Annie for Clinicians

Your VA medical facility and/or Health Care System will determine your access to the different views of Annie.

Depending on your staff user rights, Annie for Clinicians offers:

• Staff View – Find and register a patient, view and assign a health subscription, edit health subscriptions, review messages to and from a patient, see charts and tables of patient data.
• Admin View – Create and edit health subscriptions 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, 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, use 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 Search, 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 Health Subscriptions 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 Registration, and tap Annie Information and Disclosure Factsheet. 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 contact 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.

You may notice that some of the information in these sections is already pre-filled if the patient has self-registered to use Annie. However, you will still need to discuss consent with your patients for them to use the Health Subscriptions 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 health subscription is assigned to the patient and the consent/assignment noted in the medical record.

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 reviewed or read at all by the VA health care team.
• For urgent medical concerns, patients should call their VA health care team or 911. In crisis, dial 988 press 1.
• SMS text messages are not secure. Message and data rates may apply. Message frequency varies.
• For problems with Annie, or questions about Annie, text HELP. Text STOP to end participation.
• Collection of a patient's information by Annie is subject to federal law.
• Data patient shares with VA through Annie may be used for their healthcare, to better understand overall healthcare trends, for VA approved quality efforts, and for VA approved research.

Health subscriptions use templates that send to and collect information from your patient. Many health subscriptions can be accessed by any Annie for Clinicians’ user, so you can use health subscriptions other users have created. There are five types of health subscription templates:

• Vitals – The Vitals template is to request and receive readings from patient, such as blood pressure.
• Motivational/Educational – The Motivational/Educational template is to send messages to patients that do not request a response, but help motivate or educate patients, such as "It is time to take your medication."
• Categorical –  The Categorical template is to request and receive measurements and information from patients that are more qualitative than vital readings, such as mood over time.
• Yes/No –  The Yes/No template is to request and receive a response to yes/no questions, such as "Did you exercise today?"
• Scaled Response – The Scaled Response template is to 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.

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.

Submit a request for help creating new subscriptions to get started: dvagov.sharepoint.com/sites/vhaccvamobileannie/SitePages/Health-Subscription-Request.aspx#request-a-health-subscription 
 

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 health subscription. Whether the keyword is one of the below or created by the clinician, the spelling has to be EXACT.

You must be in Staff View to assign health subscriptions, and you can only assign health subscriptions to patients who are registered with Annie and who have not stopped health subscription messaging. First search and select the patient to whom you would like to assign a health subscription. Tap Assign New Health Subscription, and you will go to a list of health subscriptions that have already been created. Select the health subscription you would like to set up for your patient. Customize the health subscription as desired, and tap Assign. After tapping Assign, a pop-up Assign Health Subscription box will appear. You will automatically be the authorizing clinician. To change the authorizing clinician, tap Change, and search for and select the authorizing clinician. Tap the circle next to Yes if you would like to add the health subscription to a team. Tap the team from the list that appears. Tap Assign again, and a pop-up Success box will appear letting you know the health subscription has been assigned to the patient.

NOTE: Before you assign a health subscription, make sure the health readings information (e.g., blood pressure) requested is not already requested by another health subscription. If more than one health subscription asks for the same patient data, the duplicated data will not be properly tracked, and patients may be sent conflicting messages. For this reason, the system will not allow a clinician to assign a health subscription that collects a duplicate reading.

IMPORTANT: Please ensure that your patient understands the basics of the health subscription, such as benefits, content of messages (PHI, PII, condition) and consents to its use with the understanding of the CONSENT NOTE and SCOPE OF PRACTICE below. The patient’s informed consent to use Annie should be obtained each time a new subscription is assigned to the patient and the consent/assignment noted in the medical record.

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 Health Subscriptions features of Annie, otherwise they are limited to only receiving VA medical facility broadcast messages.

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 health subscription:

• 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 health subscription 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 health subscription, 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.

In Staff View, tap Audit Trail on the health subscription with a change history you would like to view. You will go to the health subscription’s Audit Trail screen. You will see an overview of the health subscription 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.

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.

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 health subscription. Whether the keyword is one of the below or created by the clinician, the spelling has to be EXACT.
 

Submit a request: dvagov.sharepoint.com/sites/vhaccvamobileannie/SitePages/BCM-Request.aspx   

The My Patients/Teams tab lists all the patients you are associated with. To access, tap the My Patients/Teams tab, and you will see three tabs:

• Flagged - Flag patients you view routinely for quick access and be able to see last reply to Annie.
• Associated – View all the patients you work with.
• Teams – View the teams you are associated with, as well as join/unjoin teams.

To add patients to your Flagged tab, tap the flag icon on the Associated Patients tab. To prioritize and order the patients on the Associated Patients tab, tap Flag, 1 or 2. The patients will be ordered with the flagged patients on top, then the ones marked as 1, then those marked as 2. You can change the sort order by tapping My Priority.

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 Hickam Field, Pearl Harbor.

More resources, such the POC directory, can be found on dvagov.sharepoint.com/sites/VHACCvamobileANNIE.  Internal resources, such as the Annie for Clinicians toolkit and other training resources, can be found on the Annie for Clinicians SharePoint site. VA network access is required to visit the Annie for Clinicians SharePoint site. If you need technical assistance with Annie for Clinicians, dial 866-651-3180 to speak with a VA representative.

To report a software or other Annie issue, call the VA help desk at 866-651-3180. Or, send an email (absolutely no PHI or PII please) to VHA_OCCHD@va.gov. For the best Annie experience, please ensure that your browser version is up to date.