1. 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

2. Yesterday Today “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.” – FortuneMay 15, 2005

3. 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

4. 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

5. Organizational Culture

6. Every VA Medical Center has Electronic Health Records! Electronic Health Record Computerized Patient Record System

7. VHA – CPRSBackground 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

8. CPRS Clinical Reminders • CPRS Clinical Reminders: • Time & Context Sensitive • Acquire health data beyond care delivered in VA

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

10. Retrieval of “Remote Data”

11. VistA Imaging

12. VistA BCMA VistA Bar Code Medication Administration (BCMA)

13. 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

14. The Evolution of VistA-CPRS Training: User Interface: 1997Camp CPRS Prepared VISN Key Site personnel for VistA CPRS FIVE attendees from each CPRS Key Site 2004VistA 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 2008VeHU 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) Character-based User Interface (CHUI) 2000 CPRS Graphical User Interface V14 2001 Remote Data View 2002 Federal Health Information Exchange (FHIE)

15. 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……… +1,336,000each 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

16. Three Key Quality Measures

17. Quality Evidence

18. 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 Economic Benefits

19. Online Demo of CPRS Try a working copy of VA’s Computerized Patient Record System (CPRS) at www.va.gov/cprsdemo

20. Success:A multi-disciplinary approach

21. Who owns VistA? Administration? Imaging? IT? Nursing? Pharmacy? Physicians?

22. 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

23. 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

24. 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

25. Measure, Measure, Measure