The EMR that is Transforming America…

1. The EMR that is Transforming America…

2. Harvard Honors VA's Computerized Patient Records System • One of "Top 50 Government Innovations" • WASHINGTON – Citing the Department of Veterans Affairs' (VA's) leadership role in transforming health care in America, Harvard University has recognized VA's computerized patient records as one of the "top 50 government innovations of 2006." • “VA is again recognized as a leader in the health care industry for the use of electronic patient records," said the Honorable R. James Nicholson, Secretary of Veterans Affairs. "This affirms that VA is providing America's veterans with world-class medical care and raising the bar for all health care providers."

3. VA has computerized patient records for each veteran who uses its health care system. The records allow the Department to provide better, safer, more consistent care. It permits health care professionals at each of the 1,400 locations where VA provides care to see the complete health records of any patient.

4. The value of VA's patient records was demonstrated when, within 100 hours of Hurricane Katrina’s making landfall last summer, every patient medical record from the devastated areas was available to every VA health care provider throughout the nation.

5. The Foundation of our EMR: • VISTA: Veteran’s Integrated System Technology Architecture • Within VISTA is VA File Manager • VA File Manager consists of various files/fields • VA File Manager is a standalone user interface for adding, editing, printing and searching data

6. Examples of Files: • Patient File • Drug File • Order File • Consult/Request File • TIU Document File (progress notes) • Etc…

7. Now to our EMR… • CPRS – Computerized Patient Record System • GUI – Graphical User Interface (point and click)

8. Allergies/Adverse Reactions Clinical Warnings/Crisis Notes Allergies/Advance Directives A list of patient’s active problems Clinical Reminders Future Appt/Past Visits List of medications Tabs Most recent vitals Immunizations given

9. CLINICAL REMINDERS • Reminders help us to do the right thing consistently well… • Informs clinicians when a patient is due to receive clinical activity • Identify patients to whom a reminder applies, based on VISTA patient data • Support national clinical practice guidelines • Reduce errors and promote patient safety

10. Patient has a dx of DM Type II

11. Right Click on the Reminder:

12. Processing the Clinical Reminder

13. Takes user directly to screen to order the creatinine

14. Automatically builds text into the progress note

15. List of Clinical Reminders… • 1 PV14 PC ACE (9/03 MSA) • 2 V14 PC COLORECTAL CANCER SCREEN • 3 V14 PC DEPRESSION SCREEN • 4 VA-DEPRESSION SCREENING • 5 V14 PC DIABETES-CREATININE SCREEN • 6 V14 PC DIABETES-HEMOGLOBIN A1C • 7 V14 PC DIABETES-LIPID PROFILE • 8 V14 PC DIABETES-MICROALBUMINURIA • 9 V14 PC DIABETIC EYE EXAM • 10 V14 PC DIABETIC FOOT EXAM, COMPLETE • 11 V14 PC ELEVATED BP (HTN/DIAB) • 12 V14 MH AIMS • 13 V23 FALL RISK ASSESSMENT • 14 V14 PC HEP C RISK ASSESSMENT • 15 V14 PC HGB A1C GREATER THAN 9% • 16 VA-IHD ELEVATED LDL • 17 VA-IHD LIPID PROFILE • 18 V14 PC INFLUENZA IMMUNIZATION • 19 VA-IRAQ & AFGHAN POST-DEPLOY SCREEN • 20 KN LTC PPD ADMINISTRATION

16. Vista Imaging Display… • An integrated software • Access Vista Imaging Display through CPRS • View EKG’s, Radiology Exams • View Scanned Documents • View Consents

17. Vista Imaging Icon… Icon indicates there is an image to view

18. Accessing Vista Imaging

19. Viewing the Image List

20. Viewing EKG’s

23. Progress Note Templates • Point and Click Functionality • Embedded Information • Free Text • Web Links on Template

28. Electronic Encounter Forms • Provides a primary and secondary clinical visit management utility based on appointments and related services • Prior to signing the outpt progress note, provider will enter the coding via the Encounter Forms • Capturing the Primary Provider, Secondary Provider, Visit Type, Procedures, Primary/Secondary Diagnoses etc…

33. Orders Entered Through CPRS • 100% Medication Physician Order Entry • Consults/Procedures • Radiology Exams • Labs (for inpatient) • Nursing Activity Orders (for inpatient) • Diet Orders (for inpatient)

34. Q= QUICK ORDERS

35. Medication Quick Orders…

37. Order Checks….

38. Bar Code Medication Administration • Administering the correct dose to the correct patient at the correct time…. • Provides real time, point-of-care solution for validating the administration of unit dose and IV medications • Missed Medication Report • Lists all Allergies/Adverse Reactions

39. How BCMA Works… • Log into BCMA • Scan patient’s wrist band (bar coded) • Due List appears (window of 2 hours) • Scan medication(s) to be administered • BCMA immediately validates that the medication is ordered, timely, and in the correct dosage

40. User can enter one time orders Due list for an hour before and an hour after the administration time User can document prn effectiveness

41. Summary… • The end result is enhanced patient safety and patient care at the VA Medical Centers • Every provider has access to a full medical record anywhere, anytime…