CPS Energy Joint Base San Antonio _JBSA_ Overview and Goals.ppt by pptfiles

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									Department of Veterans Affairs (VA)
EHR – Historical Overview
Robert M. Kolodner, MD
Chief Health Informatics Officer
Open Health Tools, Inc.




24 July 2012
 VETERANS HEALTH ADMINISTRATION
2006 – Innovation Award for VistA
VA’s Electronic Health Record (EHR)




VETERANS HEALTH ADMINISTRATION        2
VistA:
In Every VA Medical Center For 15 years!




VETERANS HEALTH ADMINISTRATION             3
VistA:
A Chart Metaphor Combining Text and Images

              000-50-
              5000




                        Single longitudinal health record is
                                                    000-50-
                        immediately available in    5000



                                 •Outpatient
                                 •Inpatient &
                                 •Long-term care settings




VETERANS HEALTH ADMINISTRATION                                 4
VA Used An Approach That Is Applicable in
Resource Constrained Settings Today
• Build on the latest technology – lower cost, easier for more to use

• Users and IT specialists work together

• Development and use begin with early adopters until the new
  solutions are “good enough” to spread exponentially to others

• Foster a culture of innovation




VETERANS HEALTH ADMINISTRATION                                          5
Presentation Outline
• Overview of VA’s health IT solutions implementation history

• 2 key lessons learned for creating a successful health IT initiative

• Relevance of VA’s experience for others




VETERANS HEALTH ADMINISTRATION                                           6
 From A Few Sites To The Largest Health Care
 System In The U.S. Under One Management
The Beginning
    – 1978 - Minicomputers sent to VA Medical Centers
    – 1979 - “Underground Railroad” formed



DHCP - Hospital Information System
    – 1982 - Official deployment of core applications
    – 1994 - Order Entry / Results Reporting


VistA – Electronic Health Record (EHR)
    – 1996-99 - CPRS (“Clinical Desktop”)
    – 2000 - Bar Code Medication Administration



 VETERANS HEALTH ADMINISTRATION                         7
  Bar Code Medication Administration (BCMA)
• Virtually Eliminates Errors at the Point of Administration

                                                           BCMA Assures the:

                                                               Right Medication

                                                               Right Dose

                                                               Right Patient

                                                               Right Provider

                                                               Right Time




  VETERANS HEALTH ADMINISTRATION                                                  8
 From A Few Sites To The Largest Health Care
 System In The U.S. Under One Management
The Beginning
    – 1978 - Minicomputers sent to VA Medical Centers
    – 1979 - “Underground Railroad” formed



DHCP - Hospital Information System
    – 1982 - Official deployment of core applications
    – 1994 - Order Entry / Results Reporting
                                                        Health IT For Veterans Themselves
                                                           – 1990’s – Telemedicine & Telehealth
VistA – Electronic Health Record (EHR)
    – 1996-99 - CPRS (“Clinical Desktop”)
    – 2000 - Bar Code Medication Administration
                                                           – 2004 – My HealtheVet
                                                                  (Personal Health Record – PHR)
                                                           – 2010 – Blue Button (Data Download)
 VETERANS HEALTH ADMINISTRATION                                                                   9
Home Telehealth



                                 Largest telehealth program
                                        in the world
                                  60,000 veterans received
                                 telehealth services in 2011




VETERANS HEALTH ADMINISTRATION                                 10
VA Provides My HealtheVet:
A Personal Health Record For Veterans




VETERANS HEALTH ADMINISTRATION          11
VA Conceived of and Provides:
“Blue Button”




VETERANS HEALTH ADMINISTRATION   12
2 VA Health IT “Lessons Learned” –
Applicable Anywhere
• Process

• Leadership




VETERANS HEALTH ADMINISTRATION       13
1st Lesson:
PROCESS
                   User Involvement is ESSENTIAL

• Discover major innovations by front line users/developers

• Learn from the “Positive Deviants”

• Start with the Early Adopters

• Include users at all stages


VETERANS HEALTH ADMINISTRATION                                14
1st Lesson:
PROCESS – User Involvement –
Major Innovations from Local Users (1)
                Bar Code Medication Administration (BCMA)

• 1992 - the idea of Sue Kinnick, RN –
  a Nurse at the VA Medical Center in Topeka, Kansas

• VA wide by 2000

• Now going nationwide in U.S.

• How many lives saved and
  adverse outcomes avoided?



VETERANS HEALTH ADMINISTRATION                              15
  1st Lesson:
  PROCESS – User Involvement –
  Major Innovations from Local Users (2)
                         Hurricane Katrina – August 2005
• Power and communications
  lost to 3 VA Medical Centers
• Generators provide
  emergency power
• Patient records inaccessible
  from remote facilities where
  displaced patients are treated




  VETERANS HEALTH ADMINISTRATION                           16
1st Lesson:
PROCESS – User Involvement –
Major Innovations from Local Users (2)
                                 Gulfport, Mississippi




VETERANS HEALTH ADMINISTRATION                           17
1st Lesson:
PROCESS – User Involvement –
Major Innovations from Local Users (2)
                                 Gulfport, Mississippi




VETERANS HEALTH ADMINISTRATION                           18
1st Lesson:
PROCESS – User Involvement –
Major Innovations from Local Users (2)
                             New Orleans, Louisiana




VETERANS HEALTH ADMINISTRATION                        19
1st Lesson:
PROCESS – User Involvement –
Major Innovations from Local Users (2)
                             New Orleans, Louisiana




VETERANS HEALTH ADMINISTRATION                        20
1st Lesson:
PROCESS – User Involvement –
Major Innovations from Local Users (2)
                                 VistAWeb




VETERANS HEALTH ADMINISTRATION              21
1st Lesson:
PROCESS – User Involvement –
Major Innovations from Local Users (2)
                            Monday, August 29, 2005

• Hurricane Katrina reaches landfall



                          Thursday, September 1, 2005

• All VA Medical Centers had access to complete
  health records of Gulf Coast patients through VistAWeb




VETERANS HEALTH ADMINISTRATION                             22
1st Lesson:
PROCESS – User Involvement –
Positive Deviants
        1993 – at the VA Medical Center in Washington, DC
• Order Entry / Results Reporting used by doctors for patients in the
  hospital




VETERANS HEALTH ADMINISTRATION                                          23
1st Lesson:
PROCESS – User Involvement –
Early Adopters
  1996 – Test Site for CPRS at the VA Medical Center in Seattle, WA




VETERANS HEALTH ADMINISTRATION                                        24
   1st Lesson:
   PROCESS – User Involvement –
   At All Stages
                                    Clinical Reminders Dialogue Box
           VA’s Clinicians:
                                            Links Reminder
"Have Clinical Decision Support
alerts/reminders fit OUR
workflow."

                                            With the Action



                                            With Documenta
   VETERANS HEALTH ADMINISTRATION                                     25
2nd Lesson:
LEADERSHIP
                  Foster Innovation and Creativity


• Create the environment to innovate by giving permission to fail




VETERANS HEALTH ADMINISTRATION                                      26
2nd Lesson:
LEADERSHIP – Foster Innovation and Creativity

“If we’re not making mistakes,
             we’re not at the edge.”

                                    Kenneth W. Kizer, MD, MPH
                                      Under Secretary for Health
                                  Department of Veterans Affairs
                                                     1994-1999




VETERANS HEALTH ADMINISTRATION                                     27
2nd Lesson:
LEADERSHIP – Foster Innovation and Creativity

“Beginnings are messy.”

                                 Thomas L. Garthwaite, MD, MPH
                                      Under Secretary for Health
                                  Department of Veterans Affairs
                                                      1999-2002

                                 Deputy Under Secretary for Health
                                   Department of Veterans Affairs
                                                       1995-2002



VETERANS HEALTH ADMINISTRATION                                       28
HOW IS VA’S EXPERIENCE RELEVANT
TO RESOURCE-CONSTRAINED SETTINGS?

VETERANS HEALTH ADMINISTRATION      29
                                 One Example:
OpenMRS --
A Health IT Solution That Started In Kenya…




VETERANS HEALTH ADMINISTRATION                  30
…Grew Rapidly In It’s Original Location…




                      Cumulative # of Patients Enrolled: Nov ‘01 – Feb -09
                                In OpenMRS in Eldoret, Kenya

VETERANS HEALTH ADMINISTRATION                                               31
…And Is Now Spreading Around the World…




VETERANS HEALTH ADMINISTRATION            32
 …With Many Different People Contributing!!
71 people from around the world contributed code to the last OpenMRS version
                  – and only 5 were paid for by the project!!




                                          See them all on
                    https://wiki.openmrs.org/display/RES/Release+Notes+1.9.0
 VETERANS HEALTH ADMINISTRATION                                                33
Relevance of VA’s EHR and Health IT Experience
For Resource Constrained Settings
• Build on the latest technology – lower cost, easier for more to use

• Users and IT specialists work together

• Development and use begin with early adopters until the new
  solutions are “good enough” to spread exponentially to others

• Foster a culture of innovation




VETERANS HEALTH ADMINISTRATION                                          34
                                 Thank You




VETERANS HEALTH ADMINISTRATION               35

								
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