The Veterans Health Administration (VHA) aggressively reorganized its infrastructure in the mid-1990s, undergoing a dramatic transformation from a stagnant “hospital system” to a model “healthcare system” characterized by patient-centered quality care. Central to these efforts was an enterprise-wide update of its existing health information technology (HIT), known as VistA (Veterans Health Information Systems and Technology Architecture), with the rollout of a graphical user interface familiar to most U.S. trainees, the computerized patient record system (CPRS). Although many U.S. hospitals are struggling to meet the national directive related to electronic health records (EHR), the VA boasts a comprehensive electronic records system that has been utilized across all its major clinical sites and units for over 15 years.
In light of the high price tag usually attached to HIT implementation, cost-conscious readers should be able to appreciate the magnitude of the VHA’s accomplishment in rolling out a CPRS in a cost-neutral fashion. Despite a 75% increase in the overall number of patients treated at the VA from 1996 to 2004 (2.8 million to 4.9 million), the VA witnessed a startling net decrease in cost per patient during the same time period—compare $5,058 spent per patient per year in 1996 to $5,048 per patient in 2004. Even more striking was the measurable impact on quality and efficiency in care delivery, particularly in preventive services and chronic disease management and outcomes. In a separate cost-benefit analysis of the VA’s HIT investment and implementation, a staggering benefit of $3.09 billion was found. It is not surprising that the VHA advanced to the top of the leaderboard compared to other U.S. health systems.
In a recent Medscape Electronic Health Records survey of more than 18,500 physicians in a variety of practice situations between April and June of 2014, VA-CPRS received the highest marks for user satisfaction, outshining other popular systems, including Practice Fusion, Epic Systems, and Amazing Charts. It is no wonder that international observers have praised VistA as “the gold standard in clinical informatics.”
What distinguishes the VA’s EHR from any “off-the-shelf” software available is the continued dynamic partnership that exists between frontline end users and supportive programmers. This relationship has resulted in 26 discreet versions of CPRS customized to enhance the capabilities and meet the local needs of VHA clinicians. Emphasis is placed on end user value-added functionality with the vision to optimize workflow rather than requiring physicians to align their clinical processes to a pre-scripted system.
The VA’s transformation has not ground to a halt. Rather, the successor to CPRS, known as the Health Management Platform (HMP), is already being piloted. Built as a groundbreaking, browser-based tool designed to further modernize patient care, the HMP shifts the focus away from a single-provider, single patient-chart model to a patient-centered team-based approach that better reflects and supports the way healthcare teams actually provide care. VA clinicians will be able to customize their own interface to support their workflow, communicate with other healthcare providers using secure internal instant messaging, and access built-in guideline-driven support tools that can assist clinical decision making.
Veterans will be able to input personal information using mobile devices and have complete access to their patient record, patient-provider communication tools, and consumer-friendly disease management information.
Administrators will have the ability to extract population-based data in real time to provide prompt feedback to frontline clinicians and identify specific gaps in healthcare delivery. The new HMP opens doors for improved interactions with system and developer partners worldwide.
Clearly the VA is not content to mimic the advancements of others, but once again is poised to revolutionize the arena of healthcare informatics.
Dr. Hazelrigg is section chief of hospital medicine at McGuire VAMC in Richmond, VA. Dr. Kwan is a hospitalist at the VA in San Diego, CA. Both are members of SHM's VA Task Force.