Electronic patient record initiative key to coverage for veterans

A strong flow of patient information will become even more important as the VA and the DoD build EHR systems connected to the Nationwide Health Information Network.

CHICAGO -- To gauge how well it was treating patients with hypertension or high blood pressure, the VA Medical

Center in Washington, D.C., gathered data from electronic patient records. At first, staff noticed an increase in certain types of these patients, according to Ross Fletcher, chief of staff for the medical center.

After comparing the data among three Department of Veterans Affairs (VA) medical facilities and analyzing such additional patient factors as location, weight, age and gender, doctors were able to plot the seasonal changes in severity of the hypertension and adjust treatments to help level the fluctuations. The analysis also has helped to show the relationship between controlling hypertension and mortality.

This ability to manipulate data and produce results for patients and providers is the “beauty” of the electronic record, Fletcher told his audience during a session at the American College of Healthcare Executives’ 2010 Congress for Healthcare Leadership.

Military doctors are able to use the system this way because doctors were involved in all points of its development, said Fletcher, who helped create the system, known as the Veterans Health Information Systems and Technology Architecture (VistA). “The system flows in the same manner and same pattern that they practice care,” he said.

Fletcher demonstrated the VistA electronic health record (EHR) system, walking his audience through several screens that, taken together, show seasonal changes in the treatment of patients with hypertension. Clicking through myriad electronic patient record screens at a pace that his peers training others on EHR systems might envy, he illustrated how those fluctuations were finally isolated.

That flow of information will become even more important as the Department of Veterans Affairs and the Department of Defense continue to build the Virtual Lifetime Electronic Record (VLER). The VLER initiative, announced last year, is a joint project to establish seamless care for military personnel from active duty through veteran status.

Officials from the project expect to make an announcement regarding the next phase of VLER's development in April, when the federal government awards grants through its Beacon Community Program.

The two departments have spent the last year building data-sharing projects across some 800 military medical facilities, according to Charles Campbell, chief information officer for the Military Health System. The projects' goal is to make it possible for a provider to call up the most recent version of an electronic patient record -- no matter the site of care, who the patient is, or when the record is needed.

This capability is built around a person, not a system. It’s all about the data, not about the system that collects the data.

Charles Hume, deputy CIO, Veterans Health Administration

To help facilitate that goal with the civilian health sector, where about 60% of the care for military personnel is conducted and where it’s harder than it is in the military health sector to collect data from providers who have not adopted health IT, the VA and Defense departments have also been working for the past year to become part of the Nationwide Health Information Network (NHIN). Connecting with a health information exchange (HIE) whose membership includes private-sector facilities will ensure that the civilian health sector's information about patients who are military personnel flows back to the military's records, according to Charles Hume, deputy CIO at the Veterans Health Administration.

Currently, the NHIN has only a few members, with the MedVirginia Inc. HIE and Kaiser Permanente its only private-sector participants. But the military hopes to show how interoperable information has helped its providers and to boost participation from civilian providers, Hume said. “We’re positioning ourselves” for a wave of private NHIN participants, he explained.

The key to the VLER Initiative is that the electronic patient record can collect all the information relevant to a patient, not just medical data, Hume said. “This capability is built around a person, not a system,” he said. “It’s all about the data, not about the system that collects the data. We see VLER going beyond health.”

Let us know what you think about the story; email Jean DerGurahian, News Writer.

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