Even health care organizations committed to using standards have a difficult time figuring out which standards to use. Consolidated Health Informatics CHI is an eGov initiative involving Federal agencies with responsibility for health-related activities and information. CHI participants evaluate and choose health data and communication standards to be incorporated into their IT systems maintaining, processing, or transmitting this information. We also work with external Standards Development Organizations SDOs to augment and refine available standards to ensure that they meet health care delivery needs in the VA.
Within VA, we have established a formal program across all sites of care, to coordinate the adoption, implementation, and verification of health data standards selected through the CHI process, and standards agreed upon through the AHIC process as they become available. The work involved in adopting and implementing data standards is deliberative and difficult. It requires collaboration among clinicians, health information professionals, developers, and business process experts.
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When VA developed its first EHR, the technological environment in VA hospitals — as in other hospitals at the time — was very different from the environment today. There was not a computer on every desk. No one had a mouse. As part of our data standardization effort, we went back and looked at the allergy data that had been collected over the years.
We also found thousands of entries in which penicillin had been misspelled. Not only is it a waste of time to type the same information over and over, it introduces a potential patient-safety issue. Let me give you an example. Suppose a veteran comes in for a check-up and tells the physician that he is allergic to sulfa drugs. Suppose that on a subsequent visit, another clinician orders Sulfamethoprim, which is a type of sulfa drug. By eliminating misspellings and establishing a standard vocabulary across sites, we will ensure that medication order checks work as intended, and that the EHR supports patient safety and clinical decision-making to the fullest extent.
The use of electronic health records and other information technology tools in a single medical office can improve health care quality, reduce medical errors, improve efficiency, and reduce costs for the patients treated there. However, as the President noted a year ago, the full benefits of IT will be realized when we have a coordinated, national infrastructure to accelerate the broader adoption of health information technology. The problems created by a lack of standardized data are magnified when interacting with other organizations.
Even seemingly straightforward information can be misconstrued when it is interpreted by different organizations.
The Office of the National Coordinator for Health Information Technology ONCHIT recognizes the importance of data and communications standards in developing a comprehensive network of interoperable health information systems across the public and private sectors. True interoperability between providers simply cannot be achieved without data standardization.
VHA has a long history of participation in standards development organizations. As a health care provider and early adopter of health IT on a large scale, VHA frequently identifies areas for standards development and works with other public- and private-sector organizations to develop consensus-based solutions.
This effort will foster a more cohesive, integrated approach to standards development, replacing the existing fragmented, inefficient approach in which standards are developed topic-by-topic. Our data standardization efforts at VA have already improved our ability to share information with other agencies. In April , VA and DoD adopted a joint strategy to develop interoperable electronic health records by The progress made by VA and DoD has served as a catalyst to move the health care industry toward the use of interoperable health information technologies that have the potential to improve health care delivery, increase patient safety, and support the provision of care in times of crisis.
Through collaborative efforts, VA and DoD will be better positioned to evaluate health problems among service members, veterans, and shared beneficiary patients; to address short- and long-term post-deployment health questions; and to document any changes in health status that may be relevant for determining disability.
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VHA is now working with the Centers for Medicare and Medicaid Services CMS to make the benefits of electronic health records available to private physician offices and clinics. The Health e Vet Program. Health e Vet builds on decades of VA expertise in health care IT to support the strategic goals of the department, meet interagency obligations, take advantage of new developments in technology to address weaknesses in the current system, and most importantly, improve the safety and quality of health care for veterans.
VistA and CPRS are in the public domain and have served as models for healthcare organizations in the public and the private sectors alike. VistA has been adopted for use by the District of Columbia Department of Health, and state veterans homes in Oklahoma. A number of other countries have either implemented VistA or expressed an interest in acquiring the technology.
Under the Health e Vet-VistA program, VA will incrementally enhance and supplement the current functional capabilities of VistA and will provide increased flexibility, more sophisticated analytical tools, and support for seamless data sharing among providers both within and outside VA.
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Like VistA, software developed under the Health e Vet program will be available in the public domain. Given the success of VistA, some people have asked why we are changing it. VA health IT systems have been forged and tested in the real world of health care.
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I can think of no other successful organization, with a history of innovation and a world-class system, that would simply rest on its laurels. One reason there is so much interest in VistA is that it has never been a static system. The health care environment of today is not the health care environment of ten years ago. Nor is the VistA system today the VistA system of ten years ago — or even of one year ago.
VA has continued to refine and enhance VistA since its introduction to reflect advances in clinical practice, the availability of new commercial products, the changing VA health care model, new Congressional mandates such as those related to current combat engagements , and federal laws such as the Health Insurance Portability and Accountability Act, the Federal Information Security Management Act, and the Privacy Act. The current VistA system has served us well through decades of transformation in health care.
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But VA has outgrown its facility-centric architecture, and the system is simply becoming too expensive to maintain. Health e Vet-VistA will give us a more flexible architecture so that we can support integrated ambulatory care and home-base health care, maintain continuity of operations in the event of a disaster, and improve response time by increasing system capacity and communications speed. Person Centered Health Records. Towards HealthePeople. Shepherd, M. Challenges in Health Informatics.
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Sen, A. McDaniel, S. Indianapolis, Indiana: Wiley Publishing, Inc. Pedersen, T. Research Issues in Clinical Data Warehousing. Appendices Related Papers. Medical informatics. By Saliya Nugawela. By Tony Sahama and Peter Croll.
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