VETERANS HEALTH ADMINISTRATION

Quality Improvement using the VA Electronic Health RecordMatthew Bidwell Goetz, MDChief, Infectious DiseasesVA Greater Los Angeles HCS

VETERANS HEALTH ADMINISTRATION

VHA and quality of care

• VA is now recognized nationally for quality

• Transformation into a quality institution occurred in conjunction with other changes

– Reorganization to a primary care-focused system

– Quality measurement and accountability

– Independent data gathering programs

– Public availability of performance data

– Institution of an integrated, comprehensive EHR

VETERANS HEALTH ADMINISTRATION

How did the EHR help improve quality?

• 100% access to records

• Availability of remote data (other VAs) and DoD data

• Ability to identify patients by disease or other characteristics (coding, use of data elements)

• Ability to use data to create reports, provide feedback

• Decision support tools at point of care including reminders to providers

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Examples of Summary Reports

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Secure, web-based national registries for use by all VA primary care providers

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Group comparisons

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Care Managers can produce customized, team-level reports

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Provider access to information on patients not meeting indicators

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Quality Measures in the VA

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Use of the Computerized Patient Record System (CPRS) for Management of Individual Patients

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Selected views of CPRSCover Page

Imaging and Procedure Reports Laboratory Reports

Clinician Notes

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CRPS: customized patient-specific reports

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GLA HIV Viral Loads, Includes patients not on treatment

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Viral Load

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System-Wide Quality Improvement in HIV - Testing

Facilitation by the VA Electronic Health Record (EHR) and the Functionality of CPRS

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How did the VA EHR and CPRS help HIV testing initiatives?

• Able to identify patients not previously tested and avoid repeatedly offering tests the previously tested

• Able to use data to create reports, provide feedback

• Decision support tools at point of care

VETERANS HEALTH ADMINISTRATION

Using CPRS – based decision support (Clinical Reminders)

• Used for a wide variety of purposes in the VA– Screening for depression, traumatic brain injury– Screening for Tobacco & alcohol use– Hypertension identification and management– Diabetes monitoring– Vaccination rates– Etc.

• Contributes to attainment of performance standards

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Examples of Clinical Reminders

• Sample reminders for an HIV-infected patient• OI prophylaxis

• Hepatitis screening

• Primary care indicators

• Reminders can be determined by the status of the patient

• Reminders can be customized at each facility

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Provider – specific reminder completion rates

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Relative Increase in Testing50% 390% 556%

Pre- vs Post-Intervention Routine HIV TestingMulti- VISN QI Project – Adjusted Rates

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VA-Wide Changes in HIV Testing vs Use of HIV Testing Clinical Reminder

Sites without Clinical Reminder Sites with Clinical Reminder

2009 2010

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Acknowledgements

• VA HSR&D: QUERI core funds, SDP 06-001, SDP 08-002

• VA Clinical Public Health: moral, financial and logistical support

• QUERI-HIV/HEP colleagues: Steve Asch, Allen Gifford, Jane Burgess, Tuyen Hoang, Hersch Knapp, Henry Anaya and many, many others

• Slides on the development of clinical dashboards – Caroline Goldzweig