VistA Monograph Wiki

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The initial copy of the wiki was generated from the VA's Vista Monograph in MS Word format.

It is way too big and some browsers may choke on it. Need to split this into about 10 pages or so AND keep the Table of Contents intact.

We have begun the process of manually editing and bringing it up to date.

Contents 1 Introduction 1.1 VistA-(Today) 1.2 HealtheVet-VistA-(Future) 1.3 Graphical Illustration of the HealtheVet-VistA Strategy 2 Getting WorldVistA 2.1 FOIA 2.2 WorldVistA 2.3 GT.M 3 VistA Software Packages 3.1 Health Data Systems 3.1.1 Automated Medical Information Exchange (AMIE) 3.1.2 Incident Reporting 3.1.3 Lexicon Utility 3.1.4 Occurrence Screen 3.1.5 Patient Representative 3.2 Registration, Enrollment, and Eligibility Systems 3.2.1 Admission, Discharge, Transfer (ADT) /Registration 3.2.2 Clinical Monitoring System 3.2.3 Enrollment Application System (EAS) 3.2.4 Hospital Inquiry (HINQ) 3.2.5 Income Verification Match (IVM) 3.2.6 Record Tracking 3.2.7 Resident Assessment Instrument/Minimum Data Set (RAI/MDS) 3.2.8 Veteran Identification Card (VIC) 3.3 Health Provider Systems 3.3.1 Care Management 3.3.1.1 Care Management Clinician Dashboard running in the HealtheVet desktop 3.3.2 Clinical Procedures 3.3.3 Computerized Patient Record System (CPRS) 3.3.3.1 Status: CPRS required - Porting to XO not Complete 3.3.3.2 Image: CPRS Cover Sheet Example 3.3.4 CPRS: Adverse Reaction Tracking 3.3.5 CPRS: Authorization/Subscription Utility (ASU) 3.3.6 CPRS: Clinical Reminders 3.3.6.1 Image: Clinical Reminders Example: Reminders Resolution Dialog 3.3.7 CPRS: Consult/Request Tracking 3.3.7.1 Image: Consults Example 3.3.8 CPRS: Health Summary 3.3.8.1 Image: Health Summary Example 3.3.9 CPRS: Problem List 3.3.10 CPRS: Text Integration Utilities (TIU) 3.3.11 Dentistry 3.3.12 Hepatitis C Case Registry 3.3.13 Home Based Primary Care (HBPC) 3.3.14 Immunology Case Registry (ICR) 3.3.15 Intake and Output 3.3.16 Laboratory 3.3.17 Laboratory: Anatomic Pathology 3.3.18 Laboratory: Blood Bank 3.3.19 Laboratory: Electronic Data Interchange (LEDI) 3.3.20 Medicine 3.3.21 Mental Health 3.3.21.1 Status: Mental Health supported, except ASI-MV missing 3.3.22 Nursing 3.3.23 Nutrition and Food Service (N&FS) 3.3.24 Oncology 3.3.25 Pharmacy: Automatic Replenishment/Ward Stock (AR/WS) 3.3.26 Pharmacy: Bar Code Medication Administration (BCMA) 3.3.27 Pharmacy: Consolidated Mail Outpatient Pharmacy (CMOP) 3.3.28 Pharmacy: Controlled Substances 3.3.29 Pharmacy: Drug Accountability/Inventory Interface 3.3.30 Pharmacy: Electronic Claims Management Engine (ECME) 3.3.31 Pharmacy: Inpatient Medications 3.3.32 Pharmacy: Inpatient Medications - Intravenous (IV) 3.3.33 Pharmacy: Inpatient Medications - Unit Dose (UD) 3.3.34 Pharmacy: National Drug File (NDF) 3.3.35 Pharmacy: Outpatient Pharmacy 3.3.36 Pharmacy: Pharmacy Benefits Management (PBM) 3.3.37 Pharmacy: Pharmacy Data Management (PDM) 3.3.38 Pharmacy: Pharmacy Prescription Practices (PPP) 3.3.39 Primary Care Management Module (PCMM) 3.3.40 Prosthetics 3.3.41 Quality: Audiology And Speech Analysis And Reporting (QUASAR) 3.3.42 Radiology/Nuclear Medicine 3.3.43 Remote Order Entry System (ROES) 3.3.44 Scheduling 3.3.45 Social Work 3.3.46 Spinal Cord Dysfunction 3.3.47 Surgery 3.3.48 Surgery: Risk Assessment 3.3.49 VistA Imaging System 3.3.49.1 Status: VistA Imaging: missing - Alternate Available 3.3.50 Visual Impairment Service Team (VIST) 3.3.51 Vitals/Measurements 3.3.52 Women's Health 3.4 Management and Financial Systems 3.4.1 Accounts Receivable (AR) 3.4.2 Automated Information Collection System (AICS) 3.4.3 Beneficiary Travel 3.4.4 Compensation and Pension Records Interchange (CAPRI) 3.4.5 Current Procedural Terminology (CPT) 3.4.6 Decision Support System (DSS) Extracts 3.4.7 Diagnostic Related Group (DRG) Grouper 3.4.8 Engineering 3.4.9 Equipment/Turn-In Request 3.4.10 Event Capture 3.4.11 Fee Basis 3.4.12 Generic Code Sheet 3.4.13 Incomplete Records Tracking (IRT) 3.4.14 Integrated Funds Distribution, Control Point Activity, Accounting and Procurement (IFCAP) 3.4.15 Integrated Patient Funds 3.4.16 Integrated Billing (IB) 3.4.17 Patient Care Encounter (PCE) 3.4.18 Personnel and Accounting Integrated Data (PAID) 3.4.19 Voluntary Service System (VSS) 3.5 Information and Education Systems 3.5.1 Automated Safety Incident Surveillance Tracking System (ASISTS) 3.5.2 Library 3.5.3 Police and Security 3.6 Cross-Cutting Monographs 3.6.1 Duplicate Record Merge 3.6.2 Health Level Seven (HL7) 3.6.3 Kernel 3.6.4 Kernel ToolKit 3.6.4.1 Image: Sample Capacity Planning Report 3.6.5 List Manager 3.6.6 MailMan 3.6.7 Master Patient Index (MPI) and Master Patient Index/Patient Demographics (MPI/PD) 3.6.8 My HealtheVet 3.6.9 Network Health Exchange (NHE) 3.6.10 Patient Data Exchange (PDX) 3.6.11 Remote Procedure Call (RPC) Broker 3.6.12 VA FileMan 3.6.12.1 Performance 3.6.12.2 Portability 3.6.12.3 Openness 3.6.13 VistALink 3.6.13.1 Reasons for VistALink 4 VistA Development History 4.1 On The Horizon 5 Other Resources 6 Acronyms

[edit] Introduction

VistA and HealtheVet-VistA

VA'S Current and future Computerized Patient Record System

[edit] VistA-(Today)

The Department of Veterans Affairs (VA) has had automated information systems in its medical facilities since 1985, beginning with the Decentralized Hospital Computer Program information system, including extensive clinical and administrative capabilities. The Veterans Health Information Systems and Technology Architecture (VistA), supporting ambulatory and inpatient care, delivered significant enhancements to the original system with the release of the Computerized Patient Record System (CPRS) for clinicians in 1997. CPRS provides a single interface for health care providers to review and update a patient's medical record and to place orders, including medications, special procedures, x-rays, patient care nursing orders, diets, and laboratory tests. CPRS is flexible enough to be implemented in a wide variety of settings for a broad spectrum of health care workers and provides a consistent, event-driven, Windows-style interface.

CPRS organizes and presents all relevant data on a patient in a way that directly supports clinical decision-making. The comprehensive cover sheet displays timely, patient-centric information, including active problems, allergies, current medications, recent laboratory results, vital signs, hospitalization, and outpatient clinic history. This information is displayed immediately when a patient is selected and provides an accurate overview of the patient's current status before clinical interventions are ordered. CPRS capabilities include:

• A Real-Time Order Checking System that alerts clinicians during the ordering session that a possible problem could exist if the order is processed;
• A Notification System that immediately alerts clinicians about clinically significant events;
• A Patient Posting System, displayed on every CPRS screen that alerts clinicians to issues related specifically to the patient, including crisis notes, warning, adverse reactions, and advance directives;
• The Clinical Reminder System that allows caregivers to track and improve preventive health care for patients and ensure timely clinical interventions are initiated.
• Remote Data View functionality that allows clinicians to view a patient's medical history from other VA facilities to ensure the clinician has access to all clinically relevant data available at VA facilities.

VistA Imaging is also operational at most VA Medical Centers. VistA Imaging provides a multimedia, on-line patient record that integrates traditional medical chart information with medical images, including x-rays, pathology slides, video views, scanned documents, cardiology exam results, wound photos, dental images, endoscopies, etc. into the patient record.

Bar Code Medication Administration addresses the serious issue of inpatient medication errors by electronically validating and documenting medications for inpatients. It ensures that the patient receives the correct medication in the correct dose, at the correct time, and visually alerts staff when the proper parameters are not met.

HealtheVet Desktop is an application framework that will host the new generation of Veterans Health Administration (VHA) clinical applications. Care Management is the first application to run on the new HealtheVet Desktop and is an enhancement of CPRS designed to assist health care providers to follow-up on clinical interventions that might otherwise be missed. Care Management provides an automated method for tracking follow-up actions/tasks for a panel of patients for a designated period of time. The four perspecitives of Care management are the Clinician Dashboard, the Nursing Dashboard, the Query Tool and the Sign List. Implementation of the Care Management project will improve patient care by:

• Ensuring that appropriate clinical interventions are provided on a timely basis;

• Ensuring that clinical notifications are processed on a timely basis;
• Reducing the amount of time primary care providers spend reviewing individual patient records; and
• Reducing the risk of erroneous data entry

[edit] HealtheVet-VistA-(Future)

A strategy has been developed to move the Veterans Health Information Systems toward "HealtheVet", an ideal health information system to support the ideal veterans health system. Collaboratively among the Department, field, and central office leadership and the Chief Information Officer, a proposed strategy has been developed for both VA and Veterans Health Administration needs. The strategy is built around five major systems and integrates five cross-cutting issues:

• The Health Data System [health data repository (HDR)] will create a true longitudinal health care record including data from VA and non-VA sources. The health data system will support research and population analyses, facilitate patient access to data and sharing of information across VHA, and improve data quality and data security.
• Provider Systems support healthcare providers' care for veterans and feed information to VistA today and the HDR in the future. These include CPRS, VistA Imaging, Blood Bank, Pharmacy, Laboratory, Federal Health Information Exchange (FHIE), and Scheduling.
• Management/Financial Systems include four applications that are each ten or more years old and will be replaced: the Financial Management System, Billing and Accounts Receivable (AR), and Fee Basis (paying providers).
• Information and Education Systems with an emphasis on "eHealth" include prescription refills, appointments, fillable forms online, and My HealtheVet (access to health record, on-line health assessment tools; and high quality health information).
• Registration, Enrollment, and Eligibility Systems will be developed as a single, department-wide data system and demographic database that supports registration and eligibility for the three Administrations and makes this information more accessible and consistent.
• Cross-Cutting Issues include the VA and VHA architectures, information security, data quality, and leadership and management. These issues cut across all systems and ensure effective implementation and operations of the major systems.

[edit] Graphical Illustration of the HealtheVet-VistA Strategy

Veterans Health Information System, including VistA

[edit] Getting WorldVistA

Need to tell folks what to do with this stuff after they get it.

[edit] FOIA

The FOIA Freedom Of Information Act release is available here.

[edit] WorldVistA

Download WorldVistA Software

[edit] GT.M

And you will need GT.M

[edit] VistA Software Packages

[edit] Health Data Systems

The Health Data Repository (HDR) is the cornerstone of the Health Data Systems (HDS) portfolio. The HDR will serve as an operational clinical repository-a collection of clinical information, from VA and non-VA sources, residing on one or more independent platforms-to be used by clinicians and other personnel to facilitate longitudinal, patient-centric care. Data in the HDR will be organized in a format supporting the delivery of care regardless of the physical location of a patient's clinical information. The HDR will provide additional significant benefits including providing information to support research and population analyses, facilitating patient access to data and sharing information across VHA, improving data quality and data security, and reducing the burden on local VistA systems.

[edit] Automated Medical Information Exchange (AMIE)

Overview

The Automated Medical Information Exchange (AMIE) module facilitates the electronic interchange of veteran information between Veteran Benefits Administration (VBA) Regional Offices (ROs) and VA medical facilities. The comprehensive module provides an accurate audit trail to track most requests for information.

The module is composed of two components: Facility administrative options and VBA Regional Office options. Each area has individual items to maintain daily, and its own reports to print. RO staff access VA medical facility computers through VA national telecommunications network, and exercise their options on each local medical facility's system as necessary.

Features

• Provides access to local databases for identification of a veteran's admission, discharge, outpatient treatment, patient care, and other information that may require adjudicative actions.
• Reduces overpayments previously caused by lost, misrouted, or improperly processed admission notifications.
• Provides on-line status determinations of pending compensation and pension examinations (requesting, scheduling, tracking, and updating results).
• Provides RO on-line access to the local databases for the confirmation of the propriety of payments based on hospitalization.
• Improves timeliness of the RO benefits adjustment processing.
• Allows medical centers to electronically access sections of the Physicians Guide for Disability Evaluation Examinations.
• Provides tracking of insufficiently completed compensation and pension examinations.

[edit] Incident Reporting

Overview

The Incident Reporting module supports VHA policy by compiling data on patient incidents. It organizes the data into defined categories for reporting and tracking at medical facility level and for transmission to the National Quality Assurance Database for Headquarters review and tracking.

Features

• Provides options to simplify the setup of the software.
• Allows for the entry of all required incident information plus descriptive data and actions taken on all reportable and/or locally defined incidents.
• Prints out a Pseudo 10-2633 Incident Worksheet.
• Provides an ad hoc reporting mechanism that uses VA FileMan modifiers for sorting or printing the following data fields:

Patient Type of Death

Patient ID Level of Review

Date of Admission Date of Incident

Patient Type Incident Case Status

Ward/Clinic Severity Level

Treating Specialty Fall Assessment Score

Service Person Reporting the Incident

Responsible Service Patient Diagnosis

Medication Errors Medical Center Action

Case Number Incident Description

Incident Pertinent Information

Incident Location National Case Status

[edit] Lexicon Utility

Overview

The adoption of a standardized reference for clinical terminology across VHA enables clinical information to be recorded, transmitted, retrieved, and analyzed in a precise manner independent of clinic or medical center.

The scope of the Lexicon Utility is to express diagnostic clinical problems in easy-to-understand terminology and associate these terms to coding systems such as ICD, DSM, NANDA, etc. It works in conjunction with VistA applications such as Problem List, Encounter Form, and Text Integration Utility (TIU) and provides a comprehensive API so that any application that needs to use standardized terminology can be interfaced.

Features

• Provides a basis for a common language of terminology so that all members of a health care team can communicate with each other.
• Provides terminology that is well defined, understandable, unique in concept, and encodable by multiple coding schemes.
• Provides for site modification of text presentation, term definitions, synonyms, shortcuts, and keywords.
• Provides the ability to upgrade coding systems (e.g., ICD-9-CM to ICD-10) and to add, change, and delete codes.
• Provides for limited views of vocabulary (lexicon subsets).
• Allows each site to add its own vocabulary to the lexicon.
• Accepts the provider terminology if a search of the dictionary does not find a match.
• Uses subsets of terms based on specialty or clinic.
• Allows abbreviations or shortcuts to provide quick access to frequently used definitions.
• Supports CPT terminology and codes.

[edit] Occurrence Screen

Overview

The Occurrence Screen module supports VHA policy by providing for the identification of events requiring follow-up review. It generates worksheets used by clinical, peer, management, and committee-level reviewers and identifies practitioner, systems, and equipment-related problems and results. The program enables medical facilities to define site-specific screens and to track events associated with them.

Features

• Provides automatic identification of patients for the following occurrences:

• Readmission within 10 days
• Admission within three days following unscheduled Ambulatory Care visit
• Return to operating room in same admission
• Death anywhere in medical facility, except DNR (Do Not Resuscitate)

• Allows for quick entry of exceptions.
• Provides a tracking and reporting system (ad hoc) for all screens.
• Produces worksheets for clinical, peer, management, and committee-level review.
• Tracks patient occurrences through peer and management-level reviews to final disposition.
• Relates quality of patient care with provider-specific information.
• Tracks problems by provider, systems, and equipment.
• Provides required Summary of Occurrence Screening.
• Compiles numerous reports, including:

• Occurrences by Service
• Review Level Tracking
• Patients Awaiting Clinical Review
• Delinquent Reviews
• Adverse Findings
• System/Management/Equipment Problems
• Occurrence Screen Service Statistics
• Ad Hoc Reports

[edit] Patient Representative

Overview

The purpose of the Patient Representative module is to ensure that VA medical facilities respond to patient needs. The software tracks and trends compliments and complaints and measures the facility's types of complaints as they relate to the Customer Services Standards and the National Patient Satisfaction Survey. This package supports the Patient Advocate with the collection and categorization of complaints and compliments that give the medical center an opportunity to meet and exceed the customer's expectations. The issue codes provide the opportunity to track types of complaints and provide trends of specific complaints. Included within the issue codes are the Customer Service Standards. A recent reliability study of the codes has revealed an exceptionally high reliability in the selection of appropriate codes. To help with improving perceptions, the tracking program can also extract data specific for women veterans by eras of service (i.e., Gulf War, Vietnam) as well as clinic, product line, or services.

Features

• Entering and editing contact information.
• Sending Reports of Contact via the Alert system.
• Tracking contacts that have responses due.
• Printing various lists, statistical reports, and ad hoc reports.

[edit] Registration, Enrollment, and Eligibility Systems

Registration, Eligibility, and Enrollment Systems will be developed as a single, department-wide data system and demographic database that support registration and eligibility for the three Administrations and make this information more accessible and consistent.

• Strong VHA and OneVA component
• OneVA building common system and demographic database supporting registration and eligibility
• VHA management of companion VHA registration, enrollment, and eligibility through National Health Demographic Database

[edit] Admission, Discharge, Transfer (ADT) /Registration

Overview

The Admission, Discharge, Transfer (ADT) module provides a comprehensive range of software dedicated to the support of administrative functions related to patient admission, discharge, transfer, and registration. The functions of this package apply throughout a patient's inpatient and/or outpatient stay, from registration, eligibility determination and Means Testing through discharge with on-line transmission of Patient Treatment File (PTF) data to the Austin Automation Center. The ADT software also aids in recovery of cost of care by supplying comprehensive PTF/RUG-II and Means Test software.

The ADT module functions as the focal collection point of patient information, encompassing demographic, employment, insurance, and medical history data. Many other modules, such as Laboratory, Pharmacy, Radiology, Nursing, and Dietetics, utilize information gathered through the various ADT options.

Several features have been designed to maximize efficiency and maintain control over user access of specified sensitive patient records. The Patient Sensitivity function allows a level of security to be assigned to certain records within the database (i.e., records of employees, government officials, etc.) in order to maintain control over unauthorized user access. The Patient Lookup function screens user access of these records. It also provides for efficient and faster retrieval of patient records and identified potential duplicate patient entries.

The ADT module allows for efficient and accurate collection, maintenance, and output of patient data, thus enhancing a health care facility's ability to provide quality care to its patients.

The functions within ADT currently fall into seven major categories: Application Processing (registration), Bed Control (inpatient movements), Inpatient Care Grouping (DRG)/Long Term Care Grouping (RUG), Data Transmission to National Database (PTF and RUG), Patient Assessment Instrument (PAI), Supervisor Functions (system setup and maintenance), and Local/National Management Reporting.

Features

• Provides on-line patient registration and disposition of applications for medical care.
• Tracks patient movements during inpatient stays.
• Provides up-to-date on-line patient information.
• Generates numerous managerial and statistical reports.
• Performs patient data consistency checks.
• Supports the flagging and monitoring of patient records deemed to be sensitive.
• Enrolls patients in the VA Patient Enrollment System during the registration process.
• Uses industry standard International Classification of Diseases (ICD)/Current Procedural Terminology (CPT) codes.

• Aids in cost recovery of care by supplying comprehensive PTF/RUG-II, Means Test, and pharmacy copay software.

[edit] Clinical Monitoring System

Overview

The Clinical Monitoring System allows the user to design monitors that capture patient data in support of quality management efforts. In most cases, patient data is automatically captured from the existing database and this module allows manual entry of patients into the database for tracking specific events. Statistical data is kept for the number of patients scanned and the number that meet the monitor's criteria, which allows for the trending of data over a user-selected timeframe (daily, weekly, monthly, etc.).

Features

• Enrolls from database, patients/events as defined by each monitor.
• Allows groups of similar items to be scanned as a whole (e.g., ward group, service group, admission type group).
• Allows for manual enrollment of patients/events.
• Warns the user, via MailMan bulletins, when alert levels are reached or time frames are ended.
• Allows comparison of totals for specific time frames.
• Labels each monitor as High Volume, High Risk, Problem Prone, or Other, and allows for further description.
• Allows for entry of a standard of care associated with each monitor.
• Provides for an ad hoc reporting mechanism.
• Provides site parameters allowing Information Resources Management (IRM) staff to control the manual running of the auto enroll function.

[edit] Enrollment Application System (EAS)

Overview

Enrollment Application System (EAS) is currently a single module application. It facilitates the processing of a 10-10EZ Application for Health Benefits, which has been transmitted to the VHA site from the On-Line 10-10EZWeb-based software.

This 10-10EZ module allows site staff with enrollment and registration responsibilities to review all data entered by a veteran on the electronic 10-10EZ form before committing the data to the site database. It also provides a basic tracking mechanism in order to follow the progress of the veteran's application and respond to inquiries.

Features

• Automatically receives incoming 10-10EZ data transmissions from the Web-based application into a VistA holding file.
• Provides a List Manager interface that allows the enrollment/registration staff to:

• Match the Applicant with an existing Patient record when appropriate.
• Review all 10-10EZ data and perform corrections as needed.
• Print the 10-10EZ form with data in order to send to the veteran for signature.
• Verify that the veteran has signed the 10-10EZ.
• Commit the 10-10EZ data to the VistA Patient database in preparation for further enrollment and/or registration activities.
• Respond to customer (e.g., veteran) inquiries as to the status of a 10-10EZ Application.

• Provides an audit trail of all significant actions performed in processing a 10-10EZ Application as a basis for management reports.
• Retains a copy of any original Patient database data elements overwritten by incoming 10-10EZ data elements.

[edit] Hospital Inquiry (HINQ)

Overview

The Hospital Inquiry (HINQ) module provides the capability to request and obtain veteran eligibility data via the VA national telecommunications network. Individual or group requests are sent from a local computer to a remote Veterans Benefits Administration (VBA) computer where veteran information is stored. The VBA network that supports HINQ is composed of four computer systems located in regional VA payment centers.

HINQ interfaces with other modules to allow users to make eligibility requests. An on-line suspense file stores requests for later transmission and records HINQ responses, thus creating a log of HINQ activity.

The HINQ module provides facilities with the ability to obtain veteran eligibility information quickly, accurately, and efficiently, allowing medical center personnel to act expeditiously on patient requests for medical treatment and other benefits.

Returned HINQ data may be loaded directly into the local Patient file through various screens. The screens display both the data in the HINQ message and what is currently in the Patient file for comparison.

Features

• Sends on-line requests individually and forwards multiple requests in batch mode.
• Tracks and updates requests.
• Establishes real-time links between VHA and VBA computers to service time-of-the-essence requests.
• Processes routine requests in background, allowing requesters to perform other tasks.
• Alerts requesters when responses are received from VBA computers.
• Alerts requesters when there is a discrepancy found between the returned HINQ information and what is in the Patient file.
• Provides the capability to update returned HINQ data directly into the Patient file.

[edit] Income Verification Match (IVM)

Overview

The Income Verification Match (IVM) module is designed to extract patient-reported Means Test data and transmit it to the Health Eligibility Center (HEC) located in Atlanta, Georgia. IVM allows Veterans Health Administration (VHA) to accurately assess a patient's eligibility for health care when the eligibility criterion is income-based.

IVM electronically transfers patient income and demographic data for eligible veterans whose VA health care is based on income and for whom a Means Test has been completed. It also sends automatic updates if pertinent patient data is edited at the medical center.

As part of this process, HEC compares the extracted data with earned and unearned income data retrieved from Social Security Administration (SSA) and Internal Revenue Service (IRS). Patients with reported income in the mandatory category, but whose actual income has been proven to be above that level, will have their eligibility for health care changed to the discretionary category and are subject to back billing.

The HEC sends the updated demographic and insurance information to the medical facilities for upload. The IVM module allows the HEC data to be compared with locally collected data and selectively uploaded. An invoice is then generated by MCCR to insurance companies for patients who had not previously reported health insurance coverage. Updated and verified income information from the HEC is automatically uploaded upon receipt at each VA facility, which updates the veteran's eligibility for health care and creates co-payment charges for previous episodes of care.

The software provides inquiries and reports that track all IVM activity.

Features

• Transmits data for basic demographics, next-of-kin, income, temporary address, eligibility, guardian, and employer information to the HEC for patients who meet the IVM criteria. Automatically transmits an updated message if this information is changed.
• Allows the HEC to query the medical facility for the most up-to-date patient information.
• Allows updated demographic and insurance information from the HEC to be uploaded into the patient's record.
• Automatically loads updated income information from the HEC and updates the veteran's eligibility for health care.
• Allows generation of status inquiries, statistical Means Test, and data transmission reports.

[edit] Record Tracking

Overview

The Record Tracking module provides for the maintenance and control of medical records and x-ray films to facilitate availability to a variety of users. The system offers a wide range of individual site-definable parameters such that it may be custom- tailored to specific needs and used in any type of file setting. The Record Tracking module is integrated with other associated modules such as Radiology and Patient Information Management System.

The module automates file room functions in support of the following activities. The module also supports requisitioning activities for individual records within a facility and between facilities, including:

• Creation of new records/volumes
• Charge-out/check-in of records
• Inactivation/reactivation and deletion of records
• Printing of bar code labels
• Transfer of records to other facilities
• Recharging records to other borrowers
• Flagging a record as missing
• Record retirement

Features

• Uses bar code technology, prints bar code labels for the charts, and uses bar code equipment to charge records.
• Displays informational bulletins when a record is checked into a file room. Bulletins may include the following information: pending requests for the record, the record has previously been flagged as missing, loose filing exists, the patient is currently an inpatient, or the record is being checked into a file room other than its home.
• Offers a complete system for maintenance and control of records that may be used with ease in any type of file setting.
• Produces a variety of reports associated with the module that may be used to assist management in workload analysis and control of records.
• Creates pull lists to provide requests for records in conjunction with clinic scheduling and record retirement.

[edit] Resident Assessment Instrument/Minimum Data Set (RAI/MDS)

Overview

The Resident Assessment Instrument/Minimum Data Set (RAI/MDS) provides a standardized assessment tool supporting the completion of a comprehensive, accurate, and reproducible patient assessment, and serves as the basis for developing the patient's plan of care.

The RAI/MDS aligns the VA's data collection processes with private sector skilled nursing facilities. The Centers for Medicare and Medicaid Services (CMS) and the States require that long-term care facilities implement the RAI/MDS in order to receive Medicare and/or Medicaid reimbursement. Use of the RAI/MDS in VA long-term and Nursing Home Care Unit programs provides a structure for meeting JCAHO long-term care accreditation standards. It also provides opportunities for data comparison of patient outcomes within and across VA and with non-VA long-term care and/or nursing home programs.

The VA purchased the Accu-Med Services (AMS) Clinical Software suite, which has been implemented nationally, with a gateway interface to import patient data from VistA using standard HL7 messaging. The Clinical Software suite consists of the Minimum Data Set (MDS) Version 2.0 as defined by CMS, Resident Assessment Protocols (RAPs) triggered by specific responses to the MDS, multidisciplinary Care Plans, and electronic transmission of the MDS to the national database at the Austin Automation Center (AAC). The AAC in turn utilizes the MDS to produce Resource Utilization Groups (RUG-III) and Quality Indicator reports.

Features

• Admissions module with display of demographic and patient movement information interfaced from VistA using standard HL7 messaging.
• Assessments module based on the MDS Version 2.0, a core set of preliminary screening and assessment elements including common definitions and coding categories.
• Specific responses to MDS questions trigger one or more of eighteen potential problem areas-known as Resident Assessment Protocols-identifying residents who have, or are at risk for developing, specific functional problems.

• Triggered RAPs signal the need for additional assessment and evaluation using RAI guidelines as defined by CMS. RAP summary notes are used to document analysis of the assessment findings and identify resident problems, some of which may be reversible.
• Resident Care Plan and Report Writer modules.
• Electronic signature and electronic transmission of assessments to AAC.
• Audit controls for HIPAA privacy and security compliance.
• Integration Gateway with HL7 standard messaging and monitoring tools.
• MDS 2.0 with Version 1.2 data specifications and fatal error checks.
• Contains complete on-line help manuals for all modules of the CMS RAI/MDS manual.

[edit] Veteran Identification Card (VIC)

Overview

The Veteran Identification Card (VIC) replaces the embossed data card as a means of identifying veteran patients entitled to care and services at Veterans Affairs (VA) health care facilities.

The replacement VIC displays a larger color photograph of the veteran and the veteran's name. There is no embossed information on the card. A VistA print option provides labels with the patient's identifying information. The labels can be affixed to medical record forms in lieu of using the embossed cards to imprint this information when pre-printed forms are not available.

A color photograph of the veteran is taken at the local medical center using the Patient Image Capture Software (PICS) on a Clinical Context Object Workgroup (CCOW) enabled workstation. The photograph is sent to the local VistA Imaging server, making it available to the Computerized Patient Record System (CPRS) and other VistA applications. The photograph and VistA patient data is also transmitted to the National Card Management Directory (NCMD) in Silver Spring, MD (a repository of VIC data). Once the Health Eligibility Center (HEC) has verified the patient's eligibility, the veteran has been assigned an appropriate enrollment status, and also assigned a national Integration Control Number (ICN), the VIC data and images are transmitted to the external card vendor using secure protocols. The external card vendor creates the VIC cards and mails them to the veterans. For homeless veterans, the external card vendor mails the cards to the appropriate medical center, which then issues the cards to those veterans.

Features

• Veteran's picture, name, and care type (i.e., service connected) on card face.
• Magnetic stripe on card encoded with the patient's name, social security number, date of birth, sex, patient type, veteran status, and service-connected indicator.

[edit] Health Provider Systems

Health Provider Systems are information systems supporting health care providers in the care of veterans by feeding information to main systems such as VistA today and the Health Data Repository (HDR) in the future. Key HPS systems include:

• VistA Imaging
• Blood Bank
• Pharmacy
• Laboratory Services

[edit] Care Management

Overview

Care Management is the first application to run within the HealtheVet Desktop (the VHA's new Java application framework) and the first to offer a convenient way for healthcare providers to view on a single screen pertinent information about multiple patients. With Care Management, users can see at a glance multiple patients for whom they have items that require attention. The current distribution of Care Management offers the following four perspectives (which are similar to applications):

• Clinician Dashboard-Provides an easy-to-read table of patients for whom clinicians have unacknowledged results or event notifications (such as hospital admissions, discharges, or unscheduled clinic visits), unsigned documents, or uncompleted tasks.
• Nurse Dashboard-Provides an easy-to-read table of patients for whom nurses have unacknowledged results, unviewed events, uncompleted tasks or text orders, unverified orders, or recent vitals.
• Query Tool-Enables authorized users to create reports based on the most current patient data available. The Query Tool offers five pre-defined reports and also enables users to create their own customized reports.
• Sign List-Enables users to sign multiple items for multiple patients. For example, using the Sign List, a clinician can sign a discharge summary for John Smith and notes for Jane Smith simultaneously.

This distribution of Care Management also includes the Task Editor, which enables users to create patient-related tasks.

Features

Care Management comprises an extensive set of features designed to simplify and improve patient care.

These features include (but are not limited to) the following:

• Colored-coded icons that indicate the priority status of dashboard items
• A default patient list that is based on users' Computerized Patient Record System (CPRS) default patient list
• A dynamically generated, user-based patient list
• Custom patient lists
• Checkboxes for acknowledging and verifying individual or multiple dashboard items
• The ability to set date ranges for dashboard items
• The ability to link tasks to other tasks or to events
• The ability to prioritize, edit, and delete tasks
• Text boxes that expand to provide detailed information about dashboard items
• A variety of predefined reports, including the following:
  • Abnormal Results
  • Consult Status
  • Incomplete Orders
  • Recent Activity
  • Scheduled/Due Activity
• Custom reports with a wide selection of criteria, including (but not limited to) the following:
  • Screen by Inpatient, Outpatient, or Pharmacy Visits
  • Screen by Primary Outpatient Provider
  • Orders/Results
  • Consults/Procedures
• The ability to print and export reports

Care Management is tightly integrated with CPRS. As a result, from within Care Management, users can:

• Go directly to a patient's chart in CPRS
• Clear selected result notifications in CPRS, including notifications in the following categories:
  • Events
  • Results
  • Actions

Care Management's intuitive Graphical User Interface (GUI) includes an extensive selection of clickable items from which users can:

• Select a default perspective
• Select dashboard preferences
• View demographic information for individual patients
• View details about specific action items
• And much more

[edit] Care Management Clinician Dashboard running in the HealtheVet desktop

[edit] Clinical Procedures

Overview

Clinical Procedures (CP) passes final patient results, using Health Level 7 (HL7) messaging, between vendor clinical information systems (CIS) and VistA. Patients' test results or reports are displayed through the Computerized Patient Record System (CPRS). The report data is stored on the Imaging Rapid Application Interface Development (RAID) and, in some instances, discrete data is stored in the Medicine package.

CP works with the Consult/Request Tracking, Text Integration Utility (TIU), CPRS, Patient Care Encounter (PCE), and VistA Imaging packages. In conjunction with CPRS, CP also provides a method for clinicians to document findings and to complete final procedure reports generated by medical devices. There are no specific procedures tracked through this application, nor are management workload reports generated. Links to dSs and other databases through PCE are supported through existing pathways in appropriate VistA applications. The CP functionality is not available in the List Manager (LM) version of CPRS.

CP provides features that can be used across clinical specialties such as Medicine, Women's Health, Surgery, Dental, Rehabilitation Medicine, and Neurology. Its functionality supports clinical practice in all patient care settings including clinics, Home Based Health Care (HBHC), and in-patient units.

Features

• Allows clinicians to enter, review, interpret, and sign CP orders through one application, CPRS.
• Accepts a variety of file types for result report files.
• Allows images to be acquired, processed, stored, transmitted, and displayed by the VistA Imaging package.
• Defines the Hospital Location where the procedure is performed. This location determines which Encounter Form is presented to the end user.
• Electronic transfer of patient reports from medical devices to VistA.
• Bi-directional interface capabilities.
• Easy to use user interfaces, including CP Manager, CP User, and CP Gateway.
• Improved internal communication between the proceduralist and the primary care physician.
• Improved patient education through use of reports.
• Improved medical record keeping.

[edit] Computerized Patient Record System (CPRS)

[edit] Status: CPRS required - Porting to XO not Complete

• Check
• Porting Porting Delphi Clients to the XO
• Alt CPRS Alternative OpenVista CIS
• Must Have Part of base configuration

This Status NEEDs to be propagated to the other CPRS components.

Overview

CPRS enables clinicians to enter, review, and continuously update all order-related information connected with any patient. With CPRS, you can order lab tests, medications, diets, radiology tests and procedures, record a patient's allergies or adverse reactions to medications, request and track consults, and enter progress notes, diagnoses, and treatments for each encounter, and enter discharge summaries. Close integration with the Clinical Reminders and Text Integration packages allows better record keeping and compliance with Clinical Guidelines and medical record requirements.

CPRS not only allows hospital personnel to keep comprehensive patient records, it also enables clinicians, managers, and QA staff to review and analyze the data gathered on any patient in a way that directly supports clinical decision-making.

Features

Improves the efficiency of entering orders, progress notes, encounter data, and other clinical information in the patient chart and helps clinicians comply with legislative mandates and clinical practice guidelines, through features such as:

• Order checking for:
  • Out-of-range values
  • Duplicates
  • Maximum order frequency
  • Allergies
  • Potential drug-drug, drug-dosage, drug-overlap, drug-lab, and drug-allergy interactions, with appropriate warnings issued
• Orders integrated with progress notes, results, procedures, diagnosis, and problems
• Templating utilities for speedy point-and-click composition of notes
• Interdisciplinary notes enable a single parent note to contain multiple clinicians' notes for their disciplines to make them easier to find
• Tools to create Reminder dialogs for point-and-click resolution of clinical reminders to meet Clinical Guidelines
• Quick orders
• Order sets
• Event-delay orders (for admission, discharge, or transfer orders)
• Clinical Context Management to synchronize multiple applications to the same patient
• Accessibility support for disabled users in accordance with Section 508
• Code Set Versioning that ensures current codes to comply with HIPAA legislation

Improves the accessibility of online clinical information and results via integration with:

• Clinical Reminders
• Adverse Reactions
• Discharge Summary
• Progress Notes
• Inpatient and Outpatient Pharmacy
• Dietetics
• Radiology
• Laboratory
• Notifications
• Health Summary
• Problem List
• Consult/Request Tracking
• Patient Record Flags

Provides access to clinical information from other VAMC and Department of Defense sites through Remote Data Views.

• Displays other VAMCs where the patient has been seen
• Displays a small subset of data from Department of Defense medical facilities
• From the listed VAMCs, provides the capability to view Clinical reports, nationally released Health Summary components, and results for many lab tests

Graphical User Interface (GUI) provides a consistent, event-driven, windows-style clinical user interface.

• Follows the VistA GUI Guidelines, as well as the common standard for Windows
• List Manager Interface allows Windows-like actions for terminal-based users:
• Provides parameters and defaults that allow VAMC administrators and CPRS users to fine-tune the functionality and processes specific to their needs.
• Provides communication among VistA packages participating in CPRS through event-driven HL7 messaging.

[edit] Image: CPRS Cover Sheet Example

[edit] CPRS: Adverse Reaction Tracking

Overview

The Adverse Reaction Tracking (ART) program provides a common and consistent data structure for adverse reaction data. This module has options for data entry and validation, supported references for use by external software modules, and the ability to report adverse drug reaction data to the Food and Drug Administration (FDA).

Features

• Documents patient allergy and adverse drug reaction data.
• Provides the functionality for other VistA modules to extract and add patient reaction data.
• Provides a reporting mechanism that supports VHA Directive 10-92-070 which specifies reporting of adverse drug reactions to the FDA.
• Includes ART event points in an Application Programmers Interface (API) allowing other VistA packages to know when specific ART events take place so package tasks can be performed.
• Alerts the Pharmacy and Therapeutics Committee each time the signs/symptoms are modified for a patient reaction.
• Generates progress notes. Displays all information at the time of an ART event on the Progress Notes API and allows editing of the note prior to sign off.
• Allows the site to track whether the patient has been asked if he/she has allergies.
• Tracks when the patient chart and ID bands have been marked indicating a particular reaction.
• Differentiates between historical and observed reactions.
• Tracks the particular signs/symptoms for a reaction.
• Allows for configuration of allergy files.
• Allows for editing and verification of reaction data.
• Allows for the addition of comments for each reaction to ensure completeness in reporting.
• Contains extensive reporting capabilities.
• Contains an online reference guide.

[edit] CPRS: Authorization/Subscription Utility (ASU)

Overview

The Authorization/Subscription Utility (ASU) provides a method for identifying who is authorized to perform various actions on clinical documents. These actions include signing, co-signing, and amending. ASU originated in response to Text Integration Utilities' document definition needs. Current security key capabilities were unable to efficiently manage the needs of clinical documentation (Discharge Summaries, Progress Notes, etc.).

Features

• Defines, populates, and retrieves information about user classes. User classes can be defined hospital-wide or more narrowly for a specific service and can be used across VistA to replace and/or complement keys.
• Links user classes with Text Integrated Utilities (TIU) document definitions and document events.
• Allows sites to maintain membership of users in User Classes and to distribute such maintenance tasks.
• Lists class members as active or inactive.
• Allows infinite hierarchies of subclasses.
• Defines business rules to further manage document activities.

[edit] CPRS: Clinical Reminders

Overview

The Clinical Reminders package is a valuable aid in patient treatment. Reminders assist clinical decision-making and educate providers about appropriate care. Electronic clinical reminders also improve documentation and follow-up, by allowing providers to easily view when certain tests or evaluations were performed and to track and document when care has been delivered. They can direct providers to perform certain tests or other evaluations that will enhance the quality of care for specific conditions.

Clinical Reminders may be used for both clinical and administrative purposes. However, the primary goal is to provide relevant information to providers at the point of care, for improving care for veterans. The package benefits clinicians by providing pertinent data for clinical decision-making, reducing duplicate documenting activities, assisting in targeting patients with particular diagnoses and procedures or site-defined criteria, and assisting in compliance with VHA performance measures and with Health Promotion and Disease Prevention guidelines.

The Quality Enhancement Research Initiative (QUERI), a Health Services Research and Development (HSR&D) program, and the National Clinical Practice Guidelines Committee have joined with the Office of Information, System Design & Development office (SD&D) in designing national reminders and dialogs that will help promote informed decision-making and consistency of health care practices. Cooperatively developed reminders include: Ischemic Heart Disease (IHD), Major Mood Disorder (MDD), Hypertension, Iraq and Afghan Post-Deployment Screen, Race and Ethnicity, Women's Veterans Health, My HealtheVet, and VA Geriatric Care Referral (GEC) reminders.

Version 2 of Clinical Reminders contains many enhancements to improve processing and management of reminders. Performance has been enhanced through the creation of an index of all clinical data used in reminder findings. All enhancements are intended to help the Reminders functionality smoothly transition to CPRS Reengineering.

Features

• Allows results that are unique for each patient, by basing reminder evaluation on the patient's clinical data.
• Allows clinicians to resolve reminders through dialogs within the CPRS GUI. Using point-and-click techniques, a clinician can generate text for progress notes, update current and historical encounter data in Patient Care Encounter (PCE), update vital signs, update mental health test results/scores, and place orders.
• Allows facilities to copy, create, and customize their own reminder definitions, based on local needs.
• Provides components that can be displayed on Health Summaries.
• Provides reminders reports for summary or detailed level information about patients' reminders that are due. Reports allow providers to verify diagnoses, verify that appropriate treatment was given, identify patients requiring intervention, and validate effectiveness of care. Combined reports for multiple facilities or multiple locations can now be generated.
• Provides an enhanced Exchange Utility that allows exchange of reminder definitions and dialogs among sites and Veterans Integrated Service Networks (VISNs).

[edit] Image: Clinical Reminders Example: Reminders Resolution Dialog

[edit] CPRS: Consult/Request Tracking

Overview

The Consult/Request Tracking package provides an efficient way for clinicians to order consultations and procedures from other providers or services within the hospital system, at their own facility or another facility. It also provides a framework for tracking consults and reporting the results. It uses a patient's computerized patient record to store information about consult requests.

Features

• Allows direct access to Consults functions through menu options in CPRS.
• Uses Consults' own menu options for managing the system, generating reports, tracking consults, or entering results for an existing consult request.
• Allows staff to set up consults as CPRS Quick Orders, streamlining the ordering process.
• Integrates with Prosthetics to track Home Oxygen, Eyeglasses, Contact Lenses, and other Prosthetics services.
• Produces a permanent record of the request and resolution for the patient's medical record.
• Allows all relevant parties to see the consult report in the context of the patient's record.
• Allows use of TIU templates and boilerplate to report findings.
• Allows display of Consult reports through TIU and CPRS.
• Enables clinicians to order a consult at another facility, using HL7 Messaging and the VA Intranet.

[edit] Image: Consults Example

[edit] CPRS: Health Summary

Overview

A Health Summary is a clinically oriented, structured report that extracts many kinds of data from VistA and displays it in a standard format. Health summaries can be printed or displayed for individual patients or for groups of patients. The data displayed covers a wide range of health-related information such as demographic data, allergies, current active medical problems, and laboratory results.

Features

Integrates data from the following packages:

• Adverse Reaction Tracking Nursing (Vital Signs)
• Automated Medical Information Outpatient Pharmacy
• Exchange (AMIE) Patient Care Encounter (PCE)
• Clinical Reminders Problem List
• Computerized Patient Record Progress Notes
• System (CPRS) Radiology
• Consults/Request Tracking Registration
• Dietetics Scheduling
• Discharge Summary Social Work
• Inpatient Medications Spinal Cord Dysfunction
• Laboratory System Surgery
• Medicine VistA Imaging
• Mental Health

Health Summary users can print an Outpatient Pharmacy Action Profile with bar codes in tandem with a health summary.

Health Summary now exports components that allow staff to view remote patient data through CPRS. Additionally, remote clinical data can be viewed using any Health Summary Type that has an identically named Health Summary Type installed at both the local and remote sites.

Clinical Reminders work with Health Summary to furnish providers with timely information about their patients' health maintenance schedules. Providers can work with local coordinators to set up customized schedules based on local and national guidelines for patient education, immunizations, and other procedures.

Health Summary components 'Progress Notes' and 'Selected Progress Notes' can display the new interdisciplinary progress notes and all of the entries associated with the interdisciplinary note.

[edit] Image: Health Summary Example

[edit] CPRS: Problem List

Overview

Problem List is used to document and track a patient's problems. It provides the clinician with a current and historical view of the patient's health care problems across clinical specialties and allows each identified problem to be traceable through the VistA system in terms of treatment, test results, and outcome.

This application supports primary care givers, such as physicians, nurses, social workers, and others, in inpatient and outpatient settings. It is also designed to be used by medical and coding clerks. A variety of different data entry methods are possible with this application.

Use of Problem List varies from site to site, depending on the data entry method a facility has chosen. Many sites use Encounter Forms, with clerks entering most of the data in the encounter forms. Encounter forms are generated from patient data in the system and added to or modified by clinicians.

Features

• Allows a clinician to view an individual problem list for any given patient.
• Supports a variety of specialized views of a patient's problem list.
• Uses the Lexicon utility that permits the use of "natural" terminology when selecting a problem. Each term is well defined and understandable. A user, site, or application may substitute a preferred synonym.
• Can be linked to other sections of the medical record, such as Health Summary, Progress Notes, Order Entry/Results Reporting, Consults, test results, care plans for Nursing and Mental Health, Discharge Summaries, and Billing/Encounter Forms.
• Supports import of problem information from other clinical settings outside the immediate medical facility.
• Allows reformulation of a problem.
• Supports multiple forms of data capture: direct clinician entries, clerk entry, encounter forms, foreign problem lists, scanned encounter forms, hand-held devices, etc.
• Requires minimal data entry.

[edit] CPRS: Text Integration Utilities (TIU)

Overview

Text Integration Utilities (TIU) simplifies the use and management of clinical documents for both clinical and administrative medical facility personnel. In connection with Authorization/Subscription Utility (ASU), a facility can set up policies and practices for determining who is responsible or has the privilege for performing various actions on required documents.

The Version 1.0 release included Discharge Summary and Progress Notes. With the release of

CPRS and Consults/Request Tracking, TIU has been upgraded to integrate with these packages.

Features

• Provides boilerplate functionality for the automatic fill-in of information from VistA files into TIU documents. Boilerplates and embedded objects can be set up for specific types of documents for specific clinical needs.
• Interfaces with the Computerized Patient Record System (CPRS): the template utilities in the GUI version of CPRS allow speedy point-and-click composition of notes, consults, and summaries. Templates can be set up for specific types of documents for specific clinical needs. Interfaces with Problem List, Automated Information Capture System (AICS), Patient Care Encounter (PCE), Authorization/Subscription Utility (ASU), Incomplete Record Tracking, Health Summary, and Visit Tracking. Uses a standardized and common user interface, which allows clinicians and others to retrieve many kinds of documents from a single source.
• Enables healthcare practitioners to enter interdisciplinary notes regarding a single episode of care for a patient. This is accomplished through the addition of a level to the tree structure where a note can have children (subordinate entries) and each of the children can have a different author. This provides for more complete patient records and facilitates input from a variety of practitioners regarding a single episode of care.
• Interfaces with VistA Imaging allowing clinicians to link TIU documents to all types of clinical images such as X-rays, MRIs, and CAT scans.
• Uses an integrated database, which lets clinicians, quality management staff, researchers, and management search for and retrieve clinical documents more efficiently because documents reside in a single location within the database.
• Permits document input from a variety of data capture methodologies such as transcription, direct entry through CPRS or the TIU package, or upload of ASCII formatted documents into VistA.
• Uses a uniform file structure for storage of documents and management of document types.
• Uses a consistent file structure for defining elements and parameters of a document.
• Allows a variety of user actions, such as entry, edit, electronic signature, addenda, browse, notifications, etc.
• Allows a variety of management functions, including amendment, deletion, and identification of signature surrogate, re-assignment, and administrative authentication.
• Follows HL7 interface and other communication standards.

[edit] Dentistry

Overview

The Dentistry module is a menu-based system incorporating features necessary for the maintenance of medical center dental records. Users can enter dental treatment data, edit dental records, review and print reports, schedule appointments for patients, perform patient inquiry, and print and transmit data electronically to update the VA central database.

There are two levels of users, general user and manager. General users have limited system access as determined by the manager at a given medical center, while managers have access to all menus and options.

Features

• The package transmits service reports to a VA centralized database on a monthly basis. All service report data may be edited or deleted prior to release.
• Treatment reports can be displayed in four different formats: a provider format, sittings by provider, clinic summary, and individual sittings.
• There is full screen or line-by-line data entry and edit via the Treatment Data Enter/Edit feature. A tailored template/screen is used depending upon the provider selected (e.g., Prosthodontic, Endodontic, Oral Surgery, Periodontic, General).
• Patient inquiries combine Dentistry and Patient Information Management System (PIMS) data for patient information display (e.g., current address, sex, age, ward location).
• The package is integrated with the PIMS Scheduling module to allow users to make appointments, change or delete appointments, print pre-appointment, no-show, and cancellation letters, and generate routing slips and appointment lists.
• It provides a critical path method (CPM) aid to schedule appointments for Dental patients.

[edit] Hepatitis C Case Registry

Overview

The Hepatitis C Case Registry contains important demographic and clinical data on VHA patients identified with Hepatitis C infection. The registry extracts VistA pharmacy and laboratory databases to provide key clinical information. Data from the Hepatitis C Case Registry are used on the national, regional, and local level to track and optimize clinical care of Hepatitis C infected veterans served by VHA. National summary information (without personal identifiers) will be available to VA Central Office for overall program management as well as to inform Veterans Service Organizations, Congress, and other federal public health and health care agencies.

Features

This VistA software package provides the following key functions:

• Automatically develops a list of patients with Hepatitis C infection.
• Provides a GUI interface that allows select local facility staff to add to and/or edit the list.
• Identifies patients who are receiving investigational class drugs for Hepatitis C.

• Transmits patient data to a national database, including patient demographic information, the reason(s) patients were added to the registry, pharmacy utilization information, radiology test results, and a limited set of laboratory test results.

• Generates the following local reports:

• A report that lists the patients currently on the registry. Users can filter this report to display a subset of patients based on the date range they were added to the registry.
• A report that lists patients who have received Hepatitis C therapy within a user-selected date range.
• A report that displays local software activity and error report information.
• Technical improvements include:
• Automatic nightly updates to the national registry list.
• Use of a uniform M (formerly MUMPS) program backbone that can be used for other disease case registries.
• The transformation of VistA data into standard Health Level Seven (HL7) formatted messages for transmission, including limited validation checks, error messaging, etc.

[edit] Home Based Primary Care (HBPC)

Overview

The Home Based Primary Care module is designed to allow for the local entry and verification of HBPC patient-related data. Individual medical centers can now enter HBPC-related data and maintain, validate, and manipulate the database locally. This local database structure gives the HBPC program greater accountability for the integrity of its data, and eliminates the correction cycle previously required to correct data entry errors at the central database. Each site can now transmit complete records of HBPC patient information monthly to the Austin Automation Center (AAC) for processing. The AAC will continue to generate the same quarterly reports-only the source of the data has changed. This system eliminates the paper reporting system between medical centers and the AAC database.

Features

• Uses Appointment Management to handle patient visits and captures that visit data from Patient Care Encounter for transmission to the AAC.

• Provides for the entry and editing of patient evaluations and admission/discharge data.
• Provides automatic transmission of data to the central database.
• Allows data validation and correction to be completed at the individual medical center prior to transmission to the central database.
• Allows for medical center control over the site's HBPC database.
• Enables medical facilities to generate a wide variety of reports covering:

• Visit, admission and discharge data
• Length of stay
• Rejections
• Procedures
• Census for program, team, case manager, and/or provider

• Enables the HBPC program manager to control and assess the staff workload and organizational characteristics.

[edit] Immunology Case Registry (ICR)

Overview

The Immunology Case Registry (ICR) contains important demographic and clinical data on VHA patients identified with Human Immunodeficiency Virus (HIV) infection. The ICR module accesses several other VistA files that contain information regarding diagnoses, prescriptions, surgical procedures, laboratory tests, radiology exams, patient demographics, hospital admissions, and clinical visits. This access allows identified clinical staff to take advantage of the wealth of data supported through VistA.

The key capabilities provided by the ICR to VA facilities that provide care and treatment to patients with HIV infection include the clinical categorization of patients, generation of the Center for Disease Control (CDC) case report form, clinical reports, and automatic transmission of data to the VA's National Immunology Case Registry.

Data from the ICR are used on the national, regional, and local level to track and optimize clinical care of HIV infected veterans served by VHA.

The latest version of the ICR is augmented by the capabilities of the Clinical Case Registries (CCR) software and has been further enhanced by the automation of the data collection system. The enhanced version, referred to as CCR: ICR, is a clinically relevant tool for patient management.

Features

The CCR: ICR software enhancements provide the following capabilities and features:

• New graphical user interface (GUI).
• Robust reporting capability, using both process and patient outcome measures, that allows for tailored local level reporting and divisional level reporting to help monitor the quality of patient care.
• Provides the ability to export report data to spreadsheet applications.
• Facilitates the tracking of patient outcomes related to antiretroviral drug treatment.
• Provides partial automation of HIV case identification.
• Identifies and tracks important trends in treatment response, adverse events, and time on therapy.
• Matches resources to clinical needs and utilization at local, VISN, and national levels.
• Verifies workload for VERA reimbursement.
• Automates notification to HIV coordinators that data was sent to and received by the national database.
• Automates extraction of data to the national registry.

[edit] Intake and Output

Overview

The Intake and Output (I&O) application is designed to store, in the patient's electronic medical record, all patient intake and output information associated with a hospital stay or outpatient visit. This application is not service specific and currently is interfaced with the Patient Information Management System (PIMS) (MAS), Nursing, and Pharmacy applications.

Features

Users may electronically document patient intake (e.g., oral fluids, tube feedings, intravenous fluids, irrigations, and other types of intake defined by the facility) and patient output (e.g., excreted patient material such as urine, nasogastric secretions, emesis, drainage, liquid feces/stool, and other types of output defined by the facility).

Intake data can be entered through either a quick or detailed route. The quick route documents the total fluid consumed. The detailed route requests the user to enter information regarding the specific type of fluid intake (e.g., orange juice, water, soup) along with the quantity absorbed.

The Start/Add/DC IV and Maintenance option contains nine protocols associated with intravenous therapy:

• Start IV-Start a new IV line or heparin/saline lock/port.
• Solution: Replace/DC/Convert/Finish Solution-DC current solution then replace a new solution to the selected IV line, or convert the IV according to the user's choice.
• Replace Same Solution-Replace the same solution to a selected IV.
• D/C IV Lock/Port and Site-Remove IV/lock/port from a selected IV site.
• Care/Maintenance/Flush-Check site condition, dressing change, tube change and flush.
• Add Additional Solutions(s) -Add additional solution(s) without discontinuing an existing one.
• Restart DC'd IV-Restart an IV that was DC'd due to infiltration or other reasons.
• Adjust Infusion Rate-Adjust infusion rate for a selected IV.
• Flush-Flush all IV line(s) for a selected infusion site.

The software supports documentation of intravenous intake via both single and multi-lumen catheters and is interfaced with the IV module of the Pharmacy software. The following reports are included:

• Print I/O Summary by Patient (by Shift and Day(s))
• Print I/O Summary (Midnight to Present)
• Print I/O Summary (48 Hrs)
• 24 Hours Itemized Shift Report
• Intravenous Infusion Flow Sheet

The last four reports can be printed for all patients on a ward, for patients in selected rooms on a ward, and for an individual patient.

[edit] Laboratory

Overview

The Veterans Health Information System and Technology Architecture (VistA) Laboratory module is a clinically oriented system designed to provide data to health care personnel. It assists the Pathology and Laboratory Medicine Service in managing and automating the workload and reporting process. The Laboratory module supports the following areas: General Laboratory, Microbiology, Histology, Cytology, Surgical Pathology, Electron Microscopy, Blood Donors, and Blood Bank.

Features

Phlebotomy/Ordering

• Computerized Patient Record System (CPRS)

• Supports ward order entry.
• Prints collection lists and labels and supports barcode printing.
• Provides maximum ordering frequency (e.g., daily, user-defined limits).
• Supports immediate request for blood specimen collection.
• Laboratory Electronic Data Interchange (LEDI).

Processing

• Provides worklists by urgency and accession number (instrument-specific).
• Produces lists of incomplete, workload/data capture reports, and lists for verification of data.
• Supports uni-directional and bi-directional Auto Instrument interfacing.
• Supports automatic download to automated instruments.

Verification/Release of Data

• Provides Delta Checks, flagging high/low/critical results.
• Presents critical values to the technologist in reverse video.
• Supports review/verification by group or individual accessions.
• Provides various on-screen alerts.
• Automated electronic result message generation via LEDI.

Reports

• Produces supervisory management, audit trail, data integrity, and quality management and utilization review reports.
• Provides searches for specific antibiotic with defined antimicrobial patterns.
• Produces discharge summaries and cumulative and discrete episode reports.
• Produces automatic transmission of verified data to the ordering location.
• Provides quality control/search capabilities (e.g., SNOMED, critical values, and high/low values).
• Produces reports for Laboratory Management Information Program.
• Produces and transmits roll-up reports to national database.
• Produces site-customized management reports.
• Schedules patient cumulative reports based on inpatient or outpatient treatment.

Data Extracts Capabilities for External Databases:

• Laboratory Management Index Program workload data.
• Laboratory Workload for Decision Support System.
• Hepatitis C clinical information.
• Emerging Pathogen clinical data, antimicrobial trend, infection control, and Health Department reports.

• Patient Care Encounter workload.
• LEDI messages to remote Laboratory Information Systems (LIS).
• External LIS.

[edit] Laboratory: Anatomic Pathology

Overview

The VistA Laboratory Anatomic Pathology module automates record keeping and reporting for all areas of Anatomic Pathology (i.e., Surgical Pathology (SP), Cytopathology, Electron Microscopy (EM), Autopsy). The module provides valuable quality management features, increases productivity, provides comprehensive search and reporting capabilities, and facilitates the gathering of workload statistics.

Features

Provides quality management features, including:

• Access to historical pathology data during microscopic examination of current specimens.
• Lists of incomplete cytology, surgical pathology, EM, and autopsy reports.
• Turnaround time reports for all anatomic pathology sections.
• Generation of defined groups of cases requiring additional review, as defined by the accrediting agencies.
• Compilation of all information (e.g., special stains, immunopathology, or electron microscopy studies) in a single cumulative patient summary.
• On-command printing of laboratory test results of specified tests.
• Tracking outcomes of Quality Management review.

Increases productivity through:

• On-line access to historical anatomic pathology data (diagnosis and SNOMED codes only).
• Immediate availability of information regarding surgical pathology, cytology, electron microscopy specimens, and autopsy.
• Access to verified/released reports by non-laboratory personnel.
• Generation of labels for both specimens and slides.
• Interface with Kurzweil Voice Recognition Systems.

Provides comprehensive searching/reporting capabilities, including:

• Final pathology, autopsy, cytology, and EM reports.
• A log of all specimens accessioned, including final diagnoses.
• A variety of reports based on morphology, procedure, and etiology disease field entries, including:

• List of patients with a particular diagnosis.
• List of specimens from a particular site.
• List of specimens from a particular procedure (e.g., biopsies, frozen sections).

Provides workload statistics for:

• Number of specimens accessioned by area.
• Number of blocks, slides, and stains prepared.

[edit] Laboratory: Blood Bank

Overview

The VistA Laboratory Blood Bank module uses data that can be tied primarily to a donor, a patient, or a unit of blood/blood component. Information about a blood donation or a donation attempt revolves around the name of the blood donor. Similarly, information about a unit of blood/blood component, once it appears in inventory, revolves around the donor unit identification, while information involving transfusion and testing of patient samples revolves around the patient name and social security number.

Features

• Improves the safety of blood/blood component transfusions by decreasing the number and severity of human errors through:

• Retrieval of previous records and verification of current results.
• Detection of inconsistencies and flagging results that require corrective action before release of the unit.
• Bar code entry of donor unit information.
• Computer-assisted labeling of donor units.

• Improves the quality of patient care by allowing an evaluation of the appropriateness of all transfusions and specific blood components through integration with other portions of the system. Integration is accomplished by:

• Comparison of current lab values with established standards and screening criteria for each of the various components to allow concurrent audits.
• Delta checks for pre-transfusion and post-transfusion values to determine if the increments are within the established range.

• Decreases clerical workload through:

• Bar code entry from donor unit information.
• Transfer of information via pointers to reduce duplication.
• Preparation of labels following data entry.
• Generation of consultation reports.

• ility to perform searches for generating call lists.
• Generation of workload statistics for a given collection site for use in future planning.
• Automated blood donor recruitment and thank you letters.

• Improves utilization review/resource management through:

• Workload and transfusion statistics, and cost accounting by ward, treating specialty, and physician.
• Workload statistics, including variables by time of day and day of week.
• Access to information for medical and nursing staff.

[edit] Laboratory: Electronic Data Interchange (LEDI)

Overview

The Veteran Integrated Service Network (VISN) mission is to consolidate electronic lab test ordering and lab test result reporting throughout all Veterans Affairs (VA) medical care facilities laboratories within a VISN, between VISNs, and for non-VA organizations (i.e., commercial reference laboratories). The LEDI software reduces or eliminates the need for manual ordering and reporting of laboratory results to interface laboratories. The software minimizes the amount of manual labor associated with preparing samples for delivery and processing at the host lab facility.

The VistA Laboratory Electronic Data Interchange Phase II (LEDI II) software application provides electronic messaging for Lab Test Ordering and Lab Test Results Reporting between VA health care facilities laboratories based on the Health Level Seven (HL7) Version 2.3 Standard Specification and VistA Health Level Seven (HL7) Version 1.6 Standard Specification. These Specifications are used as the basis for defining VistA Laboratory Universal Interface (UI) and LEDI HL7 Interface Standard Specification Version 1.2.

Features

• Addresses the electronic lab test order transfer from the host facility laboratory to collection facilities laboratories.
• Provides for the automated transfer of verified test results from the host facility back to the collection facility's laboratory for release to the patient electronic medical record.
• Provides storage of lab test results in the clinical database at the collection facility laboratory. The LEDI software electronically returns test results to the collection facility laboratory using the HL7 protocols. Results returned to the collection facility laboratory would be processed and verified as if completed by an auto instrument. This eliminates manual entry of results at the collection facility laboratory.
• Creates the automation of shipping lists to process the laboratory work at the collection and host laboratories.
• Provides the capability to interface non-VistA laboratory information systems. This includes university hospitals, commercial reference laboratories, other government agencies and centralized clinical patient record systems.
• Sends/Receives Laboratory HL7 Messages.
• Utilizes TCP/IP Protocol as a Communication Protocol.
• Builds lab test orders.
• Processes NTE Segments.
• Stores test reference ranges.
• Specifies final or incomplete lab test results.
• Provides new SM40 shipping codes.
• Builds and closes a Shipping Manifest.
• Generates Result (ORU) Messages.
• Referral Patient Multi-purpose Accession.

[edit] Medicine

Overview

Medicine is designed to serve clinical services and maximize the use of the VAMC database. The module allows entry, edit, and viewing of data for many medical tests and procedures. The Summary of Patient Procedures allows the clinician to view a two-line summary of all medical procedures for each patient. These summaries are most often presented in descending order from most recent to oldest. Details of the procedures can be viewed by selecting the summary of interest. Medicine currently has six components: Cardiology, Pulmonary, Gastrointestinal, Hematology, Pacemaker, Rheumatology, and Generalized Procedure.

Features

• Provides a Summary of Patient Procedures for all procedures performed on a particular patient with simple drill downs for further information. Reports for all procedures are menu options.
• Provides both scroll mode and screen entry features for all components and provides word processing-based consult software for all procedures.
• Features an extensive screen entry system for Cardiac Catheterization Lab, Holter, Electrophysiology, Exercise Tolerance Test, Echo, and Electrocardiogram. Standards-based electronic transfer of ECG and Holter data to VistA is available.
• Allows the entry and edit of Esophageal Gastroduodenoscopy (EGD), Endoscopic Retrograde Cholangiogram and Pancreatogram (ERCP), Colonoscopy, and Laparoscopy findings or data.
• Allows the entry, edit, and printing of endoscopic data and Pulmonary Function test data.
• Contains a diagnosis filter that allows the separation of primary and secondary diagnoses, a consult component, and an automatically-generated recall list within both the Gastrointestinal and Pulmonary components.
• Allows data entry and edit for Generator and Lead implants, and follow-up surveillance within the Pacemaker component. The software also permits the direct electronic transfer of a report to the National Pacemaker Centers using VA network mail.
• Permits data entry and edit of Bone Marrow Aspirates (BMA) and Bone Marrow Biopsies (BMB).
• Allows the tracking of Rheumatology visits and is based on standards developed by the American Rheumatology Associations Medical Information System (ARAMIS).

[edit] Mental Health

[edit] Status: Mental Health supported, except ASI-MV missing

Check Mental Health Features supported by WorldVistA, except:
Not ASI-MV missing from WorldVistA because of copyright issues.

Perhaps something similar to the agreement with AMA allowing use of the CPT procedure codes can be worked out.

Overview

The Mental Health module provides computer support for both clinical and administrative patient care activities associated with mental health care. Psychiatrists and psychologists have directed its design with active input from all health care disciplines, guided by the principle of creating software that makes the clinician's job easier and leads to better patient care. A by-product of this approach has been the creation of a clinical database, which is useful to mental health program managers in many ways, including evaluating clinical productivity, monitoring and improving the quality of care, and trending various patient care events. This clinical database package is comprehensive and accessible from workstations throughout medical facilities.

Features

Provides a mini clinical record that includes:

• A patient profile with demographic information and a brief index of the clinical database, including physical examinations, psychological tests, clinical interviews, problem list, and diagnoses.
• Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and International Classification of Diseases (ICD-9) diagnoses.
• Psychological test and interview results, reviews of systems, past medical histories, crisis notes, clinical patient messages, and progress notes.
• A Global Assessment of Functioning (GAF) Case Finder Report, which lists all patients that have not been given a GAF score within the last 90 days.
• The ability for patients to undergo psychological tests and clinical interviews at a workstation, saving considerable clinician time. Psychological tests are automatically scored for retrieval, with access governed by the guidelines of the American Psychological Association.

VistAMental Health (MH) Addiction Severity Index Multimedia Version (ASI-MV):

• Introduces the new functionality required to run the commercial-off-the-shelf (COTS) Addiction Severity Index Mult