The Veterans Healthcare Administration Rachel Mayo November 28, 2006

Outline Structure of the VHA VistA – the electronic system of the VA Quality measurement Results of Reengineering Current happenings How can results be replicated?

Who is the VHA? The VHA is the largest healthcare system in the U.S. consisting of: –More than 1400 facilities (hospitals, clinics, etc.) –14,800 doctors –61,000 nurses –5 million patients

Structure Cabinet level head (Secretary of VA) –Creates political pressure –Current Under-Secretary: Kussman VISN – regional network –22 nationwide –VISNs compete for funding from the national level

Changes Made at the VHA Change started under Kenneth Kizer –Appointed during Clinton administration Focused on two main areas: –Efficiency of day-to-day operations –Quality enhancement Shift from hospital-based → primary care

VistA VistA – Veteran’s Health Information and Technology Architecture Composed of four main components: –Computerized Patient Record System –VistA Imaging –Bar-Code Medication Administration –My HealtheVet

CPRS Computerized Patient Record System –Registration applications –Scheduling –Order tracking system –Patient alerts

VistA Imaging Digital imaging system –Allows caregivers to access images in any VA facility

BCMA Bar-Coded Medication Administration Prevents Prescription Errors Alerts for Missing Doses

My HealtheVet Personal Health Record for veterans Allows documentation of: –Medical History –Family History –Blood Sugars –Journal Entries

Implementation Started 15 years ago Eliminated searching for records Patients in and out faster No problems after Katrina End Result: Better Patient Care!

Tracking Performance Personnel Clinical Care Activities Performance Indicators Internal Review and Improvement External Review and Oversight

Quality Indicators IndexComponents PreventionImmunizations, cancer screening, tobacco consumption, alcohol consumption Chronic Disease Care Aspirin administration, beta blocker administration, cholesterol management, nutrition/exercise counseling, inhaler observation, regular diabetes and obesity screenings Palliative Care Discussion of resuscitation status, pain management, home-based care, management of depression, assessment of nutritional needs

Measured Benefits of Reengineering In 3 years, bed days of care reduced 62% per 1000 patients Inpatient admissions decreased 32%, ambulatory care visits increased 43% Staffing reduction of 11% in 4 years 2700 paper forms eliminated

High Quality Care *596 VA Patients **992 patients at non-VA hospitals

Current Happenings Kenneth Kizer forced out of job Limited veterans’ eligibility to system Surge of mental health patients

Governmental Role Conservatives worry expanding VHA will cause private sector to tank Tom Bock – encourage government to pay VHA instead of Medicare –Is this a concept that could work on a grander scale? –Government should consider all angles

Replicating Results Private sector does not have incentives to create change –Reimbursement “rewards inefficiency” No incentive to provide good preventive care The VHA gets to do the “right thing all the time”

Keys to Success A determined leader Functional electronic system Good quality measurement

Summary VHA – large system, high quality Award winning electronic system Quality accountability and tracking Healthier patients, better care Not rewarded by government Changes needed for private sector

Final Thought “At the VA, you get to do the right thing all the time” – Dr. Peter Woodbridge Why is this not the case everywhere else?