Department of Veterans Affairs
Veterans Health Administration
Office of Information
VA’S CURRENT AND FUTURE COMPUTERIZED PATIENT RECORD SYSTEM
Department of Veterans Affairs (VA) has had automated information systems in
its medical facilities since 1985, beginning with the Decentralized Hospital
Computer Program information system, including extensive clinical and
administrative capabilities. The
Veterans Health Information Systems and Technology Architecture (
CPRS organizes and presents all relevant data on a patient in a way that directly supports clinical decision-making. The comprehensive cover sheet displays timely, patient-centric 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 clinical interventions are ordered. CPRS capabilities include:
· A Real-Time Order Checking System that alerts clinicians during the ordering session that a possible problem could exist if the order is processed;
· A Notification System that immediately alerts clinicians about clinically significant events;
· A Patient Posting System, displayed on every CPRS screen that alerts clinicians to issues related specifically to the patient, including crisis notes, warning, adverse reactions, and advance directives;
· The Clinical Reminder System that allows caregivers to track and improve preventive health care for patients and ensure timely clinical interventions are initiated.
· Remote Data View functionality that allows clinicians to view a patient’s medical history from other VA facilities to ensure the clinician has access to all clinically relevant data available at VA facilities.
VistA Imaging is also operational at most VA Medical Centers. VistA Imaging provides a multimedia, on-line patient record that integrates traditional medical chart information with medical images, including x-rays, pathology slides, video views, scanned documents, cardiology exam results, wound photos, dental images, endoscopies, etc. into the patient record.
Bar Code Medication Administration addresses the serious issue of inpatient medication errors by electronically validating and documenting medications for inpatients. It ensures that the patient receives the correct medication in the correct dose, at the correct time, and visually alerts staff when the proper parameters are not met.
HealtheVet Desktop is an application framework that will host the new generation of Veterans Health Administration (VHA) clinical applications. Care Management is the first application to run on the new HealtheVet Desktop and is an enhancement of CPRS designed to assist health care providers to follow-up on clinical interventions that might otherwise be missed. Care Management provides an automated method for tracking follow-up actions/tasks for a panel of patients for a designated period of time. The four perspecitives of Care management are the Clinician Dashboard, the Nursing Dashboard, the Query Tool and the Sign List. Implementation of the Care Management project will improve patient care by:
A strategy has been developed to move the Veterans Health Information Systems toward “HealtheVet,” an ideal health information system to support the ideal veterans health system. Collaboratively among the Department, field, and central office leadership and the Chief Information Officer, a proposed strategy has been developed for both VA and Veterans Health Administration needs. The strategy is built around five major systems and integrates five cross-cutting issues:
· The Health Data System [health data repository (HDR)] will create a true longitudinal health care record including data from VA and non-VA sources. The health data system will support research and population analyses, facilitate patient access to data and sharing of information across VHA, and improve data quality and data security.
Provider Systems support healthcare
providers' care for veterans and feed information to
· Management/Financial Systems include four applications that are each ten or more years old and will be replaced: the Financial Management System, Billing and Accounts Receivable (AR), and Fee Basis (paying providers).
· Information and Education Systems with an emphasis on “eHealth” include prescription refills, appointments, fillable forms online, and My HealtheVet (access to health record, on-line health assessment tools; and high quality health information).
· Registration, Enrollment, and Eligibility Systems will be developed as a single, department-wide data system and demographic database that supports registration and eligibility for the three Administrations and makes this information more accessible and consistent.
· Cross-Cutting Issues include the VA and VHA architectures, information security, data quality, and leadership and management. These issues cut across all systems and ensure effective implementation and operations of the major systems.
Illustration of the HealtheVet
(Veterans Health Information System, including
Department of Veterans Affairs
VHA Office of Information Field Office
ATTN: National Help Desk (FOIA Request)
Processing fees for direct costs of FOIA requests are as follows and are subject to change (contact the National Help Desk at 1-888-596-4357 for current fees):
· VistA Software (excluding Imaging) - $35.98
The total cost for both
Under FOIA, certain records may be withheld in whole or in part from the requestor if they fall within one of nine FOIA exemptions. Two of these exemptions form the basis for withholding software by the VHA:
· Protects certain records related solely to VHA's internal rules and practices.
· Protects trade secrets and confidential commercial or financial information.
Based on these exceptions, the following packages are completely withheld from FOIA release:
· INCOME VERIFICATION MATCH
· ACCOUNTS RECEIVABLE
Also removed are copyrighted dlls, mental health tests, CPT codes, and electronic signature hashing algorithms. (These are detailed in a Readme.txt file on the CDs.)
Software is also available on the web at http://www.va.gov/vista.
The Health Data Repository (HDR) is the cornerstone of the Health Data Systems (HDS) portfolio. The HDR will serve as an operational clinical repository—a collection of clinical information, from VA and non-VA sources, residing on one or more independent platforms—to be used by clinicians and other personnel to facilitate longitudinal, patient-centric care. Data in the HDR will be organized in a format supporting the delivery of care regardless of the physical location of a patient’s clinical information. The HDR will provide additional significant benefits including providing information to support research and population analyses, facilitating patient access to data and sharing information across VHA, improving data quality and data security, and reducing the burden on local VistA systems.
The Automated Medical Information Exchange (AMIE) module facilitates the electronic interchange of veteran information between Veteran Benefits Administration (VBA) Regional Offices (ROs) and VA medical facilities. The comprehensive module provides an accurate audit trail to track most requests for information.
The module is composed of two components: Facility administrative options and VBA Regional Office options. Each area has individual items to maintain daily, and its own reports to print. RO staff access VA medical facility computers through VA national telecommunications network, and exercise their options on each local medical facility’s system as necessary.
· Provides access to local databases for identification of a veteran’s admission, discharge, outpatient treatment, patient care, and other information that may require adjudicative actions.
· Reduces overpayments previously caused by lost, misrouted, or improperly processed admission notifications.
· Provides on-line status determinations of pending compensation and pension examinations (requesting, scheduling, tracking, and updating results).
· Provides RO on-line access to the local databases for the confirmation of the propriety of payments based on hospitalization.
· Improves timeliness of the RO benefits adjustment processing.
· Allows medical centers to electronically access sections of the Physicians Guide for Disability Evaluation Examinations.
· Provides tracking of insufficiently completed compensation and pension examinations.
The Incident Reporting module supports VHA policy by compiling data on patient incidents. It organizes the data into defined categories for reporting and tracking at medical facility level and for transmission to the National Quality Assurance Database for Headquarters review and tracking.
· Provides options to simplify the setup of the software.
· Allows for the entry of all required incident information plus descriptive data and actions taken on all reportable and/or locally defined incidents.
· Prints out a Pseudo 10-2633 Incident Worksheet.
· Provides an ad hoc reporting mechanism that uses VA FileMan modifiers for sorting or printing the following data fields:
Patient Type of Death
Patient ID Level of Review
Date of Admission Date of Incident
Patient Type Incident Case Status
Ward/Clinic Severity Level
Treating Specialty Fall Assessment Score
Service Person Reporting the Incident
Responsible Service Patient Diagnosis
Case Number Incident Description
Incident Pertinent Information
Incident Location National Case Status
The adoption of a standardized reference for clinical terminology across VHA enables clinical information to be recorded, transmitted, retrieved, and analyzed in a precise manner independent of clinic or medical center.
The scope of the Lexicon Utility
is to express diagnostic clinical problems in easy-to-understand terminology
and associate these terms to coding systems such as ICD, DSM, NANDA, etc. It
works in conjunction with
· Provides a basis for a common language of terminology so that all members of a health care team can communicate with each other.
· Provides terminology that is well defined, understandable, unique in concept, and encodable by multiple coding schemes.
· Provides for site modification of text presentation, term definitions, synonyms, shortcuts, and keywords.
· Provides the ability to upgrade coding systems (e.g., ICD-9-CM to ICD-10) and to add, change, and delete codes.
· Provides for limited views of vocabulary (lexicon subsets).
· Allows each site to add its own vocabulary to the lexicon.
· Accepts the provider terminology if a search of the dictionary does not find a match.
· Uses subsets of terms based on specialty or clinic.
· Allows abbreviations or shortcuts to provide quick access to frequently used definitions.
· Supports CPT terminology and codes.
The Occurrence Screen module supports VHA policy by providing for the identification of events requiring follow-up review. It generates worksheets used by clinical, peer, management, and committee-level reviewers and identifies practitioner, systems, and equipment-related problems and results. The program enables medical facilities to define site-specific screens and to track events associated with them.
· Provides automatic identification of patients for the following occurrences:
- Readmission within 10 days
- Admission within three days following unscheduled Ambulatory Care visit
- Return to operating room in same admission
- Death anywhere in medical facility, except DNR (Do Not Resuscitate)
· Allows for quick entry of exceptions.
· Provides a tracking and reporting system (ad hoc) for all screens.
· Produces worksheets for clinical, peer, management, and committee-level review.
· Tracks patient occurrences through peer and management-level reviews to final disposition.
· Relates quality of patient care with provider-specific information.
· Tracks problems by provider, systems, and equipment.
· Provides required Summary of Occurrence Screening.
· Compiles numerous reports, including:
- Occurrences by Service
- Review Level Tracking
- Patients Awaiting Clinical Review
- Delinquent Reviews
- Adverse Findings
- System/Management/Equipment Problems
- Occurrence Screen Service Statistics
- Ad Hoc Reports
The purpose of the Patient
Representative module is to ensure that VA medical facilities respond to
patient needs. The software tracks and trends compliments and complaints and
measures the facility’s types of complaints as they relate to the Customer
Services Standards and the National Patient Satisfaction Survey. This package
supports the Patient Advocate with the collection and categorization of
complaints and compliments that give the medical center an opportunity to meet
and exceed the customer’s expectations. The issue codes provide the opportunity
to track types of complaints and provide trends of specific complaints.
Included within the issue codes are the Customer Service Standards. A recent
reliability study of the codes has revealed an exceptionally high reliability
in the selection of appropriate codes. To help with improving perceptions, the
tracking program can also extract data specific for women veterans by eras of
service (i.e., Gulf War,
· Entering and editing contact information.
· Sending Reports of Contact via the Alert system.
· Tracking contacts that have responses due.
· Printing various lists, statistical reports, and ad hoc reports.
Registration, Eligibility, and Enrollment Systems will be developed as a single, department-wide data system and demographic database that support registration and eligibility for the three Administrations and make this information more accessible and consistent.
Admission, Discharge, Transfer (ADT) module provides a comprehensive range of
software dedicated to the support of administrative functions related to
patient admission, discharge, transfer, and registration. The functions of this package apply throughout
a patient's inpatient and/or outpatient stay, from registration, eligibility
determination and Means Testing through discharge with on-line transmission of
Patient Treatment File (PTF) data to the
The ADT module functions as the focal collection point of patient information, encompassing demographic, employment, insurance, and medical history data. Many other modules, such as Laboratory, Pharmacy, Radiology, Nursing, and Dietetics, utilize information gathered through the various ADT options.
Several features have been designed to maximize efficiency and maintain control over user access of specified sensitive patient records. The Patient Sensitivity function allows a level of security to be assigned to certain records within the database (i.e., records of employees, government officials, etc.) in order to maintain control over unauthorized user access. The Patient Lookup function screens user access of these records. It also provides for efficient and faster retrieval of patient records and identified potential duplicate patient entries.
The ADT module allows for efficient and accurate collection, maintenance, and output of patient data, thus enhancing a health care facility’s ability to provide quality care to its patients.
The functions within ADT currently fall into seven major categories: Application Processing (registration), Bed Control (inpatient movements), Inpatient Care Grouping (DRG)/Long Term Care Grouping (RUG), Data Transmission to National Database (PTF and RUG), Patient Assessment Instrument (PAI), Supervisor Functions (system setup and maintenance), and Local/National Management Reporting.
· Provides on-line patient registration and disposition of applications for medical care.
· Tracks patient movements during inpatient stays.
· Provides up-to-date on-line patient information.
· Generates numerous managerial and statistical reports.
· Performs patient data consistency checks.
· Supports the flagging and monitoring of patient records deemed to be sensitive.
· Enrolls patients in the VA Patient Enrollment System during the registration process.
· Uses industry standard International Classification of Diseases (ICD)/Current Procedural Terminology (CPT) codes.
· Aids in cost recovery of care by supplying comprehensive PTF/RUG-II, Means Test, and pharmacy copay software.
The Clinical Monitoring System allows the user to design monitors that capture patient data in support of quality management efforts. In most cases, patient data is automatically captured from the existing database and this module allows manual entry of patients into the database for tracking specific events. Statistical data is kept for the number of patients scanned and the number that meet the monitor’s criteria, which allows for the trending of data over a user-selected timeframe (daily, weekly, monthly, etc.).
· Enrolls from database, patients/events as defined by each monitor.
· Allows groups of similar items to be scanned as a whole (e.g., ward group, service group, admission type group).
· Allows for manual enrollment of patients/events.
· Warns the user, via MailMan bulletins, when alert levels are reached or time frames are ended.
· Allows comparison of totals for specific time frames.
· Labels each monitor as High Volume, High Risk, Problem Prone, or Other, and allows for further description.
· Allows for entry of a standard of care associated with each monitor.
· Provides for an ad hoc reporting mechanism.
· Provides site parameters allowing Information Resources Management (IRM) staff to control the manual running of the auto enroll function.
Enrollment Application System (EAS) is currently a single module application. It facilitates the processing of a 10-10EZ Application for Health Benefits, which has been transmitted to the VHA site from the On-Line 10-10EZ Web-based software.
This 10-10EZ module allows site staff with enrollment and registration responsibilities to review all data entered by a veteran on the electronic 10-10EZ form before committing the data to the site database. It also provides a basic tracking mechanism in order to follow the progress of the veteran’s application and respond to inquiries.
Automatically receives incoming 10-10EZ data
transmissions from the Web-based application into a
· Provides a List Manager interface that allows the enrollment/registration staff to:
- Match the Applicant with an existing Patient record when appropriate.
- Review all 10-10EZ data and perform corrections as needed.
- Print the 10-10EZ form with data in order to send to the veteran for signature.
- Verify that the veteran has signed the 10-10EZ.
- Commit the 10-10EZ data to the VistA Patient database in preparation for further enrollment and/or registration activities.
- Respond to customer (e.g., veteran) inquiries as to the status of a 10-10EZ Application.
· Provides an audit trail of all significant actions performed in processing a 10-10EZ Application as a basis for management reports.
· Retains a copy of any original Patient database data elements overwritten by incoming 10-10EZ data elements.
The Hospital Inquiry (HINQ) module provides the capability to request and obtain veteran eligibility data via the VA national telecommunications network. Individual or group requests are sent from a local computer to a remote Veterans Benefits Administration (VBA) computer where veteran information is stored. The VBA network that supports HINQ is composed of four computer systems located in regional VA payment centers.
HINQ interfaces with other modules to allow users to make eligibility requests. An on-line suspense file stores requests for later transmission and records HINQ responses, thus creating a log of HINQ activity.
The HINQ module provides facilities with the ability to obtain veteran eligibility information quickly, accurately, and efficiently, allowing medical center personnel to act expeditiously on patient requests for medical treatment and other benefits.
Returned HINQ data may be loaded directly into the local Patient file through various screens. The screens display both the data in the HINQ message and what is currently in the Patient file for comparison.
· Sends on-line requests individually and forwards multiple requests in batch mode.
· Tracks and updates requests.
· Establishes real-time links between VHA and VBA computers to service time-of-the-essence requests.
· Processes routine requests in background, allowing requesters to perform other tasks.
· Alerts requesters when responses are received from VBA computers.
· Alerts requesters when there is a discrepancy found between the returned HINQ information and what is in the Patient file.
· Provides the capability to update returned HINQ data directly into the Patient file.
The Income Verification Match
(IVM) module is designed to extract patient-reported Means Test data and
transmit it to the Health Eligibility Center (HEC) located in
IVM electronically transfers patient income and demographic data for eligible veterans whose VA health care is based on income and for whom a Means Test has been completed. It also sends automatic updates if pertinent patient data is edited at the medical center.
As part of this process, HEC compares the extracted data with earned and unearned income data retrieved from Social Security Administration (SSA) and Internal Revenue Service (IRS). Patients with reported income in the mandatory category, but whose actual income has been proven to be above that level, will have their eligibility for health care changed to the discretionary category and are subject to back billing.
The HEC sends the updated demographic and insurance information to the medical facilities for upload. The IVM module allows the HEC data to be compared with locally collected data and selectively uploaded. An invoice is then generated by MCCR to insurance companies for patients who had not previously reported health insurance coverage. Updated and verified income information from the HEC is automatically uploaded upon receipt at each VA facility, which updates the veteran’s eligibility for health care and creates co-payment charges for previous episodes of care.
The software provides inquiries and reports that track all IVM activity.
· Transmits data for basic demographics, next-of-kin, income, temporary address, eligibility, guardian, and employer information to the HEC for patients who meet the IVM criteria. Automatically transmits an updated message if this information is changed.
· Allows the HEC to query the medical facility for the most up-to-date patient information.
· Allows updated demographic and insurance information from the HEC to be uploaded into the patient’s record.
· Automatically loads updated income information from the HEC and updates the veteran’s eligibility for health care.
· Allows generation of status inquiries, statistical Means Test, and data transmission reports.
The Record Tracking module provides for the maintenance and control of medical records and x-ray films to facilitate availability to a variety of users. The system offers a wide range of individual site-definable parameters such that it may be custom- tailored to specific needs and used in any type of file setting. The Record Tracking module is integrated with other associated modules such as Radiology and Patient Information Management System.
The module automates file room functions in support of the following activities. The module also supports requisitioning activities for individual records within a facility and between facilities, including:
· Creation of new records/volumes
· Charge-out/check-in of records
· Inactivation/reactivation and deletion of records
· Printing of bar code labels
· Transfer of records to other facilities
· Recharging records to other borrowers
· Flagging a record as missing
· Record retirement
· Uses bar code technology, prints bar code labels for the charts, and uses bar code equipment to charge records.
· Displays informational bulletins when a record is checked into a file room. Bulletins may include the following information: pending requests for the record, the record has previously been flagged as missing, loose filing exists, the patient is currently an inpatient, or the record is being checked into a file room other than its home.
· Offers a complete system for maintenance and control of records that may be used with ease in any type of file setting.
· Produces a variety of reports associated with the module that may be used to assist management in workload analysis and control of records.
· Creates pull lists to provide requests for records in conjunction with clinic scheduling and record retirement.
The Resident Assessment Instrument/Minimum Data Set (RAI/MDS) provides a standardized assessment tool supporting the completion of a comprehensive, accurate, and reproducible patient assessment, and serves as the basis for developing the patient’s plan of care.
The RAI/MDS aligns the VA’s data collection processes with private sector skilled nursing facilities. The Centers for Medicare and Medicaid Services (CMS) and the States require that long-term care facilities implement the RAI/MDS in order to receive Medicare and/or Medicaid reimbursement. Use of the RAI/MDS in VA long-term and Nursing Home Care Unit programs provides a structure for meeting JCAHO long-term care accreditation standards. It also provides opportunities for data comparison of patient outcomes within and across VA and with non-VA long-term care and/or nursing home programs.
The VA purchased the Accu-Med
Services (AMS) Clinical Software suite, which has been implemented nationally,
with a gateway interface to import patient data from
module with display of demographic and patient movement information interfaced
· Assessments module based on the MDS Version 2.0, a core set of preliminary screening and assessment elements including common definitions and coding categories.
· Specific responses to MDS questions trigger one or more of eighteen potential problem areas—known as Resident Assessment Protocols—identifying residents who have, or are at risk for developing, specific functional problems.
· Triggered RAPs signal the need for additional assessment and evaluation using RAI guidelines as defined by CMS. RAP summary notes are used to document analysis of the assessment findings and identify resident problems, some of which may be reversible.
· Resident Care Plan and Report Writer modules.
· Electronic signature and electronic transmission of assessments to AAC.
· Audit controls for HIPAA privacy and security compliance.
· Integration Gateway with HL7 standard messaging and monitoring tools.
· MDS 2.0 with Version 1.2 data specifications and fatal error checks.
· Contains complete on-line help manuals for all modules of the CMS RAI/MDS manual.
The Veteran Identification Card (VIC) replaces the embossed data card as a means of identifying veteran patients entitled to care and services at Veterans Affairs (VA) health care facilities.
replacement VIC displays a larger color photograph of the veteran and the
veteran’s name. There is no embossed information on the card. A
color photograph of the veteran is taken at the local medical center using the
Patient Image Capture Software (PICS) on a Clinical Context Object Workgroup (CCOW) enabled workstation. The photograph is sent to
the local VistA Imaging server, making it available to the Computerized Patient
Record System (CPRS) and other
· Veteran’s picture, name, and care type (i.e., service connected) on card face.
· Magnetic stripe on card encoded with the patient’s name, social security number, date of birth, sex, patient type, veteran status, and service-connected indicator.
Provider Systems are information systems supporting health care providers in
the care of veterans by feeding information to main systems such as
Care Management is the first application to run within the HealtheVet Desktop (the VHA’s new Java application framework) and the first to offer a convenient way for healthcare providers to view on a single screen pertinent information about multiple patients. With Care Management, users can see at a glance multiple patients for whom they have items that require attention. The current distribution of Care Management offers the following four perspectives (which are similar to applications):
· Clinician Dashboard—Provides an easy-to-read table of patients for whom clinicians have unacknowledged results or event notifications (such as hospital admissions, discharges, or unscheduled clinic visits), unsigned documents, or uncompleted tasks.
· Nurse Dashboard—Provides an easy-to-read table of patients for whom nurses have unacknowledged results, unviewed events, uncompleted tasks or text orders, unverified orders, or recent vitals.
· Query Tool—Enables authorized users to create reports based on the most current patient data available. The Query Tool offers five pre-defined reports and also enables users to create their own customized reports.
· Sign List—Enables users to sign multiple items for multiple patients. For example, using the Sign List, a clinician can sign a discharge summary for John Smith and notes for Jane Smith simultaneously.
This distribution of Care Management also includes the Task Editor, which enables users to create patient-related tasks.
Care Management comprises an extensive set of features designed to simplify and improve patient care.
These features include (but are not limited to) the following:
· Colored-coded icons that indicate the priority status of dashboard items
· A default patient list that is based on users’ Computerized Patient Record System (CPRS) default patient list
· A dynamically generated, user-based patient list
· Custom patient lists
· Checkboxes for acknowledging and verifying individual or multiple dashboard items
· The ability to set date ranges for dashboard items
· The ability to link tasks to other tasks or to events
· The ability to prioritize, edit, and delete tasks
· Text boxes that expand to provide detailed information about dashboard items
· A variety of predefined reports, including the following:
- Abnormal Results
- Consult Status
Care Management — continued
- Incomplete Orders
- Recent Activity
- Scheduled/Due Activity
· Custom reports with a wide selection of criteria, including (but not limited to) the following:
- Screen by Inpatient, Outpatient, or Pharmacy Visits
- Screen by Primary Outpatient Provider
· The ability to print and export reports
Care Management is tightly integrated with CPRS. As a result, from within Care Management, users can:
· Go directly to a patient’s chart in CPRS
· Clear selected result notifications in CPRS, including notifications in the following categories:
Care Management’s intuitive Graphical User Interface (GUI) includes an extensive selection of clickable items from which users can:
· Select a default perspective
· Select dashboard preferences
· View demographic information for individual patients
· View details about specific action items
· And much more
Care Management — continued
Care Management Clinician Dashboard running in the HealtheVet desktop.
Clinical Procedures (CP) passes
final patient results, using Health Level 7 (HL7) messaging, between vendor
clinical information systems (CIS) and
CP works with the Consult/Request
Tracking, Text Integration Utility (TIU), CPRS, Patient Care Encounter (PCE),
and VistA Imaging packages. In
conjunction with CPRS, CP also provides a method for clinicians to document
findings and to complete final procedure reports generated by medical devices. There are no specific procedures tracked
through this application, nor are management workload reports generated. Links to dSs and other databases through PCE
are supported through existing pathways in appropriate
CP provides features that can be used across clinical specialties such as Medicine, Women's Health, Surgery, Dental, Rehabilitation Medicine, and Neurology. Its functionality supports clinical practice in all patient care settings including clinics, Home Based Health Care (HBHC), and in-patient units.
· Allows clinicians to enter, review, interpret, and sign CP orders through one application, CPRS.
· Accepts a variety of file types for result report files.
· Allows images to be acquired, processed, stored, transmitted, and displayed by the VistA Imaging package.
· Defines the Hospital Location where the procedure is performed. This location determines which Encounter Form is presented to the end user.
Electronic transfer of patient reports from
medical devices to
· Bi-directional interface capabilities.
· Easy to use user interfaces, including CP Manager, CP User, and CP Gateway.
· Improved internal communication between the proceduralist and the primary care physician.
· Improved patient education through use of reports.
· Improved medical record keeping.
CPRS enables clinicians to enter, review, and continuously update all order-related information connected with any patient. With CPRS, you can order lab tests, medications, diets, radiology tests and procedures, record a patient’s allergies or adverse reactions to medications, request and track consults, and enter progress notes, diagnoses, and treatments for each encounter, and enter discharge summaries. Close integration with the Clinical Reminders and Text Integration packages allows better record keeping and compliance with Clinical Guidelines and medical record requirements.
CPRS not only allows hospital personnel to keep comprehensive patient records, it also enables clinicians, managers, and QA staff to review and analyze the data gathered on any patient in a way that directly supports clinical decision-making.
Improves the efficiency of entering orders, progress notes, encounter data, and other clinical information in the patient chart and helps clinicians comply with legislative mandates and clinical practice guidelines, through features such as:
· Order checking for:
- Out-of-range values
- Maximum order frequency
- Potential drug-drug, drug-dosage, drug-overlap, drug-lab, and drug-allergy interactions, with appropriate warnings issued
· Orders integrated with progress notes, results, procedures, diagnosis, and problems
· Templating utilities for speedy point-and-click composition of notes
· Interdisciplinary notes enable a single parent note to contain multiple clinicians’ notes for their disciplines to make them easier to find
· Tools to create Reminder dialogs for point-and-click resolution of clinical reminders to meet Clinical Guidelines
· Quick orders
· Order sets
· Event-delay orders (for admission, discharge, or transfer orders)
· Clinical Context Management to synchronize multiple applications to the same patient
· Accessibility support for disabled users in accordance with Section 508
· Code Set Versioning that ensures current codes to comply with HIPAA legislation
Computerized Patient Record System—continued
Improves the accessibility of online clinical information and results via integration with:
· Clinical Reminders
· Adverse Reactions
· Discharge Summary
· Progress Notes
· Inpatient and Outpatient Pharmacy
· Health Summary
· Problem List
· Consult/Request Tracking
· Patient Record Flags
Provides access to clinical information from other VAMC and Department of Defense sites through Remote Data Views.
Graphical User Interface (GUI) provides a consistent, event-driven, windows-style clinical user interface.
· Provides parameters and defaults that allow VAMC administrators and CPRS users to fine-tune the functionality and processes specific to their needs.
Provides communication among
Computerized Patient Record System—continued
CPRS Cover Sheet Example
The Adverse Reaction Tracking (ART) program provides a common and consistent data structure for adverse reaction data. This module has options for data entry and validation, supported references for use by external software modules, and the ability to report adverse drug reaction data to the Food and Drug Administration (FDA).
· Documents patient allergy and adverse drug reaction data.
Provides the functionality for other
· Provides a reporting mechanism that supports VHA Directive 10-92-070 which specifies reporting of adverse drug reactions to the FDA.
Includes ART event points in an Application
Programmers Interface (API) allowing other
· Alerts the Pharmacy and Therapeutics Committee each time the signs/symptoms are modified for a patient reaction.
· Generates progress notes. Displays all information at the time of an ART event on the Progress Notes API and allows editing of the note prior to sign off.
· Allows the site to track whether the patient has been asked if he/she has allergies.
· Tracks when the patient chart and ID bands have been marked indicating a particular reaction.
· Differentiates between historical and observed reactions.
· Tracks the particular signs/symptoms for a reaction.
· Allows for configuration of allergy files.
· Allows for editing and verification of reaction data.
· Allows for the addition of comments for each reaction to ensure completeness in reporting.
· Contains extensive reporting capabilities.
· Contains an online reference guide.
The Authorization/Subscription Utility (ASU) provides a method for identifying who is authorized to perform various actions on clinical documents. These actions include signing, co-signing, and amending. ASU originated in response to Text Integration Utilities' document definition needs. Current security key capabilities were unable to efficiently manage the needs of clinical documentation (Discharge Summaries, Progress Notes, etc.).
Defines, populates, and retrieves information about
user classes. User classes can be defined hospital-wide or more narrowly for a
specific service and can be used across
· Links user classes with Text Integrated Utilities (TIU) document definitions and document events.
· Allows sites to maintain membership of users in User Classes and to distribute such maintenance tasks.
· Lists class members as active or inactive.
· Allows infinite hierarchies of subclasses.
· Defines business rules to further manage document activities.
The Clinical Reminders package is a valuable aid in patient treatment. Reminders assist clinical decision-making and educate providers about appropriate care. Electronic clinical reminders also improve documentation and follow-up, by allowing providers to easily view when certain tests or evaluations were performed and to track and document when care has been delivered. They can direct providers to perform certain tests or other evaluations that will enhance the quality of care for specific conditions.
Clinical Reminders may be used for both clinical and administrative purposes. However, the primary goal is to provide relevant information to providers at the point of care, for improving care for veterans. The package benefits clinicians by providing pertinent data for clinical decision-making, reducing duplicate documenting activities, assisting in targeting patients with particular diagnoses and procedures or site-defined criteria, and assisting in compliance with VHA performance measures and with Health Promotion and Disease Prevention guidelines.
The Quality Enhancement Research
Initiative (QUERI), a Health Services Research and Development (HSR&D)
program, and the National Clinical Practice Guidelines Committee have joined
with the Office of Information, System Design & Development office
(SD&D) in designing national reminders and dialogs that will help promote
informed decision-making and consistency of health care practices.
Cooperatively developed reminders include: Ischemic Heart Disease (IHD), Major
Mood Disorder (MDD),
Version 2 of Clinical Reminders contains many enhancements to improve processing and management of reminders. Performance has been enhanced through the creation of an index of all clinical data used in reminder findings. All enhancements are intended to help the Reminders functionality smoothly transition to CPRS Reengineering.
· Allows results that are unique for each patient, by basing reminder evaluation on the patient's clinical data.
· Allows clinicians to resolve reminders through dialogs within the CPRS GUI. 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.
· Allows facilities to copy, create, and customize their own reminder definitions, based on local needs.
· Provides components that can be displayed on Health Summaries.
· Provides reminders reports for summary or detailed level information about patients' reminders that are due. Reports allow providers to verify diagnoses, verify that appropriate treatment was given, identify patients requiring intervention, and validate effectiveness of care. Combined reports for multiple facilities or multiple locations can now be generated.
· Provides an enhanced Exchange Utility that allows exchange of reminder definitions and dialogs among sites and Veterans Integrated Service Networks (VISNs).
The Consult/Request Tracking package provides an efficient way for clinicians to order consultations and procedures from other providers or services within the hospital system, at their own facility or another facility. It also provides a framework for tracking consults and reporting the results. It uses a patient's computerized patient record to store information about consult requests.
· Allows direct access to Consults functions through menu options in CPRS.
· Uses Consults' own menu options for managing the system, generating reports, tracking consults, or entering results for an existing consult request.
· Allows staff to set up consults as CPRS Quick Orders, streamlining the ordering process.
· Integrates with Prosthetics to track Home Oxygen, Eyeglasses, Contact Lenses, and other Prosthetics services.
· Produces a permanent record of the request and resolution for the patient's medical record.
· Allows all relevant parties to see the consult report in the context of the patient's record.
· Allows use of TIU templates and boilerplate to report findings.
· Allows display of Consult reports through TIU and CPRS.
CPRS: Consult/Request Tracking – continued
A Health Summary is a clinically oriented, structured report
that extracts many kinds of data from
· Integrates data from the following packages:
Adverse Reaction Tracking Nursing (Vital Signs)
Automated Medical Information Outpatient Pharmacy
Exchange (AMIE) Patient Care Encounter (PCE)
Clinical Reminders Problem List
Computerized Patient Record Progress Notes
System (CPRS) Radiology
Consults/Request Tracking Registration
Discharge Summary Social Work
Inpatient Medications Spinal Cord Dysfunction
Laboratory System Surgery
· Health Summary users can print an Outpatient Pharmacy Action Profile with bar codes in tandem with a health summary.
· Health Summary now exports components that allow staff to view remote patient data through CPRS. Additionally, remote clinical data can be viewed using any Health Summary Type that has an identically named Health Summary Type installed at both the local and remote sites.
· Clinical Reminders work with Health Summary to furnish providers with timely information about their patients' health maintenance schedules. Providers can work with local coordinators to set up customized schedules based on local and national guidelines for patient education, immunizations, and other procedures.
· Health Summary components 'Progress Notes' and 'Selected Progress Notes' can display the new interdisciplinary progress notes and all of the entries associated with the interdisciplinary note.
Health Summary Example
Problem List is used to document
and track a patient’s problems. It provides the clinician with a current and
historical view of the patient’s health care problems across clinical
specialties and allows each identified problem to be traceable through the
This application supports primary care givers, such as physicians, nurses, social workers, and others, in inpatient and outpatient settings. It is also designed to be used by medical and coding clerks. A variety of different data entry methods are possible with this application.
Use of Problem List varies from site to site, depending on the data entry method a facility has chosen. Many sites use Encounter Forms, with clerks entering most of the data in the encounter forms. Encounter forms are generated from patient data in the system and added to or modified by clinicians.
· Allows a clinician to view an individual problem list for any given patient.
· Supports a variety of specialized views of a patient’s problem list.
· Uses the Lexicon utility that permits the use of “natural” terminology when selecting a problem. Each term is well defined and understandable. A user, site, or application may substitute a preferred synonym.
· Can be linked to other sections of the medical record, such as Health Summary, Progress Notes, Order Entry/Results Reporting, Consults, test results, care plans for Nursing and Mental Health, Discharge Summaries, and Billing/Encounter Forms.
· Supports import of problem information from other clinical settings outside the immediate medical facility.
· Allows reformulation of a problem.
· Supports multiple forms of data capture: direct clinician entries, clerk entry, encounter forms, foreign problem lists, scanned encounter forms, hand-held devices, etc.
· Requires minimal data entry.
Text Integration Utilities (TIU) simplifies the use and management of clinical documents for both clinical and administrative medical facility personnel. In connection with Authorization/Subscription Utility (ASU), a facility can set up policies and practices for determining who is responsible or has the privilege for performing various actions on required documents.
The Version 1.0 release included Discharge Summary and Progress Notes. With the release of
CPRS and Consults/Request Tracking, TIU has been upgraded to integrate with these packages.
boilerplate functionality for the automatic fill-in of information from
· Interfaces with the Computerized Patient Record System (CPRS): the template utilities in the GUI version of CPRS allow speedy point-and-click composition of notes, consults, and summaries. Templates can be set up for specific types of documents for specific clinical needs. Interfaces with Problem List, Automated Information Capture System (AICS), Patient Care Encounter (PCE), Authorization/Subscription Utility (ASU), Incomplete Record Tracking, Health Summary, and Visit Tracking. Uses a standardized and common user interface, which allows clinicians and others to retrieve many kinds of documents from a single source.
· Enables healthcare practitioners to enter interdisciplinary notes regarding a single episode of care for a patient. This is accomplished through the addition of a level to the tree structure where a note can have children (subordinate entries) and each of the children can have a different author. This provides for more complete patient records and facilitates input from a variety of practitioners regarding a single episode of care.
· Interfaces with VistA Imaging allowing clinicians to link TIU documents to all types of clinical images such as X-rays, MRIs, and CAT scans.
· Uses an integrated database, which lets clinicians, quality management staff, researchers, and management search for and retrieve clinical documents more efficiently because documents reside in a single location within the database.
input from a variety of data capture methodologies such as transcription,
direct entry through CPRS or the TIU package, or upload of ASCII formatted
· Uses a uniform file structure for storage of documents and management of document types.
· Uses a consistent file structure for defining elements and parameters of a document.
· Allows a variety of user actions, such as entry, edit, electronic signature, addenda, browse, notifications, etc.
· Allows a variety of management functions, including amendment, deletion, and identification of signature surrogate, re-assignment, and administrative authentication.
The Dentistry module is a menu-based system incorporating features necessary for the maintenance of medical center dental records. Users can enter dental treatment data, edit dental records, review and print reports, schedule appointments for patients, perform patient inquiry, and print and transmit data electronically to update the VA central database.
There are two levels of users, general user and manager. General users have limited system access as determined by the manager at a given medical center, while managers have access to all menus and options.
· The package transmits service reports to a VA centralized database on a monthly basis. All service report data may be edited or deleted prior to release.
· Treatment reports can be displayed in four different formats: a provider format, sittings by provider, clinic summary, and individual sittings.
· There is full screen or line-by-line data entry and edit via the Treatment Data Enter/Edit feature. A tailored template/screen is used depending upon the provider selected (e.g., Prosthodontic, Endodontic, Oral Surgery, Periodontic, General).
· Patient inquiries combine Dentistry and Patient Information Management System (PIMS) data for patient information display (e.g., current address, sex, age, ward location).
· The package is integrated with the PIMS Scheduling module to allow users to make appointments, change or delete appointments, print pre-appointment, no-show, and cancellation letters, and generate routing slips and appointment lists.
· It provides a critical path method (CPM) aid to schedule appointments for Dental patients.
The Hepatitis C Case Registry contains
important demographic and clinical data on VHA patients identified with
Hepatitis C infection. The
· Automatically develops a list of patients with Hepatitis C infection.
· Provides a GUI interface that allows select local facility staff to add to and/or edit the list.
· Identifies patients who are receiving investigational class drugs for Hepatitis C.
· Transmits patient data to a national database, including patient demographic information, the reason(s) patients were added to the registry, pharmacy utilization information, radiology test results, and a limited set of laboratory test results.
· Generates the following local reports:
- A report that lists the patients currently on the registry. Users can filter this report to display a subset of patients based on the date range they were added to the registry.
- A report that lists patients who have received Hepatitis C therapy within a user-selected date range.
- A report that displays local software activity and error report information.
- Technical improvements include:
- Automatic nightly updates to the national registry list.
- Use of a uniform M (formerly MUMPS) program backbone that can be used for other disease case registries.
The transformation of
The Home Based Primary Care module is designed to allow for the local entry and verification of HBPC patient-related data. Individual medical centers can now enter HBPC-related data and maintain, validate, and manipulate the database locally. This local database structure gives the HBPC program greater accountability for the integrity of its data, and eliminates the correction cycle previously required to correct data entry errors at the central database. Each site can now transmit complete records of HBPC patient information monthly to the Austin Automation Center (AAC) for processing. The AAC will continue to generate the same quarterly reports—only the source of the data has changed. This system eliminates the paper reporting system between medical centers and the AAC database.
· Uses Appointment Management to handle patient visits and captures that visit data from Patient Care Encounter for transmission to the AAC.
· Provides for the entry and editing of patient evaluations and admission/discharge data.
· Provides automatic transmission of data to the central database.
· Allows data validation and correction to be completed at the individual medical center prior to transmission to the central database.
· Allows for medical center control over the site's HBPC database.
· Enables medical facilities to generate a wide variety of reports covering:
- Visit, admission and discharge data
- Length of stay
- Census for program, team, case manager, and/or provider
· Enables the HBPC program manager to control and assess the staff workload and organizational characteristics.
The Immunology Case Registry (ICR) contains important demographic and
clinical data on VHA patients identified with Human Immunodeficiency Virus
(HIV) infection. The ICR module accesses
The key capabilities provided by the ICR to VA facilities that provide care and treatment to patients with HIV infection include the clinical categorization of patients, generation of the Center for Disease Control (CDC) case report form, clinical reports, and automatic transmission of data to the VA's National Immunology Case Registry.
Data from the ICR are used on the national, regional, and local level to track and optimize clinical care of HIV infected veterans served by VHA.
The latest version of the ICR is augmented by the capabilities of the Clinical Case Registries (CCR) software and has been further enhanced by the automation of the data collection system. The enhanced version, referred to as CCR: ICR, is a clinically relevant tool for patient management.
The CCR: ICR software enhancements provide the following capabilities and features:
· New graphical user interface (GUI).
· Robust reporting capability, using both process and patient outcome measures, that allows for tailored local level reporting and divisional level reporting to help monitor the quality of patient care.
· Provides the ability to export report data to spreadsheet applications.
· Facilitates the tracking of patient outcomes related to antiretroviral drug treatment.
· Provides partial automation of HIV case identification.
· Identifies and tracks important trends in treatment response, adverse events, and time on therapy.
· Matches resources to clinical needs and utilization at local, VISN, and national levels.
· Verifies workload for VERA reimbursement.
· Automates notification to HIV coordinators that data was sent to and received by the national database.
· Automates extraction of data to the national registry.
The Intake and Output (I&O) application is designed to store, in the patient's electronic medical record, all patient intake and output information associated with a hospital stay or outpatient visit. This application is not service specific and currently is interfaced with the Patient Information Management System (PIMS) (MAS), Nursing, and Pharmacy applications.
Users may electronically document patient intake (e.g., oral fluids, tube feedings, intravenous fluids, irrigations, and other types of intake defined by the facility) and patient output (e.g., excreted patient material such as urine, nasogastric secretions, emesis, drainage, liquid feces/stool, and other types of output defined by the facility).
Intake data can be entered through either a quick or detailed route. The quick route documents the total fluid consumed. The detailed route requests the user to enter information regarding the specific type of fluid intake (e.g., orange juice, water, soup) along with the quantity absorbed.
The Start/Add/DC IV and Maintenance option contains nine protocols associated with intravenous therapy:
· Start IV—Start a new IV line or heparin/saline lock/port.
· Solution: Replace/DC/Convert/Finish Solution—DC current solution then replace a new solution to the selected IV line, or convert the IV according to the user's choice.
· Replace Same Solution—Replace the same solution to a selected IV.
· D/C IV Lock/Port and Site—Remove IV/lock/port from a selected IV site.
· Care/Maintenance/Flush—Check site condition, dressing change, tube change and flush.
· Add Additional Solutions(s) —Add additional solution(s) without discontinuing an existing one.
· Adjust Infusion Rate—Adjust infusion rate for a selected IV.
· Flush—Flush all IV line(s) for a selected infusion site.
The software supports documentation of intravenous intake via both single and multi-lumen catheters and is interfaced with the IV module of the Pharmacy software. The following reports are included:
· Print I/O Summary by Patient (by Shift and Day(s))
· Print I/O Summary (Midnight to Present)
· Print I/O Summary (48 Hrs)
· 24 Hours Itemized Shift Report
· Intravenous Infusion Flow Sheet
The last four reports can be printed for all patients on a ward, for patients in selected rooms on a ward, and for an individual patient.
The Veterans Health Information System and Technology Architecture (
· Computerized Patient Record System (CPRS)
· Supports ward order entry.
· Prints collection lists and labels and supports barcode printing.
· Provides maximum ordering frequency (e.g., daily, user-defined limits).
· Supports immediate request for blood specimen collection.
· Laboratory Electronic Data Interchange (LEDI).
· Provides worklists by urgency and accession number (instrument-specific).
· Produces lists of incomplete, workload/data capture reports, and lists for verification of data.
· Supports uni-directional and bi-directional Auto Instrument interfacing.
· Supports automatic download to automated instruments.
Verification/Release of Data
· Provides Delta Checks, flagging high/low/critical results.
· Presents critical values to the technologist in reverse video.
· Supports review/verification by group or individual accessions.
· Provides various on-screen alerts.
· Automated electronic result message generation via LEDI.
· Produces supervisory management, audit trail, data integrity, and quality management and utilization review reports.
· Provides searches for specific antibiotic with defined antimicrobial patterns.
· Produces discharge summaries and cumulative and discrete episode reports.
· Produces automatic transmission of verified data to the ordering location.
· Provides quality control/search capabilities (e.g., SNOMED, critical values, and high/low values).
· Produces reports for Laboratory Management Information Program.
· Produces and transmits roll-up reports to national database.
· Produces site-customized management reports.
· Schedules patient cumulative reports based on inpatient or outpatient treatment.
Data Extracts Capabilities for External Databases:
· Laboratory Management Index Program workload data.
· Laboratory Workload for Decision Support System.
· Hepatitis C clinical information.
· Emerging Pathogen clinical data, antimicrobial trend, infection control, and Health Department reports.
· Patient Care Encounter workload.
· LEDI messages to remote Laboratory Information Systems (LIS).
· External LIS.
The VistA Laboratory Anatomic Pathology module automates record keeping and reporting for all areas of Anatomic Pathology (i.e., Surgical Pathology (SP), Cytopathology, Electron Microscopy (EM), Autopsy). The module provides valuable quality management features, increases productivity, provides comprehensive search and reporting capabilities, and facilitates the gathering of workload statistics.
Provides quality management features, including:
· Access to historical pathology data during microscopic examination of current specimens.
· Lists of incomplete cytology, surgical pathology, EM, and autopsy reports.
· Turnaround time reports for all anatomic pathology sections.
· Generation of defined groups of cases requiring additional review, as defined by the accrediting agencies.
· Compilation of all information (e.g., special stains, immunopathology, or electron microscopy studies) in a single cumulative patient summary.
· On-command printing of laboratory test results of specified tests.
· Tracking outcomes of Quality Management review.
Increases productivity through:
· On-line access to historical anatomic pathology data (diagnosis and SNOMED codes only).
· Immediate availability of information regarding surgical pathology, cytology, electron microscopy specimens, and autopsy.
· Access to verified/released reports by non-laboratory personnel.
· Generation of labels for both specimens and slides.
· Interface with Kurzweil Voice Recognition Systems.
Provides comprehensive searching/reporting capabilities, including:
· Final pathology, autopsy, cytology, and EM reports.
· A log of all specimens accessioned, including final diagnoses.
· A variety of reports based on morphology, procedure, and etiology disease field entries, including:
- List of patients with a particular diagnosis.
- List of specimens from a particular site.
- List of specimens from a particular procedure (e.g., biopsies, frozen sections).
Provides workload statistics for:
· Number of specimens accessioned by area.
· Number of blocks, slides, and stains prepared.
The VistA Laboratory Blood Bank module uses data that can be tied primarily to a donor, a patient, or a unit of blood/blood component. Information about a blood donation or a donation attempt revolves around the name of the blood donor. Similarly, information about a unit of blood/blood component, once it appears in inventory, revolves around the donor unit identification, while information involving transfusion and testing of patient samples revolves around the patient name and social security number.
· Improves the safety of blood/blood component transfusions by decreasing the number and severity of human errors through:
- Retrieval of previous records and verification of current results.
- Detection of inconsistencies and flagging results that require corrective action before release of the unit.
- Bar code entry of donor unit information.
- Computer-assisted labeling of donor units.
· Improves the quality of patient care by allowing an evaluation of the appropriateness of all transfusions and specific blood components through integration with other portions of the system. Integration is accomplished by:
- Comparison of current lab values with established standards and screening criteria for each of the various components to allow concurrent audits.
- Delta checks for pre-transfusion and post-transfusion values to determine if the increments are within the established range.
· Decreases clerical workload through:
- Bar code entry from donor unit information.
- Transfer of information via pointers to reduce duplication.
- Preparation of labels following data entry.
- Generation of consultation reports.
- ility to perform searches for generating call lists.
- Generation of workload statistics for a given collection site for use in future planning.
- Automated blood donor recruitment and thank you letters.
· Improves utilization review/resource management through:
- Workload and transfusion statistics, and cost accounting by ward, treating specialty, and physician.
- Workload statistics, including variables by time of day and day of week.
- Access to information for medical and nursing staff.
The Veteran Integrated Service Network (VISN) mission is to consolidate electronic lab test ordering and lab test result reporting throughout all Veterans Affairs (VA) medical care facilities laboratories within a VISN, between VISNs, and for non-VA organizations (i.e., commercial reference laboratories). The LEDI software reduces or eliminates the need for manual ordering and reporting of laboratory results to interface laboratories. The software minimizes the amount of manual labor associated with preparing samples for delivery and processing at the host lab facility.
The VistA Laboratory Electronic Data Interchange Phase II (LEDI II) software application provides electronic messaging for Lab Test Ordering and Lab Test Results Reporting between VA health care facilities laboratories based on the Health Level Seven (HL7) Version 2.3 Standard Specification and VistA Health Level Seven (HL7) Version 1.6 Standard Specification. These Specifications are used as the basis for defining VistA Laboratory Universal Interface (UI) and LEDI HL7 Interface Standard Specification Version 1.2.
· Addresses the electronic lab test order transfer from the host facility laboratory to collection facilities laboratories.
· Provides for the automated transfer of verified test results from the host facility back to the collection facility’s laboratory for release to the patient electronic medical record.
· Provides storage of lab test results in the clinical database at the collection facility laboratory. The LEDI software electronically returns test results to the collection facility laboratory using the HL7 protocols. Results returned to the collection facility laboratory would be processed and verified as if completed by an auto instrument. This eliminates manual entry of results at the collection facility laboratory.
· Creates the automation of shipping lists to process the laboratory work at the collection and host laboratories.
· Provides the capability to interface non-VistA laboratory information systems. This includes university hospitals, commercial reference laboratories, other government agencies and centralized clinical patient record systems.
· Sends/Receives Laboratory HL7 Messages.
· Utilizes TCP/IP Protocol as a Communication Protocol.
· Builds lab test orders.
· Processes NTE Segments.
· Stores test reference ranges.
· Specifies final or incomplete lab test results.
· Provides new SM40 shipping codes.
· Builds and closes a Shipping Manifest.
· Generates Result (ORU) Messages.
· Referral Patient Multi-purpose Accession.
Medicine is designed to serve clinical services and maximize the use of the VAMC database. The module allows entry, edit, and viewing of data for many medical tests and procedures. The Summary of Patient Procedures allows the clinician to view a two-line summary of all medical procedures for each patient. These summaries are most often presented in descending order from most recent to oldest. Details of the procedures can be viewed by selecting the summary of interest. Medicine currently has six components: Cardiology, Pulmonary, Gastrointestinal, Hematology, Pacemaker, Rheumatology, and Generalized Procedure.
· Provides a Summary of Patient Procedures for all procedures performed on a particular patient with simple drill downs for further information. Reports for all procedures are menu options.
· Provides both scroll mode and screen entry features for all components and provides word processing-based consult software for all procedures.
an extensive screen entry system for Cardiac Catheterization Lab, Holter,
Electrophysiology, Exercise Tolerance Test, Echo, and Electrocardiogram.
Standards-based electronic transfer of ECG and Holter data to
· Allows the entry and edit of Esophageal Gastroduodenoscopy (EGD), Endoscopic Retrograde Cholangiogram and Pancreatogram (ERCP), Colonoscopy, and Laparoscopy findings or data.
· Allows the entry, edit, and printing of endoscopic data and Pulmonary Function test data.
· Contains a diagnosis filter that allows the separation of primary and secondary diagnoses, a consult component, and an automatically-generated recall list within both the Gastrointestinal and Pulmonary components.
· Allows data entry and edit for Generator and Lead implants, and follow-up surveillance within the Pacemaker component. The software also permits the direct electronic transfer of a report to the National Pacemaker Centers using VA network mail.
· Permits data entry and edit of Bone Marrow Aspirates (BMA) and Bone Marrow Biopsies (BMB).
· Allows the tracking of Rheumatology visits and is based on standards developed by the American Rheumatology Associations Medical Information System (ARAMIS).
The Mental Health module provides computer support for both clinical and administrative patient care activities associated with mental health care. Psychiatrists and psychologists have directed its design with active input from all health care disciplines, guided by the principle of creating software that makes the clinician’s job easier and leads to better patient care. A by-product of this approach has been the creation of a clinical database, which is useful to mental health program managers in many ways, including evaluating clinical productivity, monitoring and improving the quality of care, and trending various patient care events. This clinical database package is comprehensive and accessible from workstations throughout medical facilities.
Provides a mini clinical record that includes:
· A patient profile with demographic information and a brief index of the clinical database, including physical examinations, psychological tests, clinical interviews, problem list, and diagnoses.
· Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and International Classification of Diseases (ICD-9) diagnoses.
· Psychological test and interview results, reviews of systems, past medical histories, crisis notes, clinical patient messages, and progress notes.
· A Global Assessment of Functioning (GAF) Case Finder Report, which lists all patients that have not been given a GAF score within the last 90 days.
· The ability for patients to undergo psychological tests and clinical interviews at a workstation, saving considerable clinician time. Psychological tests are automatically scored for retrieval, with access governed by the guidelines of the American Psychological Association.
· Introduces the new functionality required to run the commercial-off-the-shelf (COTS) Addiction Severity Index Multimedia Version (ASI-MV) software.
· Allows clinicians and patients to enter demographics and self-administered ASI-MV interviews via a workstation using video and audio technology.
· Is a significant time-saver for clinicians, because clinicians need not be present during the interview.
· Provides the patients with privacy and appropriate time to complete an interview.
· Provides a crash recovery file.
· Displays patient demographics data, which can be printed, copied to the Windows clipboard, or saved to a text file.
· Context-sensitive help is available for most items, with suggestions for test administration and interpretations.
· Provides a user-friendly interface for entering interview data for ASI.
· Enhances the ability of both staff and patients to enter psychological test data.
· Creates reports and graphical displays of complex tests by sub-category or scales.
· Creates psychological test order windows that display tests that can be ordered based on the provider privileges.
· Provides a text report of selected tests and graphs of numeric scores.
The Nursing application is a component of the Department of Veterans Affairs VistA program. It is comprised of multiple modules (i.e., Administration, Education, Clinical, Quality Assurance, and Package Management).
The nursing software includes the following functionalities:
· Tracks staff information.
· Generates management reports on employees.
· Accumulates daily statistics on the number of patients treated.
· Generates daily, monthly, quarterly, and yearly AMIS Reports.
· Provides workload statistics based on AMIS data.
· Provides miscellaneous patient acuity reports.
· Contains a patient classification system which generates reports by bed section and ward.
· Includes nationally developed standard nursing care plans for initiating patient care plan generation.
· Allows nurses to generate a patient care plan based on patient problems, identified goals, and specified nursing interventions.
· Allows a staff nurse to update a patient's nursing ward location and/or nursing AMIS bed section to insure accurate patient classification entries.
· Allows users to enter vital signs, height, and weight for patients.
· Allows users to generate Intake and Output reports, an End of Shift Report, and a Health Summary Report by patient or ward.
· Allows sites to modify data in specified nursing files.
· Provides special ADP Coordinator functions for executing nursing options that affect patient acuity, manhours, FTEE status, etc.
· Provides ADP Coordinator options for admitting/transferring/discharging patients within the Nursing system when the MAS System is off-line.
The Nutrition and Food Service (N&FS) software integrates the automation of many Clinical Nutrition, Food Management, and Management Reports functions. The Clinical N&FS activities of Nutrition Screening, Nutrition Assessment, Diet Order Entry, Tube Feeding and Supplemental Feeding Orders, Patient Food Preferences, Specific Diet Pattern Calculations, Nutrient Analysis of meals, Consult Reporting, Encounter Tracking, and Quality Care Monitoring are all available in this program. The Food Management function has complete automation of food production activities; Service and Distribution, Inventory and Cost Management, Recipe Expansion, Menu and Recipe Nutrient Analysis, Meal and Diet Pattern Development and Implementation, Diet Card and Tray Ticket Printing, and Quality Service Tracking are available. The Management Reports include the Served Meals, Additional Meals, Cost Per Meal, Tube Feeding Cost, Supplemental Feeding Cost, Staffing Data, Encounter Data and Annual Management Reports.
· Allows the building of a site-specific listing of patient food preferences that can be incorporated in meal production calculations and the printed diet card and tray tickets programs.
· Manages patients' requests or dietary requirements for specific food items or utensils, allowing the selection of standing orders for any patient, for any meal or quantity.
· Controls all aspects of ingredient usage.
· Develops a list of site-specific recipes that includes portion size, preparation area and time, equipment and serving utensils, recipe category, ingredients, and directions for preparation. Recipes can be quickly analyzed for their nutrient value.
· Creates multiple meals and menu cycles. Meals can be used in different patterns by creating menu cycles or by creating special holiday dates within a cycle. It allows for the nutrient analysis of meals or daily/weekly menus.
· Controls quantities produced in the Food Management program. Specific patient diet orders are reorganized into production diets and diet patterns that reflect the foods to be served. This information is used along with data from the meal file to generate production reports, diet cards and/or tray tickets. A forecasting tool also exists in this section that allows the manager to anticipate, by percentage of total census, the type and quantity of various production diets that will be needed by any selected service point.
· Allows the entry of information required by the Annual Report that is not automatically retrieved from the program.
· Prints a patient-specific record of all diet order entry information.
· Controls the order entry activity.
· Manages food items and their nutrients using the latest USDA data, food items from Bowes and Church, and additional data from research.
· Handles N&FS consults and allows the reassignment of active consults from one staff member to another.
· Manages the supplemental feeding food items and menus. A supplemental feeding menu automatically goes into effect at the time of diet order entry and changes automatically with new orders.
The Oncology module automates the tumor registry and supports tumor registrars in abstracting cancer cases, following up on cancer patients and producing the Hospital Annual Report. Functions are grouped according to order of use: Case Finding and Suspense; Abstracting, Printing and Quality Management; Follow-up; Registry Lists; Annual Reports; Statistical Reports; and Utilities.
Oncology application functions in accordance with the current editions of
· The software supports multi-divisional sites.
· The program automatically finds cases by searching the database from Anatomical Pathology (Surgery, Cytology, Electron Microscopy, and Autopsy), Radiology, and Patient Treatment File (PTF). Cases can be entered into the Suspense File by date of diagnosis, and chart request pull lists can be printed.
· Demographics are drawn directly from Patient Information Management System (PIMS) patient file and stored permanently. Cancer identification data is obtained from the local database (e.g., laboratory and radiology test results).
· The program accessions and abstracts with extensive on-line help and stages extent of disease automatically.
· It produces a wide range of follow-up lists and registry lists needed for accreditation and allows entry of contacts directly into Oncology Contact File.
· Professional letters covering diverse situations and customization of letters are available.
· Predefined annual reports can be generated and the user can create specialized reports using VA FileMan.
· Reports to the Associate Chief of Staff (ACOS) can be generated using special routines that extract data onto floppy disk. The same functionality is available for state reporting.
· The database can be customized to suit the individual hospital.
· The full set of TNM codes is included from the appropriate edition of the AJCC Manual on Staging of Cancer.
· The program allows on-line completion of Patient Care Evaluations (PCEs) during the abstracting function if the case being abstracted fulfills the selection criteria for the PCE.
The Automatic Replenishment/Ward Stock (AR/WS) package provides a method to track drug distribution and inventory management within a medical center. The AR/WS module is designed to allow each medical center to adapt the system to its own needs.
The AR/WS package:
· Provides inventory management capabilities for clinical care locations and drug crash carts.
o Allows easy drug item inactivation for inventory locations.
o Provides tools to develop medication storage areas with lists of drugs to be maintained in that area. Drugs are classified by inventory type and assigned storage location and stock level.
o Groups medication storage areas together by inventory group name. Grouping may be by location, date (time or frequency of inventory), or inventory type.
o Provides tools to conduct inventory: prints inventory sheets and/or pick lists to determine stock to be replenished in medication storage areas and, by a selected method, replaces needed inventory items.
· Maintains backorder totals if a physical inventory is conducted and entered into AR/WS software.
· Provides inventory management reporting capabilities for clinical care locations and drug crash carts.
o Provides ability to select by inventory group on all reports.
o Supplies a report to fill on-demand requests for out-of-stock items or items not part of the standard inventory.
o Provides various printouts as well as several management statistical reports for the creation and maintenance of the system.
Medication Administration (BCMA) software provides a real-time, point-of-care
solution for validating the administration of Unit Dose (UD) and Intravenous
(IV) medications to inpatients in Veterans Administration Medical Centers
(VAMCs). BCMA uses a Graphical User Interface (GUI), MS Windows-based
Client/Server architecture, designed to improve the accuracy of the medication
administration process, and to increase the efficiency of the administration
documentation process. The end result is enhanced patient safety and patient
care at VAMCs. As a clinician scans each patient wristband and medication using
a bar code scanner, BCMA immediately validates the patient and their
medication, and that the medication is ordered, timely, and in the correct
dosage. At the same time, BCMA electronically updates the patient’s Medication
Administration History (MAH). The software is fully compatible with other
The BCMA software provides the following features:
· Medication Tabs on a patient’s Virtual Due List (VDL) are designed for separating and viewing the different types of active Unit Dose, IV Push, IV Piggyback, and large-volume IV medication orders. Each Tab provides an “alert” light, which turns green only when the patient has active medication orders for that Tab.
· Patient safety tools include a Missed Medications Report, an alert when due medications are not administered, a notification when a patient is transferred, and an alert light to indicate that a medication order exists for the Schedule Type and Start/Stop Date and Time selected on the VDL. Other tools include a listing of Allergies and Adverse Drug Reactions (ADRs) that are documented for a patient in the Allergy/Adverse Reaction Tracking (ART) package.
· A Computerized Patient Record System (CPRS) Med Order Button (or “Hot Button”) on the BCMA Tool Bar streamlines the workflow in ICU-type environments. This button links nurses directly to CPRS for electronically ordering, documenting, reviewing and signing verbal and telephone STAT and NOW (One-Time) medication orders already administered to patients.
· BCMA increases the amount and type of information available to nurses at the point of care, improves communications between Nursing and Pharmacy staff, records Missing Doses for patients, sends an electronic Missing Dose Request to the Pharmacy, and supports Health Level Seven (HL7) messaging.
· Management and accountability tools identify PRN entries that require effectiveness comments and pain scores, list medications that were not scanned as administered during an administration time window, list early/late administration variances, and allow nurses to set site-specific parameters and defaults on their systems.
· Compiles reports by Patient or by Ward for Nursing, Pharmacy, and Information Resources Management (IRM). Reports available for printing include: a Medication Administration History, Medication Log, Missed Medications, Missing Dose Request, PRN Effectiveness Log, Medication Due List, Medication History, Medication Variance Report, Cumulative Vitals/Measurement Report, and Administration Times Report.
The Consolidated Mail Outpatient Pharmacy (CMOP) package provides a regional system resource to expedite the distribution of mail-out prescriptions to veteran patients. CMOP host facilities, regionally located, receive data from medical centers within the area of service. Current CMOPs are designed to handle the dispensing and mailing of between 20,000 and 40,000 prescriptions in an 8-hour workday.
The CMOP package provides the following features:
· Patients submit medication requests via telephone, mail, or in person at each medical facility. When necessary, pharmacy personnel enter the orders into the patient database.
· Each area CMOP host facility establishes a schedule for the electronic transmission of the prescription data.
· Prescriptions are transmitted electronically from the medical facility to the automated prescription dispensing equipment, checked by a pharmacist, mailed to the patient, and information on the prescription filled is returned to update the medical center database.
· The process is highly integrated with the Outpatient Pharmacy software and requires no additional processing by pharmacy personnel responsible for entering the prescription.
· All prescriptions are automatically screened by the CMOP software and set for transmission if appropriate.
· The user is then notified that the prescription will be dispensed by the CMOP. Once the prescription is processed by the CMOP, the prescription file at the medical center is updated accordingly.
· Pharmacy staff may view the prescription at any time to determine if it has been transmitted to CMOP, dispensed, not dispensed, etc.
· Upon fulfillment of the medication order by the CMOP, any applicable pharmacy prescription co-payment is billed as the medical center files are updated with the release information.
· The software provides order tracking and operational data for the CMOPs.
· The software allows prescriptions written for schedule III-V controlled substances to be electronically transmitted to the CMOP facilities.
The Controlled Substances package provides functionality to monitor and track the receipt, inventory, and dispensing of all controlled substances. This software provides the pharmacy with the capability to define a controlled substance location and a list of controlled substances to maintain a perpetual inventory. The capability for Pharmacy personnel to receive a controlled substance order, which automatically updates the quantity on hand and receipt history, is also available. Nursing personnel can request orders for controlled substances via on-demand requests and receive these orders when delivered from Pharmacy. Pharmacy may dispense controlled substances, using the automated VA forms 10–2321 and 10–2638, to complete an order request.
The Controlled Substances package provides the following features:
· Monitors/tracks the receipt, inventory, and dispensing of controlled substances.
· Allows management inspections to automatically identify discrepancies in stock levels.
· Allows nursing to place orders for controlled substances via on-demand requests.
· Provides AMIS and cost reporting data.
· Maintains perpetual vault inventory balances.
· Provides the functionality to return to stock, transfer between locations, cancel orders, and log outpatient prescriptions.
· Automates current inventory requirements that allow medical facilities to detect discrepancies or diversions of controlled substances, thereby improving overall drug accountability.
The Drug Accountability/Inventory Interface works toward perpetual inventory for each VA medical facility pharmacy by tracking all drugs through pharmacy locations. Drugs are added to the pharmacy location as they are received from the Prime Vendor and CoreFLS. Both methods allow sites to receive invoice information containing data for confirmed orders. The files are uploaded into Drug Accountability, processed, and upon verification, the pharmacy locations or master vaults are updated. Dispensing data is collected from pharmacy packages to decrement balances. Drug Accountability also provides the capability for Pharmacy personnel to display or print procurement history, drug balance adjustments, and order data.
There are two primary methods of receiving invoice data into Drug Accountability:
· Prime Vendor Data
· CoreFLS Data
Both methods involve having the user place the invoice
orders with the appropriate company.
With the prime vendor, the data is uploaded into
The Prime Vendor Interface includes the following features:
· It automatically updates the Drug Accountability pharmacy locations based on dispensing and receiving information, and it also updates master vaults based on receiving information.
· Drugs are added as the invoice data is received.
· If the invoiced drug’s order unit and dispense units per order unit are the same as the information currently contained in the local DRUG file, the NDC field in the DRUG file is overwritten with the most recent National Drug Code (NDC) number.
· The reorder quantities for the pharmacy locations and master vaults are provided on a daily basis by way of a mail message.
CoreFLS Interface includes the following features:
· When a pharmacy order invoice is received and entered into the CoreFLS purchasing system, the receipt data will be collected and compiled to an Health Level Seven (HL7) message and transmitted ‘real time’ to VistA Drug Accountability. Upon receiving the message, the receipt data will be stored in a temporary global, and Drug Accountability will alert the user about the Pharmacy receipt.
· After receiving invoice data into the warehouse, the transmission from CoreFLS will place data into a temporary global.
· When Pharmacy personnel sign into the Drug Accountability package, the program will check for the existence of orders to process.
· If the orders exist, and the user has the proper security key, the data can then be received into Drug Accountability.
Pharmacy: Drug Accountability/Inventory Interface – continued
· Each Purchase Order received will be for a specific pharmacy location. If items are to be shipped/received at different pharmacy locations, a different purchase order will be created/shipped for each location.
Both Interfaces include the following features:
· Vendor-specific information and procurement history is displayed for a selected drug.
· Pharmacy locations are established and populated.
· A purge capability with scheduling queuing is provided.
· Supports NDC code set and pricing for Electronic Claims Management Engine pharmacy electronic billing.
The Electronic Claims Management Engine (ECME) package provides the ability to create and distribute electronic Outpatient Pharmacy claims to insurance companies on behalf of VHA Pharmacy prescription beneficiaries in a real-time environment. The application does not impact first party co-payments and minimizes the impact on legacy pharmacy workflow. This system meets the Health Insurance Portability and Accountability Act (HIPAA) of 1996 mandate, specific to the Electronic Transactions and Code Sets rule. The rule mandates VHA must submit claims electronically to insurance companies via the National Council for Prescription Drug Programs (NCPDP) v5.1 standard transmission format. The system, developed from a version currently utilized by Indian Health Service, has been modified to support the VHA Pharmacy Order Entry model.
ECME receives a billing determination by Integrated Billing (IB) if an Outpatient Pharmacy order is billable. If so, ECME builds a NCPDP v5.1 electronic claim transaction using data required by the insurance company for claim adjudication, as defined within the company’s individual payer sheet. Claims are submitted during the Outpatient Pharmacy finish process, and again during the Outpatient Pharmacy release process if the claim was initially rejected. If any additional edits or other events occur to the prescription, such as a return to stock, ECME generates additional electronic claims to payers updating them on the prescription billable status and updates IB with any claim specific information.
The ECME application provides the following features:
· Creation of outpatient pharmacy electronic claims for real-time submission to third party insurance companies for adjudication utilizing billing activities within the VHA prescription fill process.
· Utilization of information provided by a subscription with First DataBank to create electronic claims.
· Support and integrated functionality for TRICARE/CHAMPUS, ChampVA, and itemized charging methods for prescription pricing.
· Enhancements to VHA revenue cycle management by submitting claims at the point of service while building claim segments using payer-provided transaction formats compliant with the NCPDP v5.1 standard.
· Collection and presentation of DUR information to application users based on information received from payer claim responses.
· Reporting and on-line worklist presentation formats supporting VHA claims adjudication requirements.
· Integration with VistA IB for prescription billing determination and claims tracking.
· Integration with VistA Pharmacy applications when creating claims based on Pharmacy workflow.
· Communication with the VistA Health Level Seven (HL7) application and Vitria BusinessWare to store and forward e