1. CPRS at CHVH Louis V. Kaufman, MD, MS, CMD Medical Director Charlotte Hall Veterans Home Charlotte Hall, Maryland NASVH Conference Burlington Vermont July 2011

2. Who Are We? Medical Director Certified Network Engineer Programming Staff

4. Why VISTA/CPRS?

7. Physician Nurse Pharmacy Ancillary Services P FC T Print FaxCopy Transcribe O Courier Hand Carry H W Write Paper People M Mail Interim Physician Order Resident Chart Courier Bin Physician Order Sheet Order Requisitions Medication Admin Record Treatment Admin Record WC F D Data Entry C O TC H TTTDPM R Proofread RR Current Order Process

8. 280,000 Orders Per Year…. Which is a lot of transcribing, writing, copying, faxing,….. Order Volume at CHVH

9. Physician Nurse Pharmacy Ancillary Services P FC T Print FaxCopy Transcribe O Courier Hand Carry H W Write Paper People M Mail Interim Physician Order Resident Chart Courier Bin Physician Order Sheet Order Requisitions Medication Admin Record Treatment Admin Record W C F D Data Entry C O T C H TTT DPM R Proofread RR CPRS Current Order Process

10. Reengineered Order Order Labels Order Sheets Requisitions MARs TARs Prescriptions Current Order Process

11. CPRS/VISTA Advantages Improves Quality of Care Increased Quality Improvement process Increased nurse-patient hands-on interaction Reduced medication errors Reduced transcription errors Reduced nurse-clinical provider communication error Increased Efficiency of Quality Improvement process

12. CPRS/VISTA Advantages CPRS is 4 times less expensive to install than commercial electronic health record systems And costs 2/3 less to maintain over the long term

13. Sharing Agreement Between Washington, DC VA Medical Center and Charlotte Hall Veterans Home Concept Initially Discussed at WVAMC in 2005 3-1/2 Years of Negotiation Memorandum of Understanding Signed In Late 2008 Between Federal Veterans Administration and the Maryland Department of Veterans Affairs

14. Implementation “Nuts and Bolts” Certified Network Engineer (CNE) Hired Required by VA Information Technology and Security Departments Found existing CHVH computer network to be inadequate for CPRS Designed a new wired and wireless computer network “from the ground up” to comply with the VA’s computer hardware and IT security specifications

15. Implementation “Nuts and Bolts” Certified Network Engineer Worked closely with WVAMC telecommunications department to install redundant high speed Point To Point data lines between CHVH and WVAMC Supervised the CPRS server move from WVAMC to CHVH for programming (Required by the VA Central Office legal team)

17. Implementation “Nuts and Bolts” Certified Network Engineer After programming completed, supervised the physical move of the CPRS server from CHVH back to the WVAMC CPRS server will be physically located at the WVAMC and managed by WVAMC personnel with management and personnel fees paid by the Maryland Department of Veterans Affairs

18. Implementation in the CHVH ALF 180 bed Assisted Living facility Implementation began in April 2009 Adjustments required to use CPRS/VISTA in a non Federal VA facility Pharmacy Laboratory

19. Implementation in the CHVH ALF Laboratory Adjustments LabCorp is the laboratory services provider LabCorp has direct access to CPRS through a national agreement with the Federal VA This agreement allows bidirectional electronic lab test ordering and reporting directly through CPRS CHVH lab tests are performed in both Virginia and North Carolina This led to miscommunication between the LabCorp programmers in both states and at CHVH

22. Hmmmm!

23. Implementation in the CHVH ALF Pharmacy Adjustments CHVH uses a commercial non-VA long-term care pharmacy This means that the VA programmer pharmacist needed to approve all medications and treatments in 6 month time intervals (“Real time” order checking is not currently available in a non-VA facility)

24. Implementation in the CHVH ALF Staff Training

30. Implementation in the CHVH ALF Staff Training Group training Individual “hands on” training among staff members Computer “Screen Shot” Tutorials Lab Order Entry Medication Order Entry

31. Implementation in the CHVH ALF Staff Training Issues Started too soon prior to implementation of CPRS Staff forgot user names and passwords Tutorials need further development Training Database Currently being implemented to separate “test” patient files from the production database “real” patient files

32. Future Implementations of CPRS at CHVH 278 bed Skilled Nursing Facility Staff training to begin in September 2011 Imaging VISTA/CPRS imaging being implemented now to scan in documents, reports, EKGs, etc., from outside providers Future: scan actual x-ray images into the patient chart

33. Future Implementations of CPRS at CHVH Electronic Medication Administration Record (MAR) Electronic Treatment Administration Record (TAR) Bar Code Medication Administration (BCMA)

34. Conclusions CPRS is 4 times less expensive to install than commercial electronic health record systems CPRS Costs 2/3 less to maintain over the long term CPRS Improves Quality of Care

35. Conclusions CPRS is a great example of Federal/State Partnership Our Tax Dollars At Work! and

36. Conclusions The Best Care Anywhere!