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VA Overview Lawrence Deyton, MSPH, MD Chief, Public Health With thanks: Dr. Gary Roselle, Syed Tirmizi, Gail Graham, John Quinn, Linda Danko, et al. History. Veterans programs date back to Colonial times VA created in 1930 as an independent agency Cabinet-level department created in 1989
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VA Overview Lawrence Deyton, MSPH, MD Chief, Public Health With thanks: Dr. Gary Roselle, Syed Tirmizi, Gail Graham, John Quinn, Linda Danko, et al
History • Veterans programs date back to Colonial times • VA created in 1930 as an independent agency • Cabinet-level department created in 1989 • Major eligibility changes in 1996 • Now the 2nd largest Cabinet-level department (second to DoD) • Budget over $75,000,000,000 • VHA $29 B, VBA $35 B • 210,000 employees
VA Mission Serve America’s 25 million veterans and their families with dignity and compassion by providing health care services and benefits earned in service to this Nation Motto: “To care for him [and her] who shall have borne the battle and for his widow and his orphan.” Abraham Lincoln
Missions of the Veterans Health Administration • Medical care • Graduate medical education • Research • Emergency preparedness
VA Medical Care The largest integrated healthcare system in US: • 158 hospitals (18,828 beds, 5.4M BDOC) • 132 nursing homes (33,408 ADC) • 73 home care programs • 43 domiciliary programs • 206 veterans counseling centers • 854 clinics (50 M outpatient visits) • 186,600 employees (VHA)
Fiscal Year 2004 – VHA statistics • 7.1 million total enrollees of 25 million US veterans • 5.1 million patients treated • $29 billion total budget • 200 million 30-day equivalent Rx’s dispensed • 190 million lab tests performed
Who Are VA Patients? • Older - 49% over age 65 • Sicker - Compared to Age-Matched Americans • 3 Additional Non-Mental Health Diagnoses • 1 Additional Mental Health Diagnosis • Poorer • 70% with annual incomes < $26,000 • 40% with annual incomes < $16,000 • 31% have no health insurance • Changing Demographics – 4.5% female overall • Females: 22.5% of outpatients less than 50 years of age
VA Medical Care • Enrolled veterans eligible for full spectrum of general and specialty medical/preventive services including drug benefit • Special focus on conditions related to military service: • Prosthetics, rehab and blind rehab • Environmental exposures (agent orange, Gulf War syndrome, depleted uranium & radiation, cold injury, etc. • PTSD and mental health issues • Special focus related to VA populations served: • Geriatrics/extended care • Women Veterans programs and services • Chronic diseases; diabetes, cardiac, kidney, cancer, infectious diseases, mental health/substance abuse, homelessness
Veterans Health Administration Education Mission • Affiliated with 107 of 125 U.S. Medical Schools and 1,200 education institutions • VA has more than 5,000 affiliation agreements for Associated Health Programs • 84,510 Total trainees(Academic Year 2001)
Veterans Health Administration Research • FY04: 1.5 billion dollars of research • Mission: improve veterans health care • Medical Research • Rehabilitation Research • Cooperative Studies (large multi-center clinical trials) • Health Services Research • Accomplishments: • Invention of cardiac pacemaker, CT technology • First successful liver transplant, insulin pump • Multi-center clinical trials; Tb, MI & CHF tx, HTN, DM • 2 Nobel Prize winners, 6 Lasker Awards
Emergency Responses • VA/DoD Contingency (PL 97-174) – VA back up for DoD in event of war or national emergency involving armed conflict • NDMS – VA, HHS, DoD, FEMA (DHS) – assists state/local govts with medical & PH disasters and hospital capacity • DEMPS – VA part of Federal Response Plan when Presidential Disaster Declaration in made • Ad hoc – local responses to emergencies
2004: Who is “VA”?Veterans Health Administration Budget, Staff, & Patients: ~193,000 Employees (~15,000 Doctors, 56,000 Nurses, 33,000 AHP) • 6% decrease since 1995 13,000 fewer employees than 1995 ~ $27.4 Billion budget • 42% increase since 1995: flat at ~ $19B from 1995 - 1999 • 5.1 million patients, ~ 7.5 million enrollees • 104% increase in patients treated since 1995: from 2.5 million patients / enrollees in 1995
Success in Supporting Health Delivery for Millions of Veterans VistA (veterans health information system and technology architecture) Features Include: • 100+ separate business packages that support day-to-day activities of healthcare operations, including • Registration / Enrollment / Eligibility Systems • Provider Systems for delivery of healthcare • Management and Financial Systems • And CPRS……
VistA / CPRS(Computerized Patient Record System) VistA/CPRS supports the largest integrated health system in the United States serving over 5 million veterans • Delivers an integrated record covering all aspects of patient care and treatment • Includes electronic order entry and management, narrative notes entry, laboratory results, consultation requests and reports, alerts of abnormal results, imaging, clinical reminders, and much more • VistA Web allows clinicians to see health data from any other VA facility where the veteran has received care
And CPRS Is Actively Used... National VistA Statistics (Total / Daily) • Documents (Progress Notes, Discharge Summaries, Reports) • 658,000,000…….. +550,000 each workday • Orders • 1.35 Billion……....+910,000 each workday • Images • 300,000,000………+475,000 each workday • Medications Administeredwith the Bar Code Medication Administration (BCMA) system • 630,000,000………+605,000 each workday as of March 2005
Success In Supporting Health Care Delivery For Millions Of Veterans • VistA is a success • Publicly owned by VA; plan to remain so for the next generation system • Strong interest by public/private in using VistA (IHS, DC Dept of Health, etc) • National software w/ local flexibility/innovation: • Innovation developed locally & enterprise wide • Standard packages distributed system-wide • Initial system (1983-1996) built on “dumb terminals” • “Decentralized Hospital Computer Program (DHCP)” • Steady deployment of packages and enhancements • Applications separated out by Hospital/Clinic “Service” • Simple “roll-and-scroll” screens
In 1996, VA launched the “Computerized Patient Record System” -- CPRS-- a comprehensive, integrated Electronic Health Record (EHR)
How it all Began…… • CPRS evolved from DHCP’s text-based Order Entry/Results Reporting • Initial design and subsequent enhancements guided by clinicians • “Visually” organizes and presents all relevant data on a patient in a way that supports clinical decision making • Phased implementation of CPRS • Placed in “production” at first VA site in July 1996 • Began use at 3 more sites between August and December 1997 • Installed in “lead” site in each of VA’s 22 regions by June 1998 • Implementation completed at all VA Medical Centers (>170) in December 1999
VA Today Every VA Medical Center uses Electronic Health Records
Electronic Health Records andComputerized Provider Order Entry (CPOE) • 100 % VA Medical Centers have Electronic Health Record • CPOE is one of the Leapfrog Group’s “Top 3 Safety Strategies” • Outside of VA, CPOE < 8% nationally • < 30% among Academic Medical Centers • Nationally, 93% of all VA Rx’s by CPOE • Ultimate Goal: 100% • VA is the Benchmark for CPOE • All Medical Centers also have Desktop Imaging
Clinical Reminders Links Reminder • Contemporary Expression of Practice Guidelines • Time & Context Sensitive • Reduce Negative Variation • Create Standard Data With the Action With Documentation
Online Demo of CPRS • Try a working copy of VA’s Computerized Patient Record System (CPRS) at www.va.gov/cprsdemo