1. Health Information Management (HIM) in the Department of Veterans Affairs
Pamela Heller, MSHI, RHIA, CCS-P, FAHIMA
Director Health Information Management
Veterans Health Administration

2. Veterans Health Administration
Size of Organization and Organizational Structure
The Veterans Health Administration (VHA) is home to the United States' largest integrated health care system
Consists of 167 medical centers and over a 1,000 outpatient sites.
Type of Health Records – Longitudinal

3. How VHA is Similar to Community Single-Facility Organizations

4. How VHA is Similar to Community Health Care Systems

5. VHA Enterprise Information System

6. Backbone of Electronic Health Record
VistA – Veterans Health Information Systems and Technology Architecture
VBA = Veterans Benefits Administration
NCA = National Cemetery Administration

7. VHA Electronic Health Record Computerized Patient Record System

8. Cover Sheet Tab

9. Documentation in Longitudinal Electronic Health Record

10. Scanned Data VistA Imaging – within CPRS

11. VistA Imaging – Remote/External CPRS
VI Viewer: Uses Internet Explorer / User signs in with Access and Verify codes
Printing allowed with signature code or MAG ROI key

12. VLER – Health Information Exchange
VLER = Virtual Lifetime Electronic Record

13. Veteran Heath Information Exchange (VHIE)
Veteran Engagement
VHIE enables Veteran Authorization and Veteran-Initiated HIE
Community Partners
VHIE builds the secure network and establishes Trust Agreements
VA Clinical Adoption
VHIE develops Data Content, engages providers, establishes use cases, and incorporates HIE into the clinical workflow
75% of Veterans seek/use non-VA Health Care
Technology Solutions
Exchange
VA Direct Messaging
Value Added Process (VAP)
Blue Button
Next Generation HIE
Improved Continuity of Care
Reduced duplication of tests/ procedures

14. Health Information Management (HIM) and VA Organizational Structure
Special Project/Program Leadership
Subject Matter Expert on many projects
International Classification of Diseases, 10th Edition, Clinical Modifications (ICD-10 ) Implementation
Speech Recognition
REPORTING
Records Management / Release of Information
Electronic Health Record /Health Record Data
File Room / Scanning
CLINICAL DOCUMENTATION IMPROVEMENT
CODING
VHA LEADERSHIP
HEALTH INFORMATION GOVERNANCE
HIM PROGRAM GOVERNANCE
FACILITY LEADERSHIP
HIM LEADERSHIP
HIM STAFF

15. HIM Governance & Oversight
VHA HIM Program Office

16. HIM Resources and References
CDI = Clinical Documentation Improvement
ROI = Release of Information

17. Technical Career Field (TCF) Program

18. Since 2003… 2 classes currently underway
36 graduates on 2nd or 3rd progressive job at VA
Graduated 117 trainees

19. VHA Data as a Business Asset
Master Data Identity Management
Multiple data sources
Data is not linear or unidirectional
Single Version of the Truth
Data Management
Completeness
Accuracy
Data Quality
Data Stewardship

20. Data/Information Types of Data Using Data VA Provided Care Data
Clinical
Administrative
Claims
Employee
Care in Community on behalf of VA
Using Data
Clinical Care
Reimbursement
Research
Data Reporting
Process Improvement

21. VA Enterprise Data Warehouse
OIT REGION 1 (R1)
OIT REGION 2 (R2)
OIT REGION 4 (R4)
Enterprise
VISN:12-17
VISTAs: 29
RPT
VISN:6-11
VISTAs: 41
VISN:1-5
VISTAs: 28
VISN:18-22
VISTAs: 33 Vx Vy Vn R1 R2 R4 R3
Governance Boards
CDW GP BI AI RD
Strategy
Policy
Priorities
Requirements
OIT REGION 3 (R3)
AI = Analytics & Informatics
BI = Business Intelligence
CDW= Corporate Data Warehouse
GP = General Purpose
OIT = VA Office of Information & Technology
RD = Research & Development
RPT = Report
Vn, Vy, Vx = VISN Servers
VISN = Veterans Integrated Service Network

22. VHA Support Service Center (VSSC)

23. Turn Data into Information through Metrics
Coding Turn-A-Round Time: Inpatients and Outpatients

24. Meaningful Data Used = Information Metrics

25. Using Data Analytics to Tell the Story
Reported Issue/ Pattern Data
Review Data
Broadened Universe to look at all Facility
Ask the question – Why?
Take Action
Monitor/Measure

26. Data Driven Analytics Unsigned/Un-cosigned Documentation

27. Data Collection & Data Analytics Automated and Manual

28. Data Collection & Data Analytics Automated and Manual

29. Using Big Data Outcome Shape and Standardize Processes Coding
Analytics/Metrics
Training
Standard Process
Shape and Standardize Processes
Coding
Release of Information
Unauthenticated Documents
Lack of Documentation
Scanning
File Room Activities
Clinical Documentation Improvement

30. HIM Governance Outcome Training
Analytics/Metrics
Training
Standard Process
Training
Provide minimum of monthly trainings on specific process or best practice within process
Webinars targeting specific audiences (coding)
Talent Management System’s on-demand training for HIM Functional Areas
HIM SharePoint of References and Resource Libraries

31. Let the Data Speak for Itself
Outcome
Analytics/Metrics
Training
Standard Process
Analytics/Metrics
Health Record Completeness
Coding Accuracy and Monitoring
Coding Turn-A-Round Time and Days Outstanding

32. Use Data to Guide the Process

33. Questions