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VA records system a model for health care industry
By Sheila Watson
Contributing Writer
When most people think of cutting-edge health care technology, a system created by the government is probably not what comes to mind.
And yet the Department of Veterans Affairs has developed a system that is being touted as the low-cost foundation of the national electronic health care system President George W. Bush wants to deploy.
The Veterans Health Information Systems and Technology Architecture is the name given to a group of software modules that cover a range of health care applications.
Patient records in VISTA are fully electronic, portable and easily accessed. With one click, test results such as CAT scans, MRIs and EKGs are available, with some images available in 3-D and 360-degree viewing.
The VA developed the system to provide a single way for health care providers to review a patient’s information and order medications, special procedures, X-rays, nursing orders, diets and lab tests.
A doctor at any of the VA’s 1,300 facilities across the nation can pull up a patient’s file and add information if the patient is treated at that care center.
VISTA’s benefits
In a recent demonstration of VISTA’s capabilities, Peggy Fralin and Brenda Flanigan-Tyson, both registered nurses with the Ralph H. Johnson VA Medical Center in Charleston, pointed out the system’s benefits.
The system reduces the need for duplicate tests, which provides cost savings; increases the knowledge of care providers; provides instant access to patient records; is fully integrated across the VA network; and ensures patient safety and security.
Other specific features of the electronic health record system include:
• A checking system that alerts clinicians if an order they entered could cause a problem.
• Templates that automatically create reports.
• A clinical reminder system that electronically alerts clinicians that certain actions, such as examinations, immunizations, patient education and laboratory tests, need to be performed.
• Remote data viewing to allow clinicians to see the patient’s medical history at all the VA facilities where the patient was seen.
“The VA facilities in Myrtle Beach and Goose Creek are both using wireless systems,” said Flanigan-Tyson. “Here in Charleston, we’ll be implementing a wireless system soon.”
The VA has the only completely integrated electronic system, Franklin said.
“Other hospitals may call themselves electronic, but they’re still doing hand-written orders. And then some multiple hospital (systems) have some integration, but their records are not completely in the system. The VA was the first and is still the only one that is fully integrated,” she said.
Charleston’s VA hospital pilots many of the tests for the VA network.
“We’re good at identifying problems in the system and working the bugs out,” said Flanigan-Tyson.
Revamping the system
VISTA was not an overnight development. The initial work, which included the labs and ancillary health care systems, began in 1994.
By 1997, the areas dealing with vital signs were added to the system. In 1999, the system was fully integrated into the VA network.
Today, the Institute of Medicine calls the VA’s medical records system one of the best in the nation. Researchers have applauded the VA’s use of electronic medical records, its focus on preventive care and its outstanding results.
The system outperforms Medicare and most private health plans on many quality measures.
Yet despite the kudos, VISTA is still a tough sell to the private sector.
“It’s a culture change,” said Michael Cortright, chief information office at the Ralph H. Johnson VA Medical Center in Charleston. “Our performance measures are great; there are proven efficiencies across the board. And we can offer it to private facilities for free, other than some basic hardware needed to run the system. They just have to implement it. Which, of course, means a change in the organization’s culture. And that’s what people find so difficult.”
Going private
If the private health care industry can be persuaded toward a culture change, the benefits would be enormous.
A study published by the RAND Corp. last September shows that successful adoption of health information technology by 90% of doctors and hospitals would cut health care spending by $77 billion annually.
The largest savings would come from shorter hospital stays due to better-coordinated care and fewer redundant tests and procedures.
Fewer prescription errors, another benefit of a computerized system that warns doctors and pharmacists of potential adverse drugs reactions, could save $4 billion.
Collaboration
President Bush has called for improvements in cooperation between the Department of Defense and the VA as one of
14 key management priorities for his administration, specifically in the areas of sharing information technology, data, facilities and staffing.
According to data provided by the Federal Office of Management and Budget, the total medical benefits populace for active and retired military personnel is more than nine million people using 70 hospitals and tertiary care facilities, and visiting more than 400 medical clinics.
The DOD and VA combined account for 1.7 million patient encounters per week, which amounts to more than 19,000 inpatient admissions and 1.9 million prescriptions. And it all involves a highly mobile population, many separated from their families.
Keeping track using traditional paper files and handwritten notes would almost guarantee chaos.
However, both the DOD and the VA are up for the task.
In the field, especially in combat areas, the medical staff uses a handheld data capture system at the point of care, right down to the foxhole. The military is implementing electronic information carriers, which are similar to dog tags but that plug into a USB port and carry between 16 MB and 4 GB of data.
By December 2006, the system should be fully integrated, with all patient information for both the DOD and VA contained within a single clinical data repository.
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