dr. douglas rosendale
DESCRIPTION
VistA CPRS Value PropositionTRANSCRIPT
9th National Healthcare Conference
VistA CPRS Value PropositionMarch 19th, 2013
Dr Douglas E. Rosendale DO FACOS FACSSponsored by
A Transformation Roadmap
Healthcare Integration - (Clinicians and Patients) – Care team collaboration & patient interaction for Chronic Disease Management
Chronic Disease Management -health-related data between clinician patient and community care
Integrated health-related data within and between all participants
Derive value and intelligence to improve care quality and outcomes and to curb costs
Digitise clinical information on an individual within each care region or site
Electronic Medical Record system implementation(s)
Health Analytics – Actionable clinical & business insights
Money Follows the patient – Integrated patient/hospital/clinician information including financial
Advanced Clinical Decision Support – Evidence-based decision support
Deliver clinical and patient information to enhance patient care experiences and practitioner effectiveness
IT optimisation, modernisation and rationalisation
Existing transactional services to be delivered more efficiently and effectively
Healthcare Integration - (Clinicians and Patients) – Care team collaboration & patient interaction for Chronic Disease Management
Chronic Disease Management -health-related data between clinician patient and community care
Integrated health-related data within and between all participants
Derive value and intelligence to improve care quality and outcomes and to curb costs
Digitise clinical information on an individual within each care region or site
Electronic Medical Record system implementation(s)
Health Analytics – Actionable clinical & business insights
Money Follows the patient – Integrated patient/hospital/clinician information including financial
Advanced Clinical Decision Support – Evidence-based decision support
Deliver clinical and patient information to enhance patient care experiences and practitioner effectiveness
IT optimisation, modernisation and rationalisation
Existing transactional services to be delivered more efficiently and effectively
© 2012 IBM Corporation
History of VistA and Value in a National Federal Deployment
• Impetus• Process• Players• Challenges• Cross Agency Experience• Opportunities
“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
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….
“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
Organizational Culture
Every VA Medical Center has Electronic Health Records!
Agile Development with providers and developers!!!
Electronic Health Record
Computerized Patient
Record
System
VHA – CPRS Background• 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 is:
CPRS Clinical Reminders• CPRS Clinical
Reminders:– Time & Context
Sensitive – Acquire health data
beyond care delivered in VA
CPRS Clinical Reminders:– Contemporary
Expression of Practice Guidelines
– Reduce Negative Variation
– Create Standard Data for Orders and Documentation
CPRS Clinical Reminders
Retrieval of “Remote Data”
VistA Imaging
VistA Bar Code Medication Administration (BCMA)
VistA BCMA
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
My HealtheVet
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-CPRSTraining:
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
2000
CPRS Graphical User Interface V14
Character-based User Interface (CHUI)
2001
Remote Data View
2002
Federal Health Information Exchange (FHIE)
2008
Clinical Data Repository / Health Data Repository (CHDR)
2008 VeHU
Attendees could instantly network / exchange information through Radio Frequency Identification technology
Downloads of featured speaker presentations and podcasts available
Pay Now or Pay LaterBenefits
• 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 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
Quality Evidence
• 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
Success:A multi-disciplinary approach
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 • Development of standard
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
Measure, Measure, Measure
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
Questions