The VA e-Screening Program: Technology to Improve Veteran Healthcare

Background/Purpose:Approximately 1.6 million troops have deployed to the wars in the middle east. Early screening for mental health problems can better identify at-risk veterans. There is growing demand to screen all new veterans that enroll into the Department of Veterans Affairs (VA) healthcare for appropriate services, and to triage their care. VA social workers are often responsible to screen and assess newly enrolling combat veterans for appropriate mental health and psychosocial services. The screening process is typically accomplished using cumbersome paper and pencil tools and manual transfer of information into the medical record.

Recent research shows that technology use in mental health care services can be an effective way to improve patient care, satisfaction, and engagement. The goal of this study is to compare the usefulness of a technology-based screening process, “eScreening”, to the usual paper-based screening for newly enrolling combat veterans at a VA Hospital System. Study objectives were to evaluate veteran and clinician satisfaction, burden of screening, rate of screening completion, and impact on clinical care with eScreening compared to paper screening.

Methods: Veterans were recruited and consented to allow researchers access to their screening data for this IRB approved protocol. Two cohorts of veterans completed either the paper screening (n=798, March through November, 2012) or eScreening (n=552, December, 2012 through September, 2013). Screens included measures of posttraumatic stress disorder (PTSD), depression, traumatic brain injury (TBI), military sexual trauma, substance use, pain, and a satisfaction questionnaire. We conducted six-month post-screening chart reviews to determine the impact of screening on clinical care, such as time to provide  psychosocial or mental health intervention, veteran follow through on recommended care, and veteran access to information and resources. Data was analyzed with t-tests for continuous variables and chi-square for ordinal variables.

Results: Veterans who completed eScreening (M = 3.00, SD = 0.76) were significantly more satisfied than those who underwent paper screening (M = 2.88, SD = 0.71); t(930) = -2.55, p = .011 based on a 0-4 Likert scale satisfaction questionnaire. Screening completion took significantly more minutes for Veterans with eScreening than paper screening, (M = 54.84  vs. M = 49.66 SD = 25.83, t(700) = -2.87, p = .004). There was a no significant difference in time spent with each Veteran between paper  (M =17.73 SD=24.99) and eScreening (M =18.71, SD =23.62); t(981)=-0.50, p = 0.616. The percentages of veterans with documented screening was higher for eScreening (99.1% to 100%) compared to paper screening (89% to 93.2% ) for all high priority screens, PTSD, depression, TBI, and substance use, all ps<.001. For veterans that needed clinical care follow-up, it was significantly faster for those who completed eScreening M=2.66, SD=3.10) than for paper screening (M=16.27, SD=23.80); t(686)=13.06, p<.001.

Conclusions and Implications: eScreening was more satisfying, reduced overall screening burden, improved screening rates, and improved patient care. Our findings have far-reaching implications for how technology can be harnessed to streamline screening for mental health and psychosocial needs in healthcare systems.