> *Nancy Clum, RN, MN
> *Electronic Health Records at the VA*
> In 2006, the Department of Veterans Affairs (VA) received the
> prestigious “Innovations in American Government” Award from
> Kennedy School of Government for its advanced electronic health
> records and performance measurement system, one of the most
> comprehensive and sophisticated electronic systems for patient
> in the nation. VA clinicians began using computerized patient
> in the mid-1990s for everything from recording examinations by
> to displaying results of lab tests and x-rays. Now, patient
> are available 100 percent of the time to VA health care workers.
> Nancy Clum, Chief Health Informatics Officer at the Palo Alto VA,
> will describe the VA’s electronic health records system and, as
> in a recent study in the New England Journal of Medicine, how use
> of the comprehensive system has significantly enhanced the quality
> of patient care by largely eliminating errors stemming from lost or
> incomplete medical records, making the VA one of the safest systems
> in the health care industry.
Nancy began by explaining that in the
olden days the VA's records were paper filing cabinets full of
information. When patients moved from one service area to another their
files would frequently get lost. Some technical people figure out that
electronic records with information in one place that could be accessed
over a network might work as a better system. Electronic records at the
VA had started as a "skunk works" project back in the '70s, but by the
late '80s it was a full fledged text based whose goal was to serve all
patient records needs electronically. In 1998 they switched to
graphical user interface, which is available in all 153 VA facilities
nationwide. VA Palo Alto serves 3 inpatient facilities, a number
of outpatient clinics, and 85,000 enrolled patients.
The current system does much more than
just make it easy for the doctor to access records about previous
patient visits and medications. It also has medical images (X-rays,
electronicardiograms, etc.) on file and easy to see. In addition there
are checklists to remind doctors to ask all patients in target groups
to get (whatever the test is). For example, all male patients over
65-75 who have a history of smoking should have screening for abdominal
aortic aneurysm, so when a patient falls into that group the doctor is
reminded to request that. It also flags dangerous drug-drug
combinations and other known problems.
Nancy described the system terminal as
a computer with a monitor and a keyboard on a pushcart. The thing also
has a bar code reader to input medication labels without mistakes. When
the computer system first got adopted there was much adjusting to be
done, but now there is lots of confusion when the system goes down,
which doesn't happen often. Improvements for they system Nancy is
looking forward to include better integration with other systems,
better mobile computing support, and better task management tools. The
system is open source. There is a detailed article about electronic
medical record use in U.S. hospitals in New England Journal of
Medicine, March 2009 issue. Please see that for more information.
During Q&A the following came up:
Interns can learn the thing with just
an hour of training, which happens often.
Records are more electronic in Europe
than they are in the USA.
The Department of Defense has a totally
different record structure than the VA.
Drug companies love getting reminders
to check for stuff their product is good for solving in front of
doctors. Sometimes doctors complain of reminder overload though.
A Coast Guard serviceman who is about
to retire and go into the VA system was advised to keep a paper copy of
his medical file because Nancy was unsure if Coast Guard records would
be accessible with other DOD records.