Before, public spaces softly rumbled with the bustle of human interaction. Now, those same places linger on an endless note of disquieting silence. Many have seen their homes gradually evolve into fortified islands of solitude, while our television screens act as windows to a seemingly bygone era, now that the world has been split into “before” and “after” the virus.
A tectonic shift is occurring on the front lines of our fight against COVID-19 as telemedicine – an innovation pioneered by the Department of Veterans Affairs – delivers an increasing share of medical services without the risks of transmission, allowing doctors and nurses to continue treating patients and saving lives across a broad spectrum of care.
However, new challenges have emerged as care is increasingly conducted from a safe distance and – despite the incredible capabilities of the VA’s telehealth program – the COVID-19 pandemic is still affecting the well being of America’s veterans in other ways.
With an emergency suspension of all outside visitation, hospitalized patients can find themselves in an environment even more solitary than those sheltering in their homes. For those with longer stays, even the familiar faces of caregivers become obscured behind protective equipment. But, for those unfortunate veterans fighting for their lives, the absence of friends and family can substantially increase the emotional burden of their struggle.
Seeing this, Dr. David Lin, the chief of health informatics at the Northport VA Medical Center, realized something must be done, and he began searching for a solution.
Dr. Lin arrived at an initial strategy to combat the relentless isolation imposed by the dangers of the COVID-19 pandemic. He envisioned deploying iPads to inpatient units so veterans could finally have face-to-face conversations with friends and loved ones via video chat apps. But, before he could test his idea, he would need to find a way to revive a fleet of aging iPads that had been given to the Medical Center.
“Originally, they were supposed to be given to veterans to get them online,” Lin said. “But, [we] found it a bit difficult because [we] had to create Apple IDs, and they didn't come with power-bricks and cables.”
Starting with 140 tablets, he went through the process of obtaining special funding to source the needed cables and power supplies. When they arrived, he tackled the process of establishing unique Apple IDs for each iPad and preparing them for their initial test run. Little did Lin know, his work was only beginning.
With the devices operational again, he discovered they were not compatible with the VA’s encrypted, medical Wi-Fi network, and would require multiple updates before they could be tested. However, Apple no longer provided support or updates for models that old – the last official update was in 2016 – and the project hit a dead end. Or, so it seemed.
Facing a problem with no clear solution, Lin reached out to an old friend, Bill Cerniuk. Cerniuk is the chief technology officer with the VA’s National Telestroke Program and the former technology director for the VA Mobile Program. If there was a way forward, Lin believed Cerniuk might have the answer.
Unfortunately, the high-end medical software that runs on the VA’s encrypted medical network requires incredibly strict security protocols. Altering the network to allow outdated and unpatched software was an impossibility. So, unless there was a way to update a model of iPad that Apple no longer supported, there would be no way to get the devices to function on the network.
Approximately one week before the sudden onset of the COVID-19 pandemic sent the United States into lockdown, Apple released a software update that broke the FaceTime compatibility between older iPads and newer devices. Cerniuk, having a 35 year long relationship with Apple, was able to reach out to the AppleCare Enterprise Support team, asking they expedite a correction to enable older iPads to help America’s veterans.
“The concept was not only using retired devices in an end-of-life modality,” said Cerniuk. “it was also making sure that older iPhones that veterans may have can be used in the same FaceTime telephone modality with any and all current iPads and iPhones.”
Seeing the value this capability would bring to veterans, the tech giant agreed to help. Apple engineering created a bespoke solution for the VA that not only provided the necessary updates, but ensured the devices met the strict security standards of the VA network. Incredibly, these two teams of dedicated individuals had found a way to reconnect veterans with their families during a time of unprecedented challenge to the American healthcare system.
Wasting no time, Cerniuk worked with Daniel Bloom, an information and technology specialist at the Northport VA Medical Center, to develop a model of turning the iPads into FaceTime Telephones to ensure both security and veteran ease-of-use. Then, to ensure they could be easily disinfected, Lin assigned each device a waterproof case and deployed them throughout the facility for testing, focusing on areas with the greatest need.
There is now one iPad Mini for every bed in the hospital's COVID-19 units and community living centers, minimizing the factors of isolation for veterans – especially those in a COVID-19 unit or in hospice care, for whom precious time with family is often the only thing that matters.
“It's a standard iPad, it's not hard. Anyone that knows how to use a regular iPad can use one,” said George Newell, a Northport, N.Y. native and Army veteran who served in Vietnam. “I would have had no way to communicate with the outside.”
Newell recently recovered from COVID-19 after spending two weeks intubated at the Northport VAMC. After intubation, Newell used one of the iPad Minis Lin refurbished to communicate with his son. He was also able to use it to facilitate appointments with specialists while in isolation, a function that has found substantial use inside the hospital during the outbreak. Now, Northport’s medical teams and consulting specialties have iPad Minis at their disposal, allowing them to minimize exposure to novel coronavirus while still providing treatment to veterans anywhere in the hospital.
This expanded use of these devices has already gained national attention within the VA, as other facilities begin to use Lin’s blueprint to establish similar programs. Much like the initial development of telemedicine, the VA continues to revolutionize the medical field, finding new solutions to the problems that accompany our “new normal”.
For more photos of this innovative solution, click here!
