February/March 1998 1 Inside: Budget, 6 ✩ HR LINK$, 8 ✩ N.Y. RO Museum, 14

VAnguardU.S. DEPARTMENT OF VETERANS AFFAIRS

FEBRUARY/MARCH 1998

Acting VAActing VAActing VAActing VAActing VASecretarySecretarySecretarySecretarySecretaryOutlinesOutlinesOutlinesOutlinesOutlinesExpectationsExpectationsExpectationsExpectationsExpectationsFor VAFor VAFor VAFor VAFor VA

— page 3— page 3— page 3— page 3— page 3

Rep. Bob Stump, House Veterans' Affairs CommitteeChairman, and Acting VA Secretary Togo D. West, Jr.,right, on a break during budget hearings

2 VAnguard

Published by the Office of Public Affairs (80D)

Department of Veterans Affairs810 Vermont Ave., N.W.Washington, D.C. 20420

(202) 273-5738/5735

E-mail: vanguard@mail.va.gov

INTRODUCINGCCCCCONTENTSONTENTSONTENTSONTENTSONTENTS

Buckley Peterson

VAnguard VA’s Employee Magazine

February/March 1998 Vol. XLIV, No. 2

Printed on 50% recycled paper

Editor: Laurie TranterGraphics: Michael Nacincik

❏ Computer System Tops 4Patient record system rolled out

❏ Primary Care Expands 7Telecommunications involve Vet Centers

❏ Shared Service Center 8HR LINK$ starts at 12 sites

❏ Franchise Funds 11Pilot franchise funds make money

❏ Creative Arts Festival 13Tomah VAMC hosts sold-out show

❏ Medical Advances 15

❏ Have You Heard 16

❏ Honors 19

❏ Heroes 20

CCCCCOLUMNSOLUMNSOLUMNSOLUMNSOLUMNS

On The Cover:Photo by Michael Moore

When he decided to retire,Buckley Peterson could have just leftin 1997 and closed the book on hisVA career.

Instead, the counseling psycholo-gist from the Iowa VA RegionalOffice chose to “turn to a newchapter” and compile a volume onveterans who have benefited fromVA voc rehab and counseling. As aretired volunteer, he will continue towrite more accounts of veteranclients for the bookletto be used as a refer-ence for the VAVocational Rehabilita-tion and CounselingService.

“I liked the idea ofthese stories serving asa continuing testamentto the dreams, visionand determination ofthose veterans we areprivileged to serve,”Buckley said. “I wasoverwhelmed by thepositive response I gotfrom these veterans abouttheir lives following theirvoc rehab experiences.”

With the idea endorsed by JackHackett, VR&C officer, Buckleyinterviewed veterans, took photo-graphs and compiled his notes intoan informal book format. The 70veterans interviewed are representa-tive of the veteran population intypes of disability and degree ofseverity of symptoms. They rangefrom self-employed veterans market-ing a variety of goods and servicesfrom their homes to veterans pursu-ing careers and professions.

“If you give the Voc Rehabprogram a chance to work, it willwork for you. It put me back up onsolid ground,” said Dyrone Welch,an Iowan who completed a one-yearwork experience training program atthe Des Moines VA Regional Office.An Army veteran, Welch said, “TheVA Voc Rehab program made me

develop a sense of responsibility andfeel needed.”

Armed with transcription skillsand a command of computers, hebecame a customer service represen-tative for CDS of Des Moines, a printshop.

Several of the veterans Petersonwrites about have found ways toturn avocations into successfulvocations. Jodi Schleuger, for

instance, turned aninterest in horses intoher own businesstraining horses andtheir owners. VA VocRehab was Schleuger’spartner as she trainedin the Equine Manage-ment Program atEllsworth Commu-nity College in IowaFalls. Schleuger wasdeemed “a natural”by one instructor. Peterson workedfor the Iowa Depart-ment of VocationalRehabilitation as a

counselor for 18 years before joiningthe Des Moines VA Regional Officein 1987 as a counseling psychologist.His work with disabled veterans wasrecognized in 1994 when he wasnamed VA Counseling Psychologistof the Year and Iowa’s Veterans’Small Business Advocate by theSmall Business Administration. Inaddition to such formal recognition,there have been personal expres-sions of appreciation from manyveteran clients and colleagues.

VR&C has implemented, andeven pioneered, programs such asIndependent Living for those toodisabled to maintain␣ competitiveemployment; Independent Instruc-tion for those who aren’t well servedby the classroom; Employer Incen-tives to promote hiring veterans; andSelf-Employment, a program ofsmall business for veterans withdisabilities. ❏

February/March 1998 3

OutlookTogo D. West, Jr.Acting SecretaryOf Veterans Affairs

Let’s Keep America’s PromiseTo Veterans and Their Families

Preparationfor confir-mationhearingsand myassumptionof respon-sibilities asActingSecretary ofVeteransAffairshave kept

me close to home in Central Officeduring my first weeks at VA. I didmake a trip to New York in Januaryto dedicate the new Veterans BenefitsMuseum at the Regional Office,which put me in touch with the spiritas well as the substance of theDepartment’s mission.

The museum chronicles thehistory of veterans’ benefits. As Iwalked through its exhibits, I saw avivid overview of the developmentof our veterans’ programs — theirgrowth during the Civil War, theirconsolidation in 1930 under theVeterans Administration, theirblossoming under the GI Bill afterWorld War II, and the elevation ofVA to a Cabinet department just a

decade ago. Through it all emergedan even greater, grander story — thestory of our nation’s veterans. Aftermy tour, I was left with a profoundappreciation for what VA employeesare doing today to keep our nation’spromise to its veterans throughcommitment to our historic mission:

— to assure that veterans who, bytheir service and dedication haveearned a benefit from this nation,receive it in a timely fashion;

— to assure that veterans areprovided quality health care; and,

— to assure that we provideveterans who have served thiscountry the hero’s burial that agratefulnation,preservedin freedomby theirefforts, isobligatedto provide.

I know how far you have come inthe last five years in meeting theseresponsibilities. You have led theway in government reinvention.Paper-based procedures are beingreplaced by automated processesfocused on customer access and

convenience. The VA health-caresystem has broken out of the histori-cally bed-based mold of Americanhealth care and is on its way tobecoming a model of patient-focused, managed care. The NationalCemetery System is preparing tomeet the challenge of unprecedenteddemand for burial space and service.

Your good ideas, hard work andexcellence have been recognized.You have garnered many awards,among them more than 100 NationalPerformance Review HammerAwards. Such recognition is impres-sive and important, but there aremany measures of excellence. The

truest measure of excellence comesfrom those we serve. We know weare most successful when we hearfrom veterans and family memberswho say, “My life is better for whatyou do.”

Just after I came to VA I read aletter from a veteran’s daughter whowrote: “Two months ago my father,a Pearl Harbor veteran, became aresident of a VA rehabilitation andextended care center. Prior to that hisonly desire was to die. He wascompletely nonfunctional. He couldnot eat unless spoon fed and rarelyspoke to anyone. Today my fatherdresses himself with little help andsocializes with new-found friends.The VA has been a blessing and ananswer to our prayer.”

This is our true standard ofexcellence: that every VA facility bea blessing to the veterans andfamilies it serves. I look forward toworking with you in answeringthose prayers and keeping ournation’s promise to its heroes. ❏

This is our true standard of excellence:that every VA facility be a blessing

to the veterans and families it serves.

At budget briefings in February, Acting Secretary Togo D.West, Jr., outlined his expectations of VA in keeping thepromise to America’s veterans:

• improve the timeliness and dependability of the deliveryof benefits;

• continue the transformation of VA’s health-care system,emphasizing quality, compassion and effectiveness;

• assure employees a work environment that is conduciveto their best efforts in behalf of veterans;

• master the challenges of information technology, includingthe looming issues of the year 2000; and

• more fully integrate the department’s organizationalelements.

4 VAnguard

VHA’s information technologyputs VA out in front with the na-tional roll out of the ComputerizedPatient Record System (CPRS). Thesystem offers clinicians an improvedlook at patient data by presenting allelements on one screen at one time

Unlike an inch-thick paper file orcomputerized data files viewed onlyone at a time, CPRS makes allrelevant patient data — charts,records, notes and imagery — visibleon one screen in seconds for thepatient and doctor.

“VA will set the pace for theprivate sector with CPRS,” said Dr.Robert Kolodner, the Associate ChiefInformation Officer for BusinessEnterprise Solutions & Technology(BEST) Service.

Many health-care providers atone of the first VA medical centersto implement CPRS heartily agree.“With the CPRS, VA is like theStarship Enterprise while private-sector hospitals are still hitting sticksagainst rocks,” said Dr. DanFernicola, cardiologist at the Wash-ington, D.C., Medical Center. “Theymay have a better stand-alonepatient billing, pharmacy or labora-

Computerized Patient Record System The Besttory system, but they don’t have theguarantee we have that those pro-grams and all others will worktogether.”

The Washington, D.C.,VAMC,was one of the first medical centersto implement CPRS, in addition toTuscaloosa, Ala., West Palm Beach,Fla., and Puget Sound (Seattle andAmerican Lake), Wash.

San Francisco and Huntington,W. Va., VAMCs have followed as thefirst two key sites in their VISNs toimplement CPRS. The remaining key

sites scheduled to implement CPRSas part of Phase 2 of the nationalCPRS implementation project will doso by August 1998. VISN #7, headquartered inAtlanta, has already begun Phase 3of the national implementationproject, that is, rolling out CPRS tothe rest of its medical centers. Thenationwide implementation of CPRSat all VA medical centers, outpatientclinics, and nursing homes should becompleted in fiscal 1999.

The VistA Imaging System makesit possible for clinicians to obtainpatient information graphicallydisplayed on the screen at their

clinical workstations.The Washington, D.C., VAMC

has placed personal computers ineach of its primary care clinics sodoctors have ready access to patientdata to share it with the patients. “Aone-second click away are images ofa patient’s chest X-ray, CAT scan,MRI, endoscopy and electrocardio-gram,” said Dr. Ross Fletcher, chiefof cardiology.

“We’re excited about CPRSbecause it makes it easier for patientsto grasp information,” he said. “Ican sit with a patient and graphicallyillustrate to him how a certainmedication has been making adifference to his blood pressure orcholesterol count, for instance.”

The speed with which patientdata can be called up impresses thechief medical resident at the Wash-ington, D.C., VAMC, Dr. MaheshKrishnan. “If you’re in the emer-gency room, you can quickly pull upa patient’s electrocardiogram, forexample, and simultaneously reviewthe patient’s medical history.”

Other sites that have imple-mented CPRS are reporting benefits,too. A Tuscaloosa VAMC clinician,Debra Lindley, said CPRS has been afactor in reducing waiting times inthe outpatient pharmacy from twohours to about 30 minutes. She saidalmost no uncompleted filingremains at the end of each day.“Karen Mariner, CIO at the West PalmBeach VAMC, reports that many ofthe medical center’s business pro-cesses have changed with CPRS andthat “the software has been a successand we consider CPRS a welcomeenhancement to our EMR [electronicmedical record].” The department has committed$2.7 billion to implementing itsoverall information technology overthe three years ending in federalfiscal 1998. In fiscal 1998, VA expectsto spend approximately $874 millionon its information systems. The office of VHA’s CIO has yet todecide whether private-sector doc-tors in community-based clinics un-der VA contract will be connected. ❏

An example of what CPRS brings to the screen: a patient’s medical history (problems,medications, lab results), electrocardiogram results and an MRI of the patient’s cervical spine

February/March 1998 5

T he Veterans Benefits Adminis-tration has named two deputyunder secretaries to serve onUnder Secretary for Benefits

Joe Thompson’s management team. Patrick Nappi is the DeputyUnder Secretary for Operations andNora Egan the Deputy Secretary forManagement.

Nappi is responsible for theactivities of VBA’s field operations,Office of Human Resources and theOffice of Employee Developmentand Training. Egan is responsible forthe activities of VBA’s program andsupport offices.

Both share, with the UnderSecretary, responsibility for manag-ing benefits provided by VA, includ-ing education, home loan guaranty,compensation, pension, vocationalrehabilitation and life insurance.

Nappi had served as the Directorof the Central Area since May 1996.In this capacity he was responsiblefor the operation of all VA benefitsfacilities in the central part of theUnited States — 13 field stations andthe Records Management Center,serving some 7 million veterans inthe 13 midwestern states. Previ-

ously, Nappi served as the Directorof the San Diego VA Regional Office.

He began hisVA career at theBuffalo RO as aveterans benefitscounselor in 1974and four yearslater became amanagementanalyst. He joinedthe VBA FieldOperations staff

in Washington, D.C., in 1983, servingin a number of management posi-tions before being named ExecutiveAssistant to the Deputy ChiefBenefits Director in 1990.

Nappi has a bachelor of sciencedegree from Syracuse University in1968. He served in Vietnam with the3rd Battalion, 5th Marine Regiment,and retired from the Army NationalGuard as a Brigadier General in 1995.

Egan is the former DeputyAssistant Secretary for Planning inVA’s Office of Policy and Planning, aposition she assumed in May 1995.She was responsible for developingand maintaining a national strategicplanning program and directing

T he Waco Regional Office dedi-cated its new 127,000 squarefoot building, located down-town, on Dec. 8.

The move downtown givesemployees more office space, freeparking and a cafeteria. The locationis more accessible for veterans,especially those using public trans-portation.

“A city that develops its down-town, its heart, is destined for ahealthy future,” said U.S. Rep. ChetEdwards (D-Waco). He recentlymoved his Waco district office to thenew building.

Downtown retailers also arehappy about the move that shouldgenerate new business for them.

Employees had plenty to sayabout their new building that is40,000 square feet larger than the oldregional office.

“I’m pleased with the additional

VA’s quality improvement program.Egan was honored in 1995 with thePresidential Rank Award.

Egan previously served as theAssociate Deputy Assistant Secretaryfor Human Resources Management.In that capacity, she developed,coordinated and implementedpersonnel polices governing pay,labor relations and employee rela-tions. Her involvement in VA’shealth-care reform initiatives led to amajor role in the development ofVA’s Under Secretary for Health’s

Vision for Change. A career VAemployee, Eganhas more than 22years of federalservice, all withVA. Previousassignmentsinclude PersonnelOfficer for VACentral Office andDirector of Em-

ployee Relations and PerformanceManagement Service.

Egan holds a bachelor’s degree inpolitical science from ManhattanvilleCollege in Purchase, N.Y. ❏

space,updatedfurnishings,cleanlinessand im-provedaestheticenviron-ment,” saidone satisfiedemployee.

“I likehavingsecuritybadges thatunlock thedoors to thedivisions,restroomsand entrancedoors,” saidanotheremployee about thebuilding’s security system. ❏

From left, Deputy Secretary Hershel Gober, Congressman Chet Edwards,Waco Mayor Michael D. Morrison and VA Under Secretary for BenefitsJoe Thompson

VBA Selects 2 Deputy Under Secretaries

Waco Regional Office Dedicates New Building

Nappi

Egan

6 VAnguard

VA Employment

0

50,000

100,000

150,000

200,000

250,000

1993 1994 1995 1996 1997 1998 1999

Medical Care VBA All Other

Buyouts = 9,622 RIFs = 1,673 Attrition = 104,421233,062 228,487221,855 211,507 205,931 203,849

234,428

* proposed in President’s budget request

*

Buyouts, RIFs and attrition totals are for 1994 - 1998.

F or fiscal 1999, VA is requesting$42.8 billion for mandatory anddiscretionary programs.“We are committed to provid-

ing quality care and services to ournation’s veterans, who have servedand sacrificed in defense of ourfreedom. This budget keeps thatpromise,” said Acting Secretary ofVeterans Affairs Togo D. West, Jr.

The budget provides for:• $17.7 billion for medical care;• $21.9 billion for compensation andpension payments;• $92 million for the NationalCemetery System, an 8 percentincrease over 1998;• a 10 percent increase in fundingfor medical research; and• a 7 percent increase to administerveterans benefits.

During the next five years, VAwill work to: reduce per patient costfor health care by 30 percent; in-crease the portion of the operatingbudget obtained from non-appropri-ated sources by 10 percent; andultimately serve 20 percent moreveterans.

The President’s proposal includesa demonstration program in 1998 totest the feasibility of VA billingMedicare-eligible, higher-incomeveterans without compensabledisabilities. This program, along withthe ability to retain collections fromthird parties, copayments and othersources under the provisions of theBalanced Budget Act of 1997, willincrease by nearly $700 million theamount of funding VA receives fromnon-appropriated sources.

The budget increases mandatoryMontgomery GI Bill educationbenefits by 20 percent, or $191million, in 1999 — the most signifi-cant increase in benefits since theprogram’s inception in 1984.

The VA 1999 budget containsthese additional highlights:Benefits Program

Included is appropriation lan-guage designed to eliminate end-of-year funding shortages by providingnecessary funding for payment ofbenefits.

Also, the Administration hasproposed the following benefits-related legislation in 1999:• To disallow compensation benefits

for tobacco-related disabilities. Thisproposal would restrict service-connected disability compensationbenefits for tobacco-related condi-tions which become manifest afterservice discharge and beyond anyapplicable presumptive period,based solely on tobacco use duringmilitary service. The savings in 1999are estimated to be $741 million, witha projection of approximately $17billion in savings over five years.• $25 million over five years to payfull veterans disability and compen-

sation benefits to Filipino veteransand their survivors residing in theUnited States who are currentlyreceiving these benefits at half thelevel that U.S. veterans receive.• To provide $100 million for veter-ans training programs administeredby the Department of Labor.• To eliminate vendee home loansmade to the general public, for anestimated savings in 1999 of $2million, with five-year savings of $43million. VA will sell all foreclosedproperties on a cash basis.• To charge a $25 fee for each VAhome loan that is guaranteed andexpect to collect up to $15 million.Medical Programs

VHA expects to open 71 newoutpatient clinics and treat 134,000more veterans in 1999 than in 1998, afour percent increase.

The budget includes $300 millionfor medical research.This program ispart of the Administration’s expan-sion of research efforts through the“Research Fund for America.”

For medical and prostheticresearch, a total of $300 million and3,159 employees for than 1,795 high-priority research projects that willenhance the quality of VA healthcare.

The budget also includes alegislative proposal that wouldauthorize a new smoking cessation

program for honorably dischargedveterans who began smoking in themilitary. Veterans will be eligible tothe extent that resources are avail-able. Once this program is autho-rized, the Administration will submita budget amendment requesting anappropriation of $87 million.Construction Programs

VA’s $285 million constructionrequest includes funding to correctseismic vulnerabilities at facilitiesand for the construction ofcolumbaria niches at nationalcemeteries.National Cemetery System

NCS’ higher funding and FTElevels will permit opening four newcemeteries during the next two years— a number unprecedented since theend of the Civil War. ❏

VA’s 1999 Budget Submitted to Congress

February/March 1998 7

Primary Care Expansion Involves Vet Centers

U sing advances in telecom-munications technology, VAhas expanded primary health-care programs nationwide

through its network of “Vet Cen-ters,” which routinely providecounseling services to combat ortraumatized veterans.

In addition to $3 million inequipment and startup operatingcosts related to telemedicine at 20locations, an additional $1 million isbeing provided to expand andenhance conventional primary careprograms at 10 Vet Centers.

“Our goal is to promote access toprimary care for veterans closer totheir communities,” VA UnderSecretary for Health Dr. Kenneth W.Kizer said. “This latest effortcomplements the initiative launchedin late 1994 to implement universalprimary care at VA medical centersacross the nation, as well as the over100 community-based clinics wehave established in the last twoyears,” Dr. Kizer said.

The Vet Center-linked initiativeswill promote services such as healthscreenings for chronic diseases,health prevention programs, sexualtrauma outreach and counseling, andpsychosocial services. The programswill target special populations,including high-risk groups, minority

veterans and veterans who facebarriers to care, such as disabled andhomeless veterans.

For example, the Navajo VetCenter outstation in Chinle, Ariz.,will provide health screenings forhypertension and diabetes as wellas psychiatric assessments andconsultations with Native Americanson reservation lands, while the Phil-adelphia, Pa., Vet Center will pro-vide health screenings and follow-upmedical care to a minority veteranpopulation of primarily Puerto Ricanand African-American background.

The 20 sites participating intelemedicine initiatives will linkrural and urban Vet Centers, VAmedical centers, and other commu-nity agencies and resources.Telemedicine uses electronic infor-mation and communication tech-nologies to support health care overlong distances through such applica-tions as teleconferences or retrievalof networked records.

This initiative is part of VA’songoing major effort to make itsservices more community-based.The program is separate from VA’sdevelopment of community-basedoutpatient clinics, another initiativedesigned to increase access points forVA health care. ❏

Program Expansion Sites

VA, DoD Combine Health-Care Efforts

U nder an agreement betweenVA and the Department ofDefense (DoD), active dutymilitary personnel should get

faster decisions on their disabilitycompensation claims and requestsfor VA health care. Separating orretiring servicemembers who expectto file a claim for VA disabilitycompensation will undergo a singlephysical examination prior todischarge.

The departments also agreed oninitiatives to conduct joint research,reduce overlapping services andhave their health-care systems worktogether.

The discharge exam will meetVA’s requirements for claim determi-nations and DoD’s need for separa-

Norwich, Conn.Sanford, MaineCleveland, OhioCharleston, W.Va.Philadelphia, Pa.Cedar Rapids, IowaSioux City, IowaPine Ridge-Rosebud, S.D.Greenville, N.C.Greenville, S.C.San Juan, P.R.Tahlequah, Okla.Midland, TexasLaredo, TexasFt. Collins, Colo.Chinle, Ariz.Keams Canyon, Ariz.Eureka, Calif.Chico, Calif.Vista, Calif.Alexandria, Va.Shreveport, La.New Orleans, La.Houston, TexasAnaheim, Calif.Salem, Ore.

tion exams. The results of theseexams help determine eligibility forVA health care.

In pilot tests of the dual-purposeexam at VA and Army facilities,claims processing time was reducedto less than one-third of nationallevels under the current system. Thecurrent average time for processingan original compensation claim is133 days.

Under the new plan, VA physi-cians generally will conduct the pre-discharge exams. Where VA physi-cians are unavailable, DoD physi-cians will conduct them according toVA protocols.

A council of senior VA and DoDhealth officials agreed to worktoward reimbursable arrangements

between the two departments. Otherinitiatives include:• establishing a Military and Veter-ans Health Coordinating Board,building on the experience of theJoint Gulf War Illnesses Group.• allowing patients in both systemsto use specialized treatment centersin each department.• creating compatible computerizedmedical records and sharing automa-tion products. Creating joint clinicalpractice guidelines and coordinatingon laboratory and pathology programs.

The collaboration was spear-headed by VA Under Secretary forHealth Dr. Kenneth Kizer and ActingAssistant Secretary of Defense forHealth Affairs Dr. Edward D.Martin.❏

8 VAnguard

M oved? Married or di-vorced? Changing insur-ance beneficiaries orcoverage? Some 12,000

employees at 12 VA locations arebeginning to perform their ownpersonal actions simply by touchinga computer screen or picking up aphone and using a personal identifi-

cation number.By the end of 2000, all VA

employees will be using HR LINK$to electronically access and changetheir records.

HR LINK$ — the automation ofVA’s personnel and payroll func-tions — entered its second phaseMarch 2 with the opening of theShared Service Center in Topeka,Kans. The SSC is the operational“link” in the new system, supportedby computer operations at theAustin Automation Center andtechnological development at the HRLINK$ project office in VACO.

Recently tested by selectedemployees, including union repre-sentatives, at the 12 prototype sites,HR LINK$ Phase 2 self-servicing isnow available to all employees atthose sites. Seven days a week, 24hours a day, they can use a kiosk ora touch-tone phone — through aninteractive voice response (IVR)

system — to change personal infor-mation or pay records that rangefrom Thrift Savings Plan allotmentsto tax withholding deductions, morethan 20 transactions in all.

Later this year, in Phase 3, manag-ers in the same facilities will beinitiating recruitment and classifica-tion on their desktop computers with

“expert” systems. The mostly manualstaffing and classification processesof the past can take months to createand fill a job.

With the new expert systems,managers will select from a library ofposition descriptions to classify jobs,with grades attached and grade-

controlling duties highlighted.Managers will process and routetheir transactions electronically.Employees will be able to submit

automated applications, which willbe rated and ranked automatically atthe SSC to create referral lists.

Employees at the prototype siteswill be able to make their personaltransactions from desktop computersin Phase 3, as well.

Phase 1 of HR LINK$ began lastyear as PAY VA. HR staff at theprototype sites tested and then beganusing the new technology to tracksuch things as licensure, skills,accommodations and priorityplacements. Not until Phase 4 HRwill HR LINK$ take on timekeepingand payroll recordkeeping. Eachphase will be tested at the prototypesites before going nationwide.

This faster, easier, more privateand less costly way to processemployee transactions and personnelactions was developed in the officesof the Assistant Secretaries forHuman Resources and Administra-tion and for Management. HR LINK$technologies automate proceduresthat previously required submittingpaperwork or visiting HR or payrolloffices.

Says SSC Director BruceCarruthers, “I am reluctant to use theword ‘empower’ because it hasbecome a stock term, but that’s whatthis system does for employees andeventually will do for managers. Itwill enable them to perform theirown transactions and to deal withwork force issues in a timely, cost-effective way.”

At the end of January he directeda staff of 78, a number that couldgrow to 350 when HR LINK$ is fullyoperating VA-wide. The SSC is

organized in tiers, the first tier beingthe CSRs, who help employees carryout their transactions. The CSRsanswer questions by referring to

Personal Record Changing Gets Easier —

VA’s New HR/Payroll Employee Self-Service Model

VA WorkforceAmy 123-45-6789

PIN #1234

SharedService Center

Topeka, KSTechnology Platform•PeopleSoft•TALX (IVR)•LOTUS Notes/HTML

Tier 3ExpertTier 2

Specialist

Tier 1 Generalist

SSC OUTPUT

Kiosk/PC

1-800 NumberFront End IVR

Info/Trans

HR LINK$ reduces paper, redundancy and

misplaced documents. It offers access anywhere

and keeps employee information secure.

VA’s New HR/PayrollEmployee Self-Service Model

February/March 1998 9

computerized books of scriptedinformation on a range of topics thatinclude “life events.” Someone whocalls to report getting married, forexample, will not only be able tomake the status change but will beoffered a life event package ofinformation for considering changesin benefits. The packages can also beordered directly through a kiosk orphone. If employees at phones orkiosks decide to seek help to com-plete on-line transactions or havequestions, the CSRs will be availableon business days from 7:30 a.m. to5:30 p.m. EST. They have the detailson a wide range of topics to read tothem — in more than 1,100 scripts.(All SSC support to prototype siteswill be available during thosebusiness hours.)

When the scripts have notanswered a caller’s question, theCSRs open a “case” detailing theemployee’s concerns. They thenforward it for handling, at the SSC‘ssecond tier of expertise, to a special-ist who researches the matter andcalls the person back. The data-gathering screen for opening a caseeven permits the CSR toassign a priority for the specialist.

The volume of business —especially from employees seekingthe help of CSRs in the currentprototype — will determine eventualstaffing. A major part of the SSC staffwill be the Tier 1 CSRs, who provideinitial service to employees byphone. Their positions are at the GS-5 level.

Other SSC staff include the Tiers2 and 3 personnelspecialists, employ-ment systemstechnicians, manage-ment and systemsanalysts, programdevelopmentspecialists, informa-tion systems staffand HR and fiscalstaff internal to theSSC. These positionsrange from GS-6 to13. Currently, theSSC is recruitingpeople with person-nel managementbackgrounds. VAemployees receivepreference for SSCjobs and relocationexpenses. When the PAYVA (now HR LINK$)project began,project officialsestimated that itsefficiencies wouldeliminate 1,080 jobsin the HR/payrollfield. Already about500 of those jobshave disappearedthrough attrition,says SandraWeisman, DeputyAssistant Secretaryfor Financial Systems.

As employees learned about theplan, some found other jobs. Direc-tors of some medical centers havenot replaced them and some health-care networks have consolidated thepositions.

Field HR offices will continue to

provide HR management advisoryservices, while the SSC focuses ongiving informational and transac-tional support. For example, fieldstaffs will assist in labor and em-ployee relations, position manage-ment, training and development ofstaffing strategies.

SSC recruits who have made themove to Topeka like the area. Thenortheastern Kansas capital city, setin rolling hills along the KansasRiver (metropolitan population166,000) has a strong communityspirit that makes it easy to joinvolunteer activities, says Jo AnnSoutherland, contract specialist.

Walter Hitch, resources manager,who came from Little Rock, Ark.,touts reasonable housing costs andthe “rush minute,” in contrast to thetraffic gridlock that characterizesother metro areas. Carolyn Jackson,

HR LINK$ Now at 12 Locations

Eunice Montgomery, personnel assistant in VACO’s Office ofHuman Resources Management, makes a change in dependent’sstatus in a test of the HR LINK$ kiosk at VACO. Coaching her inusing the computer on-line program is Lorraine Grant, staffassistant, Office of Financial Management.

Prototype Sites

VACO employees ofNational CemeterySystem

Office of Financial Management

Office of Human ResourcesManagement

Austin Automation Center

Financial Services Center,Austin

Atlanta VA Medical Center

VAMCs at Albany, Bath,Batavia, Buffalo,Canandaigua, Syracuse(VISN 2)

(continued on page 10)

10 VAnguard

public affairs officer, who lived inseveral urban areas, likes the schoolsystem for her children and callsTopeka “a medium-sized city with asmall-town flavor.”

In addition to employees savingtime, taxpayers will see a savings of$90 million in staff salaries in the 10years that began with the project in1995, against an initial investment of$70 million required to build thesoftware and the SSC. And HRLINK$ eventually will be a “fran-chised” revenue producer, sellingservices to other agencies.

Converting a VA building onceused for patient care into SSC officespace with a “call center” environ-ment is not one of the most expen-sive portions of that investment. Butit will give a different look to officesthat now bear wall panels withoxygen outlets and floral windowtreatments. Renovation will befinished later this year.

What are some of the challengesfor the project and the SSC?VAnguard asked DirectorCarruthers. “Phased offering of HR

LINK$ to the rest of VA is one — theorder, the timing for more and moresites. Recruiting the right people to

HR LINK$ Technology

Two kinds of software packages will make it faster and easier formanagers to recruit. One of them will compare a job applicant’sskills and experience with what a position description “seeks,”including varying degrees of experience and skill needed for sepa-rate duties of the job. Employees will receive training in writingresumes on their computers. The other package permits writing thePD and ranking, or classifying, its duties.

While the SSC is the operational arm of HR LINK$, the AustinAutomation Center (AAC) maintains the database of employeerecords. For the SSC to send a large volume of transactions to Austindaily, new computer hardware and software were installed. Thisincluded six special telecommunications lines, each capable oftransmitting nine million bits of information per second. Every CSRstation is connected by an Integrated Data Communications Utility(ISDN) line to handle calls from employees across the country. ISDNlines carry both voice and data, including video images planned forthe future.

The PeopleSoft software for making the transactions has morefunctionality than the PAID/OLDE system, says Jaime Manzano,SSC systems manager. The CSRs’ scripts are produced throughLotus Notes.

move to Topeka and supportingthem as they relocate families;building a team of new people who

have to learn new technologies,integrate the technologies and, insome cases, develop Phase 3 technol-

Customer Service Representative Janet Keever demonstrates to SSC Director Bruce Carruthershow the “case manager” screen prompts data gathering for an employee.

ogy while still working on Phase 2operating policies are other chal-lenges.”

Deputy Director Debra Thomp-son, who headed career managementservices for Air Force informationtechnology employees, is familiarwith a system similar to VA’s. Shesaid she’s impressed with how VAhas grappled with the new technolo-gies. The system is based on a studyof both private and governmentsystems to streamline HR operations.

Carruthers summed up what themost positive and stimulatingaspects of the initiative have been sofar. From three locations — the HRLINK$ office in Washington, theAustin Automation Center and theSSC — people have formed a team.Those in Topeka have had to create awork environment from scratch.

“They represent a good crosssection of the country. They have akind of pioneering spirit, they’reinterested in doing something new,and they feel they’re part of some-thing significant. These federalemployees show they are as good asanyone in any organization.” ❏

By Jo Schuda

February/March 1998 11

providing services on a fee-for-service basis. The Austin AutomationCenter and the Financial ServicesCenter offer information technologyand financial and payroll services,respectively, and are the two largestVA franchises.

“Because of the scope of theirfinancial processing and payrollservices, there’s no organizationwithin VA not served or supportedby a franchise activity,” Spurlingsaid.

Other VA franchise serviceactivities include the Neosho, Mo.,VA Records Center and Vault,offering record storage and retrievalservices; VA Security and Investiga-tions Service, offering securityinvestigations and ID badge process-ing; the VA Law Enforcement andTraining Center in Little Rock,providing police officer trainingcourses; and VA ADP and AdaptiveTraining Service, offering officeautomation training and training forany federal “buyer.”

Formerly operating with appro-priated funds like the rest of VA,these six operations now fundthemselves through the collection offees for their products and services.These fees cover all costs and ex-penses, including depreciation.

Unlike most appropriated funds,franchise fund dollars can be carriedfrom one fiscal year to the next. VAfranchise fund operations bill their

Government entrepreneur? Whatmany regard as a classic oxymoronhas become reality in VA and fiveother federal agencies operating pilotfranchise fund programs authorizedby the Government Managementand Reform Act of 1994.

The law established a five-yearpilot phase (recently extended twoyears to 2002) for selected agencies tosell common administrative servicesand products competitively through-out the federal government. Theywere allowed to establish “franchisefunds” to provide the resourcesneeded to launch new entrepreneur-ial enterprises.These funds can retainup to four percent of their annualincomes for capital investment toimprove operations and providestartup revenue. The bottom line forfranchise fund activities is, literally,the bottom line. Revenues mustcover costs.

Project leader Susan Spurlingfollowed franchise fund legislationthrough its development and pas-sage. She later coordinated VA’ssuccessful application to become afranchise fund pilot and now worksas Franchise Fund Business Develop-ment manager in the Office ofFinancial Management. She devel-oped the VA Franchise Fund Char-ter, which outlines the purpose, legalauthority and policy-making struc-ture guiding the operation of VAfranchise service activities.

“Franchising was the term usedby the National PerformanceReview’s 1993 report to describe apractice for providing administrativeand other common support serviceson a reimbursable basis,” Spurlingexplained. “For federal providers,such services have to be offered on acompetitive bid basis, reimbursableby interagency fund transfers. Theymust meet basic standards and beself-sufficient with revenues cover-ing costs without subsidies fromparent agencies.”

VA was authorized franchisefund pilot status in 1996. Since thensix VA service activities have been

The bottom line for franchise fund activities is, literally, the bottom line. Revenues must cover costs.

customers monthly. Preparing thosebills has been both a challenging andenlightening task, according toDavid Kubacki, a member of the Center’s franchise staff.

“We have to identify our specificproducts and price them,” he said.“That’s difficult. It’s a whole newway of looking at what you do, but itreally focuses on costs. We havebecome more cost conscious and ourcustomers certainly become costconscious when they see their bills.For many VA organizations, it’s thefirst time they’ve really thoughtabout the cost of the services pro-vided.”

Kubacki said that pricing theservices you offer raises the immedi-ate question from the buyer, Whatam I getting for the money? Thatleads to continuous communicationbetween seller and buyer and,Kubacki said, increased focus oncustomer service. Customers arerepresented throughout the VAfranchise fund organization, from theFund’s policy-making Board ofDirectors down through individualfranchise service providers who meetregularly with customer groups.

NPR’s ultimate rationale forintroducing franchising to govern-ment was to reduce the size andcomplexity of government. The goalis fewer, more efficient providers ofcommon services such as ADP,payroll and travel, spurred bycompetition to minimize costs andmaximize service.

External sales of VA services rosefrom a half-million dollars in 1996 to$1.2 million in 1997.

“We can and do sell outsideVA,” Spurling explained. “But ourexternal business is only a drop inthe bucket compared to our $60million in VA internal business. It’sin our best interest as entrepreneursto keep our biggest and best cus-tomer happy.” ❏

By Chris Scheer

Franchise Funds Make Money for VA

12 VAnguard

T he department is establishing54 new community-basedoutpatient clinics around thecountry.

The clinics, which are in additionto 39 new clinics announced in June,bring to 532 the total number of VAoutpatient clinics around the countrynow in operation or being activated— including 163 located at VAmedical centers. This is part of ageneral expansion of VA outpatientservices through a re-engineering ofthe VA medical system to makehigh-quality health care availablecloser to veterans’ homes.

“The new clinics will be offering a

broad range of general medicalservices such as management ofdiabetes, hypertension or coronaryartery disease, pharmacy services orpreventive care, such as vision orcholesterol screening,” Kizer said.

As part of VHA’s transformation,VA has closed more than 22,000acute care hospital beds since 1994 —with a corresponding decrease of250,000 inpatient admissions peryear — while, over the same period,outpatient visits have risen by 7.3million for a total of more than 33.3million clinic visits in 1997.

In their proposals for approval ofnew clinics, VISNs were required to

54 New Clinics Will Broaden Access to Caresubmit business plans weighing thevalue of new “access point” strate-gies against alternative costs or cost-avoidance. Examples of cost-avoid-ance are the dollars to be saved bydecreased reimbursement for benefi-ciary travel or the higher cost ofproviding general medical services ina tertiary hospital setting.

Some VISNs are proposing thenew clinics be located in existingspace in the community to be leasedby VA, while others may provideservices through a contract with acommunity service provider such asa private group practice. ❏

Framingham, Mass., for Boston, Mass.Schenectady, Rensselaer, & S. Saratoga

Cnties, N.Y., for Albany, N.Y.Kingston, N.Y., for Albany/Montrose/Castle Point, N.Y.Jersey City, N.J., for VA N.J. HC SystemNew Brunswick, N.J., for VA N.J. HC SystemAliquippa, Pa., for VA Pittsburgh HC SystemLancaster, Pa., for Coatesville / Lebanon, Pa.Seaford, Del., for Wilmington, Del.Crawford Co., Pa., for Erie, Pa.

McKean Co., Pa., for Erie, Pa.Ashtabula Co., Ohio, for Erie, Pa.Hagerstown, Md., for Martinsburg, W.Va.Charlotte Hall, Md., for VA MD HC SystemFairfax, Va. (Vet Center) for Washington, D.C.Greenville, N.C., for Durham, N.C.Macon, Ga., for Dublin, Ga.Myrtle Beach, S.C., for Charleston, S.C.Florence, S.C., for Columbia, S.C.Albany, Ga., for Dublin/Atlanta, Ga.Ft. Pierce, Fla., for W. Palm Beach, Fla.Valdosta, Ga., for Lake City, Fla.

Community Sites(Specific site selection pending in most cases)

*HC: Health Care

Ocala, Fla., for Gainesville, Fla.S. St. Petersburg, Fla., for Bay Pines, Fla.N. Pinellas Co., Fla., for Bay Pines, Fla.SW Broward Co., Fla., for Miami, Fla.Brooksville, Fla., for Tampa, Fla.Charleston, W.Va., for Huntington, W.Va.Somerset, Ky., for Lexington, Ky.Smithville, Miss., for Memphis, Tenn.Akron, Ohio, for Cleveland, OhioLima, Ohio, for Dayton, Ohio

Springfield, Ohio, for Dayton, OhioPortsmouth, Ohio, for Chillicothe, OhioMansfield, Ohio, for Cleveland, OhioZanesville, Ohio, for Chillicothe, OhioWausau, Wis., for Madison, Wis.LaSalle Co., Ill., for Hines, Ill.Rhinelander, Wis., for Iron Mtn / Milwaukee, Wis.Aurora, Ill., for Hines, Ill.

Elgin, Ill., for Hines, Ill.Pierre, S.D., for VA Black Hills HC System and Sioux

Falls, S.D., VAM&ROCPanama City, Fla., for Biloxi, Miss.Mountain Home, Ark., for Little Rock, Ark.Bonham, Texas (Vicinity) for VA Central Texas HC SystemPalestine, Texas, for VA North Texas HC SystemKingman, Ariz., for Prescott, Ariz.Aurora, Colo., for Denver, Colo.Seattle/Puget Sound, Wash., for VA Puget Sound HC SystemSalem, Ore., for Portland, Ore. (Primary Care/Mental Health Care)Tri-Cities Area, Wash., for Walla Walla, Wash.Bend, Ore., for Portland, Ore. (Primary Care/

Mental Health Care)

Merced, Calif., for Fresno, Calif.Kingman, Ariz., for Prescott, Ariz.Aurora, Colo., for Denver, Colo.Auburn, Calif., for Reno, Nev.Oxnard, Lompoc, and San Luis Obispo, Calif., for

the W. L.A./S. Calif. System of Clinics

February/March 1998 13

A “standing room only” gala and art show capped the annualNational Veterans Creative Arts Festival, hosted by theTomah, Wis., VA Medical Center. The event, held Nov. 3-10,was co-sponsored by VA and Help Hospitalized Veterans,

with support from The Recording Industries Music Performance Trust Fund.It was the culmination of a year-long fine arts talent competition open to allveterans receiving medical treatment at VA medical centers. More than 80veterans were selected as national winners. Dr. Joyce Brothers was emcee forthe festival show. The Houston VA Medical Center hosts the 1998 FestivalNovember 2-9. ❏

STANDING ROOM ONLY

National VeteransCreative Arts Festival

Charlie

Comedian Miles Winstead, Hampton, Va.

Denise Smith, Chillicothe, Ohio, woodbuilding winner

Charley “Taps” DiMura, Albany, N.Y.,winner, song with movement - solo category

Dr. Joyce Brothers takes part in the final full-cast production number.

Walt Green, Sepulveda, Calif., won “Best of Show” for his painting,“Relic of Peace.”

14 VAnguard

A cting Secretary of VeteransAffairs Togo D. West, Jr.,delivered the keynote addressat the January 16 official

opening of the New York RegionalOffice Veterans Museum. JosephThompson, Under Secretary forBenefits, also spoke and assistedWest and Congresswoman CarolynMaloney (N.Y., District 14) with theribbon-cutting ceremony. Amongsome 150 guests attending the event

An employee team at the VARegional Office in Detroit hasreceived Vice President Gore’sHammer Award. The AppellateTeam of claims processorsreinvented the procedures forresponding to a veteran’s dis-agreement with a VA decision ona claim.

The team, without getting anyadditional resources, reduced thetime it takes to respond to adisagreement from 141 days to 7days. They also accomplishedsignificant improvements in otheraspects of processing appeals.The true success of the AppellateTeam came through ownership ofthe process they were improvingand by working together to solveproblems through incrementalimprovements.

This is the third HammerAward received by the DetroitRegional Office. ❏

Acting Secretary West Dedicates Museum

Detroit ROGets 3rdHammer

Minority Veterans Call in to VAToll-free conference calls are helping VA’s Center for Minority

Veterans to identify issues that concern local and national groups andfacilitate resolutions.

One of its recent bi-monthly call-in sessions drew approximately 30representatives of minority veterans’ groups to hear about VA activitiesrelated to homelessness. The Center began the sessions last spring.Staff members who meet minority veteran group members whiletraveling invite them to call in for the next session. Topics and speakersare selected based on interests expressed.

In the recent call, a Loan Guaranty Service staff member answeredquestions about how poor or homeless veterans can qualify for VAloans and pointed out that VA sells foreclosed homes at lower thanmarket cost. A director of a VA homeless grants per diem programdescribed how to qualify for grants. ❏

From left, Under Secretary for Benefits JoeThompson, Congresswoman CarolynMaloney and Acting Secretary Togo D.West, Jr.

were veterans who donated artifactsto the museum and representativesfrom veterans service organizations,New York State, New York City andthe National Park Service.

The museum tells the story ofU.S. servicemen and women and ofthe programs designed to help them.Included is a display highlightingitems left at the Vietnam VeteransMemorial in Washington, D.C. ❏

A veterans services representative (VSO) surveys a section of VSO history andmemorabilia.

PHOTOS BY STEPHEN FERRY

COURTESY OF

DISABLED AMERICAN VETERANS

February/March 1998 15

MEDICALadvances

Ringing in the EarsScientists have identified a small

area of the brain that appears to playa critical part in tinnitus, a constantringing in the ears that affects up to50 million Americans.

Dr. Alan H. Lockwood, of theBuffalo VA Medical Center, andcolleagues believe the auditorycortex opposite a damaged ear rather than in the ear itself to bethe source of the problem.

Researchers at the VA medical center and the StateUniversity of New York at Buffalo reported their findings in theJanuary issue of Neurology. They used positron emissiontomography to scan images of brains in a small group of tinnituspatients.

Lockwood said when the ear is damaged the brain rewiresitself to compensate for the loss of function. The rewiringproduces electrical signals that the brain interprets as noise.

“We don’t have a cure for tinnitus,” Lockwood said. “Whatwe have is precise information about the areas of the brainaffected, and some ideas that can be tested by further experi-mentation that may hopefully, eventually, lead to a cure.”

People suffering from tinnitus sense buzzing, ringing,whistling or similar sounds. No cure is known, although patientsoften use noise-producing devices to distract them or cover thesound. About 12 million Americans have tinnitus sufficientlyseverely to require them to seek medical help or be considereddisabled.

Gene Therapy May HelpHeart Failure Patients

VA researchers in San Diego have found that gene therapymay offer new hope for the 4 million Americans who suffer fromcongestive heart failure (CHF). The team, led by Dr. H. KirkHammond, discovered that inserting a specific gene into heartcells triggered a sharp increase in the chemical that causes thecells to beat more strongly.

The study was published in the February 3 issue of theProceedings of the National Academy of Science.

“This opens the possibility that the same approach can beused in people with CHF to reduce symptoms and extend life,”Hammond said. “We can alter heart function with gene transfer,and the implications are enormous.”

Hammond and fellow researchers at the VA San DiegoHealth Care System and the University of California-San Diegoused a harmless virus to ferry the gene to heart cells. The geneproduces adenylatecyclase (AC), an enzyme that stimulatesproduction of the chemical cyclic adenosine monophosphate(cAMP), which in turn directs the heart to increase its function.In heart failure cAMP levels do not rise even though twohormones typically activated by stress begin the chain of eventsthat leads to increased heart function. Hammond suspectsincreased AC production is the key, because it is the last step inthe system.

“It’s like having an eight-lane freeway that narrows down toone lane,” he said. “You’re going to have a bottleneck at thatone lane.”

Study Links VirusTo Lupus in Children A study by Oklahoma Cityresearchers suggests that thecommon Epstein-Barr virus maycause systemic lupus erythemato-sus in children and possibly inadults. Lupus is a chronic inflammatory

disease of the connective tissue that can affect the skin andvarious internal organs. Symptoms include arthritis and skinrash on the face. The kidneys, heart, lungs and brain may beaffected by progressive attacks of inflammation that result in theformation of scar tissue.

In research reported in the December issue of the Journalof Clinical Investigation, the scientists evaluated 59 children andteenagers with lupus and 96 control subjects similar to thelupus group in age, gender and race. More than 99 percent ofthe lupus patients were infected with Epstein-Barr virus,compared to 70 percent of the control group.

The researchers do not yet know whether this associationwill be found in older adults.

Harley collaborated on the study with colleagues at Okla-homa Medical Research Foundation. The study was supportedby VA; the National Institute of Arthritis, Musculoskeletal andSkin Disease; the National Institute of Allergy and InfectiousDiseases; and the Oklahoma Center for the Advancement ofScience and Technology.

Less Expensive DrugCuts Cardiovascular Risk

Research conducted under the VA Cooperative StudiesProgram has found a low-cost diuretic drug significantly lowersleft ventricular hypertrophy, which can lead to cardiovascularproblems such as strokes, heart attacks and sever hyperten-sion.

Reporting in the December issue of the Journal of theAmerican College of Cardiology, the study authors saidhydrochlorothiazide (HCTZ) is more effective than the higher-priced calcium channel blocker isradipine.

“This study confirms that hydrochlorothiazide works verywell at reducing increased heart size, but it’s also superior inreducing systolic blood pressure,” said study leader Dr. VasiliosPapademetriou of the Washington, D.C., VA Medical Center.

The study was conducted at 18 medical centers across thecountry and involved 134 patients with established hyperten-sion. Diastolic blood pressure — when ventricles are relaxedand refilling — was reduced equally in the groups receivingHCTZ and isradipine. However, the reduction in systolicpressure — when ventricles are contracting — was greater inthe group taking HCTZ.

Papademetriou also noted that the cost of HCTZ typically isabout $1 a month compared to about $70 for isradipine andsimilar drugs. ❏

By Dan Bruneau and Pat Forsyth,Research Communications Service

16 VAnguard

you heardHAVE

Two VA employees — Dean McKee , team leader atthe Tucson, Ariz., Vet Center, and Blas Falcon , teamleader at the Albuquerque, N.M., Vet Center — wereamong 26 American combat veterans who joined NorthVietnamese veterans in a goodwill bicycling event calledthe Vietnam Challenge. Falcon, who rode a recumbentbike, said, “It’s time to put the past behind us and moveforward.”

Between Jan. 1 and Jan. 16, the group traveled 1,200miles from Hanoi to Ho Chi Minh City. McKee served as aPTSD counselor. The American participants includedmale combat veterans and women combat nurses. Someof them were veterans with disabilities. The 15 Vietnameseparticipants included former combat soldiers and some“younger folks with disabilities due to land mines and otheraccidents,” McKee said. About 20 news media representa-tives accompanied the riders. The nonprofit group, WorldTeam Sports, sponsored the event along with corporatecontributors.

Lexington, Ky., VA Medical Center employees arediscovering an improved way to log on and transfer informa-tion on patients’ calls and appointments, thanks to Jerry Karr,R.N., and Wayne Citty, computer programmer.

When Karr began handling the facility’s telephone careprogram (TCP), there was no way to notify clinicians of patientcalls except paging or using e-mail, both time-consuming anddisruptive. Nor was there a simple way to capture patientworkload data.

He contacted Citty, and together they developed a localsoftware package called “Encounter Data Capture throughProgress Notes and the Electronic Progress Note View Alert.”It is a fast and simple alternative to the national Patient CareEncounter (PCE) Program.

What would have taken days and required patients to visita clinic can be done on the phone in a few hours or less withthe TCP progress note view alert system. Neither paperencounter forms nor clerical support is needed to enter data.One can document a call in the electronic medical record,capture the encounter data and forward the progress note asa VA ViewAlert to the practitioner in one program. Thecomputer programs interface with the existing VISTA elec-tronic medical record and VA View Alert packages, so learningthem is simple. They can be used at all VA medical centers.For more information, contact Jerry Karr at 606-233-4511, ext.3586, or Wayne Citty, ext. 3660.

The Newark, N.J., VARegional Office initiated avolunteer network to helpserve veterans. The ROenlisted the help of the EastOrange Youth Corps, anorganization that assistsyoung people who, afterdropping out of school, returnto complete their educationand gain work experience.Newark’s Family Develop-ment Center has alsoidentified adults in relief

programs and the SummerYouth Employee TrainingProgram has sponsored highschool students who need jobexperience. Duties haveincluded filing and data entry.

More than 100 womenveterans attended a women’sexpo sponsored by theIndianapolis VA RegionalOffice, Medical Center andVet Center . Director of theCenter for Women Veterans

Joan Furey moderated asession in which womenveterans asked questions andmet their VA representatives.The medical center sponsoreda corresponding health fair,and RO personnel assistedthe veterans in filing claims forbenefits.

A memorial honoring VBAemployees was dedicated atthe Fort Logan NationalCemetery in Denver. Themarker was inspired by thememory of Dorothy L.Starbuck, VBA manager from1946 to 1985. A Coloradonative, Miss Starbuck diedJuly 19, 1996, and is buried atthe Fort Logan cemetery. Herwork career began as a staffassistant to General OmarBradley while serving in theArmy. She was the onlywoman to have held theposition of Chief BenefitsDirector.

The Fisher HouseFoundation, Inc., has ap-pointed former VA Secretary

Jesse Brown to its board oftrustees. The internationalnot-for-profit organizationcoordinates private supportand encourages publicsupport for a network ofcomfort homes known as“Zachary and Elizabeth M.Fisher Houses.” Four of theexisting 24 — in Albany, N.Y.,Minneapolis, West PalmBeach, Fla., and Denver —are for veterans’ use.

The Philadelphia VARegional Office, InsuranceCenter and Benefits Deliv-ery Center welcomed guestsfrom the PhiladelphiaMulticultural Training andResearch Institute, TempleUniversity, to a Diversity Daycelebration at the end of theyear. A panel discussionfocused on African-American,Irish, Jewish and Hispaniccultures. The event concludedwith employees tasting foodsof the different cultures,catered by the VeteransCanteen Service.

McKee meets a North Vietnamese citizen along the way.

February/March 1998 17

Augusta, Ga., VA Medical Center Associate DirectorRalph Angelo accepted flags made by second-graders atthe Forest Hills Elementary School, coinciding withVeterans Day 1997. A local blood center had sponsored ablood drive, and each donor was asked to sign a flag.Messages included: “We stand by you” and “Thanks toveterans.”

The 1998 applicationpackage for the Robert W.Carey Quality Award can befound at http://vaww.va.gov/CareyAward98. The on-linepackage includes applicationinstructions and form,evaluation and recognitionprocess, winners’ responsibili-ties, award criteria andscoring guidelines form. Thisis the highest quality awardpresented to an organizationby VA. Applications must besubmitted by May 1. Theaward will be presented inSeptember 1998. Theapplication is available fordownload in MS Word forWin95 ver 7.0; MS Word ver6.0, and Rich Text Format.For more information contactthe Quality ImprovementService (008B4), Office of theAsst. Secretary for Policy andPlanning, (202) 273-5077 ore-mail POC: TerrenceGraham.

Al Stolpe of HumanResources Management/COaccepted a Hammer Awardalong with other planners ofthe third annual GovernmentLearning Technology Sympo-sium in January at GallaudetUniversity in Washington,D.C. Government employees

shared their experiences intechnology-based learning.Dave Raney from theEmployee Education Systemin Durham, N.C., along withregistered nurse RobertaKrol from the Omaha, Neb.,VAMC, spoke about VA’snursing software multimediatraining system; MichaelO’Connor from Durhamcovered video teleconferenc-ing in VA; and Rick Sales ,acting director of the FinancialManagement System Service,spoke about applying technol-ogy to VA’s financial system.Laura Ruyle in VA’s LearningTechnology Graphics in St.Louis designed VA’s exhibit.

Information Manage-ment Service (IMS) needsVA employees from all statesand U.S. territories to serveas volunteer monitors for theRelease of Veterans Namesand Addresses (RONA)program. IMS approves VAreleasing lists of veterans’names and addressesaccording to the law whichspecifies to whom and underwhat circumstances VA mayprovide that information andhow that information may beused. Employee monitorsvolunteer to have their names

and addresses submittedalong with these requestedaddresses, then report anymail or other contacts madeby those who requested theinformation. This feedbackhelps IMS determine if thoserequesting veterans’ ad-dresses comply with the law’srequirements. IMS notifiesvolunteer monitors when and

to whom their names andaddresses are released andprovides additional guidance.To volunteer, fax your name,station number, VA telephonenumber and home address tothe Information ManagementService (045A4), VACO, 202-273-5981. For more informa-tion, call Dolly Jackson, 202-273-8022, or Janet Pedro,202-273-8031.

Mountain Home, Tenn.,VAMC employees volun-teered to help the communitywhen a January flood,causing an estimated $14.5million of damage, ravagedNortheast Tennessee. Theflood resulted from heavyrains and melted snow fromnearby mountains. A floodassistance help desk was atthe ready and the EmployeesAssociation quickly collectedmoney, clothing and suppliesfor families. The Acquisitionand Materiel ManagementService identified cleaningsupplies and bottled water togive to the relief effort, while

One of Enar Sand-ers’ official duties beforehe retired in Decemberas the director of theQuality ImprovementService in the Office ofPolicy and Planning wasto give the records of theVA Craftsmen Club tothe library. The VACraftsmen Club wasformed in 1920 with 46members of a MasonicClub in the Office of theBureau of War RiskInsurance (whicheventually became theVeterans Administra-tion). The club’s purposes were to provide fellowship, promote veterans’ causes and makeVA “a fine place to work.” When the group disbanded in 1995, it donated the $900 remain-ing in its treasury to be used for the care of veterans at the Washington, D.C.,VAMC. (continued on page 18)

From left, Ginny DuPont, chief, VA Central Office Library, andSanders, the last surviving Craftsmen Club member

18 VAnguard

sionals and business peopleto discuss issues such aseducation, employment,policy, advocacy, the arts andassistive technology. Veter-ans will make presentationson vocational rehabilitation,assistive technology foreducation and prosthetics.Contact Mary Klinger, 607-962-1421; fax 607-936-0537.

The Loan GuarantyService is offering a televisedtraining program for employ-ees of lenders and holder/servicers who originate orservice VA home loans.During 1998 at least eighttraining sessions will bebroadcast over VA’s interac-tive satellite network, withdownlinks into VAROs andVAMCs. January and Febru-ary broadcasts covered VAcredit standards and servicingVÅ loans. Others scheduledinclude:March 12: VA Appraisals, Lender Appraisal Process ing Program and Lender AuthorityApril 29: VA Loans - Loss MitigationMay 13: Processing VA Home LoansJune 4: Closing / Post Closing VA LoansJuly 16: Foreclosure and ClaimsAugust 6: Overview for Em-ployees New to VA Loans

All broadcasts will be from11 a.m. to 3:00 p.m. Easterntime.You must make advancereservations to attend. Listedon the VA website (http://www.va.gov/vas/loan/lenders.htm) are the VA fa-cilities with downlinks for thebroadcasts, with a contactperson for each facility. Res-ervations will be taken onlyduring the two weeks prior toeach broadcast by phoningthe contact person for thatfacility. To obtain video tapesof these broadcasts, call 1-800-800-4871.

Robert E. Coy, DeputyGeneral Counsel, retiresMarch 28 after more than40 years of governmentservice, 38 of which have

been with VA. An Armyveteran, Coy joined VA asa field attorney in 1959 andwas appointed DeputyGeneral Counsel in 1977.Coy has been honored withthe Presidential RankAward three times.

Jerry W. Bowen hasannounced his resignationas Director of the NationalCemetery System effectiveApril 3. A presidentialnominee, he served in thatposition since April 1993.An Army veteran, Bowenowned and operated farm

and other businesses inArkansas. He retainedthose businesses andplans to return to them andfamily interests in Arkan-sas. Bowen was thelongest serving Directorsince NCS came to VA in1973. He led NCS duringunprecedented growth thatincluded opening onecemetery, construction ofthree others and fundingapproval for another. ❏

The Bronx, N.Y., VAMC “Not Ready for PrimeTime Players” staged a lip-sync show, for the seventhyear in a row, to honor veterans during National Saluteto Hospitalized Veterans Week. Each year 20 to 30staff members get involved, making their sets andprops, then donning costumes, many custom madefor the show.

The real voices are of such greats as LouisArmstrong, the Andrews Sisters, Charlie Daniels, theTemptations, the Four Tops, Judy Garland, GloriaEstefan and a host of other favorites. AssociateDirector Roger Johnson pitched in by recreating actsby Buddy Holly and Jerry Lee Lewis. This troupe maybe mimicking the stars but for one night they shine asthe best performers of the Bronx VA Medical Center.

Star Spangled Salute

laundry facilities wereavailable to VA staff memberswho had no water at theirhomes for several days. VA’sMental Health Crisis Re-sponse Team was at theshelters. A VA employee’shome was totally destroyedand about four VA staffmembers suffered damage orlost use of utilities at theirhomes because of damagedroads, water system, withresulting mud and debris.

The Atlanta VA MedicalCenter experienced a flood ofa different kind in Januarywhen a water main burst in aconstruction area outside theemergency room entrance.The ER staff moved patientsto a pre-designated temporarylocation while other staffmembers moved or covered

items. Engineers closed themain control valve, but morethan 200,000 gallons of waterhad surged out.When thewater subsided around 9 p.m.,nearly 75 Facility Manage-ment Service Line staffmembers worked through thenight to restore basic systemsand then clean things up soclinic appointments took placethe next morning. Everybody’sextra efforts made it possiblefor 1,500 veterans to behelped in the clinics that day.

The Disabled butEnabled and EmpoweredConference will be heldMarch 19-22 in Rochester,N.Y. Sponsored by the StateUniversity of New YorkEmpire State College, theconference will draw students,educators, veterans, profes-

Coy

Bowen

Performing “I Want To Be in America” from “West SideStory” are, from left, Alba Hernandez, Angel Salas, DarleneMulevo, Rita Roman (partially hidden), Anthony Baez, BrettVess (partially hidden), Katherine Cabrera, Tony Torres

February/March 1998 19

HONORSand awards

Under Secretary forHealth Dr. Kenneth Kizerwas one of 34 chief executiveofficers world-wide profiled inthe book, “Straight from theCEO: The World’s TopBusiness Leaders RevealIdeas that Every ManagerCan Use.” The book wascompiled by G. WilliamDauphinais and Colin Price ofPrice Waterhouse.

Dr. Mark O. Jensen ,Fargo, N.D., VAMC&ROCenter, received a three-yearappointment as CancerLiaison Physician for theHospital Cancer Program.The program is part of theCommission on Cancer of theAmerican College of Sur-geons, which reviews hospitalcancer programs. Some 22percent of U.S. hospitals havecancer programs approved bythe Commission on Cancer.

Dr. Suzanne Klimberg ,chief of Women’s Oncology,Little Rock, Ark., VAMC, wasnamed president-elect of theAssociation for AcademicSurgery. She will oversee agrant process, and selectrecipients for student researchand young investigatorawards and fellowships.

Robert Damon , VisuallyImpaired Services Team(VIST) coordinator at the AnnArbor, Mich., VA HealthSystem, was recognized atthe Blinded Veterans Associa-tion (BVA) national conventionthis past year. Damon, formore than a half a decade,has traveled in Michigan andnorthwestern Ohio to coordi-nate health care and rehabili-tation services for visuallyimpaired veterans. Damon

helped establish BVAvolunteer offices at severalVA facilities, chairs supportgroups at three VAMCs andmakes presentations toincrease community aware-ness of VA rehabilitationservices for visually impairedveterans.

Dr. John C. Rosenbek ,chief, Audiology and SpeechPathology, Madison, Wis.,VAMC, received the 1997Frank R. Kleffner ClinicalCareer Award from theAmerican Speech-Language-Hearing Foundation. He wasrecognized for more than 20years of “clinical service,supervision, administrationand research that promoteclinical excellence.”

The Tuscaloosa,Ala.,VAMC received theEmployer of the Year Awardat the Tuscaloosa Employ-ment Support ServicesAssociation Third AnnualIndustrial Fair. It was recog-nized for its successfulvocational rehabilitationprogram, providing trainingopportunities each year for upto 23 veterans with disabili-ties.

Dr. Judith Milne , chief ofstaff at the Boston VAMC,accepted the American RedCross of Mass Bay’s GoodNeighbor Award on behalf ofthe medical center. The awardrecognizes the cooperativespirit with which the medicalcenter provided mental healthstaff to assist with floodingdisasters in northern Massa-chusetts last spring.

Emma Marie Garza, R.N. ,San Antonio, Texas, VAMC,

received the St. John Fellow-ship Exemplar Award fromthat charity’s San Antoniochapter. She was honored for“inspired and inspiring care tocountless needy veterans.”Listening carefully to thepatient is one of the secrets ofeffective care, she saids. “Ifyou take the time to listen youoften learn the patient’s realproblem may have nothing todo with their medical condi-tion.”

Pat Coufal , staff nurse atSan Francisco VAMC’s SantaRosa Clinic, won the SonomaCounty Mental HealthDepartment’s “Staff Person ofthe Year” award for helping toestablish the clinic.

Dr. Abraham Zimelman ,physician at the Boston VAOutpatient Clinic, wasappointed as the statesurgeon for the Massachu-setts National Guard, makinghim the highest rankingmedical authority in Massa-chusetts.

Dr. Richard Brown of thePharmacy Service, Memphis,Tenn., VAMC, received theUniversity of TennesseeCollege of Pharmacy’s 1997Alumnus of the Year Award.

Jonathan H. Gardner ,director, Tucson, Ariz., VAMC,received the 1997 Roy E.Brown Award from theAssociation of MilitarySurgeons of the United States(AMSUS) for his accomplish-ments in federal health-caremanagement.

The Madison, Wis.,VAMC received the Preven-tion/Environment/Prosperity(P/E/P) award from theWisconsin Department ofNatural Resources in Decem-ber. The monthly environmen-tal achievement awardrecognizes the hospital’sefforts to prevent pollution.The award honors Wisconsin

businesses that have gonebeyond industry standards tominimize waste and preventpollution while improving theirbottom line.

Staff members of theMateriel ManagementProgram Office at theMilwaukee VAMC receivedthe national 1997 VA SupplyAutomated Advisory NetworkInnovation Award. Theydeveloped and implementedan electronic equipmenttracking program for mobilehospital equipment. Besides aplaque given at the NationalLogistics ManagementTraining Symposium inOrlando, Fla., $1,000 wasawarded the staff to be usedfor automation.

Dr. Philip A. DeSimone ,chief of the Medical Serviceat the Lexington, Ky., VAMC,received the KentuckyLaureate Award from theAmerican College of Physi-cians for excellence inmedical care, education andresearch.

Deborah Schwallie, R.N. ,Milwaukee VAMC, waselected to serve for a two-yearterm as president of theWisconsin Nurses Associa-tion, the state’s largestprofessional association forregistered nurses. Schwallieis a nurse practitioner in themedical center’s employeehealth department.

Dr. Charles S. Lieber ,chief, Alcohol Dependence &Treatment Program andSection of Liver Diseases andNutrition, Bronx, N.Y., VAMC,received the 1998 AmericanMedical Association (AMA)Scientific Achievement Award.The gold medallion is givenannually for outstandingscientific accomplishments. ❏

20 VAnguard

his arm, which was bleeding.Miller asked to look at his armand how it had been cut. “Idid it with this,” was the replyas the veteran pulled an openpocketknife from his pocket.She continued talking to theveteran, asking him to giveher the knife. He refused,saying, “I’m going to cutmyself again.” She tried torestrain his arm, but he wastoo strong and cut himselfagain. Meanwhile, CarolanBrooks , the director’ssecretary, alerted policewhen she saw the knife.Chuck Rutherford , supervi-sory personnel managementspecialist, responded first tothe alarm and began talking tothe patient. Soon after, officerJon Davis joined him, andboth took the patient’s knifeand subdued him until medicalpersonnel arrived to treat him.

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The Tucson, Ariz., VAMedical Center Life SupportUnit made it a memorableand thankful holiday season

HEROES✩ ✩ ✩ ✩ ✩

A life-long VA hero,Lexington, Ky., VA MedicalCenter volunteer John PaulJones , died in January with38 years and 12,161 hours asa VA volunteer to his credit.The 71-year-old retired firedepartment official was anactive VFW member and stateleader. In addition to servingin virtually every volunteercapacity at the medicalcenter, he was an avid vol-unteer recruiter and commu-nity booster for VA. Centerpublic affairs officer JudyRittenhouse said, “Hefunctioned like an unpaidVoluntary Service staffmember and hardly ever tooka vacation or called in sick.”Voluntary Service Chief GregAnderson said, “It would takeseveral volunteers to replace

the hours John Paul servedeach week, but his impact asa volunteer at our medicalcenter is irreplaceable.”Bettie Jones, John’s wife,volunteered by his side at themedical center and willcontinue her work there.

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Cool thinking and quickresponse by KnoxvilleDivision employees of the VACentral Iowa Health CareSystem prevented a seriousincident from escalating topersonal disaster. A veteranwalked past secretary AnnMiller into the associatedirector’s office and asked tosee the director. He then toldthe secretary, “I want to showthe director this” and stuck out

for a traveling family. Thefamily was on Interstate 10when their 20-month-old babywent into seizure. The fatherspotted the VA sign andrushed into the medical centeremergency room with thebaby in his arms. VA staffdiagnosed status epilecticus,a life-threatening condition,and immediately called inresources and provided carethat saved the baby’s life.

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Mountain Home, Tenn.,VA Medical Center Engineer-ing Service employee JohnMyers was mowing grass atthe center when he noticed aman alongside the road whoappeared confused. As hewatched, the man wanderedinto the busy street. Myersstopped his mower and ran tothe man, pulling him to safety.Witnesses said Myers riskedhis own life in the busy traffic.He was recently named“Employee of the Month.”

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Cleveland VA MedicalCenter Spinal Cord InjuryService nurse BeverlyKrueger, R.N., was awak-ened at home by a midnightphone call from the mother ofone of her patients. Themother described her dis-tressed son’s symptomswhich Krueger recognized asconsistent with autonomicdysreflexia, a potentially life-threatening condition for pa-tients with spinal cord dys-function. She drove to thepatient’s house and found himin serious condition becauseof a blocked catheter. Shereplaced the catheter andstayed with the patient untilhis blood pressure returned toa safe level. She literally andfiguratively went the “extramile” that night and thoseextra miles saved a veteran’slife. ❏

VA Security Officer Dimitry Upshaw raises

the POW/MIA flag over VA Central Office.

Acting Secretary of Veterans Affairs Togo D.

West, Jr., has directed that the flag be flown at

VACO daily. This year’s Dept. of Defense

appropriations act ordered federal offices and

properties to display the POW/MIA flag on

Armed Forces Day, Memorial Day, Flag Day,

Independence Day, National POW/MIA

Recognition Day and Veterans Day. The law

further directs VA medical centers to fly the

flag any day that they display the U.S. flag.