In the Department of Veterans Affairs (VA), Information Technology includes the Computerized Patient Record System consisting of patient notes, clinical reminders, consults, order sets and templates. The Barcode Medication Administration system provides encrypted wireless access at the bedside for medication administration to ensure patients receive medications as prescribed cutting down significantly on medication errors. Telehealth applications include Tele Mental Health (video conferencing eliminates the need for the patient to drive long distances to the facility for counseling). Home Care Coordination for chronically ill patients provides technology (Health Buddies) in patients’ home which are monitored by Home Care providers remotely. Medical device images can be reviewed throughout the VA enterprise.

My HealtheVet provides a secure, web-based personal health record. At this time, Veterans can order prescription refills and access valuable health information. In development is the ability to view their complete record, schedule appointments and electronically dialogue with healthcare providers.
 
Over the years, VA has continually enhanced security, accessibility, and implemented new technologies, including partnering with interfaced vendor systems to ensure we have a comprehensive clinical and administrative healthcare system. However, we are not done … we are always looking for innovative ways to streamline documentation, share information and convert old technologies into new graphical interfaces, web applications and business intelligence systems, using our core (VistA) system applications as the foundation.
 
The National Health Information Network (NHIN) has developed standards and policies to implement the secure exchange of health information via the Internet between treating physicians. Using NHIN standards, the VA is partnering with DOD and several pilot facilities to develop information sharing projects. Health Information Portability Pilots and Health and Human Services Beacon Grant projects are underway between VA, DOD and private healthcare facilities. We are also working on development of the Veterans Lifetime Electronic Record (VLER), which is a precursor of the future for all healthcare.
 
Why? The best reason is to enhance patient care and safety. With the aid of technology, West Palm Beach VA has been rated #1in overall performance among all VA medical centers nationwide (153 facilities). Reduction in medication errors is a good example of how patient safety can be achieved with this technology. If a patient presents at the Minneapolis VA, the provider there can not only review all prescriptions (from any facility in the VA), but other portions of the patient record, including labs. If the patient is seen in the community, however, the potential for drug interactions and allergies still exists. The use of secure exchange of information throughout all of healthcare will ensure the patient receives the correct medications, eliminating potential adverse events.
 
So how do you transform paper into an electronic medical record? There’s a lot of setup work. Technical and subject matter expert experience is required to implement ANY healthcare application. It is important to get the providers involved in the development of the project; give them ownership; and do LOTS of training! Resources are also critical (Hardware and Software – PCs in every clinic, mobile units for point of care documentation and applications to support all aspects of treatment). Staffing – Not only do you need subject matter experts, you also need competent technical support for installation & maintenance of equipment, system managers and programmers who can continually manage and enhance systems and applications. Also consider requirements for long term management and refresh of equipment and applications. Technology does not come cheap – but the benefits to patient care far outweigh the cost.
 
In the not too distant future, our grandchildren will NOT need to fill out a paper form identifying their medical history when they visit their healthcare provider. It will be right there in a few key strokes.
 
So what’s next? Technology never dreamed of 25 years ago, transformation to changing technologies, and continued healthcare improvements. We’re just beginning!