11

December 17, 2008

Gail GrahamVHA OI Deputy Chief Officer Healthcare Information Management VHA Office of Informationgail.graham@va.gov

Capitol Hill Seminar Series: Using Telehealth and Health IT to Deliver Using Telehealth and Health IT to Deliver Quality Care to VeteransQuality Care to Veterans

Overview of Veterans Health Overview of Veterans Health Administration ActivitiesAdministration Activities

22

Veterans Health Administration (VHA)Veterans Health Administration (VHA)

“To honor

America’s

veterans by

providing

exceptional health

care that improves

their health and

well-being”

Honoring Those Who Served

33

Medical care: In 2007, we cared for 5.5 million veterans

Training: We are among the largest providers of health professional training in the world

Research: We are among the largest and most productive research organizations in the U.S.

Disaster Assistance: We are a principal Federal asset for providing medical assistance in major disasters

Homeless Care: We are the largest direct-care provider for homeless persons in the U.S.

VHA: Key Contributor to Nation’s HealthcareVHA: Key Contributor to Nation’s Healthcare

44

Who Are Department of Veterans Affairs (VA) Patients?Who Are Department of Veterans Affairs (VA) Patients?

Older

• 49 % over age 65 (increasing population > 85)

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

Changing Demographics

• 4.5% female overall

- Females: 22.5% of outpatients less than 50 years of age

55

278,566 FTE Employees including:

Veterans

Reservists

Physicians

Pharmacists

Nurses

Dentists

Who Are VHA Personnel?

66

VVeteranseterans HealthHealth IInformationnformation SSystemsystems andand TTechnologyechnology AArchitecture (VistA)rchitecture (VistA)VVeteranseterans HealthHealth IInformationnformation SSystemsystems andand TTechnologyechnology AArchitecture (VistA)rchitecture (VistA)

• Single, integrated Computerized Patient Record System (CPRS) used throughout VHA in all healthcare settings (Inpatient, Outpatient, Long-term care)

• Delivers an integrated record covering all aspects of patient care and treatment

VistA is:

77

Key VistA Patient Comparison Statistics through September 2008Key VistA Patient Comparison Statistics through September 2008

Orders

Images

TIU Documents

Medication Administration

Vital Sign Measurements

2,028,271,561

1,019,783,809

1,138,044,845

1,074,151,892

1,351,435,897

1,054,916

1,306,635

756,082

623,282

815,839

1,016,304

1,174,706

722,675

605,955

789,611

3.80%

11.23%

4.62%

2.86%

3.32%

Total Number of File Entries (through Sep 2008)

Average daily primetime file entry change (through Sep 2008)

Average daily primetime file entry change (through June 2008)

Average percentage rate of file change (June 2008 - Sep 2008)

88

VHA – VistA ImagingVHA – VistA Imaging

99

InnovationInnovationInnovationInnovation

• Innovation will allow innovative ideas to emerge from the field, and enable the field to build communities of interest to identify and promote the ideas that have the most promise.

• The program will use innovation IT dollars to attain hardware, software and contract development resources for field based development, and Medical Care dollars for program management, stakeholder interaction, encouraging innovators, and evaluation.

1010

VHA Assets – Healthcare Delivery Sites

•Hospitals

•Clinics (Hospital, Community-Based and Independent)

•Nursing Homes

•Readjustment Counseling Centers(Includes 20 brand new centers with three more opening soon)

•Domiciliaries

•Mobile Clinics

1111

CBOCS Improve:

Facilitate transition from hospital to primary care

New Clinics Announced:VA announced on 12/4/08 that it plans to open 31 new outpatient clinics in 16 states. They will be operational by late 2010, with some opening in 2009

VHA – Community Based Outpatient Clinics (CBOCS)

• Quality of care• Access to services• Efficiency of operations• Veteran Satisfaction

1212

VA Electronic Health RecordMy HealtheVet

Personal Health Record• VistA/CPRS is the authoritative VA

medical record• Veteran "owns" his/her

My HealtheVet Personal Health Record (PHR)

• Veterans will access extracted data sent to My HealtheVet from VA Electronic Health Record (EHR)

• Veteran controls access to information (via delegation)

CPRS VistA BCMAVistA Imaging

InformEngageActivate

Complementary Health RecordsComplementary Health Records

1313

April 19, 2023 13

On-Line Prescription RefillsOn-Line Prescription Refills

Over 3.4 Million Prescription Refills Processed Through My Healthe Vet 2007 Rx Refills up 57% for January - July

123,708117,281

141,554

149,677 150,306

115,425

146,776

123,051

164,317 162,103

170,404174,144

200,535

174,336

200,427

213,618

227,798 227,630

242,317

25,000

50,000

75,000

100,000

125,000

150,000

175,000

200,000

225,000

250,000

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2006 2007

1414

Quality EvidenceQuality EvidenceQuality EvidenceQuality Evidence

1515

April 19, 2023 15

Emerging National Healthcare Delivery TrendsEmerging National Healthcare Delivery Trends

• Patient-Centered Care• Decentralized Healthcare

– Networked Virtual Organizations (NVO)• For accessing Consumer Health Information

• Point-of-care Health Information Exchange – Personal Health Records

• Pharmacogenomics & Genomic Medicine• Nanotechnology and Medical Devices• Telehealth & Teleradiology

Nanotechnology for CancerCell Directed Drug DeliveryNanotechnology for CancerCell Directed Drug Delivery

1616

16

““Veterans’ hospitals Veterans’ hospitals used to beused to be a a byword for second-rate care or byword for second-rate care or

worse. Now they’re national worse. Now they’re national leaders in efficiency and quality. leaders in efficiency and quality. What cured them? A large dose What cured them? A large dose

of technology.” of technology.”

- Fortune, - Fortune, May 15, 2005May 15, 2005

Best Healthcare AnywhereBest Healthcare Anywhere