How Innovation and Partnership are Ending Diabetic Limb Loss at VA

The Veterans Health Administration Innovation Ecosystem (VHA IE) is a leader in health care innovation, but it does not innovate alone. Using public-private partnerships, VHA IE draws in the best and brightest partners to solve challenges unique to the Veteran community. But what happens when an innovation shows value? How does VHA IE advance these promising solutions to change and save more Veteran lives?

VA’s groundbreaking partnership with Podimetrics is a great example. This partnership is led by Suzanne Shirley, VHA IE Director of Partnerships & Community Engagement and clinical social worker. The partnership, named The Initiative to End Diabetic Limb Loss at VA (TIEDLLV), supplies at-risk, diabetic Veterans with mats that use thermal imaging to measure the temperature of a Veteran’s foot. These mats can detect diabetic foot ulcers (DFUs) up to five weeks before they would normally present.

Veterans stand on the mat for 20 seconds each day, and their information is recorded and uploaded to the cloud. In the cloud, Podimetrics’ advanced artificial intelligence (AI) system analyzes it for signs of DFUs. The preliminary impact was positive, with reductions in hospital admissions and amputations.

Success, however, does not mean innovation like this stands still, and Shirley – alongside Podimetrics CEO, Jon Bloom, and VA National Podiatry Chief, Dr. Jeffrey Robbins – saw a way to make the system work better for both Veterans and VA.

A massive challenge, impacting thousands of Veteran lives

A DFU can very easily lead to an amputation or even death for a diabetic Veteran. The most at-risk Veterans face a 5-year mortality rate of 43% after developing their first DFU. With 25 percent of Veterans suffering from diabetes, DFUs are a major concern for VA. Last year, VA treated 75,000 DFUs, which accounted for more than 80% of non-traumatic amputations in VA, resulting in a cost of more than $3.2 billion.

Catching these foot ulcers early, before they are even visible, can save limbs and lives. It is why VA has worked aggressively to spread remote temperature monitoring as a standard practice. Through the creation of a national task force, Shirley tested and scaled the devices across VA. This task force completed exhaustive quality assurance (QA) chart reviews, research investigations, and educational sessions. The team also streamlined the purchasing guidelines and redesign of preventative care models.

“I saw countless Veterans lose their lives because of complications from diabetic foot ulcers,”said Shirley. “I knew we had to tackle this problem and find a solution. Once we saw the results from the use of remote temperature monitoring, we worked to make sure that it became a part of VA’s diabetic care.”

Still, the program had challenges that needed to be fixed for it to scale across VA.

Innovating and adapting to improve Veteran care

By moving from treatment to prevention, VA providers can spend more time when it matters most and improve patient outcomes while reducing their workload. Despite the promise of preventative, tech-enabled services, the challenge in scaling is adapting such systems to current VA care models. Without adaptation, a technical solution like this is unable to fall into existing infrastructure, restricting funding and access to this technology.

Through extensive research and collaboration, TIEDLLV began integrating into VA’s telehealth podiatry services. Thanks to this effort, the program is now at over 40 VA medical centers, with mats being prescribed to Veterans who are at the highest risk for amputation.

The results for Veterans are nothing short of staggering. Early QA data at participating sites has suggested that the Podimetrics system results in a near elimination of all severe ulcers, use of expensive graft product, and major amputations. In addition, hospitalizations dropped by 92%. The implications to diabetic Veteran care are dramatic.

As the program prepares to go national, VHA IE is engaging with partners to see how it can enhance and scale other impactful solutions to serve our Veterans. Through partnerships, VHA IE can combine the best of the private and public sectors to change and save Veterans lives.