To Study The Functioning Of VistA CPRS Project Overview

1. To Study The Functioning Of VistA CPRSProject Overview June 2012 Dr.Amit Kumar Srivastava Dr.Garima Malik

2. Organizational Overview MAX HEALTHCARE • Country’s leading comprehensive provider of standardized, seamless and international class healthcare services • It is committed to the highest standards of medical and service excellence, patient care, scientific and medical education • Max Healthcare operates eight facilities in Delhi & NCR, offering services in over 30 medical disciplines • Max Healthcare has a base of over 1600 leading doctors, 4300 employees and 13,00,000 patients with number of beds growing to over 1900 in the next two years

3. GENERAL OBJECTIVE: To Study the functioning of VistA CPRS SPECIFIC OBJECTIVES: • To study the workflow involved in the module CPRS • To identify the relationship of the CPRS with other modules of VistA • To reach a comprehensive training plan to the hospital customers

4. SCOPE OF STUDY: • To study CPRS in depth, so that will be able to assist end users ( nurses & physicians) while giving hands on training • Study can be used for creating user manual, training plan and schedule METHODOLOGY: • Observational • Interview of end users with close ended structured questionnaire

5. SUMMER TRAINING PROJECT TIMELINE

6. VistA • The Veterans Health Information Systems and Technology Architecture (VistA) • It is an enterprise-wide information system built around an electronic health record, used throughout the  U.S. Department of Veterans Affairs (VA) medical system, known as the Veterans Health Administration(VHA) • VistA, is an integrated system of software applications that directly supports patient care • It has various modules, some of them include laboratory, pharmacy, radiology, Bar Code Medical Administration and CPRS

7. VistA CPRS • It is graphical user interface for clinicians known as the Computerized Patient Record System (CPRS), which was released in 1997 • It allows health care providers to review and update a patient's electronic medical record • It includes the ability to place orders, including those for medications, special procedures, X-rays, nursing interventions, diets, and laboratory tests • It provides electronic data entry, editing, and electronic signatures for provider-patient encounters as well as provider orders

8. VistA– Veterans Health Information Systems and Technology Architecture computer application CPRS– Computerised Patient Record System

9. PURPOSE OF CPRS

10. CPRS Helps To

11. Salient Features of VistA CPRS • CPOE decreases :- • 1. Delay in order completion • 2. Reduces errors related to handwriting or transcription • 3. Allows order entry at point-of-care or off-site • 4. Provides error-checking for duplicate or incorrect doses or tests • 5. Simplifies inventory and posting of charges

12. BENEFITS OF CPOE a. Enables doctors to enter prescription, lab test and other orders for patient care straight into a hospital information system b. CPOE decision support includes: automated medication checking, drug dose, allergy, and interaction checking; duplicate order notification; recommendations for pre- or post-administration tests etc • Adverse Reaction Tracking a. Documents patient allergy and adverse drug reaction data b.Alertsthe Pharmacy and Therapeutics Committee each time the signs/symptoms are modified for a patient reaction • Clinical Reminders a. Allows clinicians to resolve reminders through dialogs within the CPRS GUI (graphical user interface). Using point-and-click techniques, a clinician can generate text for progress notes, update current and historical encounter data in Patient Care Encounter (PCE), update vital signs, update mental health test results/scores, and place orders

13. Before EHR Implementation • After EHR Implementation Difference in Workflows before and after EHR Implementation in Client’s Hospital

14. TRAINING – PLAN AND SCHEDULES

16. ROLES AND RESPONSIBILITIES OF THE TRAINING TEAM AND THE USERS • End User • They should be familiar with the working of the system • They should be able to access, retrieve and enter data in VistA • They shall be well versed with the module • Training Coordinators • They will coordinate the entire training process • They will check availability of trainers , staff , training material and infrastructure

22. OBJECTIVE:To Study the Physician’s Perception on EHR • METHODOLOGY: • A sample size of 30 Physicians were taken to evaluate their perception of the CPRS/ EHR • Only the physicians who have undergone 16 hours of hands on training were considered • Out of them 30 were randomly selected • A well structured questionnaire in english was used for the purpose of primary data collection • The questions were related to computer awareness as well as EHR • Physician team covered were : Junior Residents, Senior Residents, Specialists, Consultants

23. OBSERVATIONS • 64.7% of the Physicians who were sound with the computers felt that the new EHR will increase workload and entering data will consume time • 100% of the Physicians are aware that the EHR implementation will reduce medication errors and agree that EHR supports effective communication among team members. • 66.7% of the Physicians were not satisfied with the training they received on CPRS • 66.7% of the Physicians feel that the EHR is not user friendly • 8 Physicians who were sound with computer skills felt that the EHR application is not user friendly

24. RECOMMENDATIONS • More change management efforts should be made so that the physicians develop a positive attitude • The templates for entering case history can be made simpler • Free text option can be given for entering case history • Before initiating the CPRS training an orientation process should be carried out regarding the entire EHR process

26. OBJECTIVE :To do a comparative study of the Paper medical records and the Electronic Medical Records • METHODOLOGY: • Observational & Discussion method • The information is collected primarily by observation of the software and making a comparison between paper medical records & electronic medical records. • Focus points of discussion are: • Disadvantages of PMR • Advantages & EMR over PMR • Disadvantages of EMR • Also some information is collected using secondary data sources

27. OBSERVATION: PMR VS EMR PMR EMR • Patient is identified by name, medical record number & other identifier • Progress notes might be produced by dictation, free handwriting or form completion • Consists of office or progress notes in chronological sequence. These are browsed by literally flipping through pages, until the desired entry is located • Prescription is written on paper. It is manually checked for interactions & allergies. It is then taken by the patient to the pharmacy .It takes time & can also result in errors • Patient can be identified by any identifier i.e. Name, SSN, Date of birth, phone number • Progress notes are produced as the visit is produced • Stores progress notes and provides quick access by date of visit, provider and the ability to browse by diagnosis and prescription • Prescription is written in the system. It is checked for interactions & allergies by the system & then it is sent to the pharmacy by the system directly where it is verified & drug is dispensed. There are rare chances of errors.

28. DISADVANTAGES OF PMR 1. Needs lot of space for storage2. No centralization of records & collection of records is a tedious task3. More chances of medical errors caused by poor legibility on paper forms4. Less in efficiency as compared to EMR5. Data cannot be easily exchanged or transferred6. They are not eco-friendly

29. ADVANTAGES OF EMR . • Increasing storage capabilities for longer periods of time • Is accessible from remote sites to many people at the same time • Retrieval of the information is almost immediate • The record is continuously updated and is available concurrently for use everywhere • Information is immediately accessible at any unit workstation whenever it is needed • Provides medical alerts and reminders • Supports accountable autonomy, collecting and disseminating information to assist the medical professional in decision making • Allows for customized views of information relevant to the needs of various specialties • Provide information to improve risk management and assessment outcomes

30. DISADVANTAGES OF EMR • Start-up cost is high • Lack of Technical knowledge • Inability of the provider to adapt • Usability is a major issue • Placement of hardware is an issue • Crashing of computer & loss of data • Change in workflow of the department after the implementation of an EMR • Lack of standardized terminology, system architecture, and indexing • Lack of flexibility and lack of capacity for the diverse requirements of the different healthcare disciplines

31. RECOMMENDATIONS • The robust back up methods, sophisticated protection mechanisms & advanced data recovery methods should be developed • Decisions regarding the portability of the equipment must also be considered • Documentation forms must be revised in order to accommodate the changes in the workflow • Development of standard language is required • A unique health identifier must also be developed • Well planned training must be given to the end users

32. THANK YOU