U.S Department of Veterans Affair
 
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Annie App for Clinicians

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Lock Icon - DS Logon Required Apps for Health Care Professionals that display a lock icon require VistA account credentials because they connect to the VA Electronic Health Record (EHR). 

If you are a member of a VA health care team, the Annie App helps you support Veterans as they engage in self-care. It allows you to assign protocols to your patients to help them with self-care by prompting them to track and submit health information. Messages from Annie are automated and condition-specific, and allow patients to reply and receive responses from the system. Annie also allows you to create motivational and educational messages to encourage patient wellness.

Features:

  • Request and receive health readings from patients, such as blood pressure, glucose, caloric intake and more
  • Patient responses to messages are stored in the Annie system – not sent directly to you – but you can view Veterans’ messages whenever you want
  • Enroll patients in protocols having automated messages from Annie, that include alerts patients will receive if their readings fall below or above pre-set thresholds
  • Create automated motivational and educational messages Annie sends to patients to encourage them to stay on track with their care plan and achieve their goals
  • Send messages on behalf of your VA medical facility to quickly reach groups of patients who have opted-in to receiving messages and updates from your VA medical facility
  • Certain authorized VA staff will have the ability to create protocols and send messages on behalf of their VA medical facility

Videos

The following video webinar series provides an overview of training for the Annie App for Clinicians. There are five sessions including:

Known Issues: 

Navigation

Please navigate using the controls within the Annie App itself, rather than the back and forward buttons of the browser. Using the browser buttons may cause unexpected results.

Section 508/Accessibility

The Annie App is not yet Section 508 compliant and will not work properly with Assistive Technology devices, such as a screen reader, needed for individuals with visual disabilities.

Appointment Reminders

Appointment reminders are not functioning currently.

App Bookmarks

The Annie App bookmark must be explicitly specified. To bookmark the Annie App, use the URL in the documentation provided. NOTE: Creating a bookmark when the app is at the login web page will lead to login errors.

Forward Slash (“/”)

If you copy data from MS Word to create or modify protocol messages, please ensure that fractions are displayed full size, such as 1/2, rather than in a smaller size, such as ½. In some cases, messages sent from Annie that contain the smaller size fractions do not display properly as an SMS text, such as 1?2.

Logout

When you log out of the Annie App, you will be taken to the VA Staff Launchpad where you can access other VA apps. In order to access the Annie App, please use the provided URL.

Staff View – Veteran Middle Initial Not Displayed in Summary Information

In the Veteran summary information (above the navigational tabs: Patient Search, Protocols, Message History and Reports), neither the Veteran’s middle name nor middle initial is populated. However, the Veteran’s Last Name, First Name, Social Security Number, Age and Gender are displayed in the summary to help you easily identify the patient.

Staff View – Veteran Middle Name Not Displayed in Patient Info of Account Web Page

In the Veteran’s personal information that appears in the Patient Info section of the Account web page, the Veteran’s middle name nor middle initial is populated. However, the Veteran’s Last Name, First Name, Social Security Number, Age, and Gender are displayed in the Patient Info section to help you easily identify the patient.

Staff View – Staff Registration of a Veteran Not Functioning

Currently, clinicians cannot register Veterans to use Annie. A Veteran must first self-register, then a clinician can consent the Veteran.

Staff View – Patient’s Summary Information is Partially Obscured:

On an Android tablet, the patient’s summary information is partially obscured when you rotate from Landscape to Portrait. Rotate your device to Landscape, and the issue will go away so that you can see all the data in the patient summary.

Staff View - Duplicate Mobile Phone Number Error Message

Annie will not allow the entry of a mobile phone number that is already in use by another Annie user. If a user attempts to save a duplicate mobile phone number, the system displays an error message. At the end of the message it reads “if you still have a problem, contact our Help Desk at XXXX.” Instead, the error message should provide the following phone number: (855) 500 2025.

Staff View – Account Settings – Appointment / Info Messages

Some medical facilities are not listed in the facility dropdown of this Web page. Unfortunately, you can only select from one of the facilities listed.

Admin View – Measurement Areas

When creating a vitals protocol and selecting a measurement area, some of the system-provided threshold values may be incomplete or inappropriate for the protocol’s target audience. Additionally, when creating a protocol and changing back and forth among measurement areas, some of the original edited values may still appear. You can work around this issue by reviewing all threshold values in the readings/alerts section and ensuring they are appropriate before saving the protocol for use (assignment) by others.

Admin View – Specified Days

Creating protocols that are only active for a week or less can cause an issue where the protocol never sends a message after being assigned in Staff View. This can occur if you specify in the template the day(s) the protocol should deliver its message, but when it’s assigned, the intended day(s) does not fall within bounds of the Start Date and End Date created in the template. You can work around this issue by specifying a protocol duration that lasts longer than one week.

Broadcast Admin View – Erroneous Validation Messages

In certain circumstances, validation error messages for the Start Date and End Date fields appear even though you have selected/entered appropriate values. Even if these messages appear, you should still be able to save a valid Broadcast message.

Broadcast Admin View – Erroneous Validation Messages Occurring that Stop Message Save

The extent of the problem is still being determined, but appears to stop you from saving the message in certain cases. If the issue arises, contact 1-855-500-2025 to report the problem.

Broadcast Admin View – Not Displaying all Messages in Certain Cases

If the time period for messages is limited to the current date, in some cases the VA Facility Broadcast Messages page does not display the associated messages. You can work around this issue by selecting a Start Date of one day earlier.

  • Staff View, Admin View, Broadcast Admin, System Admin and Facility Team Admin

    Staff View is used to register a patient, view and assign protocols, edit protocols, review messages to and from a patient and see charts and tables of patient data. Admin View is used to create and edit protocols that can be assigned to patients in Staff View. Broadcast Admin is used to send messages on behalf of your VA medical facility to all Veterans who are registered in Annie and opt in to receive messages from your VA medical facility. System Admin (only available to a limited number of users) is used to manage permissions for staff users, edit the response messages for Annie’s text commands (Help, Pause, Resume, Start, Stop), set default values for measurements and create new measurement readings. Facility Admin View is used to add and edit team at facilities. (only available to a limited number of users).

  • Search for Patients

    In Staff View, easily find patents by last name, social security number or first initial of last name and last four digits of social security number. 

  • Register Patients

    In Staff View, consent and register patients with Annie so they can receive messages from Annie that are specific to them.

  • Create Protocols

    In Admin View, create protocols that prompt patients to send messages about their health to Annie.

  • Assign, View & Edit Protocols

    Once inside the Patient Record in Staff View, view the audit trail to see all changes, adjust patients' account settings and edit, enable and disable protocols.

  • Message History

    Once inside the Patient Record in Staff View, see the messages exchanged between Annie and your patient.

  • Health Reports

    Once inside the Patient Record in Staff View, see charts and tables of health information based on the readings a patient has sent to Annie.

  • Broadcast Medical Facility Messages to Veterans

    Send messages on behalf of your VA medical facility to all patients who have subscribed to messages from your VA medical facility.

  • Manage Staff Permissions

    In System Admin you can manage permissions for staff users, edit the response messages for Annie’s text commands (Help, Pause, Resume, Start, Stop), set default values for measurements and create new measurement readings.

The Department of Veterans Affairs’ (VA) Annie mobile application (app) is a Short Message Service (SMS) text messaging capability that promotes self-care for Veterans enrolled in VA health care. Patients using Annie receive automated prompts to track and monitor their own health and motivational/educational messages. Annie can also send messages from the patient’s local VA medical center. NOTE: Annie is for patient self-care and not for direct texting between Veterans and staff.

The Annie App for Clinicians allows clinicians to use and create care protocols that allow patients to easily submit their health readings back to Annie. Messages and patients’ data is stored in the Annie system where clinicians can view the texts and readings as needed.
The Annie App for Clinicians is intended to help clinicians (nurses, physicians, pharmacists, social workers and others) reach and support Veterans as they engage in self-care. It allows members of VA health care teams to create and use care protocols, allowing patients to easily submit their readings back to Annie. Messages and patients’ data is stored in the Annie system where members of VA health care teams can view the texts and readings as needed.
Depending on your staff user rights, the Annie App for Clinicians offers five functions:

  • Staff View – Find and register a patient, view and assign a protocol, edit protocols, review messages to and from a patient, see charts and tables of patient data
  • Admin View – Create and edit protocols assigned to patients in Staff View
  • Broadcast Admin View – Send messages on behalf of your VA medical facility to all Veterans who subscribed to messages from your VA medical facility
  • System Admin – Manage permissions for staff users, edit the response messages for Annie’s text commands, create and set default values for measurement readings
  • Facility Team Admin – Create and edit facility teams
The Staff View is available to all users. You may also have Admin View, Broadcast Admin, System Admin and/or Facility Team Admin privileges.
Your VA medical facility and/or Health Care System will determine your access to the different views of the app.
Depending on your staff user rights, the Annie App for Clinicians offers:

  • Staff View – Find and register a patient, view and assign a protocol, edit protocols, review messages to and from a patient, see charts and tables of patient data.
  • Admin View – Create and edit protocols assigned to patients in Staff View.
  • Broadcast Admin (Only certain staff members designated by the facility will have Broadcast Admin rights) – Send messages on behalf of your VA medical facility to all Veterans who are registered in Annie and opt in to receive messages from your VA medical facility.
  • System Admin (only available to a limited number of users) - Manage permissions for staff users, edit the response messages for Annie’s text commands (Help, Pause, Resume, Start, Stop), set default values for measurements and create new measurement readings.
  • Facility Team Admin (only available to a limited number of users) - Create and edit facility teams.
The Staff View is available to all users. You may also have Admin View, Broadcast Admin, System Admin and/or Facility Team Admin privileges.
If you are able to access Admin View, Broadcast Admin, System Admin and/or Facility Team Admin, you can switch among them by tapping the greeting that says, “Welcome, [Your First Name].” A drop-down menu will appear, and tap one of the potential opposing views: Switch To Admin View, Switch To Staff View, Broadcast Admin, System Admin or Facility Team Admin.
In Staff View, there are two ways to search for a patient: use the Patient Search bar at the top of the screen, or the Patient Search tab. Enter patient last name, full social security number in the format of XXX-XX-XXXX or first initial of last name and last four digits of social security number in the search bar. Tap Go, and a list of patients who match your search will appear. Tap the patient you would like to view, and you will go to the patient’s Protocols screen. The patient’s name and additional identifying information will always display at the top of the screen in Staff View as you switch among the five tabs.
To register a patient, you must be in Staff View and have searched for and selected the patient you would like to register. If you are not at the Patient Registration screen, tap Edit Account Settings under the patient name at the top of the screen, and you will go to an Account screen. On the Account screen, tap the Consent to Participate tab, and tap Annie Information and Disclosure Factsheet. A pop-up box with background information about Annie, patient responsibilities and risks will appear. Read over the information, and provide an overview to your patient to make sure he/she understands and consents to the Annie messaging service (see CONSENT NOTE below). Tap Dismiss to close the box. Tap the checkbox next to “Patient-Provider Informed Consent Discussion Occurred” to confirm the patient understands and agrees to participate in Annie.

CONSENT NOTE: As part of receiving your patient’s Consent to Participate, please ensure that your patient understands and agrees to the following:
  • Using Annie is voluntary and is designed to support patient self-care.
  • Annie messages are automated and not regularly monitored by the health care team.
  • Annie is not the right place to ask for help. Patients should call their health care teams directly with health concerns.
  • SMS text messages are not secure and there could be costs for sending and receiving texts.
  • Collection of a patient’s information by Annie is subject to federal law.
  • Sending Start and Stop begins and ends participation in the program.
When complete, please note the patient’s participation in the medical record. You may notice that some of the information in these sections is already filled out if the patient has self-registered to use Annie. However, you will still need to discuss Consent with your patients in order for them to use the Protocols features of Annie, otherwise they are limited to only receiving VA medical facility broadcast messages.

IMPORTANT: While the checkbox is only selected once, the patient’s informed consent to use Annie should be obtained each time a new protocol is assigned to the patient and the consent/assignment noted in the medical record.

SCOPE OF PRACTICE NOTE: With regard to Scope of Practice considerations, only licensed clinicians, such as the following, practicing within the licensure that they hold may solicit verbal consent from a patient to assign a protocol:
  • Licensed Practical Nurses (limited)*
  • Nurse Practitioners
  • Pharmacists
  • Physicians
  • Physician Assistants
  • Registered Dieticians
  • Registered Nurses
  • Social Workers
  • Therapists
  • Licensed clinicians are responsible for abiding by their relevant State Practice Act and any laws governing their profession and applicable to their location.
  • *An LPN can obtain informed consent, if the protocol is ordered by a physician, registered nurse, or other appropriate clinician, and if the state in which the LPN is practicing allows it.
  • A clinician need not be in the Annie system when obtaining a patient’s consent. If another team member will complete enrollment and assignment of a protocol, then the licensed clinician should create an order in CPRS (the medical record) to initiate.
  • All clinical team members can review responses sent to Annie from VA patients.
As part of receiving your patient’s Consent to Participate, please ensure that your patient understands and agrees to the following:

  • Using Annie is voluntary and is designed to support patient self-care.
  • Annie messages are automated and not regularly monitored by the health care team.
  • Annie is not the right place to ask for help. Patients should call their health care teams directly with health concerns.
  • SMS text messages are not secure and there could be costs for sending and receiving texts.
  • Collection of a patient’s information by Annie is subject to federal law.
  • Sending Start and Stop begins and ends participation in the program.
When complete, please note the patient’s participation in the medical record.
Protocols use templates that send to and collect information from your patient. Many protocols can be accessed by any Annie App for Clinicians’ user, so you can use protocols other users have created. There are five types of protocol templates:

  • Vitals – Request and receive readings from patients, such as blood pressure. You will have the option for designating the lowest and highest valid readings for patients, as well as low level, critical low level, high level and critical high level readings that fall within the thresholds you set but are still of concern in the Reading/Alerts section of the Vitals template. Patients will receive alerts if their readings fall into these categories, if their readings are rising or falling rapidly or the repeat alert type and occurrence is reached. Because readings do NOT trigger alerts to a VA clinician or health care team, make sure all patient-facing alerts are clinically relevant and that the alert messages you create are easily understandable to your patient. Please ensure your patient understands that alerts will not trigger care team action and knows what to do if a reading invokes an alert. NOTE: Additional messages to the patient may be triggered depending on the patient response.
  • Motivational/Educational – Send messages to patients that do not request a response, but help motivate or educate patients. NOTE: Pre-drafted Motivational/Educational messages are not built into Annie; you will need to write messages or edit a protocol that has already created motivational/educational messages.
  • Categorical – Request and receive measurements and information from patients that may be more qualitative than vital readings, such as mood over time. You can designate accepted responses, and whichever response a Veteran chooses will invoke a specific response from Annie (e.g., acknowledging that a Veteran is “happy” or “sad”). NOTE: Additional messages to the patient may be triggered depending on the patient response.
  • Yes/No – Request and receive a response to yes/no questions, such as “did you exercise today?” NOTE: Additional messages to the patient may be triggered depending on the patient response.
  • Scaled Response – Request and receive a numeric response to a question, such as asking the patient to rank their pain on a scale of one to ten. You can designate a value for the lowest and highest valid reading. NOTE: Additional messages to the patient may be triggered depending on the patient response.
NOTE: Messages sent to patients should NEVER reference Section 7332 information, which includes information pertaining to drug abuse, alcoholism or alcohol abuse, infection with the human immunodeficiency virus (HIV) or sickle cell anemia. VA’s approval to use the system is conditional on the exclusion of this information.
You can only create a protocol in Admin View (although you can edit an existing protocol in Staff View). Tap Add Protocol, and you will go to a Protocols screen. Type in the Protocol Name, Description and Focus Area (The Focus Area is like a tag that will help you categorize the protocol (e.g., blood pressure)). Tap Add a Template, and tap the template you would like to use (Vitals, Motivational/Educational, Categorical, Yes/No or Scaled Response). You can also add templates to the protocol by tapping Add a Template, and tapping the next template you would like to use.

After selecting the type of template, you will need to specify the name of the template. Please choose a meaningful name for the template as the patient will see this name in the Veteran facing side of the app. Next, complete the settings for the template. The format will depend on the type of template you selected. Tap the headings of the settings you may need to complete, which will expand the template details below. Set the details of the setting, usually by tapping to fill in a circle or to select an option from a drop-down menu. Tap Save, and a pop-up box will appear confirming that your changes have been saved. Tap OK, and you will be taken back to the Protocols screen.
Annie uses these keywords to know what kind of information the patient is sending. When a patient responds to a request from Annie to send in a reading (e.g., blood pressure measurement), the response MUST START with a keyword or abbreviation so that Annie understands the message. The letters can be upper or lower case, and you can create a keyword the Veteran will use when creating the protocol. Whether the keyword is one of the below or created by the clinician, the spelling has to be EXACT.

When Annie requests this information The patient must start the message response with
Blood Pressure BP or BLOOD
Pulse Oximetry (SpO2) or Oxygen level OX or OXYGEN
Blood Glucose or Sugar BG or GLUCOSE or SUGAR
Glucose Before Eating BGB or BEFORE
Glucose After Eating BGA or AFTER
Weight Loss WE or WEIGHT
Caloric Intake CAL or CALORIES
Amount of Exercise EXE or EXERCISE
Temperature TEMP
PulsePULSE
You must be in Staff View to assign protocols, and you can only assign protocols to patients who are registered with Annie and who have not paused or stopped protocol messaging. First search for and select the patient to whom you would like to assign a protocol. Tap Assign New Protocol, and you will go to a list of protocols that have already been created. Select the protocol you would like to set up for your patient. Customize the protocol as desired, and tap Assign.

IMPORTANT: Please ensure that your patient understands the basics of the protocol, such as benefits, content of the messages (PHI, PII, condition) and consents to its use. See the question about what my patient needs to know before consenting to use Annie, for a list of items your patient must understand to consent. As part of receiving a patient’s consent, please adhere to the SCOPE OF PRACTICE seen in the question of how to register a patient.

NOTE: Before you assign a protocol, make sure the health readings information (e.g., blood pressure) requested is not already requested by another protocol. If more than one protocol asks for the same patient data, the duplicated data will not be properly tracked, and the patient may be sent conflicting messages. For this reason, the system will not allow a member of a VA health care team to assign a protocol that collects a duplicate reading.
In either Staff or Admin View, tap Audit Trail on the protocol with a change history you would like to view. You will go to the protocol’s Audit Trail screen. You will see an overview of the protocol and the changes that have been made to it.
In Staff View, first search for and select a patient whose message history you would like to view. Then tap the Message History tab. You will see the details of the messages exchanged between Annie and your patient.
In Staff View, first search for and select a patient whose reports you would like to view. Then tap the Reports tab. Under Filters, tap the measurements under the Readings heading you would like to view. Tap the time frame for the data covered in the report for which you would like to view. A summary of the selected readings will be on the right including the lowest reading, the highest reading, the average and current readings and the number of days data was sent over the time period selected.

To see the data in graphical or table format, tap Combined Report (to view all measurements selected) or Reports next to a specific measurement. You will go to a graph of the selected data. Tap Table to view the data as a table and Chart to return to the graph from the table.
Facility Team Admin allows you to add and edit teams at facilities. Only certain staff members designated by the facility will have Facility Team Admin rights. To add a team, tap Add Team. Type in the team name and a brief description for the purpose of the team. You will be prompted to add team members and clinicians. Follow the steps to add team members, then tap Save to add the team or Cancel to return to the Add Teams screen without adding a team. To edit a team, tap the team you would like to view or edit. You can edit the team name, description and add or remove team members. Tap Save to save your changes.
You can change the information shown through the filter. To access the filter, tap filter. Adjust the chart’s parameters including: Readings (the measurements), Date Range (1w, 1m, 3m, 6m, 1y, All or the From and To boxes) and Navigator (shaded blue area with vertical and horizontal scroll bars).

The graph data shown in the chart depends on how you use the Date Range, and Navigator. Any one of these can be used to limit or expand the data shown.
While there are two reading parameters for a blood pressure reading: Systolic and Diastolic, there is only one message for each reading. Messages, therefore, should reference both parameters, as in the following example: “Your BP is very low. The top is 80 or less, or the bottom is 50 or less. Please contact your health care team about your BP. Thanks, Annie.”
The most likely reason Annie will reject your patient’s reading is because your patient did not use the proper keyword. Annie uses keywords to know what kind of information the patient is sending. When a patient responds to a request from Annie to send in a reading (e.g., blood pressure measurement), the response MUST START with a keyword or abbreviation so that Annie understands the message. The letters can be upper or lower case, and you can create a keyword the Veteran will use when creating the protocol. Whether the keyword is one of the below or created by the clinician, the spelling has to be EXACT.

When Annie requests this information The patient must start the message response with
Blood Pressure BP or BLOOD
Pulse Oximetry (SpO2) or Oxygen level OX or OXYGEN
Blood Glucose or Sugar BG or GLUCOSE or SUGAR
Glucose Before Eating BGB or BEFORE
Glucose After Eating BGA or AFTER
Weight Loss WE or WEIGHT
Caloric Intake CAL or CALORIES
Amount of Exercise EXE or EXERCISE
Temperature TEMP
PulsePULSE
In either Staff View or Admin View, tap the down-arrow under Actions, and tap Disable if the protocol is enabled, or tap Enable if the protocol is disabled from the drop-down menu that appears. A pop-up box will appear asking if you are certain you want to enable or disable the protocol. Type in the reason for the change, and tap OK.

NOTE: Once a protocol is disabled in Admin View, it cannot be assigned in Staff View.
Broadcast Admin allows you to send messages on behalf of your VA medical facility to all Veterans who are registered in Annie and have opted in to receive messages from your facility. To create a new broadcast message, go to Broadcast Admin view, and tap Add Message. Specify for what facilities you would like to send the message as well as a topic of interest if desired. Type in the title up to 40 characters (the title will not be sent as part of the message). Type your message up to 160 characters, and specify how often your messages should be sent. Tap Save, and then tap OK.
To set which members of staff have access to which views in Annie, you must have access to the System Admin view. From the System Admin view, tap Manage Staff, and tap the radio button next to where you would like to search for staff within Annie or Other VA Databases. Enter the last name of the staff member you wish to find. Tap Search, and a list of staff members who match your search will appear. Tap on the staff member you would like to view. Under Permissions, check the box next to Give Access, or uncheck the box to remove access to Broadcast View, Clinical (Admin) View or Facility Team Administration. If Clinical Administration is selected, a Protocol Creation Level drop-down will appear. Tap the bar under Protocol Creation Level, and tap the National, VISN or Facility. Tap Save, and a pop-up Success box appears that confirms the changes. Tap OK to return to the Manage Staff screen.
To have an additional protocol be sent to the Veteran based on a specific response from a previously sent protocol, under Schedule Settings for a template tap the drop-down menus next to Triggered by Template and Triggered by Reading to select the specific event that will invoke the chained template to send a message to the Veteran.
The Patient Summary tab provides you with all the patients that you consented and is a convenient way to view the patients you work with. To access the Patient Summary, tap Patient Summary, and tap the name of the patient and you will be taken to the protocols tab where you can see that patient’s protocols.
Annie is named after Lieutenant Annie G. Fox, the first woman to receive the Purple Heart for combat. She was Chief Nurse in the Army Nurse Corps at Hickman Field, Pearl Harbor.
More resources, such as a User Manual, Quick Start Guide and Slideshow, can be found on mobile.va.gov/app/annie-clinicians. To go to the site from the app, tap the Help tab at the top of the screen and tap the Training Materials hyperlink. If you need technical assistance with the Annie App for Clinicians, dial 1-844-482-6624 to speak with a VA representative. The Help Desk is open weekdays from 7 a.m. to 7 p.m. CT. For TTY assistance, dial 711.
You may experience technical glitches with the app as its undergoing field testing. If this happens, report the issue by calling 1-844-482-6624. Your feedback will help us improve the app before it is released nationally.

If you have technical trouble using this app, please contact the VA Mobile Health Help Desk for Veterans at (877) 470-5947 and VA Care Teams at (844) 482-6624, Monday through Friday 7 a.m. - 7 p. m. CT for TTY assistance, dial 711.

Help Desk
VA Care Teams: (844) 482-6624
Veterans: (877) 470-5947
Weekdays 7 a.m.-7 p.m. (CT)

Correspondence Address
VA Mobile Health
VHA Office of Connected Care (10P8), 375AA
U.S. Department of Veterans Affairs
810 Vermont Avenue, NW
Washington, DC 20420

Veterans
  • (877) 470-5947 (Weekdays 7am - 7pm CT)
VA Providers