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