Veterans Administration Healthcare System - My HealtheVet

With an emphasis on “eHealth,” a secure patient portal known as “My HealtheVet” will provide access to a personal health record, online health assessment tools, mechanisms for prescription refills and making appointments, and access to high quality health information.

Situation

American healthcare has been referred to as a "trillion dollar cottage industry" because of the industrial age reliance on paper-based records. In contrast, the Department of Veterans Affairs (VA) currently has a successful Veterans Health Information Systems and Technology Architecture (VistA) that supports the continuum of care extending from intensive care units and other inpatient care, to outpatient care, long-term care, and even home care environments. Veterans Administration's Computerized Patient Record System (CPRS) provides a single, windows-style interface for healthcare providers to review and update a patient's medical record as well as the ability to place orders for various items including medications, special procedures, x-rays and imaging, nursing care, diet, and laboratory tests. In fact, 91% of all pharmacy orders are electronically placed by the provider (one of the Leapfrog Group's top three safety strategies) in contrast to rates of less than 10% outside of Veterans Administration.

Although Veterans Administration is now highly computerized, achieving even better quality, safety, and cost, requires three elements: 1) a health information infrastructure for the system that provides decision support for efficient, effective population health management, 2) an integrated patient record and care system with clinical decision support for providers, and 3) a secure "portal" for patients to receive reliable, accurate health information and interact with their health records and clinicians.

Solution

Veterans Administration's next generation system, known as "HealtheVet," evolves VistA from a facility-centric to a patient-centric health information system. HealtheVet implements a standard core collection of functions in five areas: Health Data Repository System, Registration Systems, Provider Systems, Management and Financial Systems, and Information and Education Systems. The health data repository creates a true longitudinal healthcare record including data from Veterans Administration and non- Veterans Administration sources, supporting research and population analyses, improving data quality and security, and facilitating patient access to data and health information.

With an emphasis on "eHealth," a secure patient portal known as "My HealtheVet" will provide access to a personal health record, on-line health assessment tools, mechanisms for prescription refills and making appointments, and access to high quality health information. The latter information is evidence-based, consistent with the clinician practice guideline, and meant to be activating to patients such that they advocate more effectively for their own health needs, such as pneumonia vaccines for older patients or those with chronic illness. This information dovetails with automatic clinical reminders that Veterans Administration healthcare providers receive for those same patients.

The provider "view," Computerized Patient Record System, organizes and presents all relevant patient data in a way that directly supports clinical decision making. The comprehensive cover sheet displays timely, patientcentric information, including active problems, allergies, current medications, recent laboratory results, vital signs, hospitalization, and outpatient clinic history. This information is displayed immediately when a patient is selected and provides an accurate overview of the patient's current status before any clinical interventions are ordered.

Among several features in the Computerized Patient Record System that improve safety and quality of care are the Real-Time Order Checking System that alerts clinicians of potential problems (e.g., drug-drug interactions, duplicate labs, etc.) during the ordering session, the Notification System that immediately alerts clinicians about clinically significant events such as abnormal test results, and the Clinical Reminder System that allows caregivers to track and improve preventive healthcare and disease treatment for patients and to ensure timely clinical interventions are initiated. The clinical reminder system is now the preferred mechanism for implementation of clinical practice guidelines and facilitates linking the evidence with the real-time clinical reminder, with the action (e.g. pneumoccocal vaccination in elderly or chronically ill patient), and with the automatically generated documentation, which generates a trail of standardized performance data.

Better Health & Lower Costs

Computerization has improved Veterans Administration's outcomes in quality, safety, patient and provider satisfaction, and cost. Quality has improved in preventive care and disease treatment. Pneumococcal pneumonia vaccination of at-risk patients is an evidence-based practice that reduces excess morbidity, mortality, and cost. In 1995, Veterans Administration rates of pneumococcal vaccination were 29%. Today, rates exceed 80%, a national benchmark. Among patients with COPD (emphysema), this reduces cost by an average of over $100 per year and reduces rates of hospitalization by 29% and all cause mortality by 42%.

Performance improvement has similarly occurred in the areas of disease treatment encompassed by over twenty clinical practice guidelines such as coronary artery disease, diabetes, and depression. For sixteen of eighteen clinical performance indicators, critical to the care of veterans, and directly comparable externally, Veterans Administration is now the benchmark. This includes use of beta-blockers after a heart attack (halving death and reducing avoidable, excess healthcare expenditures by over $20,000 per patient episode), breast and cervical cancer screening, cholesterol screening, immunizations, tobacco screening and counseling, and diabetes care. By the way, Veterans Administration is essentially identical to the best private sector healthcare performance on the remaining two indicators. Veterans Administration cares for over 50% more patients today than it did in 1995. Cumulatively, Veterans Administration's budget has only gone up by 15% since then. Thus, costs per patient are down by 26% with measurably better outcomes. These improvements don't just look good on paper, they save lives, reduce hospitalizations, improve quality, lower costs, and satisfy patients.