Veterans Health Administration

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Veterans Health Administration
Health Information Technology in Clinical Practice
Linda Fischetti, RN, MS Chief Health Informatics
Officer Office of Health Information Department
of Veterans Affairs
Presentation to AAAS October 26, 2009
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Today
Yesterday

• Veterans hospitals used to be a byword for
  second-rate care or worse. Now theyre national
  leaders in efficiency and quality. What cured
  them? A large dose of technology.

Fortune May 15, 2005
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Department of Veterans Affairs

• Provided care to more than 5.6 veterans in 2008
• Diverse care settings
• 153 medical centers
• 745 outpatient clinics
• Many long-term care and home-based programs
• More than 7.8 million enrollees
• The Veterans Health Administration (VHA) has
  affiliations with 107 academic health systems
• Trains over 90,000 individuals annually in
  numerous clinical disciplines

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• It is not the Technology.
• It is the Culture.
• They've adopted a culture of patient safety and
  quality that is pervasive. The centerpiece of
  that culture is VistA, the VA's much praised
  electronic medical-records system.- Business
  Week July 17, 2006

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Organizational Culture
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Electronic Health Record

• Every VA Medical Center has Electronic Health
  Records!

Computerized Patient Record System
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VHA CPRS Background
CPRS is

• Single, integrated Computerized Patient Record
  System (CPRS) used throughout VA in all health
  care settings (Inpatient, Outpatient, Long-term
  care)
• Delivers an integrated record covering all
  aspects of patient care and treatment

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CPRS Clinical Reminders

• CPRS Clinical Reminders
• Time Context Sensitive
• Acquire health data beyond care delivered in VA

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CPRS Clinical Reminders

• CPRS Clinical Reminders
• Contemporary Expression of Practice Guidelines
• Reduce Negative Variation
• Create Standard Data for Orders and Documentation

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Retrieval of Remote Data
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VistA Imaging
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VistA BCMA

• VistA Bar Code Medication Administration (BCMA)

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My HealtheVet
VAs personal health record, My
HealtheVet -Access to personal, secure,
convenient and informed health information that
improves their health -Encourages patients to
become partners in their health care -Online web
portal launched nationwide in 2003. -Common
references to My HealtheVet since its launch
Pioneering Innovative Ambitious Award
Winning-www.myhealth.va.gov
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The Evolution of VistA-CPRS

• Training
• User Interface

1997 Camp CPRS Prepared VISN Key Site
personnel for VistA CPRS FIVE attendees
from each CPRS Key Site
2004 VistA eHealth University (VeHU) More
than 175 training sessions 60 hands-on
More than 1,450 physicians, nurses, pharmacists,
clinical informatics support, and health
information management personnel
2008 VeHU Attendees could instantly network
/ exchange information through Radio Frequency
Identification technology Downloads of
featured speaker presentations and podcasts
available
2008 Clinical Data Repository / Health Data
Repository (CHDR)
2000 CPRS Graphical User Interface V14
Character-based User Interface (CHUI)
2001 Remote Data View
2002 Federal Health Information Exchange (FHIE)
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VistA Use Through 12/08

• Documents (Progress Notes, Discharge Summaries,
  Reports)
• 1.2 Billion.. 760,000 each workday
• Orders
• 2.0 Billion.... 1,046,000 each workday
• Images
• 1.0 Million 1,336,000 each workday
• Vital Sign Measurements
• 1.4 Billion 811,000 each workday
• Medications Administered
• with the Bar Code Medication Administration
  (BCMA) system
• 1.1 Billion 620,000 each workday

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Three Key Quality Measures
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Quality Evidence
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Economic Benefits

• The cost per patient has remained low and stayed
  steady for the VA since the system went digital.
• By comparison, costs for Medicare patients and
  the medical consumer price index have remained
  high and are increasing.
• SOURCE The Washington Post, April 10, 2007

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Online Demo of CPRS

• Try a working copy of VAs Computerized Patient
  Record System (CPRS) at
• www.va.gov/cprsdemo

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SuccessA multi-disciplinary approach
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Who owns VistA?

• Administration?
• Imaging?
• IT?
• Nursing?
• Pharmacy?
• Physicians?

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When to start planning?

• As soon as you think about an EMR
• Policies and procedures
• Work flow issues
• Schedules
• Equipment decisions
• Training
• When to stop planning
• Never
• Updates
• Competencies

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VA Approach

• Clinical Application Coordinator (CAC) at each
  medical center
• POC for all CPRS related activities
• Work with Clinicians in the environment of use
• Decisions reported to Leadership
• Lessons Learned
• Decentralized approach to facilitate clinical
  adoption
• Central Program Office
• Development of policy
• Development of standard

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National Strategies

• National e-mail distribution lists
• SharePoint site
• Intranet web site
• Semi-monthly national conference calls
• Quarterly newsletter
• Annual conference
• Performance and accountability reports

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Measure, Measure, Measure
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