CareOrbit Assess · Published VA evidence
eScreening across the VA: the engine behind Assess, tested in the open literature
The assessment approach behind CareOrbit Assess was developed at the VA in 2012 and studied in three peer-reviewed publications: a 1,372-veteran comparison against paper screening, a four-clinic implementation study, and a veteran satisfaction study. These are VA program results, cited as evidence for the approach Assess is built on.
Topline results
Electronic screening against paper
1,372 newly enrolling post-9/11 veterans in two cohorts: 795 screened on paper, 577 through eScreening, otherwise following the same enrollment process.
10.5 days
Faster into the record
Median time from screening to medical record entry fell from 10 to 11 days on paper to 1 day.
98–100%
Mandated screens completed
TBI, PTSD, depression, and alcohol screens all documented at 98.4 to 99.7%, against 89 to 93% on paper.
5×
Faster clinician follow-up
Median 1 business day from screening to Care Management follow-up, against 5 on paper.
19+
VA medical centers
Adopted by 2022 through VA Diffusion of Excellence, with 18 more adoptions in progress.
Pittman et al., Psychological Services, 2017. VA San Diego Healthcare System.
The full ledger
What the published studies measured
Each measure below is drawn from the peer-reviewed publications, cited by author and year.
Speed to the record
Time from screening to medical record documentation
Pittman et al., 2017
1 day
median with eScreening
10–11
days median on paper
Across the four mandated clinical reminders, eScreening moved results into the record the same day or next day. The average median time savings was 10.5 days per screen.
Completion
Documentation of mandated health screens
Pittman et al., 2017
98–100%
with eScreening
89–93%
on paper
Six-month chart review of TBI, PTSD, depression, and alcohol screens. Depression documentation reached 99.7% with eScreening against 93.0% on paper.
Connection to care
From screening into the health system
Pittman et al., 2017
1 vs 5
business days to clinician follow-up
More
specialty consults, faster vesting
eScreening veterans received more specialty clinic consults, attended their vesting appointment at a higher rate, vested into the health system faster, and had required suicide risk assessments documented significantly sooner.
Satisfaction
Veteran satisfaction with screening
Pittman et al., 2017; Almklov et al., 2020
Higher
than paper screening, 2017
High
satisfaction after redesign, 2020
Veterans were slightly more satisfied with eScreening than paper in the 2017 comparison. After user-centered improvements, a follow-up study found veterans highly satisfied with usability, information security, and impact on their care.
Detection
Did the medium change the answers?
Pittman et al., 2017
Similar
rates of positive health screens
Rates of positive screens were comparable between paper and electronic cohorts across nearly all measures, evidence that moving screening onto a device did not distort what patients report.
Honest scorekeeping
What the implementation study found, including the clinic that said no
A mixed-method study followed eScreening into four diverse VA clinics for six months. We cite the result as published, not just the flattering half. Pittman et al., BMC Health Services Research, 2019.
One clinic fully implemented, two partially implemented, and one did not adopt eScreening as part of normal practice after six months.
The technology posed no barriers in any of the four settings, as published. The barriers were staffing support and perceived leadership support.
Training and technical assistance were cited as the important facilitators, and organizational engagement scores tracked with implementation success.
Why we cite it: assessment programs succeed or fail on workflow fit, which is why Assess deploys from the workflow you already run rather than adding one.
What the paperwork costs at scale
A modeled projection, labeled as a model
An internal VA time-driven activity-based costing exercise projected what clinician-administered questionnaires cost across 130 VA medical centers each year. It is a projection from one site's inputs, not a measured national result.
$214M
Projected annual cost for providers and LPNs to administer questionnaires across 130 VA medical centers
910 + 650
Physician and LPN full-time equivalents projected to be consumed by questionnaire administration each year
106M
Projected physician minutes per year spent filling out questionnaires
Provenance
Where eScreening comes from
Built by clinicians inside the largest integrated health system in the United States, then spread facility by facility.
Origin
Built by VA clinicians, for VA clinics
Developed in 2012 at the VA Center of Excellence for Stress and Mental Health, VA San Diego, for the Military 2 VA care management program.
Veteran-facing by design: patients self-report on their own device or a clinic tablet, and responses flow directly into the VA electronic medical record, satisfying clinical reminders.
Recognition
Spread through the VA's own vetting
Named a Gold Status Practice by the VA Under Secretary of Health in 2016 and a Diffusion of Excellence Promising Practice.
Adopted at 19 VA medical centers by 2022, with 18 more adoptions in progress through the Diffusion of Excellence program.
Patented: the eScreening approach is covered by US Patent 12,683,023.
The published record
Three peer-reviewed studies
Pittman et al., 2017, Psychological Services: 1,372-veteran comparison of eScreening against paper screening.
Pittman et al., 2019, BMC Health Services Research: mixed-method implementation study across four diverse VA clinics.
Almklov et al., 2020, Military Medicine: post-9/11 veteran satisfaction with eScreening after user-centered redesign.
Go deeper
Get the summary, or talk it through
A summary of the published eScreening evidence and how it maps to CareOrbit Assess. Or bring your screening requirements and we will walk through what Assess could collect for you.
Download the eScreening summary
The published results and citations, in one document.