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The Veterans Healthcare Administration

The Veterans Healthcare Administration. Rachel Mayo November 28, 2006. Outline. Structure of the VHA VistA – the electronic system of the VA Quality measurement Results of Reengineering Current happenings How can results be replicated?. Who is the VHA?.

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The Veterans Healthcare Administration

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  1. The Veterans Healthcare Administration Rachel Mayo November 28, 2006

  2. Outline • Structure of the VHA • VistA – the electronic system of the VA • Quality measurement • Results of Reengineering • Current happenings • How can results be replicated?

  3. Who is the VHA? • The VHA is the largest healthcare system in the U.S. consisting of: • More than 1400 facilities (hospitals, clinics, etc.) • 14,800 doctors • 61,000 nurses • 5 million patients

  4. Structure • Cabinet level head (Secretary of VA) • Creates political pressure • Current Under-Secretary: Kussman • VISN – regional network • 22 nationwide • VISNs compete for funding from the national level

  5. Changes Made at the VHA • Change started under Kenneth Kizer • Appointed during Clinton administration • Focused on two main areas: • Efficiency of day-to-day operations • Quality enhancement • Shift from hospital-based → primary care

  6. VistA • VistA – Veteran’s Health Information and Technology Architecture • Composed of four main components: • Computerized Patient Record System • VistA Imaging • Bar-Code Medication Administration • My HealtheVet

  7. CPRS • Computerized Patient Record System • Registration applications • Scheduling • Order tracking system • Patient alerts

  8. VistA Imaging • Digital imaging system • Allows caregivers to access images in any VA facility

  9. BCMA • Bar-Coded Medication Administration • Prevents Prescription Errors • Alerts for Missing Doses

  10. My HealtheVet • Personal Health Record for veterans • Allows documentation of: • Medical History • Family History • Blood Sugars • Journal Entries

  11. Implementation • Started 15 years ago • Eliminated searching for records • Patients in and out faster • No problems after Katrina • End Result: Better Patient Care!

  12. Tracking Performance • Personnel • Clinical Care Activities • Performance Indicators • Internal Review and Improvement • External Review and Oversight

  13. Quality Indicators

  14. Measured Benefits of Reengineering • In 3 years, bed days of care reduced 62% per 1000 patients • Inpatient admissions decreased 32%, ambulatory care visits increased 43% • Staffing reduction of 11% in 4 years • 2700 paper forms eliminated

  15. High Quality Care *596 VA Patients **992 patients at non-VA hospitals

  16. Current Happenings • Kenneth Kizer forced out of job • Limited veterans’ eligibility to system • Surge of mental health patients

  17. Governmental Role • Conservatives worry expanding VHA will cause private sector to tank • Tom Bock – encourage government to pay VHA instead of Medicare • Is this a concept that could work on a grander scale? • Government should consider all angles

  18. Replicating Results • Private sector does not have incentives to create change • Reimbursement “rewards inefficiency” • No incentive to provide good preventive care • The VHA gets to do the “right thing all the time”

  19. Keys to Success • A determined leader • Functional electronic system • Good quality measurement

  20. Summary • VHA – large system, high quality • Award winning electronic system • Quality accountability and tracking • Healthier patients, better care • Not rewarded by government • Changes needed for private sector

  21. Final Thought • “At the VA, you get to do the right thing all the time” – Dr. Peter Woodbridge • Why is this not the case everywhere else?

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