FOCUSING UPON THE REAL MISSION

   The Growing Recognition of Telehealth:  Although relatively early in the legislative process, prior to their July 4^th recess the House of Representatives Appropriations Committee reported forth their recommendations for the Fiscal Year 2018 Department of Defense (DoD) appropriations bill including two provisions which should be of considerable interest to psychology.  "Technology Solutions for Psychological Health.  The Committee is encouraged by the Department's investment in technology that allows servicemembers access to behavioral health services, including videoconferencing platforms that can be delivered in both garrison and deployed locations.  However, it is imperative that all servicemembers are aware of the resources available to them and how to readily gain access to assistance when needed.  The Committee directs the Assistant Secretary of Defense (Health Affairs) to provide a report to the congressional defense committees not later than 90 days after the enactment of this Act that details a strategy for delivering tele-behavioral health services to servicemembers."

            The effective utilization of telehealth care is one of the Department of Veterans Affairs (VA) Secretary David Shulkin's personal priorities.  Under his leadership this spring the VA announced its top five priorities which included Suicide Prevention – Getting to Zero.  The number two priority was Improving Timeliness, highlighting the potential contributions of telehealth.  The VA reported having established 10 Tele-Mental health hubs and eight Tele-Primary Care hubs.  Forty-five percent of telehealth services are for rural veterans.  Overall, there were 2.14 million episodes of telehealth care provided to 677,000 Veterans, of which 336,000 were TeleMental health visits.

APA and the Association of State and Provincial Psychology Boards (ASPPB) have positioned psychology admirably to be responsive to this technological evolution.  Within the private sector licensure mobility is critical to the effective use of telehealth services.  Accordingly, we have been well served by the vision of Steve DeMers and his colleagues Alex Siegel, Janet Orwig, and Fred Millan in establishing the Interjurisdictional Compact (PSYPACT) and in gaining the support, in principle, of the APA Council of Representatives.  Linda Campbell, Jana Martin, and Fred served as co-chairs of the original joint APA/ASPPB/APAIT Task Force for Telepsychology Guidelines.

During her tenure as Interim APA CEO Cynthia Belar established the position of Director of Military and Veterans Health Policy and appointed Heather O'Beirne Kelly as its first director.  Heather has worked for APA for 19 years and has developed impressive relationships with the relevant Hill committees and VA and DoD psychology leadership.  Several years ago, she received the VA Psychology Leadership Advocacy Award at their annual convention.

In the spring of 2010, Katherine Kolacki, who was then a psychology resident for Ray Folen at the Tripler Army Medical Center, with a jurisdiction extending over 50% of the earth's surface, reported: "As a provider, I am excited about the future of behavioral health in the military.  Like most of the other providers, I was initially cautious about participating as my training and experience up to that point had been with patients in a face-to-face encounter.  I was unsure of my ability to make a reliable assessment without having my patient sitting next to me, and was fearful I might miss some nuance or non-verbal cue to signal an area of distress or discomfort.  However, I found the opposite to be true.  I was able to conduct a complete and thorough assessment without difficulty.  I found no significant difference – web cam, videoconferencing or face-to-face – in my ability to perform a clinical interview and take in all verbal and non-verbal information.  I also had a few clients tell me that they felt more comfortable admitting to experiencing difficulties by web cam or video conference.  For example, after an initial few minutes of denying current distress, one soldier I observed as avoiding eye contact began to open up.  He has used Skype while downrange to communicate with his family and friends and felt very comfortable using that form of communication."

The VA is the largest employer of psychology and advance practice nursing (APRNs).  As the next generation of mental (behavioral) health care providers actively utilize the unprecedented opportunities created by technology within the public sector (including the development of clinical apps), the private sector and its reimbursement systems will undoubtedly be responsive, as its beneficiary population will increasingly demand equivalent access.

For most of the past two decades, Marlene Maheu has been a telebehavioral health presenter at our APA conventions.  Her focus has been to clarify the legal and ethical issues related to using a variety of technologies in clinical practice.  She has trained more than 20,000 professionals from 60 countries in these issues, using both in-person and Internet-based, eLearning instructional formats.  "With more than 50% of hospitals and employers already delivering telehealth in the United States, telepractice has come of age.  A wide variety of evidence-based models now show efficacy on par with in-person assessment and treatment.  Study after study has also clearly documented strong client/patient satisfaction with telehealth services across disciplines (e.g. cardiology, pulmonology, oncology, behavioral care).  Surprisingly, the #1 barrier to telehealth currently is the uninformed, untrained practitioner.  The issues for behavioral professionals to consider in 2017 then are twofold: 1. When will we as a group recognize that telehealth is safe?  And, 2. When will we give serious consideration to the many legal and ethical telehealth strategies now available to better serve our client/patients through a range of technologies, and especially video conferencing.  If the technology we use daily is sophisticated enough to do our banking, manage our stock portfolios and monitor our vital signs, why should we avoid using it to deliver behavioral care?  Widespread training for clinicians is not only needed, but readily available."  At this year's APA convention Marleen will be leading a full day CE Telepsychology Best Practices workshop.

The Transition Process:  The House Appropriations Committee also expressed its concern regarding the transition process which military retirees often experience – an agenda which Walter Penk and Nate Ainspan have been stressing.  "Military Medical Professionals and the Department of Veterans Affairs.  The Committee remains concerned about the transition of separating servicemembers into civilian life, the difficulties they may face in securing employment, and the shortage of staff at the Veterans Health Administration.  The Committee encourages the Assistant Secretary of Defense (Health Affairs) to work jointly with the Department of Veterans Affairs to establish a program to encourage Department of Defense medical professionals to seek employment with the Veterans Health Administration when the individual has been discharged or released from service or is contemplating separating from service."  Again, VA Secretary David Shulkin appears to be in conceptual agreement as he addressed the critical importance of DoD-VA having interoperable Electronic Medical Records.  "At VA, we know where almost all of our Veteran patients are going to come from – from the DoD…."  Of further interest, the Health Resources and Services Administration (HRSA) reports that over the past two years 30% of the new hires by Federally Qualified Community Health Centers (FQHCs) have been Veterans.  Increasingly, health policy experts have been raising the underlying issue of the importance of addressing the unique military culture and its related health and employment consequences.  They have been urging all clinicians, in the public and private sectors, to begin by asking their patients whether they have ever served in the military.

Adopting Patient-Centered Policies:  Two of our colleagues who are actively engaged in the pharmacy profession have recently highlighted another intriguing evolution.  Karen Pellegrin, a psychologist on the faculty of the University Of Hawaii Daniel K. Inouye College Of Pharmacy in Hilo: "One major advance by the VA is that they are now sharing data with the national prescription drug fill query systems.  So when a community pharmacist or other non-VA clinician wants to know what meds a patient has (and so many patients use multiple pharmacies to fill different meds), the patient's VA-filled meds are included in the query results.  Kaiser is now the only one not participating…."  Lucinda Maine, Executive Vice President and CEO of the American Association of Colleges of Pharmacy: "Having a complete and accurate medication list is essential for safe patient care.  And the insights on actual patterns of medication use from an 'all sources' integrated Med history does literally save lives.  It would be even more powerful if recommendations from an AHRQ-funded project, led by pharmacist Dr. Gordon Schiff, were fully implemented.  His work addressed the benefits of and obstacles to including a Reason-for-Use indication on prescription orders.  This enhancement would improve patient education and the consumer's ability to manage their medication regimen."  Fundamental change is inevitable.  Aloha,

Pat DeLeon, former APA President – Division 42 – July, 2017

Sent from my iPhone

ALOHA - D42 column - July

FOCUSING UPON THE REAL MISSION

            The Growing Recognition of Telehealth:  Although relatively early in the legislative process, prior to their July 4^th recess the House of Representatives Appropriations Committee reported forth their recommendations for the Fiscal Year 2018 Department of Defense (DoD) appropriations bill including two provisions which should be of considerable interest to psychology.  “Technology Solutions for Psychological Health.  The Committee is encouraged by the Department’s investment in technology that allows servicemembers access to behavioral health services, including videoconferencing platforms that can be delivered in both garrison and deployed locations.  However, it is imperative that all servicemembers are aware of the resources available to them and how to readily gain access to assistance when needed.  The Committee directs the Assistant Secretary of Defense (Health Affairs) to provide a report to the congressional defense committees not later than 90 days after the enactment of this Act that details a strategy for delivering tele-behavioral health services to servicemembers.”

            The effective utilization of telehealth care is one of the Department of Veterans Affairs (VA) Secretary David Shulkin’s personal priorities.  Under his leadership this spring the VA announced its top five priorities which included Suicide Prevention – Getting to Zero.  The number two priority was Improving Timeliness, highlighting the potential contributions of telehealth.  The VA reported having established 10 Tele-Mental health hubs and eight Tele-Primary Care hubs.  Forty-five percent of telehealth services are for rural veterans.  Overall, there were 2.14 million episodes of telehealth care provided to 677,000 Veterans, of which 336,000 were TeleMental health visits.

APA and the Association of State and Provincial Psychology Boards (ASPPB) have positioned psychology admirably to be responsive to this technological evolution.  Within the private sector licensure mobility is critical to the effective use of telehealth services.  Accordingly, we have been well served by the vision of Steve DeMers and his colleagues Alex Siegel, Janet Orwig, and Fred Millan in establishing the Interjurisdictional Compact (PSYPACT) and in gaining the support, in principle, of the APA Council of Representatives.  Linda Campbell, Jana Martin, and Fred served as co-chairs of the original joint APA/ASPPB/APAIT Task Force for Telepsychology Guidelines.

During her tenure as Interim APA CEO Cynthia Belar established the position of Director of Military and Veterans Health Policy and appointed Heather O’Beirne Kelly as its first director.  Heather has worked for APA for 19 years and has developed impressive relationships with the relevant Hill committees and VA and DoD psychology leadership.  Several years ago, she received the VA Psychology Leadership Advocacy Award at their annual convention.

In the spring of 2010, Katherine Kolacki, who was then a psychology resident for Ray Folen at the Tripler Army Medical Center, with a jurisdiction extending over 50% of the earth’s surface, reported: “As a provider, I am excited about the future of behavioral health in the military.  Like most of the other providers, I was initially cautious about participating as my training and experience up to that point had been with patients in a face-to-face encounter.  I was unsure of my ability to make a reliable assessment without having my patient sitting next to me, and was fearful I might miss some nuance or non-verbal cue to signal an area of distress or discomfort.  However, I found the opposite to be true.  I was able to conduct a complete and thorough assessment without difficulty.  I found no significant difference – web cam, videoconferencing or face-to-face – in my ability to perform a clinical interview and take in all verbal and non-verbal information.  I also had a few clients tell me that they felt more comfortable admitting to experiencing difficulties by web cam or video conference.  For example, after an initial few minutes of denying current distress, one soldier I observed as avoiding eye contact began to open up.  He has used Skype while downrange to communicate with his family and friends and felt very comfortable using that form of communication.”

The VA is the largest employer of psychology and advance practice nursing (APRNs).  As the next generation of mental (behavioral) health care providers actively utilize the unprecedented opportunities created by technology within the public sector (including the development of clinical apps), the private sector and its reimbursement systems will undoubtedly be responsive, as its beneficiary population will increasingly demand equivalent access.

For most of the past two decades, Marlene Maheu has been a telebehavioral health presenter at our APA conventions.  Her focus has been to clarify the legal and ethical issues related to using a variety of technologies in clinical practice.  She has trained more than 20,000 professionals from 60 countries in these issues, using both in-person and Internet-based, eLearning instructional formats.  “With more than 50% of hospitals and employers already delivering telehealth in the United States, telepractice has come of age.  A wide variety of evidence-based models now show efficacy on par with in-person assessment and treatment.  Study after study has also clearly documented strong client/patient satisfaction with telehealth services across disciplines (e.g. cardiology, pulmonology, oncology, behavioral care).  Surprisingly, the #1 barrier to telehealth currently is the uninformed, untrained practitioner.  The issues for behavioral professionals to consider in 2017 then are twofold: 1. When will we as a group recognize that telehealth is safe?  And, 2. When will we give serious consideration to the many legal and ethical telehealth strategies now available to better serve our client/patients through a range of technologies, and especially video conferencing.  If the technology we use daily is sophisticated enough to do our banking, manage our stock portfolios and monitor our vital signs, why should we avoid using it to deliver behavioral care?  Widespread training for clinicians is not only needed, but readily available.”  At this year’s APA convention Marleen will be leading a full day CE Telepsychology Best Practices workshop.

The Transition Process:  The House Appropriations Committee also expressed its concern regarding the transition process which military retirees often experience – an agenda which Walter Penk and Nate Ainspan have been stressing.  “Military Medical Professionals and the Department of Veterans Affairs.  The Committee remains concerned about the transition of separating servicemembers into civilian life, the difficulties they may face in securing employment, and the shortage of staff at the Veterans Health Administration.  The Committee encourages the Assistant Secretary of Defense (Health Affairs) to work jointly with the Department of Veterans Affairs to establish a program to encourage Department of Defense medical professionals to seek employment with the Veterans Health Administration when the individual has been discharged or released from service or is contemplating separating from service.”  Again, VA Secretary David Shulkin appears to be in conceptual agreement as he addressed the critical importance of DoD-VA having interoperable Electronic Medical Records.  “At VA, we know where almost all of our Veteran patients are going to come from – from the DoD….”  Of further interest, the Health Resources and Services Administration (HRSA) reports that over the past two years 30% of the new hires by Federally Qualified Community Health Centers (FQHCs) have been Veterans.  Increasingly, health policy experts have been raising the underlying issue of the importance of addressing the unique military culture and its related health and employment consequences.  They have been urging all clinicians, in the public and private sectors, to begin by asking their patients whether they have ever served in the military.

Adopting Patient-Centered Policies:  Two of our colleagues who are actively engaged in the pharmacy profession have recently highlighted another intriguing evolution.  Karen Pellegrin, a psychologist on the faculty of the University Of Hawaii Daniel K. Inouye College Of Pharmacy in Hilo: “One major advance by the VA is that they are now sharing data with the national prescription drug fill query systems.  So when a community pharmacist or other non-VA clinician wants to know what meds a patient has (and so many patients use multiple pharmacies to fill different meds), the patient’s VA-filled meds are included in the query results.  Kaiser is now the only one not participating….”  Lucinda Maine, Executive Vice President and CEO of the American Association of Colleges of Pharmacy: “Having a complete and accurate medication list is essential for safe patient care.  And the insights on actual patterns of medication use from an ‘all sources’ integrated Med history does literally save lives.  It would be even more powerful if recommendations from an AHRQ-funded project, led by pharmacist Dr. Gordon Schiff, were fully implemented.  His work addressed the benefits of and obstacles to including a Reason-for-Use indication on prescription orders.  This enhancement would improve patient education and the consumer’s ability to manage their medication regimen.”  Fundamental change is inevitable.  Aloha,

Pat DeLeon, former APA President – Division 42 – July, 2017

 

 

OFF WE GO INTO THE WILD BLUE YONDER

            Signs of a Unified Federal Health Care System?  Those intrigued by the seeming inconsistencies which exist when reflecting upon the role of the federal government as a provider of health care should develop an appreciation for the importance of historical precedent, as well as the vision/responsibility of individual members of Congress and especially of Congressional Committees.  The professions of psychology and nursing often advocate for the holistic and psychosocial-environmental-cultural elements of health care, pursuant to the vision of the World Health Organization (WHO).  "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (1948)."  There is growing scientific evidence to support this orientation.  Those who appreciate the all-important nature of prevention should especially seek out federal programs prioritizing the "environment" in which health care is provided.

And yet, the Bureau of Indian Affairs and the Indian Health Service are in different federal departments.  The Food and Drug Administration is administratively located within the Department of Health and Human Services, while its budget is the responsibility of the Agriculture Appropriations subcommittee.   And, those interested in pursuing funding for developing women-in-technology STEM initiatives, especially for those residing in rural America, should consider seeking funding from the Department of Agriculture, where support for the nation's land-grant universities has long resided.  Elaine Foster, who had a wonderful career for over two decades as a USAF prescribing psychologist (RxP), has noted how she could still prescribe necessary psychotropic medications for her patients as a USAF civilian contractor in a DoD clinic, but not in the local VA clinic which was just across the parking lot.   "I could no longer prescribe to that same patient I'd been prescribing to while he or she was active duty.  The current VA restrictions are illogical….  Because New Mexico recognizes prescribing psychologists, I can now prescribe to our veterans, but only in New Mexico and only through a third party contractor….  This just does not make sense."

Prior to being confirmed by the U.S. Senate as the first non-Veteran Secretary of the Department of Veterans Affairs, Dr. David Shulkin served as the VA Under Secretary for Health.  In that capacity, in January 2017, he approved the unprecedented expansion of nursing practice within the VA, which is the largest employer of nurses and psychologists in the nation, as well as the largest health care system.  VA advanced practice registered nurses (APRN) (other than nurse anesthetists) now possess full practice authority, without the clinical oversight of a physician, regardless of State or local law restrictions, when working within the scope of their VA employment.  This includes taking comprehensive histories, providing physical examinations and other health assessment and screening activities, diagnosing, treating, and managing patients with acute and chronic illnesses and diseases.  APRNs can order laboratory and imaging studies and integrate the results into clinical decision making; prescribe medications; and make appropriate referrals for patients and families, etc.  "To achieve important Federal interests, including but not limited to the ability to provide the same comprehensive care to Veterans in all States… this section preempts conflicting State and local laws relating to the practice of APRNs…."

During its deliberations on the FY 2017 Appropriations Legislation [P.L. 115-31] the Appropriations Committees noted that: "Concerns remain with the progress being made by the Departments of Defense and Veterans Affairs to fully develop, procure, and deploy an interoperable electronic health record solution.  The two systems must be completely and meaningfully interoperable….  Given that full deployment of this new electronic health record is not scheduled until fiscal year 2022, the Department of Defense is expected to continue working on interim modifications and enhancements to the current system to improve interoperability in the near-term…."

            Notwithstanding Congress's generous timeframe, on June 5, 2017 Secretary Shulkin announced his decision on the next-generation Electronic Health Record (EHR) system for his Department.  "The health and safety of our Veterans is one of our highest national priorities.  Having a Veteran's complete and accurate health record in a single common EHR system is critical to that care, and to improving patient safety.  Let me say at the onset that I am extremely proud of VA's longstanding history in IT innovation and in leading the country in advancing the use of EHRs.  It was a group of courageous VA clinicians that began this groundbreaking work in the basements of VAs in the 1970's that led to the system that we have today, known as the Veterans Health Information Systems and Technology Architecture, or VistA….

"At VA, we know where almost all of our Veteran patients are going to come from – from the DoD, and for this reason, Congress has been urging the VA and DoD for at least 17 years – from all the way back in 2000 – to work more closely on EHR issues….  (T)he bottom line is we still don't have the ability to trade information seamlessly for our Veteran patients and seamlessly execute… with smooth handoffs.  Without improved and consistently implemented national interoperability standards, VA and DoD will continue to face significant challenges if the Departments remain on two different systems.  For these reasons, I have decided that VA will adopt the same EHR system as DoD….  It's time to move forward, and as Secretary I was not willing to put this decision off any longer….  Because of the urgency and the critical nature of this decision, I have decided that there is a public interest exception to the requirement for full and open competition in this technology acquisition….

"In many ways VA is well ahead of DoD in clinical IT innovations and we will not discard our past work.  And our work will help DoD in turn.  Furthermore VA must obtain interoperability with DoD but also with our academic affiliates and community partners, many of whom are on different IT platforms.  Therefore we are embarking on creating something that has not been done before – that is an integrated product that, while utilizing the DOD platform, will require a meaningful integration with other vendors to create a system that serves Veterans in the best possible way.  This is going to take the cooperation and involvement of many companies and thought leaders, and can serve as a model for the federal government and for all of healthcare….  This is an exciting new phase for VA, DoD, and for the country.  Our mission is too important not to get this right and we will."

            During her tenure as Interim CEO, Cynthia Belar established the position of APA Director of Military and Veterans Health Policy and appointed Heather O'Beirne Kelly to serve as the first director for this critical initiative.   Heather has worked for APA for nearly two decades and one of her top priorities is to facilitate the acceptance of appropriately trained prescribing psychologists (RxP) within the Department of Veterans Affairs.  She recently testified before the House of Representatives urging the adoption of a pilot RxP project, similar to that once contemplated by then-VA Secretary Anthony Principi under President G.W. Bush.  Will the clinical inappropriateness of Elaine's experiences become the catalyst for change – perhaps by the adoption of a national federal scope of RxP practice for psychology?  Thinking of the future, both DoD and VA have long been on the cutting-edge of effectively utilizing telehealth with excellent clinical results.

            Developing That All-Important Grass Roots Interest:  This summer I was invited to participate on a convention program entitled "Doing the Most for the Many: Psychological Scientists Who Inform Public Policies" at the 29^th annual convention of the Association for Psychological Science (APS) in Boston.  On our panel, which was the first of two, was Massachusetts State Representative Ruth Balser and APA's Elena Eisman (who previously served as executive director of MPA).  Approximately 4,500 colleagues attended the convention and their enthusiasm for the future was palpable, especially among the early career attendees.  Our panel provided a personal perspective from the state, association, and federal level.  On the second panel Elizabeth Gershoff passionately described her efforts, over a prolonged period of time, including testifying on the Hill, on behalf of our nation's youth.

            "Corporal punishment remains legal as a form of discipline in public schools in 22 states (and in private schools in 48 states).  APA has long opposed school corporal punishment, having passed a resolution calling for its end back in 1975.  After I briefed his Department of Education senior staff, the former Secretary of Education John King issued a statement in November, 2016 to Governors and state heads of education in which he urged states to end the use of corporal punishment in schools based on demonstrations of harm to children and on discriminatory use of corporal punishment against boys, black students, and students with disabilities.  In January 2017, Representative Alcee Hastings (D-FL) introduced H.R. 160, the Ending Corporal Punishment in Schools Act of 2017, that would tie state receipt of federal education funds to a ban on corporal punishment in public schools."  Solid scientific (or clinical) evidence, personal presence, and dedication over the long-term in the public policy process are critical.  There was considerable enthusiasm among the audience and both Ruth and Elena reported subsequent discussions with attendees who expressed a willingness to become personally involved as a result of their presentations.  "We live in fame, or go down in flame."  Aloha,

Pat DeLeon, former APA President – Division 55 -- June, 2017

 

Sent from my iPhone

Division 55 June column

“OFF WE GO INTO THE WILD BLUE YONDER”

            Signs of a Unified Federal Health Care System?  Those intrigued by the seeming inconsistencies which exist when reflecting upon the role of the federal government as a provider of health care should develop an appreciation for the importance of historical precedent, as well as the vision/responsibility of individual members of Congress and especially of Congressional Committees.  The professions of psychology and nursing often advocate for the holistic and psychosocial-environmental-cultural elements of health care, pursuant to the vision of the World Health Organization (WHO).  “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (1948).”  There is growing scientific evidence to support this orientation.  Those who appreciate the all-important nature of prevention should especially seek out federal programs prioritizing the “environment” in which health care is provided.

And yet, the Bureau of Indian Affairs and the Indian Health Service are in different federal departments.  The Food and Drug Administration is administratively located within the Department of Health and Human Services, while its budget is the responsibility of the Agriculture Appropriations subcommittee.   And, those interested in pursuing funding for developing women-in-technology STEM initiatives, especially for those residing in rural America, should consider seeking funding from the Department of Agriculture, where support for the nation’s land-grant universities has long resided.  Elaine Foster, who had a wonderful career for over two decades as a USAF prescribing psychologist (RxP), has noted how she could still prescribe necessary psychotropic medications for her patients as a USAF civilian contractor in a DoD clinic, but not in the local VA clinic which was just across the parking lot.   “I could no longer prescribe to that same patient I’d been prescribing to while he or she was active duty.  The current VA restrictions are illogical….  Because New Mexico recognizes prescribing psychologists, I can now prescribe to our veterans, but only in New Mexico and only through a third party contractor….  This just does not make sense.”

Prior to being confirmed by the U.S. Senate as the first non-Veteran Secretary of the Department of Veterans Affairs, Dr. David Shulkin served as the VA Under Secretary for Health.  In that capacity, in January 2017, he approved the unprecedented expansion of nursing practice within the VA, which is the largest employer of nurses and psychologists in the nation, as well as the largest health care system.  VA advanced practice registered nurses (APRN) (other than nurse anesthetists) now possess full practice authority, without the clinical oversight of a physician, regardless of State or local law restrictions, when working within the scope of their VA employment.  This includes taking comprehensive histories, providing physical examinations and other health assessment and screening activities, diagnosing, treating, and managing patients with acute and chronic illnesses and diseases.  APRNs can order laboratory and imaging studies and integrate the results into clinical decision making; prescribe medications; and make appropriate referrals for patients and families, etc.  “To achieve important Federal interests, including but not limited to the ability to provide the same comprehensive care to Veterans in all States… this section preempts conflicting State and local laws relating to the practice of APRNs….”

During its deliberations on the FY 2017 Appropriations Legislation [P.L. 115-31] the Appropriations Committees noted that: “Concerns remain with the progress being made by the Departments of Defense and Veterans Affairs to fully develop, procure, and deploy an interoperable electronic health record solution.  The two systems must be completely and meaningfully interoperable….  Given that full deployment of this new electronic health record is not scheduled until fiscal year 2022, the Department of Defense is expected to continue working on interim modifications and enhancements to the current system to improve interoperability in the near-term….”

            Notwithstanding Congress’s generous timeframe, on June 5, 2017 Secretary Shulkin announced his decision on the next-generation Electronic Health Record (EHR) system for his Department.  “The health and safety of our Veterans is one of our highest national priorities.  Having a Veteran’s complete and accurate health record in a single common EHR system is critical to that care, and to improving patient safety.  Let me say at the onset that I am extremely proud of VA’s longstanding history in IT innovation and in leading the country in advancing the use of EHRs.  It was a group of courageous VA clinicians that began this groundbreaking work in the basements of VAs in the 1970’s that led to the system that we have today, known as the Veterans Health Information Systems and Technology Architecture, or VistA….

“At VA, we know where almost all of our Veteran patients are going to come from – from the DoD, and for this reason, Congress has been urging the VA and DoD for at least 17 years – from all the way back in 2000 – to work more closely on EHR issues….  (T)he bottom line is we still don’t have the ability to trade information seamlessly for our Veteran patients and seamlessly execute… with smooth handoffs.  Without improved and consistently implemented national interoperability standards, VA and DoD will continue to face significant challenges if the Departments remain on two different systems.  For these reasons, I have decided that VA will adopt the same EHR system as DoD….  It’s time to move forward, and as Secretary I was not willing to put this decision off any longer….  Because of the urgency and the critical nature of this decision, I have decided that there is a public interest exception to the requirement for full and open competition in this technology acquisition….

“In many ways VA is well ahead of DoD in clinical IT innovations and we will not discard our past work.  And our work will help DoD in turn.  Furthermore VA must obtain interoperability with DoD but also with our academic affiliates and community partners, many of whom are on different IT platforms.  Therefore we are embarking on creating something that has not been done before – that is an integrated product that, while utilizing the DOD platform, will require a meaningful integration with other vendors to create a system that serves Veterans in the best possible way.  This is going to take the cooperation and involvement of many companies and thought leaders, and can serve as a model for the federal government and for all of healthcare….  This is an exciting new phase for VA, DoD, and for the country.  Our mission is too important not to get this right and we will.”

            During her tenure as Interim CEO, Cynthia Belar established the position of APA Director of Military and Veterans Health Policy and appointed Heather O’Beirne Kelly to serve as the first director for this critical initiative.   Heather has worked for APA for nearly two decades and one of her top priorities is to facilitate the acceptance of appropriately trained prescribing psychologists (RxP) within the Department of Veterans Affairs.  She recently testified before the House of Representatives urging the adoption of a pilot RxP project, similar to that once contemplated by then-VA Secretary Anthony Principi under President G.W. Bush.  Will the clinical inappropriateness of Elaine’s experiences become the catalyst for change – perhaps by the adoption of a national federal scope of RxP practice for psychology?  Thinking of the future, both DoD and VA have long been on the cutting-edge of effectively utilizing telehealth with excellent clinical results.

            Developing That All-Important Grass Roots Interest:  This summer I was invited to participate on a convention program entitled “Doing the Most for the Many: Psychological Scientists Who Inform Public Policies” at the 29^th annual convention of the Association for Psychological Science (APS) in Boston.  On our panel, which was the first of two, was Massachusetts State Representative Ruth Balser and APA’s Elena Eisman (who previously served as executive director of MPA).  Approximately 4,500 colleagues attended the convention and their enthusiasm for the future was palpable, especially among the early career attendees.  Our panel provided a personal perspective from the state, association, and federal level.  On the second panel Elizabeth Gershoff passionately described her efforts, over a prolonged period of time, including testifying on the Hill, on behalf of our nation’s youth.

            “Corporal punishment remains legal as a form of discipline in public schools in 22 states (and in private schools in 48 states).  APA has long opposed school corporal punishment, having passed a resolution calling for its end back in 1975.  After I briefed his Department of Education senior staff, the former Secretary of Education John King issued a statement in November, 2016 to Governors and state heads of education in which he urged states to end the use of corporal punishment in schools based on demonstrations of harm to children and on discriminatory use of corporal punishment against boys, black students, and students with disabilities.  In January 2017, Representative Alcee Hastings (D-FL) introduced H.R. 160, the Ending Corporal Punishment in Schools Act of 2017, that would tie state receipt of federal education funds to a ban on corporal punishment in public schools.”  Solid scientific (or clinical) evidence, personal presence, and dedication over the long-term in the public policy process are critical.  There was considerable enthusiasm among the audience and both Ruth and Elena reported subsequent discussions with attendees who expressed a willingness to become personally involved as a result of their presentations.  “We live in fame, or go down in flame.”  Aloha,

Pat DeLeon, former APA President – Division 55 -- June, 2017