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Health IT Strategic FrameworkAttachment 2III. The VA Electronic Health RecordVA is a leader in the provision of a world-class electronic health record (EHR). Recently, the Institute of Medicine (IOM) noted "VA's integrated health information system, including its framework for using performance measures to improve quality, is considered one of the best in the nation." Moreover, a 2004 survey conducted by the American College of Physician Executives resulted in the finding that while many physician executives and doctors "loathe" clinical information systems, VA clinicians provided a "notable outlier from the nexus of negativity." 1 The current system, VistA provides clinical, financial and management system for the entire enterprise. VistA has enabled organizational transformation by providing the ability to respond to contemporary best practices with quantifiable system-wide measurement. An IOM Report provides that the single most important safety gain that could be realized by technology is the act of providers entering their own orders. VA had already implemented order entry; VistA permitted VA to quickly measure compliance across the enterprise and make the compliance measurement a performance measure for hospital directors and their supervisors. Utilizing VistA, VA is able to determine that VA's current measure of direct order entry of medication orders is at 93 percent. Other forms of quality performance measures are employed throughout VA and supported by VistA. CPRSis the medical record component. CPRS is currently used in outpatient, inpatient, Mental Health, intensive care unit (ICU), Emergency Department, Clinic, Homecare, Nursing Home and other diverse environments. CPRS contains all components of the medical record, including but not limited to, laboratory, test results, medical images, decision support, bar code medication administration, progress notes, and appointments. CPRS permits VA clinicians to access a patient's record from anywhere within the health enterprise, at the point-of-care. VA is presently improving and modernizing VistA. VA is migrating its present-day VistA system to HealtheVet-VistA. HealtheVet-VistA will consist of VistA upon an improved platform that will be built with modern day information tools and languages. Most importantly, HealtheVet-VistA will utilize an enterprise architecture constructed to standardize data and core communications. HealtheVet-VistA will move away from a facility-centric model of data utilization to a patient-centric model that supports the real-time provision of health data to the point of care, wherever it is needed. The IOM has identified the eight core capabilities that EHRs should possess. A cross-walk between the target IOM EHR and current VA EHR capabilities demonstrate that VA has achieved a "gold standard" EHR. See Table 1, below. 1 Weber, David O., Survey Reveals Physicians' Love/Hate Relationship with Technology, The Physician Executive, March/April 2004. Table 1, EHR CapabilitiesUtilization of VA's EHR has yielded tremendous benefits to clinical care and permits VA to capture data for virtually every clinical performance measure. For instance, a comparison of VA patient care quality data from 2003 with Medicare data from 2003, and with the best reported performance of other health care systems in the U.S., shows that VA care sets the benchmark for every one of these clinical performance indicators. See Table 2, Comparison of Performance Indicators.
SOURCE: VHA Office of Quality and Performance |
Last revised: July 29, 2004