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Veterans Health AdministrationVistA

Veterans Health AdministrationVistA

January 2008

Veterans health information systems & technology Architecture

Linda F. Fischetti, RN, MSChief Health Informatics Officer (Acting)Office of InformationVeterans Health AdministrationLinda.Fischetti@va.gov

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Disclaimer - VistADisclaimer - 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.

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Table of Contents - VistA 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

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VA Health Technology - VistAVA 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

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Praise for VHA - VistAPraise 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 WeekJuly 17, 2006

ABC News in December 2007 reported Electronic Health Record success throughout VA – showcasing VistA at work in a clinical setting.

-ABC Nightly NewsDecember 12, 2007

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VA-Organizational Culture - VistAVA-Organizational Culture - VistA

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VA-Organizational Culture - VistAVA-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.

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VistA – An Integrated Approach

Veterans Health InformationSystems andTechnologyArchitecture

VistA is the single, integrated Health Information System used throughout VA in all health care settings (Inpatient, Outpatient, Long-term care).

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VHA – VistA BackgroundVHA – 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:

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VHA – VistA ImagingVHA – VistA Imaging

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VHA – VistA BCMAVHA – VistA BCMA

• VistA Bar Code Medication Administration (BCMA) – Virtually eliminates errors at the point of

administration– Coming Soon: Bar-Coded Lab Acquisition

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VHA – VistA Clinical RemindersVHA – 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

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VHA – My HealtheVetVHA – 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-www.myhealth.va.gov

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VistA Saves MoneyVistA 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

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VHA- National VistA StatisticsVHA- 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%

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VHA- VistAVHA- VistA

Moving from an electronic environment to

an interoperable electronic future…

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VistAVistA

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)

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VistA-Why is IHE important?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

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VistA- VA/IHE Success StoryVistA- 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.

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Cumulative Images Captured 2003 – 2007 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

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Consistent Integration 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

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VA National Diabetic Retinopathy Surveillance NetworkVA 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)

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VistA- VA/IHE Success StoryVistA- 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

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VistA- Wrapping UpVistA- 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

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VistA- QuestionsVistA- 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:

– http://www.va.gov/MyHealtheVet/– http://www.va.gov

• For more information, contact Ms. Linda Fischetti, RN, MS

• Linda.fischetti@va.gov

• My HealtheVet National Demo Account– www.myhealth.va.gov

• Username: mhvuserUsername: mhvuser• Password: mhvdemo#1Password: mhvdemo#1

My HealtheVet Pilot– http://www.health-evet.va.gov/

• Username: demouserbUsername: demouserb• Password: password_$1Password: password_$1