11 December 17, 2008 Gail Graham VHA OI Deputy Chief Officer Healthcare Information Management VHA Office of Information Using Telehealth and Health IT to Deliver Quality Care to Veterans Capitol Hill Seminar Series: Using Telehealth and Health IT to Deliver Quality Care to Veterans Overview of Veterans Health Administration Activities

22 Veterans Health Administration (VHA) “To honor America’s veterans by providing exceptional health care that improves their health and well-being” Honoring Those Who Served

33 Medical care: In 2007, we cared for 5.5 million veterans Training: We are among the largest providers of health professional training in the world Research: We are among the largest and most productive research organizations in the U.S. Disaster Assistance: We are a principal Federal asset for providing medical assistance in major disasters Homeless Care: We are the largest direct-care provider for homeless persons in the U.S. VHA: Key Contributor to Nation’s Healthcare

44 Who Are Department of Veterans Affairs (VA) Patients? Older 49 % over age 65 (increasing population > 85) Sicker Compared to Age-Matched Americans - 3 Additional Non-Mental Health Diagnoses - 1 Additional Mental Health Diagnosis Poorer ~ 70% with annual incomes < $26,000 ~ 40% with annual incomes < $16,000 Changing Demographics 4.5% female overall - Females: 22.5% of outpatients less than 50 years of age

55 278,566 FTE Employees including: Veterans Reservists Physicians Pharmacists Nurses Dentists Who Are VHA Personnel?

66 Veterans Health Information Systems and Technology Architecture (VistA) Single, integrated Computerized Patient Record System (CPRS) used throughout VHA in all healthcare settings (Inpatient, Outpatient, Long-term care) Delivers an integrated record covering all aspects of patient care and treatment VistA is:

77 Key VistA Patient Comparison Statistics through September 2008 Orders Images TIU Documents Medication Administration Vital Sign Measurements 2,028,271,561 1,019,783,809 1,138,044,845 1,074,151,892 1,351,435,897 1,054,916 1,306, , , ,839 1,016,304 1,174, , , , % 11.23% 4.62% 2.86% 3.32% Total Number of File Entries (through Sep 2008) Average daily primetime file entry change (through Sep 2008) Average daily primetime file entry change (through June 2008) Average percentage rate of file change (June Sep 2008)

88 VHA – VistA Imaging

99 InnovationInnovation Innovation will allow innovative ideas to emerge from the field, and enable the field to build communities of interest to identify and promote the ideas that have the most promise. The program will use innovation IT dollars to attain hardware, software and contract development resources for field based development, and Medical Care dollars for program management, stakeholder interaction, encouraging innovators, and evaluation.

10 VHA Assets – Healthcare Delivery Sites Hospitals Clinics (Hospital, Community- Based and Independent) Nursing Homes Readjustment Counseling Centers (Includes 20 brand new centers with three more opening soon) Domiciliaries Mobile Clinics

11 CBOCS Improve: Facilitate transition from hospital to primary care New Clinics Announced: VA announced on 12/4/08 that it plans to open 31 new outpatient clinics in 16 states. They will be operational by late 2010, with some opening in 2009 VHA – Community Based Outpatient Clinics (CBOCS) Quality of care Access to services Efficiency of operations Veteran Satisfaction

12 VA Electronic Health Record My HealtheVet Personal Health Record VistA/CPRS is the authoritative VA medical record Veteran "owns" his/her My HealtheVet Personal Health Record (PHR) Veterans will access extracted data sent to My HealtheVet from VA Electronic Health Record (EHR) Veteran controls access to information (via delegation) CPRS  VistA  BCMA VistA Imaging Inform Engage Activate Complementary Health Records

13 10 October On-Line Prescription Refills

14 Quality Evidence

15 10 October Emerging National Healthcare Delivery Trends Patient-Centered Care Decentralized Healthcare –Networked Virtual Organizations (NVO) For accessing Consumer Health Information Point-of-care Health Information Exchange –Personal Health Records Pharmacogenomics & Genomic Medicine Nanotechnology and Medical Devices Telehealth & Teleradiology Nanotechnology for Cancer Cell Directed Drug Delivery Nanotechnology for Cancer Cell Directed Drug Delivery

16 “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 Best Healthcare Anywhere