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Veterans Health Administration VistA

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1 Veterans Health Administration VistA
Veterans health information systems & technology Architecture Linda F. Fischetti, RN, MS Chief Health Informatics Officer (Acting) Office of Information Veterans Health Administration On behalf of Patient Care Services and the Office of Information, I am pleased to take this opportunity to reintroduce the My HealtheVet program and to inform you of updated features to be deployed in Spring 2008. With me is Theresa Hancock from VHA’s Office of Information and the Acting Director of the My HealtheVet Program. January 2008 1

2 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. My HealtheVet is a web-based personal health record portal which includes access to patient education, VA benefits and resources, a comprehensive personal health journal, and online prescription refills. Collaborating agencies include the Department of Defense; National Institutes of Health; Centers for Disease Control; and the American Health Information Community. The My HealtheVet Program provides America’s veterans with secure universal access to their personal health information in order to improve their health care. My HealtheVet is based on the core belief that knowledgeable patients are better able to make informed health care choices, stay healthy, and seek services when they need them. The program enables and supports veterans by making them more empowered health care consumers. Quality, access, value, and patient satisfaction are improved through the development of a collaborative health care tool. My HealtheVet uses innovative technology to complement the delivery of traditional health care services. The program meets the President’s charge to agencies to use technology to its fullest potential to provide services and information that are centered on citizen groups. My HealtheVet furthers the aim of electronic government (E-Gov) by exemplifying citizen-centric, interactive tools that the government can provide to veterans and their relatives. The My HealtheVet Program meets the needs of veterans, families, and caregivers by providing secure and universal access to comprehensive health and medical information that is crucial to patient care. This access is an important patient safety factor for high quality care, and it becomes critically important during emergencies ranging from an individual situation to a natural disaster or some other catastrophe. My HealtheVet allows Veterans and their families to collaborate in the management of their personal healthcare through innovative capabilities: online viewing of Personal Health Records (PHR); filling prescriptions; and management of medical history. This collaboration serves to map the care accessible online to existing clinical practices within VA hospitals. The result is improved quality and greater satisfaction of care. Additionally, My HealtheVet assists both long-term veterans and new veterans transitioning from active duty by integrating with the Department of Defense. An Executive Order issued on August 22, 2006 directed agencies to “ensure that health care programs administered or sponsored by the Federal Government promote quality and efficient delivery of health care through the use of health information technology.” As a complement to VA’s award-winning fully Electronic Medical Record, the My HealtheVet Personal Health Record enables veterans to more fully participate as partners with physicians in their health care. My HealtheVet is part of VA Strategic Initiative 1.2 that uses the PHR to enhance the veteran/provider partnership and optimize veteran health. My HealtheVet goals are: Using MHV to support the dissemination of standard patient education and clinical business practices. Using Information Technology to increase convenience and response time for veterans requesting VHA services. Increasing communication / collaboration between veterans and clinicians. Enabling veterans to consolidate and monitor their own health records and share this information with non-VA clinicians and others involved in their care. Empowering the patient to control what information is accessible by others. Collaboration with DoD eHealth portal TriCareONLINE to maximize VA and DoD resources and achieve a seamless transition from military to civilian life.

3 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 An Executive Order issued on August 22, 2006 directed agencies to “ensure that health care programs administered or sponsored by the Federal Government promote quality and efficient delivery of health care through the use of health information technology.” As a complement to VA’s award-winning fully Electronic Medical Record, the My HealtheVet Personal Health Record enables veterans to more fully participate as partners with physicians in their health care. My HealtheVet is part of VA Strategic Initiative 1.2 that uses the PHR to enhance the veteran/provider partnership and optimize veteran health. My HealtheVet goals are: Using MHV to support the dissemination of standard patient education and clinical business practices. Using Information Technology to increase convenience and response time for veterans requesting VHA services. Increasing communication / collaboration between veterans and clinicians. Enabling veterans to consolidate and monitor their own health records and share this information with non-VA clinicians and others involved in their care. Empowering the patient to control what information is accessible by others. Collaboration with DoD eHealth portal TriCareONLINE to maximize VA and DoD resources and achieve a seamless transition from military to civilian life. More than 500,000 registered users have access to the portal’s full range of features, although registration is not required to utilize the site’s evidence-based health information libraries. For both VA and community clinicians and care providers, My HealtheVet means access to a more comprehensive online health record that may include veteran’s self-entered health information, e.g. blood pressure readings, weight, medications, allergies, and Family and Personal Health History. With this convenient access to information, clinicians may gain a more complete understanding of a veteran’s health status, and the PHR may also provide continuity of care across multiple care providers. With My HealtheVet, clinicians have a trusted and safe source where they may direct patients for health education, which enhances the veteran’s ability to participate in shared and informed health care decision-making. For VHA, My HealtheVet means more well-informed and empowered health care consumers as a result of veterans using the rich information, tools, and resources provided by the online portal. My HealtheVet also means streamlined organizational processes and transactions, with improved quality, access, value, and patient satisfaction. A critical advantage of My HealtheVet's accomplishments is the cost effective delivery of health care for this community using technology. The transactional efficiency of online services such as ordering prescription refills represents a significant cost savings. Online health care capability reduces and streamlines office visits by providing needed information and services while increasing the quality of an in-person health care visit by providing the patient with valuable health data that they can share with their provider. The net result is more effective usage of health care dollars through use of the Internet without sacrificing the effectiveness of in-person care. Outcomes The My HealtheVet Pilot Program demonstrated that VA can provide veterans with a safe, secure, and private electronic copy of their own VA health information through a secure and private Internet environment. More than 7,000 patients have participated in the pilot, and many have responded enthusiastically: “I feel more in control and aware of my choices.” “I go home and update my ‘record’ after I see my doctor in clinic.” “It’s been great; I wish I had it years ago.” “Thank you for making this available.” “This has greatly improved my healthcare.” The RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) framework is being used as a model for evaluating the impact and effectiveness of the National My HealtheVet (MHV) Program to the veteran population. The process to evaluate this effectiveness is two-fold: metrics that evaluate current performance and the identification of research study questions that will contribute to practical and relevant research evidence. In addition to metrics and a research agenda, key data elements are necessary for overall program management. For all three areas, the benefit of using this model is that it enables the evaluation of a health behavior intervention’s potential for translation, its ultimate public health impact, and the standard methods for determining if an intervention has been efficacious. Examples of performance measurements for Reach: Determining the number of people who are exposed to and eligible for the MHV program Categorizing the representativeness of those using the program including demographics Identifying target populations who can most benefit from participation in the program and comparing participation rates for these populations Comparing methods of recruitment and spread across the veteran population Identifying and reducing barriers to recruitment or continued use (ex. Lack of Internet access or computer literacy) Examples of performance measurements for Effectiveness: Determining the key targeted outcomes and assessing the extent to which the program achieves these outcomes, including clinical outcomes, utilization management, case management, cost savings, and satisfaction of patients and providers Identifying any unintended consequences and designing strategies to address Analyzing impact on quality of life dimensions The products of collaboration include VA participation in a growing number of agency and industry forums to advance the use of health information technology to improve delivery of health care services to citizens. From a clinical perspective, secure and universal access to important medical information improves the effectiveness of co-managed care and enhances patient safety by enabling a more comprehensive view to those who collaborate in a patient’s care. This may include the patient, family members, care givers, VA clinicians, and multiple community care providers. This is especially important to rural and disabled patients who can not easily visit clinics. My HealtheVet has been named a national finalist in the “Consumer Empowerment and Protection Awards” given by a national accreditation organization.  VA is one of 19 finalists in the “Best Practices” first-time awards from URAC (formerly the Utilization Review Accreditation Commission), an independent health care accreditation commission.  The contest attracted entries detailing innovative and proven programs to enhance patient safety and give consumers control over their health care.  Winners represent health plans, pharmacy benefit management organizations, health care management firms and health information technology companies.   My HealtheVet also has been recognized for outstanding achievement by the Web Marketing Association earlier and in 2007 was a winner of the “Top 5” Excellence.Gov Awards for innovative technology from the private sector Industry Advisory Council.

4 VA Health Technology - VistA
“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 My HealtheVet provides access to trusted patient health education information, links to Federal and VA benefits and resources, a comprehensive personal health journal, and online requests for VA prescription refills anywhere, anytime Internet access is available. For example, patients can easily track, record, and graph metrics like weight, blood pressure, and blood glucose. Medications, immunizations, and allergies can be documented and kept current. Veterans can track medical, family, and military health histories. A customized at-a-glance summary of all relevant information can be created and printed for sharing with the patient’s health care provider at the next clinic visit. One of the most popular features is the opportunity to refill VA-prescriptions online. Health Education Information “Encourage each patient to be a “smart patient”. Teach patients how to keep track of their health history using personal health journals & medication logs, explain health facts accurately, educate themselves on basic health issues & ask questions of care staff, & engage staff in active dialogue.” The Joint Commission Guide to Patient & Family Education, 2nd Edition, page 64 MHV uses Healthwise, Medline Plus, and health content from subject matter experts and health content jointly developed by MHV and TriCare Online (DoD’s eportal). Condition Centers The VA National Center for Health Promotion and Disease Prevention, and partnering with VHA patient education and VHA Environmental Hazards and Public Health, has developed an educational and health promotion library of materials on certain, health conditions to enable veterans to take control of their own health (Diabetes, Heart Disease, Hypertension, etc.) Self-assessment Screening Tools Offers mental health anonymous screening tools for Alcohol Use, Depression, PTSD and Substance Abuse (different from health risk assessment). These tools can be printed and shared with the provider. Veteran Specific Conditions (e.g., Agent Orange) Seasonal Health Reminders (e.g., flu) My Complete Medications View Provides In-Person Authenticated patients (upgraded MHV account to access personal health information) the capability to view an integrated view of their medications (Prescribed VA meds, VA prescription history, Self-entered meds, OTCs, herbals, and supplements. MHV pulls the VA medication data from the Pharmacy File at each site. Calendar Released on August 25, the Enhanced Calendaring Solution allows Public Affairs Officers to enter national events and have it display to all MHV users. In future releases veterans will be able to subscribe to timely reminders related to their health care and choose to have their VA appointments and wellness reminders display on their health calendar. Increased patient self care and management (patient and family centric care) Patients will be more involved in their own care, self-management, increased demand to know about the quality of their care Increased access to health information from many sources, More emphasis on and tools to support patient education Increased communication between providers and patient More reliance on family members for care More ways to provide information for patients with hearing impairment, low vision, cognitive impairment. In responding to the needs of our veterans, MHV will continue to fulfill its commitment to provide the highest standard of tools, information, and services to ALL veterans it serves. We must anticipate the changing needs of our veterans. In an age of incredible advancements in technology, VHA defines its vision in terms of how these advancements can be applied to improve veterans’ health. MHV can address these needs for those who have returned from the war, those with chronic conditions, seniors, those with disabilities, mental health issues, homebound, those who live in rural areas, families, stakeholders and communities, and employees. The framework emphasizes VA’s vision of how to best provide safe, effective, efficient and compassionate care. We continue our commitment to identify and deploy features for veterans, their families, and employees. Coming Soon – will be described in the upcoming slides.

5 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 WebTrends provides data on My HealtheVet Visits and Unique Visitors. 2007 VISITS are up 23% over 2006 and 169% over 2005. 2007 VISITORS are up 16% over 2006 and 205% over 2005. Rx Refill is on a steady climb: 2007 is up 57% over 2006. The 2005 Rx weekly average is only for 4 months, so the % is very high – up 279%. We introduced RX Refill August 31, 2005 and steep increase in visits, unique visitors and registrants began then. Registrations from 2004 to 2005 went up 43% Averages level out extreme values, so they may not tell the whole truth. This is particularly true with our weekly average registrants. Although MHV Registrants Weekly Average for 2007 is slightly down by 3.5% from 2006, trend lines show MHV Registrations in a steady growth state, awaiting the next surge with our new functions. We believe MHV will experience the next tipping point with Secure Messaging and the release of Labs. We prepare the MHV Registrant Age Distribution at the end of each quarter. Our registrant age distribution remains pretty constant: 21% are 70 or better 13% are under 40 66% are between 40 and 69. Our Median Age is 59, although those 60 to 64 are our largest segment % Our Median percent growth across all our age segments is 11%. BUT for the past 2 quarters, the younger age segments are growing the most: Current Top 3: up 25% 25-29 up 15% 30-34 up 13% 5

6 VA-Organizational Culture - VistA
The secure messaging will allow clinicians and patients, as well as care teams, to electronically communicate non-urgent health care issues in a protected and private technical environment, ensuring patients’ identifiable health information is safe and secure. The objective is to improve the veteran-clinician relationship and efficiency of communication by providing an electronic communications medium. Secure messaging will be offered as an opt-in option for both the patient and the clinicians. We have requested a CPT code to capture workload. Initially secure messaging will offer basic functionality and features allowing patients and care team staff time to become acquainted with the system. The first release will offer: Access SMS from CPRS toolbar Send and receive electronic communications Generate templates for the most common communications topics Ability to establish Triage Teams Ability to identify a surrogate Save electronic communications as TUI Progress Notes Receive notification of electronic communication Studies have indicated that secure messaging facilitates the participation of people with Traumatic Brain Injury and Mental Health in qualitative interviews. Advantages include increased time for reflection, composing answers and greater control of the interview setting. In addition, patients are capable of greater insight, reflection and humor than indicated by previous research. Study findings indicate that new technologies may advance data collection methods for people with cognitive-linguistic impairments and mental health disorders who face participation barriers in face-to-face interviews. Patient-physician messaging is a service that patients will use given the opportunity. The messaging service enables physicians to answer medical questions with less time spent compared with telephone messaging. Patients reported enhanced communication and access with the messaging service. My HealtheVet Personal Health Record National Secure Messaging Clinical Adoption Implementation Guidelines Policy and guidelines Generic clinical workflows Clinical triage decision trees Implementation team guidelines Communications/outreach strategies Education and training guidelines Best Practices Lessons Learned

7 VA-Organizational Culture - VistA
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. The four primary sites are: Boston: JP and West Roxbury Dr. Jacqueline Spencer Portland VA Medical Center: Dr. David Douglas Seattle: Puget Sound: Dr. Paul Nichol Washington DC Medical Center: Dr. Neil Evans Pre alpha test release in February 2008 to test features and functionality with a very limited number of health care providers and patients as well as initiate clinical adoption implementation processes. Alpha and beta releases will test increased feature and functionality with a large test population and enhanced clinical adoption processes. Incremental national roll out will be based on the pilot feedback.

8 VistA – An Integrated Approach
Veterans Health Information Systems and Technology Architecture My HealtheVet is a collaborative effort with many partners. Sources of input range from veterans / VSOs, workgroups, focus groups, help desk requests, and recently through feedback from the American Customer Satisfaction Index. We have involved stakeholders from the start. A collaboration solution can gain immediate momentum by involving stakeholders of the solution from the onset. These stakeholders can become evangelists inside and outside of the organization, and can also lend instant credibility to the ideas that form the concept of the solutions. Stakeholder Management Every one across the organization shares “ownership” of the vision Sustain unequivocal support of clinical leadership and staff. Components broken down into specific action steps to make this vision operational Specific, detailed plans, clear methods for measuring success, guide towards implementation and beyond Every feature includes veterans and clinicians in the decision making process Become integrators of change Drive change and set the stage for using MHV as a tool to improve health outcomes Create smooth transition from a national level to local level. Patient Care Services Patient Care Services is the business owner and sponsor of the MHV Program. Clinical Advisory Board The Clinical Advisory Board is MHV’s Steering Committee for content, functionality, subject matter experts, policy, and recommended prioritizations. Office of Information, Veteran Consumer Health Informatics Office Responsible for managing the business aspects of MHV and serves as the “Voice of the Veteran.” Enterprise Strategy Management and Office Information and Technology The MHV Program Management Office will be represented in the entire lifecycle process at defined touch points, working side-by-side with the ESM and OI&T Offices. Tightly coupling business strategy and work processes with information systems is essential in order to merit the trust given us and to improve the care and enhance the experience of those we serve. Points of Contact Paul Revere heard the scuffling in town about the British being seen scurrying at the boat docks. He got on his horse and within 2 hours covered 13 miles, knocking on all doors of leaders to warn them that the British were coming. The towns were prepared…one man, one horse; through word of mouth. Extraordinary news traveled a long distance in a very short time, mobilizing an entire region to arms…..imagine what we can do and have done with our Points of Contacts. There is a designated Point of Contact at every VAMC, committed to bear arms to promote MHV through communication, training and education, outreach, clinical adoption/change management, and implementation. We have champions that range from the release of information clerk, to clinicians, to CIOs. Veterans and VSOs My HealtheVet, for example, is built around the needs of veterans and the program involves them in its design, management, and operation. Recognizing that some users did not have Internet access at home, the program made terminals available at VHA facilities so those constituents could set up and benefit from the services available to them. The Veteran Service Organizations are a key collaborative partner with our veteran populations. VistA is the single, integrated Health Information System used throughout VA in all health care settings (Inpatient, Outpatient, Long-term care).

9 VistA is: 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 The MHV National site will include all functionality currently in the pilot site (see list above). Future functionality includes: Additional medical record extracts, additional self-entered metrics, delegation, viewing appoints, requesting an appointment, a mental health recovery plan, treatment plans, and secure messaging. We have already seen significant benefits as relayed by one of our veterans. - Veteran has significant chronic medical related problems and is on 17 medications. The veteran went on vacation out of the country and was hospitalized. The veteran (a pilot patient) had difficulty with the language barrier, but was able to instruct the medical team to go into his MHV account to retrieve his medical record. MHV eliminated the need to reorder tests and order unnecessary medications. In his book “Blink”, Malcolm Gladwell notes that high quality decisions can often be made by experts in a field within the blink of an eye. This is possible, Gladwell proposes, because those experts have in-depth knowledge and experience in their particular fields, having assimilated information over many years that enables almost instantaneous decision-making. He further notes that exhaustive analysis can often lead to poor decisions because too much data clouds problems that experts could discern with relatively little information at hand. My HealtheVet provides an excellent example of this principle. Through its consolidated platform for prescription delivery and refills, medical records, and patient-doctor interaction, the platform acts as a broker of trusted information upon which life-critical decisions can be made. The users of the information are a diverse group—doctors, patients, medical facilities, and families—and each benefits from having access to real-time, accurate, trusted information (self-entered and VistA).

10 VHA – VistA Imaging

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 VHA – 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 VHA – My HealtheVet 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-

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 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 1,779,743,528 1,090,860 939,661 16.09% Images 755,788,621 1,080,543 980,746 10.18% TIU Documents 969,012,392 731,349 661,927 10.49% Medication Administration 935,362,184 678,110 599,753 13.06% Vital Sign Measurements 1,174,004,338 853,920 748,918 14.02%

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

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 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 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 Cumulative Images Captured 2003 – 2007
Over 20K new images captured each hour 24X360 = 8,760 hours in a year 183 million images / 8,760 hours = over 20K images/ hour 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.

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 The VA healthcare enterprise consists of 157 medical centers and over 850 outpatient clinics. The VA is installing approximately 140 retinal camera systems for its diabetic retinopathy surveillance project. In order to be convenient for the patient, the examinations are performed at sites chosen to minimize travel. The VA is also establishing approximately 20 reading centers around the country for diagnosis. A reading center can serve any acquisition site, not just the ones in its region.

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 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, Patient’s DOB, Patient Sex Save old values in Original Attributes Sequence Don’t change Study, Series, SOP Instance UIDs System sends updated portable media images to VistA Image Archive Provider can retrieve image anywhere within VA’s network

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 Office of Information, Chief Health Informatics Office
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: mhvuser Password: mhvdemo#1 My HealtheVet Pilot Username: demouserb Password: password_$1

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