Let's get going with the talk today. I am so thrilled to have Dr. Armstrong come back. I say, she's actually a friend and valued colleague of mine, and it's been a privilege to work with her over the years. 

Dr. Armstrong is a leader in the development, implementation, and evaluation of programs that facilitate increased adoption of health technologies throughout the VA health care system. Some of the programs she leads that serve to advance digital literacy across the VA include Ambient AI Scribe, Virtual Health Resource Centers, Virtual Care University, Connected Health Implementation, and national virtual care implementation efforts. 

Before joining the VA, she worked for a decade for the US Department of Defense, where she led the connected health education and training program. She is also an associate editor for the Journal of Technology in Behavioral Science, and serves on the Ethics Committee for the LA County Psychological Association. So with that, it's time for me to exit stage left and hand it over to Dr. Armstrong. 

Thank you, Dr Felker, for that wonderful introduction. So the goal of today's training, and you can go to the next slide, please, is to provide learners with a foundational understanding of what digital health literacy really is, why it's important, and also go through some of the digital health tools and programs that are available through the VA Department of Defense, but also to anybody. And also, resources. So you can increase your skills and knowledge so that you're increasing your digital health literacy as well. Next slide. 

At the end of today's training, learners are going to have an understanding of those core components of digital literacy. Identify common barriers to digital literacy among patients, but also clinicians and staff, and how to overcome those barriers across diverse health settings. Next slide. 

This is just a really high level overview of what we're going to do. Our goal here for anything that we're doing is really thinking big, thinking about digital health transformation and how that should look across health systems. Next slide. 

So I work with, as you guys all do, I work with some of the smartest people you could imagine physicians, nurses, designers, developers, policy experts, people who are all deeply committed to making things better. And together, we build systems that don't work oftentimes. 

Now, this is not because anybody's careless or clueless. It's not because anyone involves lacks expertise. In fact, it's usually quite the opposite. What really fascinates me about this is that when something we identify a new innovation that's very cool. And we want to use it, and maybe we ourselves like it. When we see those things fail to scale up across a healthcare system, we go looking for incompetence. 

Why wasn't this created? Why isn't this user friendly? Why aren't clinicians adopting this like they should? We're looking for that resistance. Or we're looking for poor execution. But after decades of watching this happen over and over again, across big healthcare systems, I've noticed something quieter than that, and I hope this is something that you guys can all-- when you think about it, you'll say, oh, I recognize that. I've seen that too. 

The fact is that in these situations, almost everybody did exactly what their role rewarded them for viewing. And the system performed exactly it was designed to do. And so that's where the gaps fall in. Let's go to the next slide. 

So let me describe a little bit more about a pattern that you might recognize. New tool is built. Maybe it technically works. We launch it. There's training. Maybe we do some webinars. Maybe there's a slide deck and a dashboard. The metrics look great. Leadership is excited. They're feeling proud of the work. Project is marked complete. 

And then something subtle but very big happens. The people who are supposed to use it patients, providers, staff, they begin to adapt. They create workarounds. They keep parallel systems. They stop mentioning the friction because they assume it's temporary, or that it's just them, or that the system won't help them anyway. 

So on paper, the system is live, but in reality, the real work has shifted the massive amount of-- massive amounts of people who are trying to prop the system up. So we often see all these technologies, but what we don't see is the huge burden that is then placed on all the people that are meant to use it. 

So that's the problem. When you think back, you say, well, what happened? What went wrong? Everyone actually did their job well, but the actual system doesn't work. Thumbs up. You guys are relating to this. So let's go to the next slide. 

So if everybody did their job and the outcome still doesn't work, then the problem isn't effort or resources, it's alignment. Builders were rewarded for delivery. Leaders were rewarded for momentum. Teams were rewarded for compliance. 

But no one was rewarded for what happened next. Not for whether the tool fit into our actual workflow. Not for whether it actually reduced effort, not for whether anyone would still choose this tool six months later. 

So the system didn't drift, it didn't decay. It didn't fail. It did exactly what we quietly asked it to do. And the end results are inefficient systems that negatively impact healthcare and patients. And what I see day after day is people have new innovations and say, oh, let's put it out, let's put it out. 

And then, you hear that quiet rumbling all across the health care system. Oh, geez, not another this. Oh, this isn't going to work. And that's the reality. And that's the issue. Let's go to the next slide. 

So the burden didn't disappear. It just moved. The clinician ends up having to stay late to accommodate this. The employee has to build a workaround. The patient has to figure out how to navigate it all alone. 

So from the outside, it looks like resilience. From the inside, it's compensation for poorly designed systems. And the people who make broken systems function, are the same people whose experiences never make it into the metrics. I'm sure you guys can relate to that. 

You see those metrics that was a success. Maybe it was even in the news. And deep down you say, I know what really happened in that wasn't successful. So instead, so it appears successful precisely because someone else is paying the real cost. And that's when I stopped asking why people resist systems and started asking a different question, who is this system optimized to protect? Next slide. 

And when I think of what is the end goal for all of that, everything that I'm doing, everything that we're all doing, it really is how does it benefit the patient. I also a huge part of my work is also how does it benefit the clinician and the team. Because if it doesn't benefit all of those involved, it's not worth it. 

But what if we redesigned the system so it was optimized for people actually using it? The people working with the tools every day, not just the people building them. Listening to those who interact with the technology with patients workflow. And these are the voices that tell us actually what work and what doesn't. 

And then we invest in systems that improve these foundational pieces. Improving digital literacy, deploying tools that actually work, and not pushing down-- I mean, as pushing down the throats of patients and providers, things that actually don't work. 

I know that when we invest in systems that improve those foundational pieces, digital literacy included, that's when these tools begin to empower people instead of just adding burden. So the tools that are learned, understood, and integrated into real workflow are actually benefiting. And that's really the goal. Next slide. 

So when we're thinking about all this, we want to be thinking who's the system really serving. And we want to create systems that reward alignment over effort, adoption, things like that. We want to reward usability over what I call as the new shiny thing, novelty. 

Everyone-- it's like everyone in healthcare systems, a lot of leadership are the ADHD, like, oh, there's a new squirrel. I call it the new shiny thing. New shiny thing over here, new shiny thing over here. And all the patients are providers end up just being exhausted by that. 

So instead of scrambling and being wowed by cool new innovation, instead of being sold by a sales pitch, we really need to have a change. And this is intentional listening. And when we act, we do based on established best practices. Technology, I know these things seem new and shiny to some leaders. But the reality is, we do have a lot of systems and policies and foundations in place. 

So that we're not feeling as a healthcare system, we're ping ponging around. We need to make digital health-- digital health literacy as a foundational piece of what we're doing, so that we can be truly effective and sustainable. Let's go to the next slide. 

So this revolution that I'm calling for, it isn't loud. It's quiet. It's about asking better questions. Who's the system helping? Who's it burdening? Who's being left out? And most importantly, it's about listening. Really, really listening to the people that actually do the work. 

Because innovation is not about launching a new cool tool. We've done that plenty of times and we've seen how that works. It's not about the newest shiny tool that we're impressed by or sold, it's about implementing tools that actually work and doing so in the most efficient and effective manner possible. 

So tools that people understand that they can actually use and integrate into their daily lives, and tools that improve digital literacy and empower the workforce and make systems work for the people. So this is not just a theory. This is practice built on a foundation of decades of research and best practices. And it starts with one simple principle. Listen to the people that do the work and design systems around them. Next slide. 

So wrap up this and then we'll get to go into solutions. Broken systems aren't a failure of intelligence. All the people I work with are brilliant. Their failure of incentives, focus, priorities. But those can be redesigned. The focus can be shifted to better align with priorities. 

If we align our rewards with the people who actually use the tools and prioritize the-- I think of the meat and potatoes, the foundation of what we're doing here. Prioritize digital health literacy, systems will no longer quietly fail. They will succeed. And that is the revolution I'm calling for. Next slide. 

Next, let's talk about standardized program. Let's talk about some strategies and solutions that we've developed over the course of a couple decades, but that we've used in the Department of Defense, Department of Veterans Affairs. But a lot of these can be reused because what works in this healthcare system, honestly will work in any healthcare system or clinic or practice. So I'm going to walk through some of those examples of what we've done. So let's go to the next slide. 

So when we think about a healthcare system, there are many different layers that have to be put in place to meet the needs. And especially, when we're thinking about digital literacy, everybody's at a different point on and everybody has a different need. So the need to see over here are what I see as these need to be a given. They're not a given though. 

We need to have user friendly tools. We need to have staff that are prepared. We need to have accessible help. We need to have an awareness of what products are available. We need access to the technology and the training and all the materials in multiple formats. Because everybody has a different learning style. 

So what this ends up looking like are centralized help desks, in-person, locations where people can get help beyond just it support marketing, outreach, education training, digital navigators, coaching, mentoring, on and on and on. That's what the needs translate into solutions in healthcare system. And we're still working on a lot of this. We're always working on, can we make more user friendly products? Absolutely, we can. So all of those go hand in hand. 

So let's walk through some of these solutions that we built. First let's look at digital health-- I've been talking about digital health literacy. Let's go to the next slide. But I want to give an actual what I really mean when we see that. When we talk about digital literacy, it isn't just well, I got a smartphone. So I must know about-- I must know about things. It's way beyond that. 

It's about understanding the tools, the software, the safety pieces, how to effectively communicate. And there are gaps. And honestly, in my experience, in two decades of doing this often in health systems, there's this misperception that the information that patients need is very, very different than the information the staff need. 

The reality is, often staff usually have the same level of digital literacy than the patients. This is definitely true in the Department of Defense. Very high tech, younger group of patients and Department of Defense. 

However, VA, I heard for the longest of time saying, oh, that'll never work in the VA. And I was motivated. I heard this when I was in the Department of Defense. And I continue hear that now. Research does not bear that out. 

Actually, veterans are some of the most tech savvy out of all the adults, especially of their age. We do tend to US adults or all adults, we're less connected, but veterans, no, they're pretty-- they're pretty locked in. 

And we often find that when we hear providers say, no, my patients will never use it, it's actually because they themselves are uncomfortable with it. And so that's why I'm like, no, we've got to do this hand in hand. I'm always thinking veterans and staff all together. Let's go to the next slide. 

So I think I probably hit this hard, but I'll make it even more clear. Like directly, what are the outcomes we're looking for when we aim to increase digital literacy? We want to increase access to care. We want to improve quality care. We want to increase satisfaction of care. 

And I will say, although I'm sure you guys are all completely sold at this point of, oh, yeah, digital literacy, we absolutely need this. I will say, that is not a perspective that's actually shared by many others in health care systems. 

Often leaders, again, are just what's the new shiny? What's the new shiny? And all this gets neglected. And I say, we've got to reverse it. We've got to get the foundations or else it doesn't matter how many new shiny things you propose, you're going to burn more people out. Build the foundation. And then as you bring in new innovations, we are now set to be able to use them in a way that's going to be effective. Now, let's go to the next slide. 

This is something I'm really proud of. This is Virtual Care University. We aim to increase digital literacy in every way possible. From two to three minute videos, to flyers, to guides. And I'll show you some of that. 

But we also wanted to do it in a really interactive way. And so when I started to build all this curriculum, I actually started this back in like 2011 or 2012. And I finally, have about eight days of curriculum in the Virtual Care University. 

Now, this is behind the firewall. So you see a link there. You won't be able to access it unless you're on the VA network. However, I will share-- we do work with people outside the firewall, so I have created a resource that includes some of the links. It's not beautifully designed or anything, but it's just like a PDF, but that you'll be able to access some of those resources that are not behind the firewall. I aim to put the fewer silos, the better for everybody. 

But for now, this is behind the firewall. But it is 8 days of curriculum and it is a choose your own adventure. Most people have a base level of skills already. Maybe they know virtual care basics security privacy issues, but they know telehealth. Usually, that's the case. 

But they'll say what I don't know, I don't know about all these apps. Tell me about all these apps. So they could just go directly into module 5. And say, OK, I know about the apps, but what about these devices? What about syncing data and patient generated health data? How does that work? We have a whole module on that. 

And so then this combines everything in one location. And this is available 24/7. And all VA staff have access to this and can use it. Let's go to the next slide. 

How do we build this? We build this over started in 2011, 2012. And we were delivering in-person trainings to military treatment facilities really all over the world. And as the clinical competencies began to be published by some of our amazing colleagues, Dr. Don Hilty, Dr. Felker, many others, as we begin to publish these clinical competencies. I was like, let's take this and translate this into actual training that staff can actually use. 

And so that's really what Virtual Care University was all about. Self-paced. They can customize the learning experience. And it covers all the key virtual care tools components. And it's all in one place. 

And this next slide here shows some of the learning modules. Because really these are the key components that people, again, and again and again. This is what they need to know. And we interweave, and really it isn't just about this technology. And this technology. And this technology. I know oftentimes leadership think that that's what staff need to know. 

But trust me, it's overwhelming. If I just sat down and described every single app that [INAUDIBLE] have, you would-- your hair would blow back and say, this is too much. So there's an approach to go about that in a way that is not blowing your hair back. And we've created a process to do that. 

And so here in the next slide, you can see really the initial development once we started testing out this curriculum and really refining it, 2014, I said, oh, this needs to be an interactive platform. 

At the time, I didn't have the funding to be able to do that. But then in 2019, when I came to the VA, I began looking for resources to be able to do that. We finally launched it in 2023, and then we launched the 2.0 2024. And then we had-- as many people we had our learning management system platform that we had that we're using got cut, the funding got cut, and so we had to rebuild it on essentially a SharePoint site that links to the learning management system that the VA use called TMS. 

And so that seems to work. It's fine. It's not ideal, but it's the solution we have now. And people really actually seem to love it. So let's go to the next slide. So that's one solution. Like let's provide access to all this information in a way that's consumable for staff. That's key. 

Because often they're-- like inadvertent gatekeepers to all this information, often it's the patients that come and say, hey, can't I just share-- can I share my Fitbit data with you. And staff are just as big, what does that mean? It's usually that process that the patients are bringing this tech-- these technologies in, and we want to empower the staff to be able to be prepared to handle that. So that's one big chunk that we have been working to solve. 

The next big chunk is, hey you know what, we have help desks. We have all these things. That's great. They are used. However, no matter who you are, whether you're patient, staff, family member, caregiver, you sometimes just want somebody to be right by you and say, can you help me push the button? 

And beyond just IT support, I don't know how all your guys' IT support are in hospitals. I never have a good experience. No offense to any IT people, but usually it's not customer service friendly. It isn't about troubleshooting and learning and teaching and education. It's about solving a problem. 

I said you know what, I want to create an entirely different process. I want to create genius bars in every single VA Medical Center that are a one stop shop for anyone that wants to know about, what are the apps available? Can you show me how would I use these? How would I connect my device to it? 

And I also-- this was hard to do at a VA system, but I insisted upon it is I don't want any gates. One of the most frustrating situations for patients navigating VA systems, are, oh, well, you can have access to that resource only if you served for this branch or you only served during this year's. 

Those of you that are veterans know exactly what I'm talking about. It's frustrating. I said no, take out all those gates. I don't care if you are part of the VA or not. You walk on in, you get some help. You're a family member, caregiver. We're not taking down your Social Security Number. We're not. We don't care. We're just here to help. And whoever needs help is who we're providing help to. 

Also includes staff. So this is a different we wanted to not restrict it just to patients needing help. A huge amount of staff come in to ask for help too. Again, leadership wasn't tracking this. Leadership was like, oh, they all know. It's just the patients that don't know that's the barrier. I said, no, it's staff and you need to open this up to everybody. 

That's the aim. So I've been working on this for seven years now. And we now-- let's go to the next slide. We have a whole website and this is open to the public this facility locator. So you can see, hey, are there any nearby? 

And I will say, that we're in the beginning, although, we've been working on this for seven years now. We're in the beginning stages and different locations are in different stages of development, and we're actively working with them to enhance their capacity, capability, make sure they get more staff, make sure they get more space. Things like that. 

And so look see if you have a location near you, go meet them, talk to them, tell them they're doing a great job. Some of them maybe just have one person working there. Some have a whole staff of 15 people working there. So it really depends on where they're at in their mature-- their maturity process, and that we are supporting them in getting to the next step. So how do we do this? Let's go to the next slide. 

So seven years ago, somebody told me this idea of a genius bars. And hey, I got an idea. Let's have genius bars all across VA healthcare centers. So I don't know about that. I'm a data driven person. If I don't see the data that actually shows this could help. I'm not in. 

And so I said, well, let's check this out. Let's see if I also want to not recreate any wheels. So I want to see, does this exist anywhere already? And you know what, I scoured every bit of the VA and I found in St. Cloud, Minnesota, there was this ragtag team of awesome people that had created essentially what I was looking for. I said, aha, this is what it is. 

So I flew to St. Cloud. I spent a week there. I figured out exactly how they're doing it. Then I partnered with them to make it to a whole other level. So we can begin to scale this. And that's what we did. 

And then we launched one in San Diego and New Orleans and Tampa. Then we tested it. Then we said, does this really work? And then when I saw the data and it's published, I said, whoa, this is my mind is completely convinced, and this is so much better than I could have thought. And this is really going to work. And this has a huge impact. And I'll show you some of the data. 

But after I found out that I realized, how are we going to get each VA Medical Center where there's about 175 of them, there's about 1,200 to 1,400 VA facilities. VA is the largest healthcare system. I was like, how are we going to get one Virtual Health Resource Center at every VA Medical Center. And so we created a whole process, a six month implementation timeline for and we do this in cohorts. 

Right now, we're currently in our 17th cohort of facilities that work with us over a six month timeline that we go through everything, everything from space, staffing, evaluation plan, dashboards, tracking, everything. We walk through everything with them. And that has been super, super effective. Let's go to the next slide. 

Here are the key things. No matter-- it's funny. And one of the sayings in the VA is you've seen one VA, you've seen one VA. That is one of my least favorite sayings I ever. I cringe every time I hear it. Because it's like, well, I guess we'll never know. So I guess we'll never try. 

However, I work with every single facility, and these are actually far more similar than you'd think. 100% of the facilities that we work with, their primary barriers to adopting anything at all, is I don't have enough space, I don't have enough staff, I don't have enough resources to do this. That is never going to change. 

That's always the case no matter what the VA is and always will be. So those are the key things we tackle directly in that cohort process. Because the real idea is, change is incremental. Change is making change with the resources you have now and then scaling up slowly in a way that makes sense for that facility over time. 

Anything else that's just shoving down throats is going to break and going to fail. And so that's why we really customize for each and every facility. So on one hand, you see one VA, you see one VA. But on the other hand, all VA's are the same in many ways too. Let's go to the next slide. 

Here are some of the examples of the ribbon cutting events that many of our locations have had. You could see me in some of them. Long Beach, California I was there when they launched. So each of these sites, when they launch, have worked with us for six months, but they may have been working toward this for a year or two. 

Just sometimes it takes the most amount of time just to get their leadership to buy in on the concept. That's usually the biggest barrier. And then you empower these folks at these facilities and they are often run in and they make it happen. And that's what I love. So you can see Iowa City, Prescott, Las Vegas, Fayetteville, on and on. So they are doing fantastic work. Let's go to the next slide. 

So the strategies that I've been talking about can work with for any health care setting. These are just like putting in the foundational infrastructure to be able to help staff and patients succeed. 

And when we do that, we improve access, efficiency, safety, and we strengthen professional development by actually equipping staff with that critical digital health knowledge, the digital literacy, so they can then promote engagement with their patients through an inclusive approach. Let's go to the next slide. 

Let's look at the data. So what do we know so far? So far we crossed about 172 to 175 VA medical centers. We have 83 that have a Virtual Health Resource Center that is launched, and we have about 10 that are about to launch. 

Now, every single one of those, as soon as they launch it, they'll say, hey, this is great, I've got a CBOC. And so for all of you guys, these community based outpatient clinics that are attached in a way to a VA Medical Center. VA Medical Center is like the big hospital. And then they have all these outreach clinics that are in a way connected but separate. 

And so every single time they say, hey, can I start one in my CBOC? Can I-- many facilities have a mobile medical unit, a big mobile medical unit that's tricked out with all their telehealth gear and they say, hey, can I use my mobile medical unit? Absolutely, yes. So you see a number 83. It's more like 120 actual happening. 

Actually in Seattle, the Seattle area, the VHRC there, it was the first one that tested out using a mobile medical unit. And they would go out to is it Martin or Milton. I always get those confused. I've been to both, but so they would drive out to rural communities in order to increase access to all of this stuff. It was fantastic. They published on it. Dr. Ashok Reddy and team led that, was wonderful. So go to the next slide. 

You can see when I'm thinking about let's build the foundation and build it up, I'm like being literal about it. I'm like-- it's a pyramid scheme in a way. But not really. Not in a bad way. It's like you know what, if we create these systems. And then so we've-- then you just see this massive reach beyond. And so we have 96 sites that have completed a cohort. So 83 that are launched and 96 that have completed a cohort. There's that in between the 13 that are like just about to launch. 

So you have 96 essentially that will be live. We got the 83 that are launched. But then from there, we have this massive, massive continuing to grow reach. And so we have them track all of their visits. We call them visits. They're not clinical visits. Some take five minutes, some take two hours. 

But it's like troubleshooting and talking and working through whatever issues that they may have. And we also do proactive education and marketing events too. So let's go to the next slide. Because we track all this. We have dashboards on all of this. 

So far, we have reached 227,000 participants. And again, this is staff. This is Veterans. This is their family members. This is their caregivers coming to get help. 227,000 of them. We also track how long did each visit take. And we don't do this because we're not like a factory line. We're not like-- we need to pump up those numbers. We need to decrease the time so we can get more numbers. No opposite. 

We are like, I don't care if a patient is sitting and talking for an hour about their grandkids. Wonderful, great. I want them leaving feeling like the VA cares about them. VA is there to help them. So however long that takes, is what we're going to do. 

And so on average we spend about 25 minutes. We also track what are they asking about? Because essentially, what products do they need help with where are they having problems. Like what services do they need. And essentially, what I show leadership is, look, this is where everybody was falling through the cracks before. 

We had all these health help desks, things like that in place before, but these were all of the people that would not have received that help otherwise. And in the customer service aspect is super important to me. We had a patient in come into the San Diego Virtual Health Resource Center, and at the end of it, and it makes me choke up thinking about it. 

He just sat there quietly and the VHRC staff member working with him said, sir, are you OK? And he started to tear up. He said, this is I've been going to the VA a long time. This is the first time anybody has ever taken the time to actually help me. And he just-- I tear up thinking about it. That's the goal. We don't want people to cry, but we do want people to leave feeling cared about. That's the goal. 

Now, let's look at the impact. This is where I started to see the data when I did the first test with those first four sites. And I was complete, I started to see this impact back then. That was about six years ago now, and that's what convinced me. But now, six years later, it is only the significance of these data has just increased. 

So when-- there's all these metrics in the VA. Telehealth services who receives it, who doesn't. We have 100 different things we're really tracking. I want to highlight a couple. Here, you're going to see a series of graphs. And there's sites VA facilities that do not have a virtual Resource Center, compared to VA facilities that have a Virtual Resource Center, but it has been opened up to a year. So it's just starting. They're getting their feet wet. 

And then we have the ones that have been open up to two years. And is there a difference in actual use of technologies? And we see this huge difference. And it's really, really cool. And we also see this huge difference over time because we see an increase no matter the facility. But the increase is far more steep for these other sites because they have the infrastructure in place to do it. And let's go to the next slide. 

We'll show you again, this was interesting. It wasn't that perfect sloped thing. So we're like, that's interesting. But we are seeing really if you don't have a VHRC, you're the use is far lower. Let's go to the next one. 

Again, we're seeing a similar pattern here, and we see it again and again and again. Again, we look across 50 to 100 different metrics. And it's just like, wow. So that's-- when I think of all the implementation strategies that we create, this has had really the biggest impact. 

And it's complicated. It's not an easy solution. But the problem is not easy. You need to have a complicated solution for a very complicated problem. So that's what we do. Let's go to the next slide. 

Now, let's talk about-- and let's go to the next one. Let's talk about now, that you guys are all excited, jazzed up. Let's be raring to go. Let's go to the next slide. Let's talk about actual integration and practice. 

So you may not have virtual resource centers at your facility because you're not in the VA. But it's a model that can work anywhere. I had one of the heads of the military health called me a couple of years ago and said, hey, we hear about what you're doing. Could this work for Department of Defense? And I'm like, absolutely, 100%. 

And really, it's a model that could work in any healthcare system. But it took a lot of planning and there's ways we can make it a lot more. I don't want anyone to have to bumble through the first couple of years that we did. We learned a lot in those first five years. And so now, we've got this very tight system that just is absolutely efficient. And so that's what I hope. Let's go to the next slide. 

Let's talk about some of the things you actually can access and use. One of the coolest things that we have is it's called the VA mobile health practice guide. Actually guys it's really a VA virtual health practice guide. The goal with this and I mean, honestly, I was at the-- so I'm the lead author on this but it used to be the DOD mobile health practice guide. 

And we were up to the fourth edition. So when it came to the VA, I said, we're going to call the VA mobile health practice guide. And now, we're continue to update it. So now, we're on the second edition for this. But it is really about clinical integration. It isn't just this app, this app, this tool this tool. No. 

It's about let's get to the bottom of well, how do you assess whether somebody is going to want to use something or not? How do you have that conversation? So we'll actually have a script. How do you choose what tool for somebody to use? We actually have all this details. 

Hey, is there any research that supports any of this? Oh, I've got that, too. Hey, does any-- how will I prescribe? What's the prescription process like for a virtual care tool? Got that too. As well as ethical legal considerations and cultural considerations. So I break it down like that. Introducing apps or introducing virtual care. Same thing. And prescribing and on and on. 

And also through here, you'll hear veterans veterans. But honestly, it doesn't matter. Just insert patients. It doesn't matter. People think that those are very different. But you can even insert people because that's the same thing. We're all people trying to learn. 

Let's go to the next slide. And these are also tools that are available for you. It's interesting. We have a clinician's guide and we have a prescription pad. So the clinician's guide has all together. All on the front side has all the-- has different categories of symptoms that people have. 

Most people say, hey, are there any apps for sleep? Are there any apps for cancer? Are there-- on and on and on. And I'm not tracking. This is just VA runs. But because I'm not going to promote non-federal government apps, although there's some wonderful ones out there. 

But this lays it out in a very clear way. And then also, hey, what apps for sleep are available on iOS? What apps for sleep are available on iOS that don't require a login? And it's got all the information on one side or on one piece. 

Then on the back side, it all organized by functionality. And often people say, well, what tools can I use to secure message my provider? Well, we have it. By that, I want a secure message somebody. Hey, I want to get automated text messages. I want to pay a bill or something, whatever it may be. And so I have it by functionality on the back. So that is a clinical decision support tool for staff to work through, walk through with patients. 

Next thing that's really important is a prescription pad. And so that involves communication with the patient shared decision process of hey, these are what's available. What are we agreeing upon together that you're going to use? Let's go to the next slide. 

We started building those prescription pads and things like that in the DOD back in like 2012. And there they were so popular. People love them. But what the most common question I get is, hey, can you make a prescription pad for pain? Can you make a prescription pad just for sleep? Can you make it just for-- and sounds like a great idea. 

And so I started to do that. Honestly, it's a horrible idea. It takes about if you work for the federal government, sometimes it takes six months just to create one flier and then you got to keep it forever. And it's a big mess. 

Let alone, if you ask, if I asked hundreds or even just 10 sleep experts, what are the top five apps that you use, they'll be all different. So instead of making a prescription pad for oncology and nutrition and pain, which I've done, I said you know what, let's think outside the box. 

Let's actually create a tool that allows staff or people or whoever this is open to public. You all can use it to create your own prescription pad with Minneapolis. So that is this back end feature that is accessible to the public. So you can just customize that all you want. It is specific to-- well, there's probably some non VA apps but mostly VA apps. Let's go to the next slide. 

So you may be going OK great. Virtual University eight days. That's a lot. Virtual Resource Centers. Maybe you have one near, you maybe you don't. But many people love to learn by short videos. So I have about 30 to 50 of these, but these are some of the top ones I think that people will go, oh, my gosh, this is exactly what I need. 

So we have intro to virtual care. We have what about virtual care for sleep, virtual care for well-being, virtual care for diabetes, on and on and on. And we have all these different short and these are all on YouTube. So they're available for anyone to use. Next slide. 

Another thing challenge that staff have is sharing this information with others. You need some swag. I know that sounds silly, but you do. You need your swag. And so we created a free site for people to go and be able to order. Order we pay, but the people-- and then you can just have it shipped to your house. 

I just did this. I have a whole box of materials. I'm going to have an in-person event that I'll be going to in about a month. And so then I've got all my lanyards and cards and pins and swag to be able to share. And the integrals increase information that these things exist. So it's a win-win. People love swag, and people increase awareness as we go. 

Another way that-- let's go to the next slide. Another way people love to learn, this is one of my favorite ways to learn, are podcasts. These are free accessible to anybody. And here are four fantastic ones. I want to highlight, Let's Talk Digital Health. That is a video podcast as well as just an audio podcast. HealthCast I think is similar fantastic. PTSD Bytes is actually built by all the people, all the VA apps that you know and love. 

Mindfulness coach, PTSD coach, pain coach, those people are actually part of the VA's National Center for PTSD. So even though this is called PTSD Bytes because they have to-- because that's who they're paid under, they actually build all of these awesome apps. So that podcast is just really awesome. And they interview all these great people all across the VA and outside the VA. It's great talking about all these technologies. 

Next one is Next Generation Behavioral Health. This is a little bit older now. This is myself and Dr. Julie Kin. And when we were in the Department of Defense we were like, let's do 10 minute tips for integrating technology into clinical practice. And so we just and it's public. But you'll hear my voice in Dr. Kin's voice and she has just as much energy as me. So buckle up guys for exciting listen. Let's go to the next slide. 

Some of the key infrastructure that needs to be in place in a health system is help desk. Some things like that. So here are some of the help desks that we have in the VA for our VA products. So whether you're in VA or outside the VA, pro tip is program all those help desk phone numbers into all your phones. That's what I do. 

And so guess what? No matter what technology you're using, you're going to need help at a certain point. So not only do you want to decrease the frustration for yourself, but you also want to model that process for your patients and your colleagues. So if they ask you a question you don't know, you can say, hey, good question. Let's call the help desk. And you just. It's easy. You don't have to search around. You just want to decrease any barrier to any of that. Let's go to the next side and then the next side and then the next. 

Perfect. We are to the key takeaways. So the key takeaways for today are the healthcare workforce needs to be prepared for digital transformation. And really when it comes down to it all of the headquarters or central offices of healthcare systems, need to be creating the infrastructure to be able to support that those digital literacy needs. 

And with the rapid integration of telehealth, virtual care, health informatics, and so on, we really do need to be equipped with all the skills and knowledge and infrastructure to be able to navigate all these new technologies. And in a way that's not overwhelming. 

And through the development of effective systems and programs, we really can support the workforce to increase digital literacy and make sure that we're doing so in an evidence based manner. And with that, I will stop for any questions. 

Let's see. First question is, how is telehealth addressing the rural community health crisis? And is there a specific program designed for rural communities. 

That is a fantastic question. We have so many programs and-- even with all the programs that we have, it still isn't completely meeting the need, to be honest with you. Virtual Resource Centers, that's one piece of the big picture. Because they do aim to serve those rural communities. 

We also have several other programs. One is called Atlas. I can put the link in the chat, but we also have a digit in the VA. We have it's called a digital divide program, where those that are rural or don't have access to either broadband internet or a device, we provide those to the veterans that need those. That's one of the biggest pieces of this, is being able to make sure that they have all that equipment that they need. 

Also, it's very important, not just for rural veterans, but for veterans experiencing homelessness or fear of homelessness. That is a really important resource for them too. So we work directly with all the national groups that work with unhoused veterans. 

And so we-- but those are some of the many, many things. Telehealth in and of itself. I mean, as long as we can get them the access to the device and the broadband, then it really opens up not just their access to telehealth, but also access to every other resource. Now they can secure message, now they can manage their prescriptions, now-- and on and on and on. 

[INAUDIBLE] 

Exactly. We can hook them up with remote patient monitoring if that needs to happen with them. All of those we can send them equipment. And so we have a huge device equipment, logistics infrastructure in the VA to provide that. 

I love that. And unfortunately, in essence of time, it's one minute past the hour. I just want to share that there's a lot of gratitude and thanks in the chat for your presentation and your passion and your due diligence in this topic. So thank you very much.