential to improve productivity and patient care in VA hospitals, says Baker. "When a clinician moves from patient room to patient room, he is either carrying a laptop or logging onto the system every time he enters a new patient room. With the tablet, he can walk room to room and not have to log on repeatedly."

    Ultimately, however, it's not the iPads or other platforms that excite Baker. It's the apps, or software. VA encourages the development of medical applications through integrated project teams, which include clinical, IT, and business staff. Over the years, these teams have developed numerous software applications-including an award-winning post-traumatic stress disorder mobile app-to help enhance patient care. Future apps may vary from heart rate monitors to clinician advisory live video conferencing.

    "One of the exciting things is that I have no idea what apps the clinicians are going to come up with to better serve our veterans."  

    Roger Baker is CIO and assistant secretary for information and technology, Department of Veterans Affairs, Washington, D.C.