Users are able to retrieve multiple types of patient data that is contained within electronic systems at other VA’s or even DoD. This example is viewing data for outpatient encounters are multiple facilities. Clinicians can view clinical data such as medication orders, lab results, images, consults,etc by using views for remote data retrieval.
The CACs created a national e-mail distribution list that contained the addresses of all the CACs and another that includes the names of support staff and developers as well. This opened a line of communication between all the coordinators as well as developers. The SharePoint site provides a place where CACs can upload and share locally developed documents, policies, procedures, data collection and reporting tools, etc. The SharePoint also contains a discussion board and is the primary mechanism for the to disseminate questionnaires directly to CACs. The web site provides a reference beyond the CACs because it is accessible to anyone within the VA firewall. Related directives, national policies, performance data, schedule for national conference calls, etc. have been placed on the site.We have monthly national conference calls for the CACs. During these calls, the development team provides updates on status of new software and there is always a presentation by a facility on a best-practice they have developed or education regarding new software releases. There is an annual conference dedicated to the CACs and clinical end-users that provides education, networking, and the ability for facilities to share their best-practices face-to-face.
Strategic goals 3 – 6 – Based on combined input from stakeholder groups, steering committees and users. Objectives - ( approximately 10 per strategic goal) Operational objectives designed to achieve the strategic goals.Performance Measure – ( approximately 10 per Objective) Quantifiable Measure or metrics Target Goal – What we want to achieve. All of the above are validated by all of the groups that helped to create the strategic goal. Run an example. Goal of the larger organization: Access/improved scanning/
9 th National Healthcare Conference VistA CPRS Value Proposition March 19th, 2013Dr Douglas E. Rosendale DO FACOS FACS Sponsored by
History of VistA and Value in a National Federal Deployment• Impetus• Process• Players• Challenges• Cross Agency Experience• Opportunities
“Veterans’ hospitals used tobe a byword for second-ratecare or worse. Now they’renational leaders in efficiencyand quality. What curedthem? A large dose oftechnology.” – Fortune May 15, 2005
Department of Veterans Affairs• Provides care to more than 5.6m veterans• 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
It is not the Technology…. It is the Culture….“Theyve adopted a culture of patient safety and quality that is pervasive. The centerpiece of that culture is VistA, the VAs much praised electronic medical- records system.”- Business Week July 17, 2006
Electronic Health Record Every VA Medical Center has Electronic Health Records!Agile Development with providers and developers!!! Computerized Patient Record System
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
CPRS Clinical Reminders• CPRS Clinical Reminders: – Time & Context Sensitive – Acquire health data beyond care delivered in VA
CPRS Clinical RemindersCPRSClinicalReminders:– Contemporary Expression of Practice Guidelines– Reduce Negative Variation– Create Standard Data
VistA BCMAVistA Bar Code Medication Administration (BCMA)
My HealtheVetVA’s personal health record,My HealtheVet:-Access to personal, secure,convenient and informedhealth information thatimproves their health-Encourages patients tobecome partners in theirhealth care-Online web portal launchednationwide in 2003.-Common references to MyHealtheVet since its launch:Pioneering… Innovative…Ambitious… AwardWinning-www.myhealth.va.gov
Massive Culture Shock• Paper to Digital change• New Work Flow• Data Entry Challenges• Performance issues• Sign On issues• Data Integrity Issues• Change Management/Training/ Education/Tech/User
The Evolution of VistA-CPRS Training:1997 Camp CPRS 2004 VistA eHealth 2008 VeHU University (VeHU) Attendees could instantly Prepared VISN Key Site personnelfor VistA CPRS network / exchange More than 175 training sessions; 60 information through Radio hands-on FIVE attendees from each CPRS Frequency IdentificationKey Site technology More than 1,450 physicians, User Interface: nurses, pharmacists, clinical Downloads of featured informatics support, and health speaker presentations and information management personnel podcasts available 2000 2001 2002 2008 Character- based CPRS Remote Federal Clinical Data User Graphical Data Health Repository / Interface User View Information Health Data (CHUI) Interface Exchange Repository V14 (FHIE) (CHDR)
Pay Now or Pay Later Benefits• Up front data entry vs. ease of access to all data• Stopped the paper chase• Clinician to Clinician “Multidisciplinary Note”• Performance Metric capture• Clinical Work Flow• Embedded “Business Rules”• Quality Outcome Monitor• Business Intelligence “Analytics”
VistA Use Through 12/08Documents (Progress Notes, Discharge Summaries, Reports) – +1.2 Billion…….. +760,000 each workdayOrders – +2.0 Billion…….... +1,046,000 each workdayImages – +1.0 Million……… +1,336,000 each workdayVital Sign Measurements – +1.4 Billion……… +811,000 each workdayMedications Administeredwith the Bar Code Medication Administration (BCMA) system – +1.1 Billion……… +620,000 each workday
Economic Benefits• The cost per patient has remained low and stayed steady for the VA since the system went digital.• By comparison, cost s for Medicare patients and the medical consumer price index have remained high
Who owns VistA?Administration?Imaging?IT?Nursing?Pharmacy?Physicians?
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
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
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
HIT Interoperability Movement• US Congressional Commitment• OSEHRA (Open Source Electronic Health Record Association)• iEHR VA/DoD• Office of National Coordinator HHS• Meaningful Use• Standards Based, Modular, Service Oriented Architecture• Value Based (V=Q/C)• International Collaborations• Simulation Test-Beds