Health IT Strategic Framework
Attachment 2
III. The VA Electronic Health Record
VA 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 Capabilities
Utilization 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.
Footnotes describe adjustments made to match indicator
measures as closely as possible with Non VA benchmarks. |
Clinical Performance Indicator |
VA Base (FY) |
VA 2002 |
VA 2003 |
Medicare 2003 |
Best Reported
Not VA or Medicare |
Beta blocker on discharge after AMI |
70% (96) |
97% |
98% |
93% |
94% NCQA (2002) |
Breast cancer screening |
68% (96) |
80% |
84% |
75% |
75% NCQA (2002) |
Cervical cancer screening |
64% (96) |
89% |
90% |
62% |
81% NCQA (2002) |
Cholesterol screening in all patients |
84% (00) |
91% |
91% |
N/A |
73% BRFSS (1) (2001) |
Cholesterol measured after AMI (2) |
85% (00) |
92% |
94% |
78% |
79% NCQA (2002) |
LDL Cholesterol less than 130 after AMI (2) |
67% (00) |
74% |
78% |
62% |
61% NCQA (2002) |
Colorectal cancer screening |
34% (96) |
64% |
67% |
N/A |
49% BRFSS (1) (2002) |
Diabetes: HgbA1c done past year |
59% (95) |
94% |
94% |
85% |
83% NCQA (2002) |
Diabetes: Poor control (lower is better) |
23% (99) |
17% |
15% |
N/A |
34% NCQA (2002) |
Diabetes: Cholesterol (LDL-C) measured |
64% (98) |
94% |
95% |
88% |
85% NCQA (2002) |
Diabetes: Cholesterol (LDL-C) controlled (<130) |
23% (98) |
70% |
77% |
63% |
55% NCQA (2002) |
Diabetes: Eye Exam |
44% (95) |
72% |
75% |
68% |
52% NCQA (2002) |
Diabetes: Renal Exam |
36% (98) |
78% |
70% (3) |
57% |
52% NCQA (2002) |
Hypertension: BP <= 140/90 most recent visit (4) |
46% (00) |
55% |
68% |
57% |
58% NCQA (2002) |
Immunizations: influenza, patients 65 and older (5) |
27% (96) |
74% |
76% |
69% |
68% BRFSS (1) (2002) |
Immunizations: pneumococcal, patients 65 and older (5) |
26% (96) |
87% |
90% |
65% |
72.5% BRFSS (6) (2002) |
Mental Health follow-up within 30 days of inpatient discharge |
72% (98) |
81% |
77% |
61% |
74% NCQA (2002) |
| |
1) BRFSS scores are medians,
VA scores are averages |
2) VA evaluates
cholesterol every 2 years ongoing (FY 01 if ever an AMI; FY 02 if
AMI in past 5 years); NCQA evaluates 1st year after AMI only. |
3) Drop in scores
from 2002 levels are attributable to change in scoring methodology
and not indicative of drop in performance. |
4) VA Baseline reflects
data collected based on a BP < 140/90. NCQA and VA changed in
02 to include both < and = in 2002. |
5) For this comparison
the score shown for the VA was calculated utilizing the NCQA methodology.
It varies from the score on the Network Directors Performance Plan
which includes additional populations (high risk patients regardless
of age). |
6) Represents "best"
state results |
SOURCE: VHA Office of Quality and Performance
|
