U.S. flag

An official website of the United States government

Talk to the Veterans Crisis Line now
Skip to main content

Last updated

FLOW System (formerly FLOW3)

Share Print

The original design team, included physicians, prosthetists, purchasing, contracting, and administrative staff, who worked together to design a novel workflow to optimize the prosthetic limb care process, improve timeliness in care, employee satisfaction, and Veteran customer experience.

The FLOW system was designed to work alongside CPRS using custom software, including the FLOW Consult Comment© application and a web-based application. With support from Diffusion of Excellence as a 2017 VHA Shark Tank Competition winner, the FLOW team, expanded the practice to VISN 12 and started their journey to implement on a national scale. By 2021, the third version of the FLOW system, FLOW3, was an enterprise-wide solution; implemented in 142 facilities and benefiting over 15,300 Veterans.

In September 2023, the team launched FLOW4—an updated version designed to seamlessly integrate into the rollout of VA’s new electronic health record (EHR) system. FLOW4 is the culmination of years of Veteran and clinician feedback and provides greater transparency and access to prosthetic limb care.

This innovation is scaling widely with the support of national stakeholders. See more scaling innovations.

Origin:

January 2013, Seattle VA Medical Center

Adoptions:

157 successful

Awards and Recognition:

FedHealth IT Award, Gears of Government Winner, Igniting Innovation Award, QUERI Partnered Evaluation Initiative, VHA Shark Tank Winner

Partners:

Diffusion of Excellence, Quality Enhancement Research Initiative, VHA Innovators Network

Contact Team

Overview

Problem

Communication between clinical and purchasing staff lacked consistency leading to delays in processing prosthetic limb care for Veterans with limb loss.

Solution

Using human centered design with front line VA staff, we designed a communication strategy built with custom software using VA infrastructure to standardize the prosthetic limb care process at VA.

Results

The FLOW system, formerly FLOW3, has transformed prosthetic limb care at VA with improved timeliness and increased satisfaction with the process by staff and patients.

Metrics

  • By January 2024, the FLOW system had impacted the lives of over 28,000 Veterans with limb loss who were prescribed prosthetic limb care.

Diffusion tracker

Does not include Clinical Resource Hubs (CRH)

Statuses

AL: Birmingham VA Medical Center (Birmingham, Alabama)
  • Started adoption on 10/2020.
AL: Central Alabama VA Medical Center-Montgomery (Montgomery) AL: Central Alabama VA Medical Center-Tuskegee (Tuskegee)
  • Started adoption on 05/2020.
AL: Tuscaloosa VA Medical Center (Tuscaloosa)
  • Started adoption on 05/2020.
AR: Eugene J. Towbin Healthcare Center (North Little Rock)
  • Started adoption on 05/2020.
AR: Fayetteville VA Medical Center (Fayetteville, Arkansas)
  • Started adoption on 05/2020.
AZ: Bob Stump Department of Veterans Affairs Medical Center (Prescott) AZ: Carl T. Hayden Veterans' Administration Medical Center (Phoenix, Arizona) AZ: Tucson VA Medical Center (Tucson) CA: Bakersfield VA Clinic (Bakersfield) CA: Cypress Avenue VA Clinic (Cypress Avenue) CA: Fresno VA Medical Center (Fresno) CA: Jennifer Moreno Department of Veterans Affairs Medical Center (San Diego, California) CA: Jerry L. Pettis Memorial Veterans' Hospital (Loma Linda, California) CA: Loma Linda VA Clinic (Loma Linda Redlands) CA: Los Angeles VA Clinic (Los Angeles) CA: Martinez VA Medical Center (Martinez) CA: Modesto VA Clinic (Modesto) CA: Palo Alto VA Medical Center-Livermore (Palo Alto Livermore) CA: Palo Alto VA Medical Center-Menlo Park (Palo Alto Menlo Park) CA: Rancho Cucamonga VA Clinic (Rancho Cucamonga) CA: Richard A. Pittman VA Clinic (Stockton) CA: San Francisco VA Medical Center (San Francisco) CA: Sepulveda VA Medical Center (Sepulveda) CA: Tibor Rubin VA Medical Center (Long Beach) CA: West Los Angeles VA Medical Center (West Los Angeles) CO: Denver VA Medical Center (Denver) CO: Grand Junction VA Medical Center (Grand Junction, Colorado)
  • Started adoption on 05/2020.
CO: Jewell VA Clinic (Jewell) CO: Valor Point VA Domiciliary (Valor Point Domiciliary) CT: Newington VA Clinic (Newington) DC: Washington VA Medical Center (Washington, District of Columbia) DE: Wilmington VA Medical Center (Wilmington, Delaware) FL: Bruce W. Carter Department of Veterans Affairs Medical Center (Miami)
  • Started adoption on 05/2020.
FL: C.W. Bill Young Department of Veterans Affairs Medical Center (Bay Pines)
  • Started adoption on 05/2020.
FL: Daytona Beach VA Clinic (Daytona Beach) FL: Hidden River VA Clinic (Hidden River) FL: Jacksonville 1 VA Clinic (Jacksonville 1) FL: James A. Haley Veterans' Hospital (Tampa, Florida) FL: Lake City VA Medical Center (Lake City, Florida)
  • Started adoption on 05/2020.
FL: Malcom Randall Department of Veterans Affairs Medical Center (Gainesville)
  • Started adoption on 05/2020.
FL: New Port Richey VA Clinic (New Port Richey) FL: Orlando VA Medical Center (Orlando)
  • Started adoption on 05/2020.
FL: South Hillsborough VA Clinic (South Hillsborough) FL: Viera VA Clinic (Viera) FL: West Palm Beach VA Medical Center (West Palm Beach)
  • Started adoption on 05/2020.
GA: Carl Vinson Veterans' Administration Medical Center (Dublin)
  • Started adoption on 05/2020.
GA: Charlie Norwood Department of Veterans Affairs Medical Center (Augusta Downtown)
  • Started adoption on 05/2020.
GA: Joseph Maxwell Cleland Atlanta VA Medical Center (Atlanta, Georgia)
  • Started adoption on 05/2020.
HI: Spark M. Matsunaga Department of Veterans Affairs Medical Center (Honolulu) IA: Iowa City VA Medical Center (Iowa City, Iowa)
  • Started adoption on 05/2020.
ID: Boise VA Medical Center (Boise) IL: Bob Michel Department of Veterans Affairs Outpatient Clinic (Peoria) IL: Captain James A. Lovell Federal Health Care Center (North Chicago) IL: Danville VA Medical Center (Danville, Illinois) IL: Edward Hines Junior Hospital (Hines) IL: Evanston VA Clinic (Evanston, Illinois) IL: Freeport VA Clinic (Freeport) IL: Jesse Brown Department of Veterans Affairs Medical Center (Chicago, Illinois) IL: Marion VA Medical Center (Marion, Illinois)
  • Started adoption on 05/2020.
IL: Rockford VA Clinic (Rockford) IN: Marion VA Medical Center (Marion, Indiana) IN: Richard L. Roudebush Veterans' Administration Medical Center (Indianapolis, Indiana)
  • Started adoption on 05/2020.
KS: Dwight D. Eisenhower Department of Veterans Affairs Medical Center (Leavenworth)
  • Started adoption on 05/2020.
KS: Robert J. Dole Department of Veterans Affairs Medical and Regional Office Center (Wichita)
  • Started adoption on 05/2020.
KY: Franklin R. Sousley Campus (Lexington Leestown)
  • Started adoption on 05/2020.
KY: Robley Rex Department of Veterans Affairs Medical Center (Louisville)
  • Started adoption on 05/2020.
LA: Alexandria VA Medical Center (Alexandria, Louisiana)
  • Started adoption on 05/2020.
LA: New Orleans VA Medical Center (New Orleans)
  • Started adoption on 05/2020.
LA: Overton Brooks Veterans' Administration Medical Center (Shreveport)
  • Started adoption on 05/2020.
MA: Edward P. Boland Department of Veterans Affairs Medical Center (Central Western Massachusetts) MA: Jamaica Plain VA Medical Center (Jamaica Plain) MD: Baltimore VA Medical Center (Baltimore) ME: Togus VA Medical Center (Togus) MI: Aleda E. Lutz Department of Veterans Affairs Medical Center (Saginaw, Michigan)
  • Started adoption on 05/2020.
MI: Battle Creek VA Medical Center (Battle Creek)
  • Started adoption on 05/2020.
MI: John D. Dingell Department of Veterans Affairs Medical Center (Detroit)
  • Started adoption on 05/2020.
MI: Lieutenant Colonel Charles S. Kettles VA Medical Center (Ann Arbor)
  • Started adoption on 05/2020.
MI: Oscar G. Johnson Department of Veterans Affairs Medical Facility (Iron Mountain) MN: Minneapolis VA Medical Center (Minneapolis, Minnesota) MN: St. Cloud VA Medical Center (St. Cloud)
  • Started adoption on 05/2020.
MO: Harry S. Truman Memorial Veterans' Hospital (Columbia, Missouri)
  • Started adoption on 05/2020.
MO: John J. Cochran Veterans Hospital (St. Louis John Cochran)
  • Started adoption on 05/2020.
MO: Kansas City VA Medical Center (Kansas City, Missouri)
  • Started adoption on 05/2020.
MO: St. Louis VA Medical Center-Jefferson Barracks (St. Louis Jefferson Barracks)
  • Started adoption on 05/2020.
MS: Biloxi VA Medical Center (Biloxi)
  • Started adoption on 05/2020.
MS: G.V. (Sonny) Montgomery Department of Veterans Affairs Medical Center (Jackson, Mississippi)
  • Started adoption on 05/2020.
MS: Tupelo VA Clinic (Tupelo) NC: Charles George Department of Veterans Affairs Medical Center (Asheville)
  • Started adoption on 05/2020.
NC: Durham VA Medical Center (Durham)
  • Started adoption on 05/2020.
NC: W.G. (Bill) Hefner Salisbury Department of Veterans Affairs Medical Center (Salisbury)
  • Started adoption on 05/2020.
ND: Fargo VA Medical Center (Fargo)
  • Started adoption on 05/2020.
NE: Omaha VA Medical Center (Omaha, Nebraska)
  • Started adoption on 05/2020.
NH: Manchester VA Medical Center (Manchester) NJ: East Orange VA Medical Center (East Orange) NM: Las Vegas VA Clinic (Las Vegas) NM: Raymond G. Murphy Department of Veterans Affairs Medical Center (Albuquerque) NM: Silver City VA Clinic (Silver City) NV: Ioannis A. Lougaris Veterans' Administration Medical Center (Reno) NY: Bath VA Medical Center (Bath) NY: Buffalo VA Medical Center (Buffalo, New York) NY: Canandaigua VA Medical Center (Canandaigua) NY: Castle Point VA Medical Center (Castle Point) NY: James J. Peters Department of Veterans Affairs Medical Center (Bronx) NY: Margaret Cochran Corbin VA Campus (Manhattan) NY: Northport VA Medical Center (Northport) NY: Rochester Clinton Crossings VA Clinic (Rochester Clinton Crossings) NY: Samuel S. Stratton Department of Veterans Affairs Medical Center (Albany, New York) NY: Syracuse VA Medical Center (Syracuse) OH: Chalmers P. Wylie Veterans Outpatient Clinic (Columbus, Ohio)
  • Started adoption on 05/2020.
OH: Chillicothe VA Medical Center (Chillicothe)
  • Started adoption on 05/2020.
OH: Cincinnati VA Medical Center (Cincinnati, Ohio)
  • Started adoption on 05/2020.
OH: Dayton VA Medical Center (Dayton)
  • Started adoption on 05/2020.
OH: Louis Stokes Cleveland Department of Veterans Affairs Medical Center (Cleveland, Ohio)
  • Started adoption on 05/2020.
OK: Jack C. Montgomery Department of Veterans Affairs Medical Center (Muskogee, Oklahoma)
  • Started adoption on 05/2020.
OK: Oklahoma City VA Medical Center (Oklahoma City)
  • Started adoption on 05/2020.
OR: Klamath Falls VA Clinic (Klamath Falls) OR: Portland VA Medical Center (Portland, Oregon) OR: White City VA Medical Center (White City) PA: Butler VA Medical Center (Butler New Castle Road) PA: Coatesville VA Medical Center (Coatesville) PA: Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center (Philadelphia, Pennsylvania) PA: Erie VA Medical Center (Erie) PA: H. John Heinz III Department of Veterans Affairs Medical Center (Heinz) PA: James E. Van Zandt Veterans' Administration Medical Center (Altoona) PA: Lebanon VA Medical Center (Lebanon) PA: Wilkes-Barre VA Medical Center (Wilkes-Barre) PR: San Juan VA Medical Center (San Juan)
  • Started adoption on 05/2020.
RI: Providence VA Medical Center (Providence) SC: Ralph H. Johnson Department of Veterans Affairs Medical Center (Charleston, South Carolina)
  • Started adoption on 05/2020.
SC: Wm. Jennings Bryan Dorn Department of Veterans Affairs Medical Center (Columbia, South Carolina)
  • Started adoption on 05/2020.
SD: Royal C. Johnson Veterans' Memorial Hospital (Sioux Falls)
  • Started adoption on 05/2020.
TN: Alvin C. York Veterans' Administration Medical Center (Murfreesboro) TN: Jackson VA Clinic (Jackson, Tennessee) TN: James H. Quillen Department of Veterans Affairs Medical Center (Mountain Home, Tennessee)
  • Started adoption on 05/2020.
TN: Lt. Col. Luke Weathers, Jr. VA Medical Center (Memphis) TN: Nashville VA Medical Center (Nashville) TX: Audie L. Murphy Memorial Veterans' Hospital (San Antonio, Texas)
  • Started adoption on 05/2020.
TX: Dallas VA Medical Center (Dallas)
  • Started adoption on 05/2020.
TX: El Paso VA Clinic (El Paso) TX: Harlingen VA Clinic (Harlingen)
  • Started adoption on 05/2020.
TX: Michael E. DeBakey Department of Veterans Affairs Medical Center (Houston)
  • Started adoption on 05/2020.
TX: Olin E. Teague Veterans' Center (Temple)
  • Started adoption on 05/2020.
TX: Thomas E. Creek Department of Veterans Affairs Medical Center (Amarillo)
  • Started adoption on 05/2020.
UT: George E. Wahlen Department of Veterans Affairs Medical Center (Salt Lake City)
  • Started adoption on 05/2020.
VA: Hampton VA Medical Center (Hampton)
  • Started adoption on 05/2020.
VA: Richmond VA Medical Center (Richmond, Virginia) VT: White River Junction VA Medical Center (White River Junction) WA: American Lake VA Medical Center (American Lake) WA: Seattle VA Medical Center (Seattle) WI: Clement J. Zablocki Veterans' Administration Medical Center (Milwaukee, Wisconsin) WI: Madison West VA Clinic (Madison West) WI: Tomah VA Medical Center (Tomah) WV: Beckley VA Medical Center (Beckley) WV: Hershel "Woody" Williams VA Medical Center (Huntington, West Virginia) WV: Louis A. Johnson Veterans' Administration Medical Center (Clarksburg) WV: Martinsburg VA Medical Center (Martinsburg)

There are no in-progress adoptions for this innovation.

There are no unsuccessful adoptions for this innovation.

Multimedia

Images

The FLOW system, formerly FLOW3, creates excellent results for Veterans with limb loss. It has been implemented at 157 VA facilities, improved the lives over 28,000 patients, and continues to grow. This practice generates a 50% increase in productivity, from initial prescription to final prosthetic limb delivery and continues to contribute to the medical performance goal of “spreading innovation and best practices to modernize systems and optimize market area health systems.”

The story of the FLOW system begins and ends with the Veteran/ Provider relationship. Prosthesis prescription is entered through an easy-to-use template, with standard format and built-in codes, results in a consistent, clear, and thorough prescription.

The Prosthetist uses the Consult Comment Tool for Prescription coding. Easy application of codes eliminates need for back-and-forth with physician, outside vendors, and purchasing agents. It's easier to document the fabrication activity!

The web-based app is used by all staff involved with managing prosthetic limb care. Dashboards provide improved visibility and transparency and facilitate communication and workflow.

The FLOW system, formerly FLOW3, provides a faster process from prescription (Rx) to purchase order (PO) to limb delivery:• Rx to PO authorization reduced from 21.3 to 10.3 days (non-VA providers)• Variability in timeliness reduced 57%• Rx to limb delivery reduced 39-50%FLOW3 provides greater data transparency and accuracy with data mining related to:• Prosthetics• Veterans with limb loss• Current VA services and need for new services

The FLOW system, formerly FLOW3, improves communication, patient engagement, and continuity of care:• More Veterans returning to clinic, excited to receive their prosthetic limbs

Videos

Dr. Jeffrey Heckman speaks about the collaborative origins of the FLOW system, formerly FLOW3, and how it uses three custom-designed features to address issues with artificial limb authorizations.

Implementation

Timeline

  • Month 1
    Locate installed tools and familiarize yourself. Participate in training modules appropriate for your role
  • Months 2-12
    Early adoption of the system. Socialize with staff and communicate with FLOW3 team at FLOW3@va.gov with any questions

Departments

  • Administration
  • Purchasing and supplies
  • Education and training
  • Patient services

Core Resources

Resource type Resource description
PEOPLE
  • n/a

Files

Risks and mitigations

Risk Mitigation
Poor adoption may result from ineffective communication amongst team members Support Practice Champions with a pre-implementation readiness checklist to help identify pitfalls in their planning. Empower and support Practice Champions with official training materials.

Contact

Comment

Comments and replies are disabled for retired innovations and non-VA users.

Email

Email with questions about this innovation.

About

Origin story

Based on the challenges to consistently provide prosthetic limbs for Veterans, a team of VA staff in VISN 20 including physicians, prosthetists, prosthetics purchasing, contracting, and administrative staff worked together to understand the process. They recognized the need for accurate information on the initial consult and created prosthesis prescription ... Based on the challenges to consistently provide prosthetic limbs for Veterans, a team of VA staff in VISN 20 including physicians, prosthetists, prosthetics purchasing, contracting, and administrative staff worked together to understand the process. They recognized the need for accurate information on the initial consult and created prosthesis prescription templates and the FLOW system was born.

Original team

Dr. Jeffrey T. Heckman

Clinical Lead (Gold Status Fellow)

Jeff Bott

Technical Lead (Developer)

Wayne Biggs

Prosthetist (Coding and Template Lead)

Brian Stevenson

Diffusion of Excellence (Project Manager)

Carl McCoy

Diffusion Specialist