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Dr. Douglas Rosendale

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VistA CPRS Value Proposition

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Dr. Douglas Rosendale

  1. 1. 9 th National Healthcare Conference VistA CPRS Value Proposition March 19th, 2013Dr Douglas E. Rosendale DO FACOS FACS Sponsored by
  2. 2. A Transformation Roadmap © 2012 IBM Corporation
  3. 3. History of VistA and Value in a National Federal Deployment• Impetus• Process• Players• Challenges• Cross Agency Experience• Opportunities
  4. 4. “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
  5. 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. 6. 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
  7. 7. Organizational Culture
  8. 8. Electronic Health Record Every VA Medical Center has Electronic Health Records!Agile Development with providers and developers!!! Computerized Patient Record System
  9. 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. 10. CPRS Clinical Reminders• CPRS Clinical Reminders: – Time & Context Sensitive – Acquire health data beyond care delivered in VA
  11. 11. CPRS Clinical RemindersCPRSClinicalReminders:– Contemporary Expression of Practice Guidelines– Reduce Negative Variation– Create Standard Data
  12. 12. Retrieval of “Remote Data”
  13. 13. VistA Imaging
  14. 14. VistA BCMAVistA Bar Code Medication Administration (BCMA)
  15. 15. 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
  16. 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. 17. 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)
  18. 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. 19. 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
  20. 20. Quality Evidence
  21. 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
  22. 22. Success:A multi-disciplinary approach
  23. 23. Who owns VistA?Administration?Imaging?IT?Nursing?Pharmacy?Physicians?
  24. 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. 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. 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
  27. 27. Measure, Measure, Measure
  28. 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
  29. 29. Questions