3. History of VistA and Value in a
National Federal Deployment
• Impetus
• Process
• Players
• Challenges
• Cross Agency Experience
• Opportunities
4. “Veterans’ hospitals used to
be a byword for second-rate
care or worse. Now they’re
national leaders in efficiency
and quality. What cured
them? A large dose of
technology.” – Fortune
May 15, 2005
5. 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
6. 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
8. Electronic Health Record
Every VA Medical Center has
Electronic Health Records!
Agile Development with providers and
developers!!!
Computerized
Patient
Record
System
9. 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
10. CPRS Clinical Reminders
• CPRS Clinical
Reminders:
– Time & Context
Sensitive
– Acquire health data
beyond care
delivered in VA
15. My HealtheVet
VA’s 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
16. 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
17. The Evolution of VistA-CPRS
Training:
1997 Camp CPRS 2004 VistA eHealth 2008 VeHU
University (VeHU) Attendees could instantly
Prepared VISN Key Site personnel
for VistA CPRS network / exchange
More than 175 training sessions; 60
information through Radio
hands-on
FIVE attendees from each CPRS Frequency Identification
Key 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)
18. 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”
19. 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
21. 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
24. 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
25. 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
26. 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
28. 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
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/
