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11 Veterans Health Administration VistA January 2008 V eterans health information systems & technology A rchitecture Linda F. Fischetti, RN, MS Chief Health.

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Presentation on theme: "11 Veterans Health Administration VistA January 2008 V eterans health information systems & technology A rchitecture Linda F. Fischetti, RN, MS Chief Health."— Presentation transcript:

1 11 Veterans Health Administration VistA January 2008 V eterans health information systems & technology A rchitecture Linda F. Fischetti, RN, MS Chief Health Informatics Officer (Acting) Office of Information Veterans Health Administration

2 22 Disclaimer - VistA Summarizes work of the Veterans Health Administration, Office of Information (VHA OI). May amplify elements of private sector activities or products. None of the information is meant to endorse private sector activities, obligate the Federal Government to follow any particular course of action, nor to espouse an official position of the Federal Government, for the present or in the future.

3 33 Table of Contents - VistA VHA is currently electronic Planning the transition to an interoperable future IHE supports internal business needs and interoperability IHE (via HITSP) uniquely positioned as an accelerant to move from an electronic environment within VHA towards interoperability with others

4 44 VA Health Technology - VistA Veterans hospitals used to be a byword for second-rate care or worse. Now theyre national leaders in efficiency and quality. What cured them? A large dose of technology. - Fortune May 15, 2005

5 55 Praise for VHA - VistA And the health care industry is missing an opportunity, if patients, in order to make sure they get quality care, have to carry files from one specialist to the next. It's like IT, Information Technology, hasn't shown up in health care yet. But it has in one place, in one department, as you're about to hear, and that's the Veterans Department. (Applause.) -President George W. Bush (2004) 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 ABC News in December 2007 reported Electronic Health Record success throughout VA – showcasing VistA at work in a clinical setting. -ABC Nightly News December 12, 2007

6 66 VA-Organizational Culture - VistA

7 77 Clinical Practice Guideline Implementation Strategy Patterns in Veterans Affairs Primary Care Clinics Sylvia J. Hysong, Richard G. Best, and Jacqueline A. Pugh High Adoption Sites: –(a) invested significantly in the implementation of the electronic medical record and locally adapting it to provider needs, –(b) invested dedicated resources to guideline-related initiatives, and –(c) exhibited a clear direction in their strategy choices.

8 88 VistA – An Integrated Approach Veterans Health Information Systems and Technology Architecture VistA is the single, integrated Health Information System used throughout VA in all health care settings (Inpatient, Outpatient, Long-term care).

9 99 VHA – VistA Background Single, integrated Computerized Patient Record System (CPRS) used throughout VHA in all health care settings (Inpatient, Outpatient, Long-term care) Delivers an integrated record covering all aspects of patient care and treatment VistA is:

10 10 VHA – VistA Imaging

11 11 VHA – VistA BCMA VistA Bar Code Medication Administration (BCMA) –Virtually eliminates errors at the point of administration –Coming Soon: Bar-Coded Lab Acquisition

12 12 VHA – VistA Clinical Reminders VistA Clinical Reminders: –Contemporary Expression of Practice Guidelines –Time & Context Sensitive –Reduce Negative Variation –Create Standard Data –Acquire health data beyond care delivered in VA

13 13 VHA – My HealtheVet VAs 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 Common references to My HealtheVet since its launch: Pioneering… Innovative… Ambitious… Award Winning-

14 14 VistA Saves Money 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

15 15 VHA- National VistA Statistics Type of Requests Total Number of File Entries (through Sep 2007) Average Daily Primetime File Entry Change (through 9/07) Average Daily Primetime File Entry Change (through 6/07) Average Percentage Rate of File Change (6/07 – 9/07) Orders 1,779,743,5281,090,860939, % Images 755,788,6211,080,543980, % TIU Documents 969,012,392731,349661, % Medication Administration 935,362,184678,110599, % Vital Sign Measurements 1,174,004,338853,920748, %

16 16 VHA- VistA Moving from an electronic environment to an interoperable electronic future…

17 17 VistA Requires Improved Standards: Major improvements needed are: Reduction/elimination of optionality in current standards Reduction/elimination of need for point-to-point Improved consistency of information/terminologies Improved security and privacy of information exchange The primary method of achieving these improvements are the development of comprehensive, standardized implementation guides. Healthcare Information Technology Standards Panel (HITSP) is developing these implementation guides (interoperability specifications)

18 18 VistA-Why is IHE important? HITSP interoperability specifications are built using existing standards and implementation guides wherever possible, including a significant number of IHE integration profiles HITSP interoperability specifications and the IHE integration profiles they reference/contain will support the interoperability needs of EHR-S and PHR applications such as VistA and My HealtheVet

19 19 VistA- VA/IHE Success Story All VA DICOM image acquisition uses IHE Radiology Transactions to interface modalities to PACS: –#5 - Modality Worklist Provided - download patient and study –#8 - Modality Images Stored - send images to the PACS 400 different models of radiology instruments interfaced Exactly the same IHE DICOM interface to Consults for ophthalmology (eye care), dentistry, endoscopy, pathology, and cardiology. VA will not purchase a new modality unless it supports both of these capabilities.

20 20 Cumulative Images Captured 2003 – 2007 As of December 2007, 700 million images have been captured. FY 2004 – 72 million new images. FY 2005 – 104 million new images. FY 2006 – 155 million new images. FY 2007 – 183 million new images. Over 20K new images captured each hour

21 21 Consistent Integration VistA was awarded with both an Innovations in Government Award and a IHE User Success Story One interface for over 400 different models of instruments! Consistency & Interoperability throughout the US Currently rolling out the largest diabetic retinopathy surveillance network in the world

22 22 VA National Diabetic Retinopathy Surveillance Network TeleOphthalmology application based upon IHE Eye Care Workflow Software field test 10/06 – 3/07 Simultaneous training of imagers and installation of equipment –159 Retinal Camera Acquisition Sites –58 Reading Sites 90,501 patients were seen first year (125% of goal)

23 23 VistA- VA/IHE Success Story The Portable Media Importer Patient arrives with images on portable media Provider places order for study on RIS, if needed –System Queries Modality Worklist to get patient & study –System compares Portable Media to RIS data values and verifies –System updates Portable Media images with RIS data values –Patient Name, Patient ID, Patients DOB, Patient Sex –Save old values in Original Attributes Sequence –Dont change Study, Series, SOP Instance UIDs –System sends updated portable media images to VistA Image Archive Provider can retrieve image anywhere within VAs network

24 24 VistA- Wrapping Up IHE work items in which VA will participate: Cross-community information exchange Patient identification/correlation Security and confidentiality Medical Devices Import reconciliation workflow Radiation Dosage Reporting

25 25 VistA- Questions VHA Office of Information, Chief Health Informatics Office Check us out again, or for the first time: Look for additional information on the My HealtheVet or VistA at: – – For more information, contact Ms. Linda Fischetti, RN, MS My HealtheVet National Demo Account – Username: mhvuserUsername: mhvuser Password: mhvdemo#1Password: mhvdemo#1 My HealtheVet Pilot – Username: demouserbUsername: demouserb Password: password_$1Password: password_$1

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