VistA Monograph Wiki: Difference between revisions

From OLPC
Jump to navigation Jump to search
(restore from piracy)
 
(196 intermediate revisions by 7 users not shown)
Line 1: Line 1:
{{WorldVistA}}
=== INTRODUCTION ===
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. '''
*VistA, and
Need to split this into about 10 pages or so AND keep the Table of Contents intact.
*HealtheVet-VistA


We have begun the process of manually editing and bringing it up to date.
VistA's Computerized Patient Record System


__TOC__
==== VistA (Today) ====


<!-- file -->
The Department of Veterans Affairs (VA) has had automated information
== Introduction ==
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.


VistA and Health<u>e</u>Vet-VistA
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:


VA'S Current and future Computerized Patient Record System
* A Real-Time Order Checking System that alerts clinicians during the ordering session that a possible problem could exist if the order is processed;

=== 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 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;
* 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.
* 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.
* 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.
VistA Imaging is also operational at most VA Medical Centers. VistA

Imaging provides a multimedia, on-line patient record that integrates
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.
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.


Health''<u>'''e'''</u>''Vet 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 Health''<u>'''e'''</u>''Vet 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:
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.


* Ensuring that appropriate clinical interventions are provided on a timely basis;
Health<sub>e</sub>Vet 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 Health<sub>e</sub>Vet 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;
* Ensuring that clinical notifications are processed on a timely basis;
Line 68: Line 40:
* Reducing the risk of erroneous data entry
* Reducing the risk of erroneous data entry


==== Health<sub>e</sub>Vet-VistA (Future) ====
=== Health<u>'''e'''</u>Vet-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:
A strategy has been developed to move the Veterans Health Information
Systems toward Health<sub>e</sub>Vet, 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.
* 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
* '''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.
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).
* '''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 Health''<u>'''e'''</u>''Vet (access to health record, on-line health assessment tools; and high quality health information).
* '''Information and Education Systems''' with an emphasis on "eHealth" include prescription refills, appointments, fillable forms online, and My Health''<u>'''e'''</u>''Vet (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
* '''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.
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.
* '''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.


==== Graphical Illustration of the Health<sub>e</sub>Vet VistA Strategy ====
=== Graphical Illustration of the Health<u>e</u>Vet-VistA Strategy ===


[[Image:vista_monograph2005_06_html_3c0d9bc8.gif]]
[[Image:vista_monograph2005_06_html_3c0d9bc8.gif|650px]]<br clear="left" /> Veterans Health Information System, including VistA


<!-- file -->
Veterans Health Information System, including VistA
== Getting WorldVistA ==


Need to tell folks what to do with this stuff after they get it.
=== VistA SOFTWARE PACKAGES ===


==== Health Data Systems ====
=== WorldVistA ===


See the [http://www.vistapedia.net Vistapedia] website for WorldVistA download and installation instructions.
<font face="Times New Roman, serif"><font size="3"><font
color="black"><font face="Arial, sans-serif">'''The Health Data Repository
(HDR) is the cornerstone of the Health Data Systems (HDS) portfolio. The
HDR will serve as an operational clinical repositoryâ€"a collection of
clinical information, from VA and non-VA sources, residing on one or more
independent platformsâ€"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.'''</font></font></font></font>


=== FOIA ===
===== Automated Medical Information Exchange (AMIE) =====


The FOIA Freedom Of Information Act release is available [ftp://ftp.va.gov/vista/ here].
<font size="3">'''Overview'''</font>


==== GT.M ====
<font face="Arial, sans-serif"><font size="2">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.</font></font>


And you will need [http://sourceforge.net/projects/fis-gtm GT.M]
<font face="Arial, sans-serif"><font size="2">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.</font></font>


<!-- file -->
<font size="3">'''Features'''</font>


== VistA Software Packages ==
* 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.


=== 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.


==== 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.
===== Incident Reporting =====


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.
<font size="3">'''Overview'''</font>
* 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.


<!-- file -->
The Incident Reporting module supports VHA policy by compiling data on
==== Incident Reporting ====
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.


'''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.


<font size="3">'''Features'''</font>
'''Features'''


* Provides options to simplify the setup of the software. * <font
* 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.
face="Arial, sans-serif"><font size="2">Allows for the entry of all
* Prints out a Pseudo 10-2633 Incident Worksheet.
required incident information plus descriptive data and actions taken
* Provides an ad hoc reporting mechanism that uses VA FileMan modifiers for sorting or printing the following data fields:
on all reportable and/or locally defined incidents.</font></font>
* <font face="Arial, sans-serif"><font size="2">Prints out a Pseudo
10-2633 Incident Worksheet.</font></font> * Provides an ad hoc reporting
mechanism that uses VA FileMan modifiers for sorting or printing the
following data fields:


Patient Type of Death
Patient Type of Death
Line 193: Line 130:
Medication Errors Medical Center Action
Medication Errors Medical Center Action


<font face="Arial, sans-serif"><font size="2">Case Number Incident
Case Number Incident Description
Description</font></font>


<font face="Arial, sans-serif"><font size="2">Incident Pertinent
Incident Pertinent Information
Information</font></font>


<font face="Arial, sans-serif"><font size="2">Incident Location National
Incident Location National Case Status
Case Status</font></font>


<!-- file -->
==== 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'''
===== Lexicon Utility =====


* 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.


<!-- file -->
==== Occurrence Screen ====


<font size="3">'''Overview'''</font>
'''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.
<font face="Arial, sans-serif"><font size="2">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.</font></font>


'''Features'''


* Provides automatic identification of patients for the following occurrences:


* Readmission within 10 days
<font face="Arial, sans-serif"><font size="2">The scope of the Lexicon
* Admission within three days following unscheduled Ambulatory Care visit
Utility is to express diagnostic clinical problems in easy-to-understand
* Return to operating room in same admission
terminology and associate these terms to coding systems such as ICD,
* Death anywhere in medical facility, except DNR (Do Not Resuscitate)
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.</font></font>


* 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


<!-- file -->
<font size="3">'''Features'''</font>
==== Patient Representative ====


'''Overview'''
* 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.


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.
===== Occurrence Screen =====


'''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.


<!-- file -->
<font size="3">'''Overview'''</font>
=== 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.
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.


* 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


==== Admission, Discharge, Transfer (ADT) /Registration ====


'''Overview'''
<font size="3">'''Features'''</font>


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.
* Provides automatic identification of patients for the following
occurrences:


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.
* 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)


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.
* 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:


'''Features'''
* 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


* 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.


<!-- file -->
==== 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.


<!-- file -->
==== Enrollment Application System (EAS) ====


'''Overview'''
===== Patient Representative =====


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 10-10EZ''Web-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'''
<font size="3">'''Overview'''</font>


* Automatically receives incoming 10-10EZ data transmissions from the Web-based application into a VistA holding file.
The purpose of the Patient Representative module is to ensure that VA
* Provides a List Manager interface that allows the enrollment/registration staff to:
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.



<font size="3">'''Features'''</font>

* <font size="2">Entering and editing contact information.</font> *
Sending Reports of Contact via the Alert system. * Tracking contacts
that have responses due. * Printing various lists, statistical reports,
and ad hoc reports.





==== Registration, Enrollment, and Eligibility Systems ====





<font face="Arial, sans-serif"><font size="3">'''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.'''</font></font>

* <font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif">'''Strong VHA and OneVA component'''</font></font></font> *
<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif">'''OneVA building common system and demographic database
supporting registration and eligibility'''</font></font></font> * <font
face="Arial, sans-serif"><font size="3">'''VHA management of companion
VHA registration, enrollment, and eligibility through National Health
Demographic Database'''</font></font>























===== Admission, Discharge, Transfer (ADT) /Registration =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

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.



<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font size="3">'''Features'''</font>

* <font size="2">Provides on-line patient registration and disposition of
applications for medical care.</font> * 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.

* <font face="Arial, sans-serif"><font size="2">Aids in cost recovery
of care by supplying comprehensive PTF/RUG-II, Means Test, and pharmacy
copay software.</font></font>





===== Clinical Monitoring System =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

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.).



<font size="3">'''Features'''</font>

* <font size="2">Enrolls from database, patients/events as defined by
each monitor.</font> * 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.

























===== Enrollment Application System (EAS) =====



<font size="3">'''Overview'''</font>

<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">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</font></font> <font face="Arial, sans-serif"><font
size="2">''On-Line 10-10EZ''</font></font><font face="Arial,
sans-serif"><font size="2">Web-based software.</font></font></font></font>



<font face="Arial, sans-serif"><font size="2">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.</font></font>

<font size="3">'''Features'''</font>

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















===== Hospital Inquiry (HINQ) =====



<font size="3">'''Overview'''</font>

<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font size="3">'''Features'''</font>

* <font size="2">Sends on-line requests individually and forwards
multiple requests in batch mode.</font> * 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.

























===== Income Verification Match (IVM) =====


* 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.


<!-- file -->
==== Hospital Inquiry (HINQ) ====


<font size="3">'''Overview'''</font>
'''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.
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.


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.
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.


'''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.


<!-- file -->
As part of this process, HEC compares the extracted data with earned and
==== Income Verification Match (IVM) ====
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.


'''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.
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.


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.
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.


<!-- file -->
<font size="3">'''Features'''</font>
==== Record Tracking ====


'''Overview'''
* 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.


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.


<!-- file -->
==== 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'''
===== Record Tracking =====


* 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.


<!-- file -->
<font size="3">'''Overview'''</font>
==== Veteran Identification Card (VIC) ====


'''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 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.
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:


'''Features'''
* <font size="2">Creation of new records/volumes</font> *
<font size="2">Charge-out/check-in of records</font> * <font
size="2">Inactivation/reactivation and deletion of records</font> * <font
size="2">Printing of bar code labels</font> * <font size="2">Transfer
of records to other facilities</font> * <font size="2">Recharging
records to other borrowers</font> * <font size="2">Flagging a record as
missing</font> * <font size="2">Record retirement</font>


* 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.


<!-- file -->
=== 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:
<font size="3">'''Features'''</font>


* VistA Imaging
* <font size="2">Uses bar code technology, prints bar code labels for
* Blood Bank
the charts, and uses bar code equipment to charge records.</font> *
* Pharmacy
Displays informational bulletins when a record is checked into a file
* Laboratory Services
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. * <font face="Arial, sans-serif"><font
size="2">Creates pull lists to provide requests for records in conjunction
with clinic scheduling and record retirement.</font></font>


==== Care Management ====
'''Overview'''


Care Management is the first application to run within the Health''e''Vet 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


===== Care Management Clinician Dashboard running in the Health''e''Vet desktop =====
===== Resident Assessment Instrument/Minimum Data Set (RAI/MDS) =====


[[Image:vista_monograph2005_06_html_2c0271fe.png|650px]]
<!-- file -->


==== Clinical Procedures ====


'''Overview'''
<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>


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.
<font face="Arial, sans-serif"><font size="2">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.</font></font>


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'''
<font face="Arial, sans-serif"><font size="2">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.</font></font>


* 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.
<font face="Arial, sans-serif"><font size="2">The VA purchased
* Defines the Hospital Location where the procedure is performed. This location determines which Encounter Form is presented to the end user.
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.</font></font>



<font size="3">'''Features'''</font>

* <font face="Arial, sans-serif"><font size="2">Admissions module with
display of demographic and patient movement information interfaced from
VistA using standard HL7 messaging.</font></font> * <font face="Arial,
sans-serif"><font size="2">Assessments module based on the MDS Version
2.0, a core set of preliminary screening and assessment elements
including common definitions and coding categories.</font></font>
* <font face="Arial, sans-serif"><font size="2">Specific responses
to MDS questions trigger one or more of eighteen potential problem
areasâ€"known as Resident Assessment Protocolsâ€"identifying
residents who have, or are at risk for developing, specific functional
problems.</font></font>

* <font face="Arial, sans-serif"><font size="2">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.</font></font> * <font face="Arial, sans-serif"><font
size="2">Resident Care Plan and Report Writer modules.</font></font>
* <font face="Arial, sans-serif"><font size="2">Electronic signature
and electronic transmission of assessments to AAC.</font></font> *
<font face="Arial, sans-serif"><font size="2">Audit controls for HIPAA
privacy and security compliance.</font></font> * <font face="Arial,
sans-serif"><font size="2">Integration Gateway with HL7 standard
messaging and monitoring tools.</font></font> * <font face="Times
New Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">MDS 2.0 with Version 1.2 data specifications and fatal error
checks.</font></font></font></font> * <font face="Times New Roman,
serif"><font size="2">Contains complete on-line help manuals for all
modules of the CMS RAI/MDS manual.</font></font>

===== Veteran Identification Card (VIC) =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

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 (<font color="black">CCOW) enabled
workstation</font>. 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.



<font size="3">'''Features'''</font>

* 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.

==== Health Provider Systems ====





<font face="Arial, sans-serif"><font size="3">'''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:'''</font></font>

* <font face="Times New Roman, serif"><font size="3"><font
face="Arial, sans-serif">'''VistA Imaging'''</font></font></font>
* <font face="Times New Roman, serif"><font size="3"><font
face="Arial, sans-serif">'''Blood Bank'''</font></font></font> *
<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif">'''Pharmacy'''</font></font></font> * <font face="Times New
Roman, serif"><font size="3"><font face="Arial, sans-serif">'''Laboratory
Services'''</font></font></font>































===== Care Management =====



<font size="3">'''Overview'''</font>

<font face="Times New Roman, serif"><font style="font-size: 11pt"
size="2"><font face="Arial, sans-serif"><font size="2">Care Management
is the first application to run within the Health</font></font><font
face="Arial, sans-serif"><font size="2">''e''</font></font><font
face="Arial, sans-serif"><font size="2">Vet 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):</font></font></font></font>

* <font face="Times New Roman, serif"><font style="font-size: 11pt"
size="2"><font face="Arial, sans-serif"><font size="2">'''Clinician
Dashboardâ€"'''</font></font><font face="Arial, sans-serif"><font
size="2">P</font></font><font face="Arial, sans-serif"><font
size="2">rovides 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.</font></font></font></font> *
<font face="Times New Roman, serif"><font style="font-size: 11pt"
size="2"><font face="Arial, sans-serif"><font size="2">'''Nurse
Dashboard'''</font></font><font face="Arial, sans-serif"><font
size="2">â€"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.</font></font></font></font>
* <font face="Times New Roman, serif"><font style="font-size: 11pt"
size="2"><font face="Arial, sans-serif"><font size="2"><span>'''Query
Toolâ€"'''</span></font></font><font face="Arial, sans-serif"><font
size="2"><span>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.</span></font></font></font></font> *
<font face="Times New Roman, serif"><font style="font-size: 11pt"
size="2"><font face="Arial, sans-serif"><font size="2"><span>'''Sign
Listâ€"'''</span></font></font><font face="Arial, sans-serif"><font
size="2"><span>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.</span></font></font></font></font>

<font face="Times New Roman, serif"><font style="font-size:
11pt" size="2"><font face="Arial, sans-serif"><font size="2">This
distribution of Care Management also includes the Task Editor,
which enables users to</font></font> <font face="Arial,
sans-serif"><font size="2"><span>create patient-related
tasks.</span></font></font></font></font>



<font size="3">'''Features'''</font>

<font face="Arial, sans-serif"><font size="2">Care Management comprises
an extensive set of features designed to simplify and improve patient
care.</font></font>

<font face="Arial, sans-serif"><font size="2">These features include
(but are not limited to) the following:</font></font>



* <font face="Arial, sans-serif"><font size="2">Colored-coded icons
that indicate the priority status of dashboard items</font></font> *
<font face="Arial, sans-serif"><font size="2">A default patient list
that is based on users’ Computerized Patient Record System (CPRS)
default patient list</font></font>

* <font face="Arial, sans-serif"><font size="2">A dynamically generated,
user-based patient list</font></font>

* <font face="Arial, sans-serif"><font size="2">Custom patient
lists</font></font>

* <font face="Arial, sans-serif"><font size="2">Checkboxes for
acknowledging and verifying individual or multiple dashboard
items</font></font>

* <font face="Arial, sans-serif"><font size="2">The ability to set date
ranges for dashboard items</font></font>

* <font face="Arial, sans-serif"><font size="2">The ability to link
tasks to other tasks or to events</font></font>

* <font face="Arial, sans-serif"><font size="2">The ability to prioritize,
edit, and delete tasks</font></font>

* <font face="Arial, sans-serif"><font size="2">Text boxes that expand
to provide detailed information about dashboard items</font></font>

* <font face="Arial, sans-serif"><font size="2">A variety of predefined
reports, including the following:</font></font>

<div style="margin-left: 2em">

* <font face="Arial, sans-serif"><font size="2">Abnormal
Results</font></font> * <font face="Arial, sans-serif"><font
size="2">Consult Status</font></font>

</div>

<font size="3">'''Care Management â€" continued'''</font>

<div style="margin-left: 2em">

* <font face="Arial, sans-serif"><font size="2">Incomplete
Orders</font></font> * <font face="Arial, sans-serif"><font
size="2">Recent Activity</font></font> * <font face="Arial,
sans-serif"><font size="2">Scheduled/Due Activity</font></font>

</div>

* <font face="Arial, sans-serif"><font size="2">Custom reports with
a wide selection of criteria, including (but not limited to) the
following:</font></font>

<div style="margin-left: 2em">

* <font face="Arial, sans-serif"><font size="2">Screen by
Inpatient, Outpatient, or Pharmacy Visits</font></font> * <font
face="Arial, sans-serif"><font size="2">Screen by Primary Outpatient
Provider</font></font> * <font face="Arial, sans-serif"><font
size="2">Orders/Results</font></font> * <font face="Arial,
sans-serif"><font size="2">Consults/Procedures</font></font>

</div>

* <font face="Arial, sans-serif"><font size="2">The ability to print
and export reports</font></font>



<font face="Arial, sans-serif"><font size="2">Care Management is tightly
integrated with CPRS. As a result, from within Care Management, users
can:</font></font>

* <font face="Arial, sans-serif"><font size="2">Go directly to a
patient’s chart in CPRS</font></font> * <font face="Arial,
sans-serif"><font size="2">Clear selected result notifications in CPRS,
including notifications in the following categories:</font></font>

<div style="margin-left: 2em">

* <font face="Arial, sans-serif"><font size="2">Events</font></font> *
<font face="Arial, sans-serif"><font size="2">Results</font></font> *
<font face="Arial, sans-serif"><font size="2">Actions</font></font>

</div>



<font face="Arial, sans-serif"><font size="2">Care Management’s
intuitive Graphical User Interface (GUI) includes an extensive selection
of clickable items from which users can:</font></font>

* <font face="Arial, sans-serif"><font size="2">Select a default
perspective</font></font> * <font face="Arial, sans-serif"><font
size="2">Select dashboard preferences</font></font> * <font face="Arial,
sans-serif"><font size="2">View demographic information for individual
patients</font></font> * <font face="Arial, sans-serif"><font
size="2">View details about specific action items</font></font> * <font
face="Arial, sans-serif"><font size="2">And much more</font></font>





<font size="3">'''Care Management â€" continued'''</font>

[[Image:vista_monograph2005_06_html_2c0271fe.png]]



<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">Care Management Clinician Dashboard running
in the Health</font></font><font face="Arial, sans-serif"><font
size="2">''e''</font></font><font face="Arial, sans-serif"><font
size="2">Vet desktop.</font></font></font></font>

=== <font face="Arial, sans-serif"><font style="font-size: 16pt"
size="4"><span lang="en-US">'''Clinical Procedures'''</span></font></font>




<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>

* 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.
* Electronic transfer of patient reports from medical devices to VistA.
* Bi-directional interface capabilities. * Easy to use user interfaces,
* Bi-directional interface capabilities.
including CP Manager, CP User, and CP Gateway. * Improved internal
* Easy to use user interfaces, including CP Manager, CP User, and CP Gateway.
communication between the proceduralist and the primary care physician.
* Improved internal communication between the proceduralist and the primary care physician.
* Improved patient education through use of reports. * Improved medical
* Improved patient education through use of reports.
record keeping.
* Improved medical record keeping.


<!-- file -->
==== Computerized Patient Record System (CPRS) ====
===== Status: CPRS required - Porting to XO not Complete =====
*{{WorldVistA-Check}}
*{{WorldVistA-Porting}} [[Porting Delphi Clients to the XO]]
*{{WorldVistA-Alt}} [[CPRS Alternative OpenVista CIS]]
*{{WorldVistA-OLPC-MustHave}} 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.
===== Computerized Patient Record System (CPRS) =====


* 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.


===== Image: CPRS Cover Sheet Example =====


[[Image:vista_monograph2005_06_html_me4ce41f.png|650px]]
<font color="red"><font color="black"><font
size="3">'''Overview'''</font></font></font>


==== CPRS: Adverse Reaction Tracking ====
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.


'''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'''
<font face="Arial, sans-serif"><font size="2">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.</font></font>


* Documents patient allergy and adverse drug reaction data.
<font face="Times New Roman, serif"><font size="3"><font face="Arial,
* Provides the functionality for other VistA modules to extract and add patient reaction data.
sans-serif">'''Features'''</font></font></font>
* 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.


==== CPRS: Authorization/Subscription Utility (ASU) ====
<font face="Arial, sans-serif"><font size="2">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:</font></font>


'''Overview'''
* <font face="Arial, sans-serif"><font size="2">Order checking
for:</font></font>


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.).
<div style="margin-left: 2em">


'''Features'''
* <font face="Arial, sans-serif"><font size="2">Out-of-range
values</font></font> * <font face="Arial, sans-serif"><font
size="2">Duplicates</font></font> * <font face="Arial, sans-serif"><font
size="2">Maximum order frequency</font></font> * <font face="Arial,
sans-serif"><font size="2">Allergies</font></font> * <font face="Arial,
sans-serif"><font size="2">Potential drug-drug, drug-dosage, drug-overlap,
drug-lab, and drug-allergy interactions, with appropriate warnings
issued</font></font>


* 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.
</div>
* 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.


==== CPRS: Clinical Reminders ====
* <font face="Arial, sans-serif"><font size="2">Orders integrated with
progress notes, results, procedures, diagnosis, and problems</font></font>
* <font face="Arial, sans-serif"><font size="2">Templating utilities
for speedy point-and-click composition of notes</font></font> * <font
face="Arial, sans-serif"><font size="2">Interdisciplinary notes enable
a single parent note to contain multiple clinicians’ notes
for their disciplines to make them easier to find</font></font>
* <font face="Arial, sans-serif"><font size="2">Tools to create
Reminder dialogs for point-and-click resolution of clinical reminders
to meet Clinical Guidelines</font></font> * <font face="Arial,
sans-serif"><font size="2">Quick orders</font></font> * <font face="Arial,
sans-serif"><font size="2">Order sets</font></font> * <font face="Arial,
sans-serif"><font size="2">Event-delay orders (for admission, discharge,
or transfer orders)</font></font> * <font face="Arial, sans-serif"><font
size="2">Clinical Context Management to synchronize multiple applications
to the same patient</font></font> * <font face="Arial, sans-serif"><font
size="2">Accessibility support for disabled users in accordance with
Section 508</font></font> * <font face="Arial, sans-serif"><font
size="2">Code Set Versioning that ensures current codes to comply with
HIPAA legislation</font></font>


'''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.
<font size="3">'''Computerized Patient Record
Systemâ€"continued'''</font>


The Quality Enhancement Research Initiative (QUERI), a Health Services Research and Development (HSR&amp;D) program, and the National Clinical Practice Guidelines Committee have joined with the Office of Information, System Design &amp; Development office (SD&amp;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 Health''e''Vet, and VA Geriatric Care Referral (GEC) reminders.
Improves the accessibility of online clinical information and results
via integration with:


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.
* <font face="Arial, sans-serif"><font size="2">Clinical
* 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.
Reminders</font></font> * <font face="Arial, sans-serif"><font
* Allows facilities to copy, create, and customize their own reminder definitions, based on local needs.
size="2">Adverse Reactions</font></font> * <font face="Arial,
* Provides components that can be displayed on Health Summaries.
sans-serif"><font size="2">Discharge Summary</font></font> * <font
* 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.
face="Arial, sans-serif"><font size="2">Progress Notes</font></font> *
* Provides an enhanced Exchange Utility that allows exchange of reminder definitions and dialogs among sites and Veterans Integrated Service Networks (VISNs).
<font face="Arial, sans-serif"><font size="2">Inpatient and Outpatient
Pharmacy</font></font> * <font face="Arial, sans-serif"><font
size="2">Dietetics</font></font> * <font face="Arial, sans-serif"><font
size="2">Radiology</font></font> * <font face="Arial, sans-serif"><font
size="2">Laboratory</font></font> * <font face="Arial, sans-serif"><font
size="2">Notifications</font></font> * <font face="Arial,
sans-serif"><font size="2">Health Summary</font></font> * <font
face="Arial, sans-serif"><font size="2">Problem List</font></font>
* <font face="Arial, sans-serif"><font size="2">Consult/Request
Tracking</font></font> * <font face="Arial, sans-serif"><font
size="2">Patient Record Flags</font></font>


===== Image: Clinical Reminders Example: Reminders Resolution Dialog =====


[[Image:vista_monograph2005_06_html_56cf5031.png|650px]]


==== CPRS: Consult/Request Tracking ====
<font face="Arial, sans-serif"><font size="2">Provides access to clinical
information from other VAMC and Department of Defense sites through
Remote Data Views.</font></font>


'''Overview'''
* <font face="Arial, sans-serif"><font size="2">Displays other VAMCs
where the patient has been seen</font></font> * <font face="Arial,
sans-serif"><font size="2">Displays a small subset of data from Department
of Defense medical facilities</font></font> * <font face="Arial,
sans-serif"><font size="2">From the listed VAMCs, provides the capability
to view Clinical reports, nationally released Health Summary components,
and results for many lab tests</font></font>


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.
Graphical User Interface (GUI) provides a consistent, event-driven,
* Uses Consults' own menu options for managing the system, generating reports, tracking consults, or entering results for an existing consult request.
windows-style clinical user interface.
* 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.
===== Image: Consults Example =====


[[Image:vista_monograph2005_06_html_m465fd7a.png|650px]]
* <font face="Arial, sans-serif"><font size="2">Follows the VistA GUI
Guidelines, as well as the common standard for Windows</font></font>
* <font face="Arial, sans-serif"><font size="2">List Manager Interface
allows Windows-like actions for terminal-based users:</font></font> *
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.


==== 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.


===== Image: Health Summary Example =====


[[Image:vista_monograph2005_06_html_m7191f48f.gif|650px]]
<font size="3">'''Computerized Patient Record
Systemâ€"continued'''</font>


==== 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.
'''CPRS Cover Sheet Example'''


'''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.


==== CPRS<nowiki>:</nowiki> Text Integration Utilities (TIU) ====
[[Image:vista_monograph2005_06_html_me4ce41f.png]]


'''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: Adverse Reaction Tracking =====


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.
<font size="3">'''Overview'''</font>
* 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.


<!-- file -->
The Adverse Reaction Tracking (ART) program provides a common and
==== Dentistry ====
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).


'''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.
<font size="3">'''Features'''</font>


'''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.


* 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.


<!-- file -->
==== Hepatitis C Case Registry ====


'''Overview'''
===== CPRS: Authorization/Subscription Utility (ASU) =====


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'''

<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

<font face="Arial, sans-serif"><font size="2">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.).</font></font>



<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>

* <font face="Arial, sans-serif"><font size="2">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.</font></font>
* <font face="Arial, sans-serif"><font size="2">Links user classes
with Text Integrated Utilities (TIU) document definitions and
document events.</font></font> * <font face="Arial, sans-serif"><font
size="2">Allows sites to maintain membership of users in User Classes
and to distribute such maintenance tasks.</font></font> * <font
face="Arial, sans-serif"><font size="2">Lists class members as active
or inactive.</font></font> * <font face="Arial, sans-serif"><font
size="2">Allows infinite hierarchies of subclasses.</font></font> *
<font face="Arial, sans-serif"><font size="2">Defines business rules to
further manage document activities.</font></font>











===== CPRS: Clinical Reminders =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">The Quality Enhancement Research Initiative
(QUERI), a Health Services Research and Development (HSR&amp;D) program,
and the National Clinical Practice Guidelines Committee have joined
with the Office of Information, System Design &amp; Development
office (SD&amp;D) in designing national reminders and dialogs
that will help</font></font> <font face="Arial, sans-serif"><font
size="2">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 Health</font></font><font face="Arial,
sans-serif"><font size="2">''e''</font></font><font face="Arial,
sans-serif"><font size="2">Vet, and VA Geriatric Care Referral (GEC)
reminders.</font></font></font></font>



<font face="Arial, sans-serif"><font size="2">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.</font></font>



====== <font size="3">Features</font> ======



* Allows results that are unique for each patient, by basing reminder
evaluation on the patient's clinical data. * <font face="Arial,
sans-serif"><font size="2">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.</font></font> * <font face="Arial, sans-serif"><font
size="2">Allows facilities to copy, create, and customize their own
reminder definitions, based on local needs.</font></font> * <font
face="Arial, sans-serif"><font size="2">Provides components that can
be displayed on Health Summaries.</font></font> * <font face="Arial,
sans-serif"><font size="2">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.</font></font> * <font
face="Arial, sans-serif"><font size="2">Provides an enhanced Exchange
Utility that allows exchange of reminder definitions and dialogs among
sites and Veterans Integrated Service Networks (VISNs).</font></font>



======= CPRS: Clinical Reminders - continued =======

======= Clinical Reminders Example: Reminders Resolution Dialog =======



[[Image:vista_monograph2005_06_html_56cf5031.png]]



===== CPRS: Consult/Request Tracking =====

<font size="3">'''Overview'''</font>

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.



<font size="3">'''Features'''</font>



* <font size="2">Allows direct access to Consults functions through menu
options in CPRS.</font>



* <font size="2">Uses Consults' own menu options for managing the system,
generating reports, tracking consults, or entering results for an existing
consult request.</font>



* <font size="2">Allows staff to set up consults as CPRS Quick Orders,
streamlining the ordering process.</font>



* <font size="2">Integrates with Prosthetics to track Home Oxygen,
Eyeglasses, Contact Lenses, and other Prosthetics services.</font>



* <font size="2">Produces a permanent record of the request and resolution
for the patient's medical record.</font>



* <font size="2">Allows all relevant parties to see the consult report
in the context of the patient's record.</font>



* <font size="2">Allows use of TIU templates and boilerplate to report
findings.</font>



* <font size="2">Allows display of Consult reports through TIU and
CPRS.</font>



* <font face="Arial, sans-serif"><font size="2">Enables clinicians to
order a consult at another facility, using HL7 Messaging and the VA
Intranet.</font></font>

















<font face="Arial, sans-serif"><font size="3">'''CPRS: Consult/Request
Tracking â€" continued'''</font></font>





<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif">'''Consults Example'''</font></font></font>



[[Image:vista_monograph2005_06_html_m465fd7a.png]]

===== CPRS: Health Summary =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>

* <font face="Arial, sans-serif"><font size="2">Integrates data from
the following packages:</font></font>



<font face="Arial, sans-serif"><font size="2">Adverse Reaction Tracking
Nursing (Vital Signs)</font></font>

<font face="Arial, sans-serif"><font size="2">Automated Medical
Information Outpatient Pharmacy</font></font>

<font face="Arial, sans-serif"><font size="2">Exchange (AMIE) Patient
Care Encounter (PCE)</font></font>

<font face="Arial, sans-serif"><font size="2">Clinical Reminders Problem
List</font></font>

<font face="Arial, sans-serif"><font size="2">Computerized Patient Record
Progress Notes</font></font>

<font face="Arial, sans-serif"><font size="2">System (CPRS)
Radiology</font></font>

<font face="Arial, sans-serif"><font size="2">Consults/Request Tracking
Registration</font></font>

<font face="Arial, sans-serif"><font size="2">Dietetics
Scheduling</font></font>

<font face="Arial, sans-serif"><font size="2">Discharge Summary Social
Work</font></font>

<font face="Arial, sans-serif"><font size="2">Inpatient Medications
Spinal Cord Dysfunction</font></font>

<font face="Arial, sans-serif"><font size="2">Laboratory System
Surgery</font></font>

<font face="Arial, sans-serif"><font size="2">Medicine VistA
Imaging</font></font>

<font face="Arial, sans-serif"><font size="2">Mental Health</font></font>



* <font face="Arial, sans-serif"><font size="2">Health Summary users
can print an Outpatient Pharmacy Action Profile with bar codes in tandem
with a health summary.</font></font>

* <font face="Times New Roman, serif"><font size="3"><font
face="Arial, sans-serif"><font size="2">Health Summary now exports
components that allow staff to view remote patient data through
CPRS. Additionally,</font></font> <font face="Arial, sans-serif"><font
size="2">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.</font></font></font></font>

* <font face="Arial, sans-serif"><font size="2">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.</font></font> * <font face="Arial, sans-serif"><font
size="2">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.</font></font>

<font face="Arial, sans-serif"><font size="3">'''Health Summary
Example'''</font></font>

<font
color="#3366FF">[[Image:vista_monograph2005_06_html_m7191f48f.gif]]</font><br
/>









===== CPRS: Problem List =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font size="3">'''Features'''</font>

* <font size="2">Allows a clinician to view an individual problem list
for any given patient.</font> * 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.
* <font face="Arial, sans-serif"><font size="2">Requires minimal data
entry.</font></font>

<div style="margin-left: 2em">

</div>

=== CPRS<font size="3"><nowiki>:</nowiki></font> Text Integration
Utilities (TIU) ===



<font size="3">'''Overview'''</font>

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.



<font face="Arial, sans-serif"><font size="2">The Version 1.0 release
included Discharge Summary and Progress Notes. With the release
of</font></font>

<font face="Arial, sans-serif"><font size="2">CPRS and Consults/Request
Tracking, TIU has been upgraded to integrate with these
packages.</font></font>



<font size="3">'''Features'''</font>



* <font size="3"><font size="2">Provides boilerplate functionality for the
automatic fill-in of information from</font> <font size="2">VistA</font>
<font size="2">files into TIU documents. Boilerplates and embedded
objects can be set up for specific types of documents for specific
clinical needs.</font></font> * 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. * <font size="3"><font size="2">Interfaces with</font>
<font size="2">VistA</font> <font size="2">Imaging allowing clinicians
to link TIU documents to all types of clinical images such as X-rays,
MRIs, and CAT scans.</font></font> * <font size="2">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.</font>
* <font size="3"><font size="2">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</font> <font size="2">VistA</font><font size="2">.</font></font> *
<font size="2">Uses a uniform file structure for storage of documents and
management of document types.</font> * <font size="2">Uses a consistent
file structure for defining elements and parameters of a document.</font>
* <font size="2">Allows a variety of user actions, such as entry, edit,
electronic signature, addenda, browse, notifications, etc.</font> *
<font size="2">Allows a variety of management functions, including
amendment, deletion, and identification of signature surrogate,
re-assignment, and administrative authentication.</font> * <font
size="3"><font size="2">Follows HL7 interface and other communication
standards.</font></font>

===== Dentistry =====



<font size="3">'''Overview'''</font>

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.



<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font size="3">'''Features'''</font>

* <font size="2">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.</font> * 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.



































===== Hepatitis C Case Registry =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

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.



<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>


This VistA software package provides the following key functions:
This VistA software package provides the following key functions:


* Automatically develops a list of patients with Hepatitis C infection.
* Automatically develops a list of patients with Hepatitis C infection.
* Provides a GUI interface that allows select local facility staff to
* 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.
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
* 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.
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:
* Generates the following local reports:


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


<!-- file -->
==== 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.
===== Home Based Primary Care (HBPC) =====


* 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.
<font size="3">'''Overview'''</font>


<!-- file -->
<font face="Arial, sans-serif"><font size="2">The Home Based Primary
==== Immunology Case Registry (ICR) ====
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
reportsâ€"only the source of the data has changed. This system
eliminates the paper reporting system between medical centers and the
AAC database.</font></font>


'''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.
<font size="3">'''Features'''</font>


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


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:
* <font size="2">Provides for the entry and editing of patient evaluations
and admission/discharge data.</font> * 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:


* New graphical user interface (GUI).
* Visit, admission and discharge data * Length of stay * Rejections *
* 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.
Procedures * Census for program, team, case manager, and/or provider
* 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.


<!-- file -->
* Enables the HBPC program manager to control and assess the staff
==== Intake and Output ====
workload and organizational characteristics.


'''Overview'''


The Intake and Output (I&amp;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.


<!-- file -->
==== 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'''





===== Immunology Case Registry (ICR) =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>

<font face="Arial, sans-serif"><font size="2">The CCR: ICR
software enhancements provide the following capabilities and
features:</font></font>

* <font face="Arial, sans-serif"><font size="2">New graphical user
interface (GUI).</font></font> * <font face="Arial, sans-serif">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.</font> * <font
face="Arial, sans-serif">Provides the ability to export report data to
spreadsheet applications.</font> * <font face="Arial, sans-serif"><font
size="2">Facilitates the tracking of patient outcomes related to
antiretroviral drug treatment.</font></font> * <font face="Arial,
sans-serif"><font size="2">Provides partial automation of HIV case
identification.</font></font> * <font face="Arial, sans-serif"><font
size="2">Identifies and tracks important trends in treatment response,
adverse events, and time on therapy.</font></font> * <font face="Arial,
sans-serif"><font size="2">Matches resources to clinical needs and
utilization at local, VISN, and national levels.</font></font> * <font
face="Arial, sans-serif">Verifies workload for VERA reimbursement.</font>
* <font face="Arial, sans-serif">Automates notification to HIV
coordinators that data was sent to and received by the national
database.</font> * <font face="Arial, sans-serif">Automates extraction
of data to the national registry.</font>







===== Intake and Output =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

<font face="Arial, sans-serif"><font size="2">The Intake and
Output (I&amp;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.</font></font>



<font face="Arial, sans-serif">'''Features'''</font>

<font face="Arial, sans-serif"><font size="2">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).</font></font>



<font face="Arial, sans-serif"><font size="2">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.</font></font>



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

* <font face="Arial, sans-serif">Start IVâ€"Start a new IV
line or heparin/saline lock/port.</font> * <font face="Arial,
sans-serif">Solution: Replace/DC/Convert/Finish Solutionâ€"DC current
solution then replace a new solution to the selected IV line, or convert
the IV according to the user's choice.</font> * <font face="Arial,
sans-serif">Replace Same Solutionâ€"Replace the same solution to a
selected IV.</font> * <font face="Arial, sans-serif">D/C IV Lock/Port
and Siteâ€"Remove IV/lock/port from a selected IV site.</font>
* <font face="Arial, sans-serif">Care/Maintenance/Flushâ€"Check
site condition, dressing change, tube change and flush.</font> *
<font face="Arial, sans-serif">Add Additional Solutions(s) â€"Add
additional solution(s) without discontinuing an existing one.</font> *
<font face="Arial, sans-serif">Restart DC'd IVâ€"Restart an IV that
was DC'd due to infiltration or other reasons.</font> * <font face="Arial,
sans-serif">Adjust Infusion Rateâ€"Adjust infusion rate for a selected
IV.</font> * <font face="Arial, sans-serif">Flushâ€"Flush all IV
line(s) for a selected infusion site.</font>



<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">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:</font></font></font></font>

* <font face="Arial, sans-serif">Print I/O Summary by Patient (by Shift
and Day(s))</font> * <font face="Arial, sans-serif">Print I/O Summary
(Midnight to Present)</font> * <font face="Arial, sans-serif">Print
I/O Summary (48 Hrs)</font> * <font face="Arial, sans-serif">24 Hours
Itemized Shift Report</font> * <font face="Arial, sans-serif">Intravenous
Infusion Flow Sheet</font>



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.

===== Laboratory =====



<font size="3">'''Overview'''</font>

<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">The Veterans Health Information System
and Technology Architecture (</font></font><font face="Arial,
sans-serif"><font size="2">VistA</font></font><font face="Arial,
sans-serif"><font size="2">) 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.</font></font></font></font>



<font size="3">'''Features'''</font>


<u>Phlebotomy/Ordering</u>
<u>Phlebotomy/Ordering</u>
Line 2,185: Line 873:
* Computerized Patient Record System (CPRS)
* Computerized Patient Record System (CPRS)


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




<u>Processing</u>
<u>Processing</u>


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




<u>Verification/Release of Data</u>
<u>Verification/Release of Data</u>


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




<u>Reports</u>
<u>Reports</u>


* Produces supervisory management, audit trail, data integrity, and
* Produces supervisory management, audit trail, data integrity, and quality management and utilization review reports.
* Provides searches for specific antibiotic with defined antimicrobial patterns.
quality management and utilization review reports.
* Produces discharge summaries and cumulative and discrete episode reports.

* Produces automatic transmission of verified data to the ordering location.
<font size="3">'''Laboratoryâ€"continued'''</font>
* 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.
* Provides searches for specific antibiotic with defined antimicrobial
* Schedules patient cumulative reports based on inpatient or outpatient treatment.
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.




<u>Data Extracts Capabilities for External Databases:</u>
<u>Data Extracts Capabilities for External Databases:</u>


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


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


===== Laboratory: Anatomic Pathology =====
==== 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'''
<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>


Provides quality management features, including:
Provides quality management features, including:


* Access to historical pathology data during microscopic examination
* Access to historical pathology data during microscopic examination of current specimens.
of current specimens. * Lists of incomplete cytology, surgical
* Lists of incomplete cytology, surgical pathology, EM, and autopsy reports.
pathology, EM, and autopsy reports. * Turnaround time reports for all
* Turnaround time reports for all anatomic pathology sections.
anatomic pathology sections. * Generation of defined groups of cases
* 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.
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.
* On-command printing of laboratory test results of specified tests.
* Tracking outcomes of Quality Management review.
* Tracking outcomes of Quality Management review.




Increases productivity through:
Increases productivity through:


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




Provides comprehensive searching/reporting capabilities, including:
Provides comprehensive searching/reporting capabilities, including:


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


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


Provides workload statistics for:
Provides workload statistics for:


* Number of specimens accessioned by area.
<div style="margin-left: 2em">
* Number of blocks, slides, and stains prepared.


==== '''Laboratory: Blood Bank''' ====
* Number of specimens accessioned by area. * Number of blocks, slides,
and stains prepared.


'''Overview'''
</div>


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.
=== <font face="Arial, sans-serif"><font style="font-size:
16pt" size="4"><span lang="en-US">'''Laboratory: Blood
Bank'''</span></font></font> ===


'''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.
<font size="3">'''Overview'''</font>
* 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:
<font face="Arial, sans-serif"><font size="2">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.</font></font>


* 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.

<font size="3">'''Features'''</font>

* 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:
* Decreases clerical workload through:


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


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


* Improves utilization review/resource management through:
* Improves utilization review/resource management through:


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


===== Laboratory: Electronic Data Interchange (LEDI) =====
==== 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.
<font size="3">'''Overview'''</font>


'''Features'''
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.


* 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.


<!-- file -->
==== Medicine ====


'''Overview'''
<font face="Arial, sans-serif"><font size="2">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.</font></font>


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.
<font size="3">'''Features'''</font>
* 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).


<!-- file -->
* Addresses the electronic lab test order transfer from the host facility
==== Mental Health ====
laboratory to collection facilities laboratories. * Provides for the
===== Status: Mental Health supported, except ASI-MV missing =====
automated transfer of verified test results from the host facility back
{{WorldVistA-Check}} Mental Health Features supported by WorldVistA, except:<br>
to the collection facility’s laboratory for release to the patient
{{WorldVistA-Not}} ASI-MV missing from WorldVistA because of copyright issues.
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.


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


'''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'''
<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

<font face="Arial, sans-serif"><font size="2">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.</font></font>



<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>

* <font face="Arial, sans-serif"><font size="2">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.</font></font> * <font face="Arial,
sans-serif"><font size="2">Provides both scroll mode and screen
entry features for all components and provides word processing-based
consult software for all procedures.</font></font> * <font face="Arial,
sans-serif"><font size="2">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.</font></font>
* <font face="Arial, sans-serif"><font size="2">Allows the entry
and edit of Esophageal Gastroduodenoscopy (EGD), Endoscopic
Retrograde Cholangiogram and Pancreatogram (ERCP), Colonoscopy,
and Laparoscopy findings or data.</font></font> * <font face="Arial,
sans-serif"><font size="2">Allows the entry, edit, and printing of
endoscopic data and Pulmonary Function test data.</font></font> *
<font face="Arial, sans-serif"><font size="2">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.</font></font>
* <font face="Arial, sans-serif"><font size="2">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.</font></font> * <font face="Arial, sans-serif"><font
size="2">Permits data entry and edit of Bone Marrow Aspirates (BMA)
and Bone Marrow Biopsies (BMB).</font></font> * <font face="Arial,
sans-serif"><font size="2">Allows the tracking of Rheumatology visits and
is based on standards developed by the American Rheumatology Associations
Medical Information System (ARAMIS).</font></font>





















===== Mental Health =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

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.



<font size="3">'''Features'''</font>


<u>Provides a mini clinical record that includes:</u>
<u>Provides a mini clinical record that includes:</u>


* 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.
* <font face="Arial, sans-serif"><font size="2">A patient profile
* Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and International Classification of Diseases (ICD-9) diagnoses.
with demographic information and a brief index of the clinical
* Psychological test and interview results, reviews of systems, past medical histories, crisis notes, clinical patient messages, and progress notes.
database, including physical examinations, psychological tests,
* 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.
clinical interviews, problem list, and diagnoses.</font></font> * <font
* 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.
face="Arial, sans-serif"><font size="2">Diagnostic and Statistical Manual
of Mental Disorders (DSM-IV) and International Classification of Diseases
(ICD-9) diagnoses.</font></font> * <font face="Arial, sans-serif"><font
size="2">Psychological test and interview results, reviews of systems,
past medical histories, crisis notes, clinical patient messages, and
progress notes.</font></font> * <font face="Arial, sans-serif"><font
size="2">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.</font></font> * <font face="Arial, sans-serif"><font
size="2">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.</font></font>



<u>VistA</u><u>Mental Health (MH)</u> <u>Addiction Severity Index</u>
<u>Multimedia Version (ASI-MV)</u><u><nowiki>:</nowiki></u>

* Introduces the new functionality required to run the
commercial-off-the-shelf (COTS) Addiction Severity Index Multimedia
Version (ASI-MV) software. * Allows clinicians and patients to enter
demographics and self-administered ASI-MV interviews via a workstation
using video and audio technology. * Is a significant time-saver for
clinicians, because clinicians need not be present during the interview.
* Provides the patients with privacy and appropriate time to complete
an interview.


<u>VistA</u><u>Mental Health (MH)</u> <u>Addiction Severity Index</u> <u>Multimedia Version (ASI-MV)</u><u><nowiki>:</nowiki></u>


* Introduces the new functionality required to run the commercial-off-the-shelf (COTS) Addiction Severity Index Multimedia Version (ASI-MV) software.
* Allows clinicians and patients to enter demographics and self-administered ASI-MV interviews via a workstation using video and audio technology.
* Is a significant time-saver for clinicians, because clinicians need not be present during the interview.
* Provides the patients with privacy and appropriate time to complete an interview.


<u>VistA Mental Health Assistant (MHA) Graphical User Interface (GUI):</u>
<u>VistA Mental Health Assistant (MHA) Graphical User Interface (GUI):</u>


* Provides a crash recovery file. * Displays patient demographics data,
* Provides a crash recovery file.
which can be printed, copied to the Windows clipboard, or saved to a
* Displays patient demographics data, which can be printed, copied to the Windows clipboard, or saved to a text file.
text file. * Context-sensitive help is available for most items, with
* Context-sensitive help is available for most items, with suggestions for test administration and interpretations.
* Provides a user-friendly interface for entering interview data for ASI.
suggestions for test administration and interpretations. * Provides a
* Enhances the ability of both staff and patients to enter psychological test data.
user-friendly interface for entering interview data for ASI.
* Creates reports and graphical displays of complex tests by sub-category or scales.

* Creates psychological test order windows that display tests that can be ordered based on the provider privileges.
<font face="Arial, sans-serif"><font size="3">'''Mental
* Provides a text report of selected tests and graphs of numeric scores.
Healthâ€"continued'''</font></font>
<!-- file -->

* <font face="Arial, sans-serif"><font size="2">Enhances the ability of
both staff and patients to enter psychological test data.</font></font>
* <font face="Arial, sans-serif"><font size="2">Creates reports
and graphical displays of complex tests by sub-category or
scales.</font></font>

* <font face="Arial, sans-serif"><font size="2">Creates psychological
test order windows that display tests that can be ordered based on the
provider privileges.</font></font> * <font face="Arial, sans-serif"><font
size="2">Provides a text report of selected tests and graphs of numeric
scores.</font></font>

===== Nursing =====



<font face="Arial, sans-serif">'''Overview'''</font>


==== Nursing ====
<font face="Arial, sans-serif"><font size="2">The Nursing application is
a component of the Department of Veterans Affairs VistA program. It is
comprised of multiple modules (i.e., Administration, Education, Clinical,
Quality Assurance, and Package Management).</font></font>


'''Overview'''


The Nursing application is a component of the Department of Veterans Affairs VistA program. It is comprised of multiple modules (i.e., Administration, Education, Clinical, Quality Assurance, and Package Management).


'''Features'''
<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>


The nursing software includes the following functionalities:
The nursing software includes the following functionalities:


<u>Administration:</u>
<font face="Arial, sans-serif"><font
size="2"><u>Administration:</u></font></font>


* Tracks staff information.
* <font face="Arial, sans-serif"><font size="2">Tracks staff
* Generates management reports on employees.
information.</font></font> * <font face="Arial, sans-serif"><font
* Accumulates daily statistics on the number of patients treated.
size="2">Generates management reports on employees.</font></font> * <font
* Generates daily, monthly, quarterly, and yearly AMIS Reports.
face="Arial, sans-serif"><font size="2">Accumulates daily statistics
* Provides workload statistics based on AMIS data.
on the number of patients treated.</font></font> * <font face="Arial,
* Provides miscellaneous patient acuity reports.
sans-serif"><font size="2">Generates daily, monthly, quarterly, and
yearly AMIS Reports.</font></font> * <font face="Arial, sans-serif"><font
size="2">Provides workload statistics based on AMIS data.</font></font>
* <font face="Arial, sans-serif"><font size="2">Provides miscellaneous
patient acuity reports.</font></font>


<u>Clinical:</u>


* Contains a patient classification system which generates reports by bed section and ward.
* Includes nationally developed standard nursing care plans for initiating patient care plan generation.
* Allows nurses to generate a patient care plan based on patient problems, identified goals, and specified nursing interventions.
* Allows a staff nurse to update a patient's nursing ward location and/or nursing AMIS bed section to insure accurate patient classification entries.
* Allows users to enter vital signs, height, and weight for patients.
* Allows users to generate Intake and Output reports, an End of Shift Report, and a Health Summary Report by patient or ward.


<u>Package Management:</u>
<font face="Arial, sans-serif"><font
size="2"><u>Clinical:</u></font></font>


* Allows sites to modify data in specified nursing files.
* <font face="Arial, sans-serif"><font size="2">Contains a patient
* Provides special ADP Coordinator functions for executing nursing options that affect patient acuity, manhours, FTEE status, etc.
classification system which generates reports by bed section
* Provides ADP Coordinator options for admitting/transferring/discharging patients within the Nursing system when the MAS System is off-line.
and ward.</font></font> * <font face="Arial, sans-serif"><font
size="2">Includes nationally developed standard nursing care plans
for initiating patient care plan generation.</font></font> * <font
face="Arial, sans-serif"><font size="2">Allows nurses to generate a
patient care plan based on patient problems, identified goals, and
specified nursing interventions.</font></font> * <font face="Arial,
sans-serif"><font size="2">Allows a staff nurse to update a patient's
nursing ward location and/or nursing AMIS bed section to insure accurate
patient classification entries.</font></font> * <font face="Arial,
sans-serif"><font size="2">Allows users to enter vital signs,
height, and weight for patients.</font></font> * <font face="Arial,
sans-serif"><font size="2">Allows users to generate Intake and Output
reports, an End of Shift Report, and a Health Summary Report by patient
or ward.</font></font>


<!-- file -->
==== Nutrition and Food Service (N&amp;FS) ====


'''Overview'''


The Nutrition and Food Service (N&amp;FS) software integrates the automation of many Clinical Nutrition, Food Management, and Management Reports functions. The Clinical N&amp;FS activities of Nutrition Screening, Nutrition Assessment, Diet Order Entry, Tube Feeding and Supplemental Feeding Orders, Patient Food Preferences, Specific Diet Pattern Calculations, Nutrient Analysis of meals, Consult Reporting, Encounter Tracking, and Quality Care Monitoring are all available in this program. The Food Management function has complete automation of food production activities; Service and Distribution, Inventory and Cost Management, Recipe Expansion, Menu and Recipe Nutrient Analysis, Meal and Diet Pattern Development and Implementation, Diet Card and Tray Ticket Printing, and Quality Service Tracking are available. The Management Reports include the Served Meals, Additional Meals, Cost Per Meal, Tube Feeding Cost, Supplemental Feeding Cost, Staffing Data, Encounter Data and Annual Management Reports.
<font face="Arial, sans-serif"><font size="2"><u>Package
Management:</u></font></font>


'''Features'''
* <font face="Arial, sans-serif"><font size="2">Allows sites to modify
data in specified nursing files.</font></font> * <font face="Arial,
sans-serif"><font size="2">Provides special ADP Coordinator
functions for executing nursing options that affect patient acuity,
manhours, FTEE status, etc.</font></font> * <font face="Arial,
sans-serif"><font size="2">Provides ADP Coordinator options for
admitting/transferring/discharging patients within the Nursing system
when the MAS System is off-line.</font></font>


* Allows the building of a site-specific listing of patient food preferences that can be incorporated in meal production calculations and the printed diet card and tray tickets programs.
* Manages patients' requests or dietary requirements for specific food items or utensils, allowing the selection of standing orders for any patient, for any meal or quantity.
* Controls all aspects of ingredient usage.
* Develops a list of site-specific recipes that includes portion size, preparation area and time, equipment and serving utensils, recipe category, ingredients, and directions for preparation. Recipes can be quickly analyzed for their nutrient value.
* Creates multiple meals and menu cycles. Meals can be used in different patterns by creating menu cycles or by creating special holiday dates within a cycle. It allows for the nutrient analysis of meals or daily/weekly menus.
* Controls quantities produced in the Food Management program. Specific patient diet orders are reorganized into production diets and diet patterns that reflect the foods to be served. This information is used along with data from the meal file to generate production reports, diet cards and/or tray tickets. A forecasting tool also exists in this section that allows the manager to anticipate, by percentage of total census, the type and quantity of various production diets that will be needed by any selected service point.
* Allows the entry of information required by the Annual Report that is not automatically retrieved from the program.
* Prints a patient-specific record of all diet order entry information.
* Controls the order entry activity.
* Manages food items and their nutrients using the latest USDA data, food items from Bowes and Church, and additional data from research.
* Handles N&amp;FS consults and allows the reassignment of active consults from one staff member to another.
* Manages the supplemental feeding food items and menus. A supplemental feeding menu automatically goes into effect at the time of diet order entry and changes automatically with new orders.


<!-- file -->
==== Oncology ====


'''Overview'''


The Oncology module automates the tumor registry and supports tumor registrars in abstracting cancer cases, following up on cancer patients and producing the Hospital Annual Report. Functions are grouped according to order of use: Case Finding and Suspense; Abstracting, Printing and Quality Management; Follow-up; Registry Lists; Annual Reports; Statistical Reports; and Utilities.


The Oncology application functions in accordance with the current editions of American College of Surgeons (ACOS). It contains required data standards and data sets necessary to bring the tumor registry module into compliance with the Facility Oncology Registry Data Standards (FORDS) 2003 specifications approved by the Commission on Cancer (COC); Surveillance, Epidemiology, and End Results Reporting (SEER) Extent of Disease for site-specific surgery; International Classification of Disease-Oncology 3rd Edition; and American Joint Commission on Cancer (AJCC) Manual for the Staging of Cancer, 1st through 6th Editions.
===== Nutrition and Food Service (N&amp;FS) =====


'''Features'''


* The software supports multi-divisional sites.


* The program automatically finds cases by searching the database from Anatomical Pathology (Surgery, Cytology, Electron Microscopy, and Autopsy), Radiology, and Patient Treatment File (PTF). Cases can be entered into the Suspense File by date of diagnosis, and chart request pull lists can be printed.
<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>
* Demographics are drawn directly from Patient Information Management System (PIMS) patient file and stored permanently. Cancer identification data is obtained from the local database (e.g., laboratory and radiology test results).
* The program accessions and abstracts with extensive on-line help and stages extent of disease automatically.
* It produces a wide range of follow-up lists and registry lists needed for accreditation and allows entry of contacts directly into Oncology Contact File.
* Professional letters covering diverse situations and customization of letters are available.
* Predefined annual reports can be generated and the user can create specialized reports using VA FileMan.
* Reports to the Associate Chief of Staff (ACOS) can be generated using special routines that extract data onto floppy disk. The same functionality is available for state reporting.
* The database can be customized to suit the individual hospital.
* The full set of TNM codes is included from the appropriate edition of the AJCC Manual on Staging of Cancer.
* The program allows on-line completion of Patient Care Evaluations (PCEs) during the abstracting function if the case being abstracted fulfills the selection criteria for the PCE.


<!-- file -->
The Nutrition and Food Service (N&amp;FS) software integrates the
==== Pharmacy: Automatic Replenishment/Ward Stock (AR/WS) ====
automation of many Clinical Nutrition, Food Management, and Management
Reports functions. The Clinical N&amp;FS activities of Nutrition
Screening, Nutrition Assessment, Diet Order Entry, Tube Feeding and
Supplemental Feeding Orders, Patient Food Preferences, Specific Diet
Pattern Calculations, Nutrient Analysis of meals, Consult Reporting,
Encounter Tracking, and Quality Care Monitoring are all available in
this program. The Food Management function has complete automation of
food production activities; Service and Distribution, Inventory and
Cost Management, Recipe Expansion, Menu and Recipe Nutrient Analysis,
Meal and Diet Pattern Development and Implementation, Diet Card and
Tray Ticket Printing, and Quality Service Tracking are available. The
Management Reports include the Served Meals, Additional Meals, Cost
Per Meal, Tube Feeding Cost, Supplemental Feeding Cost, Staffing Data,
Encounter Data and Annual Management Reports.


'''Overview'''


The Automatic Replenishment/Ward Stock (AR/WS) package provides a method to track drug distribution and inventory management within a medical center. The AR/WS module is designed to allow each medical center to adapt the system to its own needs.


<font size="3">'''Features'''</font>
'''Features'''


The AR/WS package:
* <font face="Arial, sans-serif"><font size="2">Allows the building of a
site-specific listing of patient food preferences that can be incorporated
in meal production calculations and the printed diet card and tray
tickets programs.</font></font> * <font face="Arial, sans-serif"><font
size="2">Manages patients' requests or dietary requirements for
specific food items or utensils, allowing the selection of standing
orders for any patient, for any meal or quantity.</font></font> *
<font face="Arial, sans-serif"><font size="2">Controls all aspects of
ingredient usage.</font></font> * <font face="Arial, sans-serif"><font
size="2">Develops a list of site-specific recipes that includes portion
size, preparation area and time, equipment and serving utensils, recipe
category, ingredients, and directions for preparation. Recipes can
be quickly analyzed for their nutrient value.</font></font> * <font
face="Arial, sans-serif"><font size="2">Creates multiple meals and
menu cycles. Meals can be used in different patterns by creating menu
cycles or by creating special holiday dates within a cycle. It allows
for the nutrient analysis of meals or daily/weekly menus.</font></font>
* <font face="Arial, sans-serif"><font size="2">Controls quantities
produced in the Food Management program. Specific patient diet orders
are reorganized into production diets and diet patterns that reflect
the foods to be served. This information is used along with data from
the meal file to generate production reports, diet cards and/or tray
tickets. A forecasting tool also exists in this section that allows
the manager to anticipate, by percentage of total census, the type and
quantity of various production diets that will be needed by any selected
service point.</font></font> * <font face="Arial, sans-serif"><font
size="2">Allows the entry of information required by the Annual Report
that is not automatically retrieved from the program.</font></font> *
<font face="Arial, sans-serif"><font size="2">Prints a patient-specific
record of all diet order entry information.</font></font> * <font
face="Arial, sans-serif"><font size="2">Controls the order entry
activity.</font></font> * <font face="Arial, sans-serif"><font
size="2">Manages food items and their nutrients using the latest
USDA data, food items from Bowes and Church, and additional data
from research.</font></font> * <font face="Arial, sans-serif"><font
size="2">Handles N&amp;FS consults and allows the reassignment of
active consults from one staff member to another.</font></font> * <font
face="Arial, sans-serif"><font size="2">Manages the supplemental feeding
food items and menus. A supplemental feeding menu automatically goes
into effect at the time of diet order entry and changes automatically
with new orders.</font></font>


* Provides inventory management capabilities for clinical care locations and drug crash carts.
===== Oncology =====


* Allows easy drug item inactivation for inventory locations.
* Provides tools to develop medication storage areas with lists of drugs to be maintained in that area. Drugs are classified by inventory type and assigned storage location and stock level.
* Groups medication storage areas together by inventory group name. Grouping may be by location, date (time or frequency of inventory), or inventory type.
* Provides tools to conduct inventory: prints inventory sheets and/or pick lists to determine stock to be replenished in medication storage areas and, by a selected method, replaces needed inventory items.


* Maintains backorder totals if a physical inventory is conducted and entered into AR/WS software.
* Provides inventory management reporting capabilities for clinical care locations and drug crash carts.


* Provides ability to select by inventory group on all reports.
<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>
* Supplies a report to fill on-demand requests for out-of-stock items or items not part of the standard inventory.
* Provides various printouts as well as several management statistical reports for the creation and maintenance of the system.


==== Pharmacy: Bar Code Medication Administration (BCMA) ====
<font face="Arial, sans-serif"><font size="2">The Oncology module
automates the tumor registry and supports tumor registrars in abstracting
cancer cases, following up on cancer patients and producing the Hospital
Annual Report. Functions are grouped according to order of use: Case
Finding and Suspense; Abstracting, Printing and Quality Management;
Follow-up; Registry Lists; Annual Reports; Statistical Reports; and
Utilities.</font></font>


'''Overview'''


Bar Code Medication Administration (BCMA) software provides a real-time, point-of-care solution for validating the administration of Unit Dose (UD) and Intravenous (IV) medications to inpatients in Veterans Administration Medical Centers (VAMCs). BCMA uses a Graphical User Interface (GUI), MS Windows-based Client/Server architecture, designed to improve the accuracy of the medication administration process, and to increase the efficiency of the administration documentation process. The end result is enhanced patient safety and patient care at VAMCs. As a clinician scans each patient wristband and medication using a bar code scanner, BCMA immediately validates the patient and their medication, and that the medication is ordered, timely, and in the correct dosage. At the same time, BCMA electronically updates the patient's Medication Administration History (MAH). The software is fully compatible with other VistA applications.


'''Features'''
<font face="Arial, sans-serif"><font size="2">The Oncology application
functions in accordance with the current editions of American College
of Surgeons (ACOS). It contains required data standards and data sets
necessary to bring the tumor registry module into compliance with the
Facility Oncology Registry Data Standards (FORDS) 2003 specifications
approved by the Commission on Cancer (COC); Surveillance, Epidemiology,
and End Results Reporting (SEER) Extent of Disease for site-specific
surgery; International Classification of Diseaseâ€"Oncology 3rd
Edition; and American Joint Commission on Cancer (AJCC) Manual for the
Staging of Cancer, 1st through 6th Editions.</font></font>


The BCMA software provides the following features:


* Medication Tabs on a patient's Virtual Due List (VDL) are designed for separating and viewing the different types of active Unit Dose, IV Push, IV Piggyback, and large-volume IV medication orders. Each Tab provides an "alert" light, which turns green only when the patient has active medication orders for that Tab.
* Patient safety tools include a Missed Medications Report, an alert when due medications are not administered, a notification when a patient is transferred, and an alert light to indicate that a medication order exists for the Schedule Type and Start/Stop Date and Time selected on the VDL. Other tools include a listing of Allergies and Adverse Drug Reactions (ADRs) that are documented for a patient in the Allergy/Adverse Reaction Tracking (ART) package.
* A Computerized Patient Record System (CPRS) Med Order Button (or "Hot Button") on the BCMA Tool Bar streamlines the workflow in ICU-type environments. This button links nurses directly to CPRS for electronically ordering, documenting, reviewing and signing verbal and telephone STAT and NOW (One-Time) medication orders already administered to patients.
* BCMA increases the amount and type of information available to nurses at the point of care, improves communications between Nursing and Pharmacy staff, records Missing Doses for patients, sends an electronic Missing Dose Request to the Pharmacy, and supports Health Level Seven (HL7) messaging.
* Management and accountability tools identify PRN entries that require effectiveness comments and pain scores, list medications that were not scanned as administered during an administration time window, list early/late administration variances, and allow nurses to set site-specific parameters and defaults on their systems.
* Compiles reports by Patient or by Ward for Nursing, Pharmacy, and Information Resources Management (IRM). Reports available for printing include: a Medication Administration History, Medication Log, Missed Medications, Missing Dose Request, PRN Effectiveness Log, Medication Due List, Medication History, Medication Variance Report, Cumulative Vitals/Measurement Report, and Administration Times Report.


==== Pharmacy: Consolidated Mail Outpatient Pharmacy (CMOP) ====
<font size="3">'''Features'''</font>


'''Overview'''
* <font size="2">The software supports multi-divisional sites.</font>


The Consolidated Mail Outpatient Pharmacy (CMOP) package provides a regional system resource to expedite the distribution of mail-out prescriptions to veteran patients. CMOP host facilities, regionally located, receive data from medical centers within the area of service. Current CMOPs are designed to handle the dispensing and mailing of between 20,000 and 40,000 prescriptions in an 8-hour workday.
* <font size="2">The program automatically finds cases by searching
the database from Anatomical Pathology (Surgery, Cytology, Electron
Microscopy, and Autopsy), Radiology, and Patient Treatment File
(PTF). Cases can be entered into the Suspense File by date of diagnosis,
and chart request pull lists can be printed.</font> * Demographics are
drawn directly from Patient Information Management System (PIMS) patient
file and stored permanently. Cancer identification data is obtained from
the local database (e.g., laboratory and radiology test results). * The
program accessions and abstracts with extensive on-line help and stages
extent of disease automatically. * It produces a wide range of follow-up
lists and registry lists needed for accreditation and allows entry of
contacts directly into Oncology Contact File. * Professional letters
covering diverse situations and customization of letters are available.
* Predefined annual reports can be generated and the user can create
specialized reports using VA FileMan. * Reports to the Associate Chief
of Staff (ACOS) can be generated using special routines that extract data
onto floppy disk. The same functionality is available for state reporting.
* The database can be customized to suit the individual hospital. *
The full set of TNM codes is included from the appropriate edition of the
AJCC Manual on Staging of Cancer. * <font face="Arial, sans-serif"><font
size="2">The program allows on-line completion of Patient Care Evaluations
(PCEs) during the abstracting function if the case being abstracted
fulfills the selection criteria for the PCE.</font></font>


'''Features'''








===== Pharmacy: Automatic Replenishment/Ward Stock (AR/WS) =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

The Automatic Replenishment/Ward Stock (AR/WS) package provides a method
to track drug distribution and inventory management within a medical
center. The AR/WS module is designed to allow each medical center to
adapt the system to its own needs.



<font size="3">'''Features'''</font>

<font size="2">The AR/WS package:</font>

* <font face="Arial, sans-serif"><font size="2">Provides inventory
management capabilities for clinical care locations and drug crash
carts.</font></font>

* <font face="Arial, sans-serif"><font size="2">Allows easy drug
item inactivation for inventory locations.</font></font> * <font
face="Arial, sans-serif"><font size="2">Provides tools to develop
medication storage areas with lists of drugs to be maintained in that
area. Drugs are classified by inventory type and assigned storage location
and stock level.</font></font> * <font face="Arial, sans-serif"><font
size="2">Groups medication storage areas together by inventory group
name. Grouping may be by location, date (time or frequency of inventory),
or inventory type.</font></font> * <font face="Arial, sans-serif"><font
size="2">Provides tools to conduct inventory: prints inventory sheets
and/or pick lists to determine stock to be replenished in medication
storage areas and, by a selected method, replaces needed inventory
items.</font></font>

* <font face="Arial, sans-serif"><font size="2">Maintains backorder
totals if a physical inventory is conducted and entered into
AR/WS software.</font></font> * <font face="Arial, sans-serif"><font
size="2">Provides inventory management reporting capabilities for clinical
care locations and drug crash carts.</font></font>

* <font face="Arial, sans-serif"><font size="2">Provides ability
to select by inventory group on all reports.</font></font> *
<font face="Arial, sans-serif"><font size="2">Supplies a report
to fill on-demand requests for out-of-stock items or items not
part of the standard inventory.</font></font> * <font face="Arial,
sans-serif"><font size="2">Provides various printouts as well as several
management statistical reports for the creation and maintenance of the
system.</font></font>

<div style="margin-left: 2em">

</div>



===== Pharmacy: Bar Code Medication Administration (BCMA) =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

<font face="Arial, sans-serif"><font size="2">Bar Code Medication
Administration (BCMA) software provides a real-time, point-of-care
solution for validating the administration of Unit Dose (UD) and
Intravenous (IV) medications to inpatients in Veterans Administration
Medical Centers (VAMCs). BCMA uses a Graphical User Interface (GUI),
MS Windows-based Client/Server architecture, designed to improve the
accuracy of the medication administration process, and to increase the
efficiency of the administration documentation process. The end result
is enhanced patient safety and patient care at VAMCs. As a clinician
scans each patient wristband and medication using a bar code scanner,
BCMA immediately validates the patient and their medication, and that
the medication is ordered, timely, and in the correct dosage. At the
same time, BCMA electronically updates the patient’s Medication
Administration History (MAH). The software is fully compatible with
other VistA applications.</font></font>



<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>

<font face="Arial, sans-serif"><font size="2">The BCMA software provides
the following features:</font></font>

* <font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">Medication Tabs on a patient’s
Virtual Due List (VDL) are designed for separating and viewing
the different types of active</font></font> <font face="Arial,
sans-serif"><font size="2">Unit Dose, IV Push, IV Piggyback, and
large-volume IV</font></font> <font face="Arial, sans-serif"><font
size="2">medication orders. Each Tab provides an “alertâ€
light, which turns green only when the patient has active medication
orders for that Tab.</font></font></font></font> * <font face="Arial,
sans-serif"><font size="2">Patient safety tools include a Missed
Medications Report, an alert when due medications are not administered, a
notification when a patient is transferred, and an alert light to indicate
that a medication order exists for the Schedule Type and Start/Stop Date
and Time selected on the VDL. Other tools include a listing of Allergies
and Adverse Drug Reactions (ADRs) that are documented for a patient in the
Allergy/Adverse Reaction Tracking (ART) package.</font></font> * <font
face="Arial, sans-serif"><font size="2">A Computerized Patient Record
System (CPRS) Med Order Button (or “Hot Buttonâ€) on the BCMA
Tool Bar streamlines the workflow in ICU-type environments. This button
links nurses directly to CPRS for electronically ordering, documenting,
reviewing and signing verbal and telephone STAT and NOW (One-Time)
medication orders already administered to patients.</font></font> * <font
face="Times New Roman, serif"><font size="3"><font face="Helvetica,
sans-serif"><font size="2">BCMA</font></font> <font face="Arial,
sans-serif"><font size="2">increases the amount and type of information
available to nurses at the point of care, improves communications between
Nursing and Pharmacy staff, records Missing Doses for patients, sends an
electronic Missing Dose Request to the Pharmacy, and supports Health Level
Seven (HL7) messaging.</font></font></font></font> * <font face="Arial,
sans-serif"><font size="2">Management and accountability tools identify
PRN entries that require effectiveness comments and pain scores, list
medications that were not scanned as administered during an administration
time window, list early/late administration variances, and allow nurses to
set site-specific parameters and defaults on their systems.</font></font>
* <font face="Arial, sans-serif"><font size="2">Compiles reports by
Patient or by Ward for Nursing, Pharmacy, and Information Resources
Management (IRM). Reports available for printing include: a Medication
Administration History, Medication Log, Missed Medications, Missing Dose
Request, PRN Effectiveness Log, Medication Due List, Medication History,
Medication Variance Report, Cumulative Vitals/Measurement Report, and
Administration Times Report.</font></font>

===== Pharmacy: Consolidated Mail Outpatient Pharmacy (CMOP) =====



<font size="3">'''Overview'''</font>

The Consolidated Mail Outpatient Pharmacy (CMOP) package provides
a regional system resource to expedite the distribution of mail-out
prescriptions to veteran patients. CMOP host facilities, regionally
located, receive data from medical centers within the area of
service. Current CMOPs are designed to handle the dispensing and mailing
of between 20,000 and 40,000 prescriptions in an 8-hour workday.



<font size="3">'''Features'''</font>


The CMOP package provides the following features:
The CMOP package provides the following features:


* Patients submit medication requests via telephone, mail, or in person at
* Patients submit medication requests via telephone, mail, or in person at each medical facility. When necessary, pharmacy personnel enter the orders into the patient database.
* Each area CMOP host facility establishes a schedule for the electronic transmission of the prescription data.
each medical facility. When necessary, pharmacy personnel enter the orders
* Prescriptions are transmitted electronically from the medical facility to the automated prescription dispensing equipment, checked by a pharmacist, mailed to the patient, and information on the prescription filled is returned to update the medical center database.
into the patient database. * Each area CMOP host facility establishes
* The process is highly integrated with the Outpatient Pharmacy software and requires no additional processing by pharmacy personnel responsible for entering the prescription.
a schedule for the electronic transmission of the prescription data. *
* All prescriptions are automatically screened by the CMOP software and set for transmission if appropriate.
Prescriptions are transmitted electronically from the medical facility to
* The user is then notified that the prescription will be dispensed by the CMOP. Once the prescription is processed by the CMOP, the prescription file at the medical center is updated accordingly.
the automated prescription dispensing equipment, checked by a pharmacist,
* Pharmacy staff may view the prescription at any time to determine if it has been transmitted to CMOP, dispensed, not dispensed, etc.
mailed to the patient, and information on the prescription filled
* Upon fulfillment of the medication order by the CMOP, any applicable pharmacy prescription co-payment is billed as the medical center files are updated with the release information.
is returned to update the medical center database. * The process is
* The software provides order tracking and operational data for the CMOPs.
highly integrated with the Outpatient Pharmacy software and requires
* The software allows prescriptions written for schedule III-V controlled substances to be electronically transmitted to the CMOP facilities.
no additional processing by pharmacy personnel responsible for entering
the prescription. * All prescriptions are automatically screened by the
CMOP software and set for transmission if appropriate. * The user is
then notified that the prescription will be dispensed by the CMOP. Once
the prescription is processed by the CMOP, the prescription file at the
medical center is updated accordingly. * Pharmacy staff may view the
prescription at any time to determine if it has been transmitted to CMOP,
dispensed, not dispensed, etc. * Upon fulfillment of the medication order
by the CMOP, any applicable pharmacy prescription co-payment is billed
as the medical center files are updated with the release information. *
The software provides order tracking and operational data for the CMOPs.
* The software allows prescriptions written for schedule III-V controlled
substances to be electronically transmitted to the CMOP facilities.


==== Pharmacy: Controlled Substances ====


'''Overview'''


The Controlled Substances package provides functionality to monitor and track the receipt, inventory, and dispensing of all controlled substances. This software provides the pharmacy with the capability to define a controlled substance location and a list of controlled substances to maintain a perpetual inventory. The capability for Pharmacy personnel to receive a controlled substance order, which automatically updates the quantity on hand and receipt history, is also available. Nursing personnel can request orders for controlled substances via on-demand requests and receive these orders when delivered from Pharmacy. Pharmacy may dispense controlled substances, using the automated VA forms 10-2321 and 10-2638, to complete an order request.


'''Features'''


The Controlled Substances package provides the following features:


* Monitors/tracks the receipt, inventory, and dispensing of controlled substances.
* Allows management inspections to automatically identify discrepancies in stock levels.
* Allows nursing to place orders for controlled substances via on-demand requests.
* Provides AMIS and cost reporting data.
* Maintains perpetual vault inventory balances.
* Provides the functionality to return to stock, transfer between locations, cancel orders, and log outpatient prescriptions.
* Automates current inventory requirements that allow medical facilities to detect discrepancies or diversions of controlled substances, thereby improving overall drug accountability.


==== Pharmacy: Drug Accountability/Inventory Interface ====


'''Overview'''


The Drug Accountability/Inventory Interface works toward perpetual inventory for each VA medical facility pharmacy by tracking all drugs through pharmacy locations. Drugs are added to the pharmacy location as they are received from the Prime Vendor and CoreFLS. Both methods allow sites to receive invoice information containing data for confirmed orders. The files are uploaded into Drug Accountability, processed, and upon verification, the pharmacy locations or master vaults are updated. Dispensing data is collected from pharmacy packages to decrement balances. Drug Accountability also provides the capability for Pharmacy personnel to display or print procurement history, drug balance adjustments, and order data.


'''Features'''


There are two primary methods of receiving invoice data into Drug Accountability:
===== Pharmacy: Controlled Substances =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

The Controlled Substances package provides functionality to monitor
and track the receipt, inventory, and dispensing of all controlled
substances. This software provides the pharmacy with the capability to
define a controlled substance location and a list of controlled substances
to maintain a perpetual inventory. The capability for Pharmacy personnel
to receive a controlled substance order, which automatically updates the
quantity on hand and receipt history, is also available. Nursing personnel
can request orders for controlled substances via on-demand requests and
receive these orders when delivered from Pharmacy. Pharmacy may dispense
controlled substances, using the automated VA forms 10â€"2321 and
10â€"2638, to complete an order request.



<font size="3">'''Features'''</font>

<font size="2">The Controlled Substances package provides the following
features:</font>

* <font size="2">Monitors/tracks the receipt, inventory, and dispensing
of controlled substances.</font> * Allows management inspections to
automatically identify discrepancies in stock levels. * Allows nursing to
place orders for controlled substances via on-demand requests. * Provides
AMIS and cost reporting data. * Maintains perpetual vault inventory
balances. * Provides the functionality to return to stock, transfer
between locations, cancel orders, and log outpatient prescriptions. *
Automates current inventory requirements that allow medical facilities
to detect discrepancies or diversions of controlled substances, thereby
improving overall drug accountability.







===== Pharmacy: Drug Accountability/Inventory Interface =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

The Drug Accountability/Inventory Interface works toward perpetual
inventory for each VA medical facility pharmacy by tracking all drugs
through pharmacy locations. Drugs are added to the pharmacy location as
they are received from the Prime Vendor and CoreFLS. Both methods allow
sites to receive invoice information containing data for confirmed
orders. The files are uploaded into Drug Accountability, processed,
and upon verification, the pharmacy locations or master vaults are
updated. Dispensing data is collected from pharmacy packages to
decrement balances. Drug Accountability also provides the capability
for Pharmacy personnel to display or print procurement history, drug
balance adjustments, and order data.



<font size="3">'''Features'''</font>

<font face="Arial, sans-serif"><font size="2">There are two primary
methods of receiving invoice data into Drug Accountability:</font></font>

* <font face="Arial, sans-serif"><font size="2">Prime Vendor
Data</font></font> * <font face="Arial, sans-serif"><font size="2">CoreFLS
Data</font></font>



<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">Both methods involve having the user
place the invoice orders with the appropriate company. With the prime
vendor, the data is uploaded into</font></font> <font face="Arial,
sans-serif"><font size="2">VistA</font></font><font face="Arial,
sans-serif"><font size="2">using a Graphical User Interface to perform the
upload. With CoreFLS, the data is automatically shipped to</font></font>
<font face="Arial, sans-serif"><font size="2">VistA</font></font>
<font face="Arial, sans-serif"><font size="2">upon receipt at the
warehouse.</font></font></font></font>


* Prime Vendor Data
* CoreFLS Data


Both methods involve having the user place the invoice orders with the appropriate company. With the prime vendor, the data is uploaded into VistAusing a Graphical User Interface to perform the upload. With CoreFLS, the data is automatically shipped to VistA upon receipt at the warehouse.


The '''Prime Vendor Interface''' includes the following features:
The '''Prime Vendor Interface''' includes the following features:


* It automatically updates the Drug Accountability pharmacy locations based on dispensing and receiving information, and it also updates master vaults based on receiving information.
* <font face="Arial, sans-serif"><font size="2">It automatically
* Drugs are added as the invoice data is received.
updates the Drug Accountability pharmacy locations based on dispensing
* If the invoiced drug's order unit and dispense units per order unit are the same as the information currently contained in the local DRUG file, the NDC field in the DRUG file is overwritten with the most recent National Drug Code (NDC) number.
and receiving information, and it also updates master vaults based
* The reorder quantities for the pharmacy locations and master vaults are provided on a daily basis by way of a mail message.
on receiving information.</font></font> * <font face="Arial,
sans-serif"><font size="2">Drugs are added as the invoice data
is received.</font></font> * <font face="Arial, sans-serif"><font
size="2">If the invoiced drug’s order unit and dispense units
per order unit are the same as the information currently contained in
the local DRUG file, the NDC field in the DRUG file is overwritten with
the most recent National Drug Code (NDC) number.</font></font> * <font
face="Arial, sans-serif"><font size="2">The reorder quantities for the
pharmacy locations and master vaults are provided on a daily basis by
way of a mail message.</font></font>

<div style="margin-left: 2em">

</div>


'''CoreFLS Interface''' includes the following features:
'''CoreFLS Interface''' includes the following features:


* When a pharmacy order invoice is received and entered into the CoreFLS purchasing system, the receipt data will be collected and compiled to an Health Level Seven (HL7) message and transmitted 'real time' to VistA Drug Accountability. Upon receiving the message, the receipt data will be stored in a temporary global, and Drug Accountability will alert the user about the Pharmacy receipt.
* <font face="Arial, sans-serif"><font size="2">When a pharmacy order
invoice is received and entered into the CoreFLS purchasing system, the
receipt data will be collected and compiled to an Health Level Seven
(HL7) message and transmitted ‘real time’ to VistA Drug
Accountability. Upon receiving the message, the receipt data will be
stored in a temporary global, and Drug Accountability will alert the
user about the Pharmacy receipt.</font></font>


* After receiving invoice data into the warehouse, the transmission from CoreFLS will place data into a temporary global.
* <font face="Times New Roman, serif"><font size="3"><font
* When Pharmacy personnel sign into the Drug Accountability package, the program will check for the existence of orders to process.
color="black"><font face="Arial, sans-serif"><font size="2">After
* If the orders exist, and the user has the proper security key, the data can then be received into Drug Accountability.
receiving invoice data into the warehouse,</font></font></font> <font
* Each Purchase Order received will be for a specific pharmacy location. If items are to be shipped/received at different pharmacy locations, a different purchase order will be created/shipped for each location.
face="Arial, sans-serif"><font size="2">the transmission from CoreFLS will
place data into a temporary global.</font></font></font></font> * <font
face="Arial, sans-serif"><font size="2">When Pharmacy personnel sign into
the Drug Accountability package, the program will check for the existence
of orders to process.</font></font> * <font face="Arial, sans-serif"><font
size="2">If the orders exist, and the user has the proper security key,
the data can then be received into Drug Accountability.</font></font>


Both Interfaces include the following features:
<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif">'''Pharmacy: Drug Accountability/Inventory Interface â€"
continued'''</font></font></font>


* Vendor-specific information and procurement history is displayed for a selected drug.
* Pharmacy locations are established and populated.
* A purge capability with scheduling queuing is provided.
* Supports NDC code set and pricing for Electronic Claims Management Engine pharmacy electronic billing.


==== Pharmacy: Electronic Claims Management Engine (ECME) ====


'''Overview'''
* <font face="Arial, sans-serif"><font size="2">Each Purchase Order
received will be for a specific pharmacy location. If items are to be
shipped/received at different pharmacy locations, a different purchase
order will be created/shipped for each location.</font></font>


The Electronic Claims Management Engine (ECME) package provides the ability to create and distribute electronic Outpatient Pharmacy claims to insurance companies on behalf of VHA Pharmacy prescription beneficiaries in a real-time environment. The application does not impact first party co-payments and minimizes the impact on legacy pharmacy workflow. This system meets the Health Insurance Portability and Accountability Act (HIPAA) of 1996 mandate, specific to the Electronic Transactions and Code Sets rule. The rule mandates VHA must submit claims electronically to insurance companies via the National Council for Prescription Drug Programs(NCPDP) v5.1 standard transmission format. The system, developed from a version currently utilized by Indian Health Service, has been modified to support the VHA Pharmacy Order Entry model.
<font face="Arial, sans-serif"><font size="2">Both Interfaces include
the following features:</font></font>


ECME receives a billing determination by Integrated Billing (IB) if an Outpatient Pharmacy order is billable. If so, ECME builds a NCPDP v5.1 electronic claim transaction using data required by the insurance company for claim adjudication, as defined within the company's individual payer sheet. Claims are submitted during the Outpatient Pharmacy finish process, and again during the Outpatient Pharmacy release process if the claim was initially rejected. If any additional edits or other events occur to the prescription, such as a return to stock, ECME generates additional electronic claims to payers updating them on the prescription billable status and updates IB with any claim specific information.
* <font face="Arial, sans-serif"><font size="2">Vendor-specific
information and procurement history is displayed for a selected
drug.</font></font> * <font face="Arial, sans-serif"><font
size="2">Pharmacy locations are established and populated.</font></font> *
<font face="Arial, sans-serif"><font size="2">A purge capability with
scheduling queuing is provided.</font></font> * <font face="Arial,
sans-serif"><font size="2">Supports NDC code set and pricing
for Electronic Claims Management Engine pharmacy electronic
billing.</font></font>


'''Features'''




===== Pharmacy: Electronic Claims Management Engine (ECME) =====



<font size="3">'''Overview'''</font>

The Electronic Claims Management Engine (ECME) package provides the
ability to create and distribute electronic Outpatient Pharmacy claims to
insurance companies on behalf of VHA Pharmacy prescription beneficiaries
in a real-time environment. The application does not impact first party
co-payments and minimizes the impact on legacy pharmacy workflow. This
system meets the Health Insurance Portability and Accountability Act
(HIPAA) of 1996 mandate, specific to the Electronic Transactions and
Code Sets rule. The rule mandates VHA must submit claims electronically
to insurance companies via the National Council for Prescription Drug
Programs<font face="Verdana, sans-serif">(</font>NCPDP) v5.1 standard
transmission format. The system, developed from a version currently
utilized by Indian Health Service, has been modified to support the VHA
Pharmacy Order Entry model.



ECME receives a billing determination by Integrated Billing (IB) if an
Outpatient Pharmacy order is billable. If so, ECME builds a NCPDP v5.1
electronic claim transaction using data required by the insurance company
for claim adjudication, as defined within the company’s individual
payer sheet. Claims are submitted during the Outpatient Pharmacy finish
process, and again during the Outpatient Pharmacy release process if the
claim was initially rejected. If any additional edits or other events
occur to the prescription, such as a return to stock, ECME generates
additional electronic claims to payers updating them on the prescription
billable status and updates IB with any claim specific information.



<font size="3">'''Features'''</font>


The ECME application provides the following features:
The ECME application provides the following features:


* Creation of outpatient pharmacy electronic claims for real-time
* Creation of outpatient pharmacy electronic claims for real-time submission to third party insurance companies for adjudication utilizing billing activities within the VHA prescription fill process.
* Utilization of information provided by a subscription with First DataBank to create electronic claims.
submission to third party insurance companies for adjudication
* Support and integrated functionality for TRICARE/CHAMPUS, ChampVA, and itemized charging methods for prescription pricing.
utilizing billing activities within the VHA prescription fill process.
* Enhancements to VHA revenue cycle management by submitting claims at the point of service while building claim segments using payer-provided transaction formats compliant with the NCPDP v5.1 standard.
* Utilization of information provided by a subscription with First
* Collection and presentation of DUR information to application users based on information received from payer claim responses.
DataBank to create electronic claims. * Support and integrated
* Reporting and on-line worklist presentation formats supporting VHA claims adjudication requirements.
functionality for TRICARE/CHAMPUS, ChampVA, and itemized charging
* Integration with VistA IB for prescription billing determination and claims tracking.
methods for prescription pricing. * Enhancements to VHA revenue cycle
* Integration with VistA Pharmacy applications when creating claims based on Pharmacy workflow.
management by submitting claims at the point of service while building
* Communication with the VistA Health Level Seven (HL7) application and Vitria BusinessWare to store and forward electronic pharmacy claims for third party insurance adjudication.
claim segments using payer-provided transaction formats compliant
with the NCPDP v5.1 standard. * Collection and presentation of DUR
information to application users based on information received from
payer claim responses. * Reporting and on-line worklist presentation
formats supporting VHA claims adjudication requirements. * Integration
with VistA IB for prescription billing determination and claims tracking.
* Integration with VistA Pharmacy applications when creating claims based
on Pharmacy workflow. * Communication with the VistA Health Level Seven
(HL7) application and Vitria BusinessWare to store and forward electronic
pharmacy claims for third party insurance adjudication.

===== Pharmacy: Inpatient Medications =====



<font face="Times New Roman, serif"><font size="3">'''<font face="Arial,
sans-serif">Overview</font>'''</font></font>

The Inpatient Medications package integrates functions from the
Intravenous (IV) and Unit Dose (UD) modules (described on the following
page). This integration provides a comprehensive record of medications
utilized during hospitalization of the veteran, the functionality for
clinician order entry through Computerized Patient Record System (CPRS),
and tailors processes by facility, user, and/or medication.



<font size="3">'''Features'''</font>

<font size="2">The Integrated software allows these features, via the
List Manager interface, for both IV and Unit Dose:</font>

* <font face="Arial, sans-serif"><font size="2">Provides the user the
capability to</font></font>

* <font face="Arial, sans-serif"><font size="2">Browse through a list
of orders and take action(s) against those items.</font></font> * <font
face="Arial, sans-serif"><font size="2">Print 7-day, 14-day, and 24-hour
MARs, labels, and profiles from within the options.</font></font> *
<font face="Arial, sans-serif"><font size="2">Select a detailed allergy
report, document new allergies or adverse drug reactions.</font></font> *
<font face="Arial, sans-serif"><font size="2">Update the Patient’s
Record from within List Manager.</font></font>

* <font face="Arial, sans-serif"><font size="2">Provides Drug/Drug
Interaction, Drug/Class Interaction, Duplicate Drug, and Duplicate
Class Order checks.</font></font> * <font face="Arial, sans-serif"><font
size="2">Allows easier drug selection using Orderable Item.</font></font>
* <font face="Arial, sans-serif"><font size="2">Provides on-line order
maintenance (for example: edit, renewal, cancellation) and marks orders
that need attention.</font></font> * <font face="Arial, sans-serif"><font
size="2">Provides on-line order entry with an integrity check for
each order type.</font></font> * <font face="Arial, sans-serif"><font
size="2">Generates labels containing order and patient information upon
the entry/maintenance of an order.</font></font> * <font face="Arial,
sans-serif"><font size="2">Provides on-line or printed patient
profiles that include a history of medication orders for the current
or last medical center visit.</font></font> * <font face="Arial,
sans-serif"><font size="2">Displays patient order information and
histories of all actions taken on active orders.</font></font> * <font
face="Arial, sans-serif"><font size="2">Provides an Action Profile of
patient medication orders for use by physicians to cancel or continue
medications.</font></font> * <font face="Arial, sans-serif"><font
size="2">Provides a Stop Order Notice report to notify users of orders
near expiration.</font></font> * <font face="Arial, sans-serif"><font
size="2">Cancels/holds medication orders for patients transferred
between wards and/or services.</font></font> * <font face="Arial,
sans-serif"><font size="2">Provides dispensing cost reports by patient,
ward, service, drug, and providers.</font></font> * <font face="Arial,
sans-serif"><font size="2">Provides reports and forms by patient,
ward, and selected groups of wards.</font></font> * <font face="Arial,
sans-serif"><font size="2">Allows electronic entry and inpatient
processing of medication orders for an outpatient receiving treatment
via a clinic or ancillary service.</font></font>

===== Pharmacy: Inpatient Medications - Intravenous (IV) =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

Inpatient Medications’ Intravenous (IV) module provides pharmacists
and their staffs with IV labels, manufacturing worksheets, ward lists
for order updates, and management reports. It permits the Pharmacy
staff to track the manufacture of IV formulas with greater control than
manual procedures allow. Through order entry and ward list updating,
the staff can easily establish and maintain an accurate and timely data
set of IV orders. A carefully designed set of checks and balances has
been incorporated to ensure that the patient is supplied IV solutions
quickly and accurately.



<font size="3">'''Features'''</font>

<font size="2">The IV module:</font>

* Generates Manufacturing Lists to facilitate maximum efficiency in the
preparation and delivery of IV products. * Generates IV labels containing
all necessary patient, drug, and schedule information. Labels provide
a bar-coded identifier which when used in conjunction with Bar Code Med
Administration greatly enhances patient safety. * Generates management
reports designed to track drug costs and workload by ward, provider, IV
room, and patient. * Provides on-line generation of production reports
such as renewal lists, active order lists, and formulary drug reports.
* Discontinues/holds orders for patients transferred between wards
and/or services.





===== Pharmacy: Inpatient Medications - Unit Dose (UD) =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

The Unit Dose (UD) module of Inpatient Medications provides a
standard computerized system for dispensing and managing inpatient
medications. Timely, accurate, accessible, and up-to-date patient
medication information is available from any terminal within the
facility. Computer-generated working forms allow personnel to dedicate
more time to patient care.



<font size="3">'''Features'''</font>

<font size="2">The Unit Dose module:</font>

* <font face="Arial, sans-serif"><font size="2">Allows immediate entry of
pre-defined sets of unit dose orders.</font></font> * <font face="Arial,
sans-serif"><font size="2">Provides computerized pick lists, which include
pre-calculated doses for pharmacists.</font></font> * <font face="Arial,
sans-serif"><font size="2">Provides an interface to automated dispensing
equipment.</font></font>

===== Pharmacy: National Drug File (NDF) =====



<font size="3">'''Overview'''</font>

<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">The National Drug File (NDF) package
provides standardization of the local drug files in all VA medical
facilities. Standardization includes the adoption of new drug nomenclature
and drug classification, as well as linking the local drug file entries
to data in the National Drug files. For drugs approved by the Food and
Drug Administration (FDA), NDF provides VA medical facilities with
the ability to access information concerning dosage form, strength
and unit, package size and type, manufacturer’s trade name,
and National Drug Code (NDC) information. The NDF software also lays
the foundation for sharing prescription information among medical
facilities.</font></font></font></font>



<font size="3">'''Features'''</font>

<font size="3"><font size="2">The</font> <font size="2">National Drug
File:</font></font>

* <font face="Arial, sans-serif"><font size="2">Standardizes drug file
information.</font></font> * <font face="Arial, sans-serif"><font
size="2">Standardizes drug classifications.</font></font> *
<font face="Arial, sans-serif"><font size="2">Adopts standard
nomenclature.</font></font> * <font face="Arial, sans-serif"><font
size="2">Provides up-to-date prescription and over-the-counter
information.</font></font> * <font face="Arial, sans-serif"><font
size="2">Provides available sources for drugs manufactured
and approved by the FDA.</font></font> * <font face="Arial,
sans-serif"><font size="2">Provides a base for implementation
of drug inventory control and management throughout VA (i.e.,
Consolidated Mail Outpatient Pharmacy and Pharmacy Benefits
Management).</font></font> * <font face="Arial, sans-serif"><font
size="2">Allows file access by NDC, manufacturer’s trade name,
ingredient, dosage form, dosage strength, route of administration,
and VA drug classification.</font></font> * <font face="Arial,
sans-serif"><font size="2">Allows management of drug information,
including reports on drugs by classification, ingredient, NDC, trade
name, and/or active/inactive status.</font></font> * <font face="Arial,
sans-serif"><font size="2">Matches additions to medical center drug files
with the national drug database.</font></font> * <font face="Arial,
sans-serif"><font size="2">Provides an ingredient file that is an
integral component of the Allergy Tracking and Outpatient Pharmacy
(drug-drug interactions) modules.</font></font> * <font face="Arial,
sans-serif"><font size="2">Provides an enhanced formulary report listing
local, VISN, and National Formulary information.</font></font> * <font
face="Arial, sans-serif"><font size="2">Includes the Patient Medication
Information Sheets that feature the following:</font></font>

* <font size="2">An explanation of how and why to take a medication and
the possible side effects.</font> * <font size="2">Information supplied
by commercial sources.</font> * <font size="2">Information that is
copyrighted and periodically updated.</font>

* <font face="Arial, sans-serif"><font size="2">Utilizes data provided
and standardized by First DataBank for point of sale electronic billing
using Electronic Claims Management Engine (ECME).</font></font>

===== Pharmacy: Outpatient Pharmacy =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

<font face="Arial, sans-serif"><font size="2">The Outpatient Pharmacy
package provides a way to manage the medication regimen of veterans seen
in outpatient clinics and to monitor and manage the workload and costs
in the Outpatient Pharmacy.</font></font>



<font face="Arial, sans-serif"><font size="2">The primary benefits to
the veteran are the assurance that he or she is receiving the proper
medication and the convenience of obtaining refills easily. The clinicians
and pharmacists responsible for patient care benefit from a complete,
accurate, and current medication profile available at any time to
allow professional evaluation of treatment plans. Utilization, cost,
and workload reports provide management cost-controlling tools while
maintaining the highest level of patient care.</font></font>



<font size="3">'''Features'''</font>

<font size="2">The Outpatient Pharmacy package:</font>

* <font face="Arial, sans-serif"><font size="2">Checks new prescriptions
against existing prescriptions (for the same medication, therapeutic
class, reported allergies, reactions, or drug interactions).</font></font>
* <font face="Arial, sans-serif"><font size="2">Allows pharmacists
to verify data entered by technicians prior to the printing of
labels.</font></font> * <font face="Arial, sans-serif"><font
size="2">Allows for the renewal of prescriptions that have no
remaining refills. Prints labels for new, renewed, and refilled
prescriptions.</font></font> * <font face="Arial, sans-serif"><font
size="2">Auto-cancels individual prescriptions for a patient after
admission for inpatient treatment.</font></font> * <font face="Arial,
sans-serif"><font size="2">Creates medication profiles for patient charts
to meet the Joint Commission on Accreditation of Healthcare Organizations
(JCAHO) requirements for a current medication list. Profiles are
suitable for counseling patients.</font></font> * <font face="Arial,
sans-serif"><font size="2">Allows the Action Profile to be used as
a quick renew/cancel request form by clinic providers, which allows
for rapid entry of request by Pharmacy staff.</font></font> * <font
face="Arial, sans-serif"><font size="2">Provides the Screen Profile for
review at several points in the order/entry process.</font></font>
* <font face="Arial, sans-serif"><font size="2">Provides basic
Drug Use Evaluation (DUE) template generator.</font></font> * <font
face="Arial, sans-serif"><font size="2">Provides necessary laboratory
checks and reports to meet national requirements for Clozapine
dispensing.</font></font> * <font face="Arial, sans-serif"><font
size="2">Provides finishing of orders entered through CPRS.</font></font>
* <font face="Arial, sans-serif"><font size="2">Provides information
for billing any applicable medication co-payment when the prescription
is released.</font></font> * <font face="Arial, sans-serif"><font
size="2">Allows the user to select a different action without leaving
an option.</font></font> * Uses List Manager features to allow:

* Pharmacist or technician to browse through a list of actions. *
Pharmacist or technician to take action against those items. * User to
select an action that displays an action or informational profile.

* Works with Integrated Billing (IB) and Electronic Claims Management
Engine (ECME) to enable and manage point of sale billing supporting
the Healthcare Insurance Portability and Accountability Act (HIPAA)
Electronic Claims and Code set congressional mandate. *

<font size="3">'''Pharmacy: Outpatient Pharmacy â€" continued'''</font>


==== Pharmacy: Inpatient Medications ====


'''Overview'''


The Inpatient Medications package integrates functions from the Intravenous (IV) and Unit Dose (UD) modules (described on the following page). This integration provides a comprehensive record of medications utilized during hospitalization of the veteran, the functionality for clinician order entry through Computerized Patient Record System (CPRS), and tailors processes by facility, user, and/or medication.
* Allows prescription labels and Prescription Medication Information
(PMI) sheets to be printed in another language if the system has the other
language fields populated in Pharmacy Data Management and the individual
patient is identified with the other language preference flag. * Allows
the ability to print a microchip-embedded label for a prescription. This
label can then be read by ScripTalk®, thus improving patient safety
for visually impaired veterans. * Provides display of Herbal, over the
counter (OTC), and Non-VA medications documented through CPRS. The data
will be used for screening of Drug-Herbal and Drug-Drug Interactions
with prescribed medications in VistA.


'''Features'''
===== Pharmacy: Pharmacy Benefits Management (PBM) =====


The Integrated software allows these features, via the List Manager interface, for both IV and Unit Dose:


* Provides the user the capability to


* Browse through a list of orders and take action(s) against those items.
* Print 7-day, 14-day, and 24-hour MARs, labels, and profiles from within the options.
* Select a detailed allergy report, document new allergies or adverse drug reactions.
* Update the Patient's Record from within List Manager.


* Provides Drug/Drug Interaction, Drug/Class Interaction, Duplicate Drug, and Duplicate Class Order checks.
* Allows easier drug selection using Orderable Item.
* Provides on-line order maintenance (for example: edit, renewal, cancellation) and marks orders that need attention.
* Provides on-line order entry with an integrity check for each order type.
* Generates labels containing order and patient information upon the entry/maintenance of an order.
* Provides on-line or printed patient profiles that include a history of medication orders for the current or last medical center visit.
* Displays patient order information and histories of all actions taken on active orders.
* Provides an Action Profile of patient medication orders for use by physicians to cancel or continue medications.
* Provides a Stop Order Notice report to notify users of orders near expiration.
* Cancels/holds medication orders for patients transferred between wards and/or services.
* Provides dispensing cost reports by patient, ward, service, drug, and providers.
* Provides reports and forms by patient, ward, and selected groups of wards.
* Allows electronic entry and inpatient processing of medication orders for an outpatient receiving treatment via a clinic or ancillary service.


==== Pharmacy: Inpatient Medications - Intravenous (IV) ====
<font size="3">'''Overview'''</font>


'''Overview'''
<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">The Pharmacy Benefits Management (PBM) package
replaced the Drug and Pharmaceutical Products management (D&amp;PPM)
application. The software extracts medication dispensing data elements
from the Outpatient Pharmacy, Inpatient Medications IV and Unit Dose,
Automatic Replenishment/Ward Stock, and Controlled Substance modules;
Procurement information from Drug Accountability, Integrated Funds
Control, Accounting and Procurement (IFCAP); and a limited amount of
Laboratory data on a monthly basis.</font></font></font></font>


Inpatient Medications' Intravenous (IV) module provides pharmacists and their staffs with IV labels, manufacturing worksheets, ward lists for order updates, and management reports. It permits the Pharmacy staff to track the manufacture of IV formulas with greater control than manual procedures allow. Through order entry and ward list updating, the staff can easily establish and maintain an accurate and timely data set of IV orders. A carefully designed set of checks and balances has been incorporated to ensure that the patient is supplied IV solutions quickly and accurately.


'''Features'''


The IV module:
<font face="Arial, sans-serif"><font size="2">The software makes data
extraction reports available at Department of Veterans Affairs Medical
Centers (VAMCs) and allows local management to use the data to project
local drug usage and identify potential drug accountability problem
areas. The Pharmacy Benefits Management Strategic Health Group (PBM)
is able to provide information on local facility, Veterans Integrated
Service Network (VISN) and national product use on monthly, quarterly,
and annual intervals.</font></font>


* Generates Manufacturing Lists to facilitate maximum efficiency in the preparation and delivery of IV products.
* Generates IV labels containing all necessary patient, drug, and schedule information. Labels provide a bar-coded identifier which when used in conjunction with Bar Code Med Administration greatly enhances patient safety.
* Generates management reports designed to track drug costs and workload by ward, provider, IV room, and patient.
* Provides on-line generation of production reports such as renewal lists, active order lists, and formulary drug reports.
* Discontinues/holds orders for patients transferred between wards and/or services.


==== Pharmacy: Inpatient Medications - Unit Dose (UD) ====


'''Overview'''
<font face="Arial, sans-serif"><font size="2">The extracted data is
transmitted to the PBM using VA Mailman. The MailMan message headers
display how many messages were sent for a particular module along with
the facility name and number from which the data was extracted. The
header easily identifies the module from which the data was extracted,
and confirmation messages include the number of MailMan messages generated
for each module.</font></font>


The Unit Dose (UD) module of Inpatient Medications provides a standard computerized system for dispensing and managing inpatient medications. Timely, accurate, accessible, and up-to-date patient medication information is available from any terminal within the facility. Computer-generated working forms allow personnel to dedicate more time to patient care.


'''Features'''


The Unit Dose module:
<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>


* Allows immediate entry of pre-defined sets of unit dose orders.
<font face="Arial, sans-serif"><font size="2">Pharmacy Benefits Management
* Provides computerized pick lists, which include pre-calculated doses for pharmacists.
contains the following:</font></font>
* Provides an interface to automated dispensing equipment.


==== Pharmacy: National Drug File (NDF) ====
* <font face="Arial, sans-serif"><font size="2">Breakout of Inpatient
Medications IV and Unit Dose, Outpatient Pharmacy, and Controlled
Substance modules by dispensing occurrence.</font></font> * <font
face="Arial, sans-serif"><font size="2">Breakout of procurement
information by line item.</font></font> * <font face="Arial,
sans-serif"><font size="2">Collection of the Prime Vendor Procurement
Information (requires implementation of Drug Accountability V 3.0),
Pharmacy AMIS data, Laboratory data, and Patient and Provider
information.</font></font> * <font face="Arial, sans-serif"><font
size="2">Capture of controlled substance dispensing to patients
if electronic Controlled Substance Administration Record (CSAR) is
implemented with Controlled Substance Version 3.0.</font></font> *
<font face="Arial, sans-serif"><font size="2">Extraction of data and
generation of drug and statistical data summary reports by inpatient
division or outpatient site whenever possible.</font></font> *
<font face="Arial, sans-serif"><font size="2">Inclusion of National
Formulary Indicator and Restriction.</font></font> * <font face="Arial,
sans-serif"><font size="2">Mechanism to monitor the successful completion
of the automatic monthly extraction job and to notify users if a problem
exists.</font></font>


'''Overview'''


The National Drug File (NDF) package provides standardization of the local drug files in all VA medical facilities. Standardization includes the adoption of new drug nomenclature and drug classification, as well as linking the local drug file entries to data in the National Drug files. For drugs approved by the Food and Drug Administration (FDA), NDF provides VA medical facilities with the ability to access information concerning dosage form, strength and unit, package size and type, manufacturer's trade name, and National Drug Code (NDC) information. The NDF software also lays the foundation for sharing prescription information among medical facilities.


'''Features'''


The National Drug File:


* Standardizes drug file information.
* Standardizes drug classifications.
* Adopts standard nomenclature.
* Provides up-to-date prescription and over-the-counter information.
* Provides available sources for drugs manufactured and approved by the FDA.
* Provides a base for implementation of drug inventory control and management throughout VA (i.e., Consolidated Mail Outpatient Pharmacy and Pharmacy Benefits Management).
* Allows file access by NDC, manufacturer's trade name, ingredient, dosage form, dosage strength, route of administration, and VA drug classification.
* Allows management of drug information, including reports on drugs by classification, ingredient, NDC, trade name, and/or active/inactive status.
* Matches additions to medical center drug files with the national drug database.
* Provides an ingredient file that is an integral component of the Allergy Tracking and Outpatient Pharmacy (drug-drug interactions) modules.
* Provides an enhanced formulary report listing local, VISN, and National Formulary information.
* Includes the Patient Medication Information Sheets that feature the following:


* An explanation of how and why to take a medication and the possible side effects.
* Information supplied by commercial sources.
* Information that is copyrighted and periodically updated.


* Utilizes data provided and standardized by First DataBank for point of sale electronic billing using Electronic Claims Management Engine (ECME).


==== Pharmacy: Outpatient Pharmacy ====


'''Overview'''
===== Pharmacy: Pharmacy Data Management (PDM) =====


The Outpatient Pharmacy package provides a way to manage the medication regimen of veterans seen in outpatient clinics and to monitor and manage the workload and costs in the Outpatient Pharmacy.


The primary benefits to the veteran are the assurance that he or she is receiving the proper medication and the convenience of obtaining refills easily. The clinicians and pharmacists responsible for patient care benefit from a complete, accurate, and current medication profile available at any time to allow professional evaluation of treatment plans. Utilization, cost, and workload reports provide management cost-controlling tools while maintaining the highest level of patient care.


'''Features'''
<font size="3">'''Overview'''</font>


The Pharmacy Data Management (PDM) package provides tools for managing
The Outpatient Pharmacy package:
site configurable data in pharmacy files. It includes tools for creating
the Pharmacy Orderable Items and maintaining files necessary for the
Computerized Patients Records Systems (CPRS). PDM consolidates tools
for managing the various pharmacy software products, such as Outpatient
Pharmacy and Inpatient Medications, to facilitate the maintenance of
files used within these applications. Prior to the release of the Pharmacy
Data Management (PDM) software, the maintenance of pharmaceutical items
within the local DRUG file (#50) was accomplished using application
specific options. PDM provides a single option to maintain this file to
facilitate this process.


* Checks new prescriptions against existing prescriptions (for the same medication, therapeutic class, reported allergies, reactions, or drug interactions).
* Allows pharmacists to verify data entered by technicians prior to the printing of labels.
* Allows for the renewal of prescriptions that have no remaining refills. Prints labels for new, renewed, and refilled prescriptions.
* Auto-cancels individual prescriptions for a patient after admission for inpatient treatment.
* Creates medication profiles for patient charts to meet the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requirements for a current medication list. Profiles are suitable for counseling patients.
* Allows the Action Profile to be used as a quick renew/cancel request form by clinic providers, which allows for rapid entry of request by Pharmacy staff.
* Provides the Screen Profile for review at several points in the order/entry process.
* Provides basic Drug Use Evaluation (DUE) template generator.
* Provides necessary laboratory checks and reports to meet national requirements for Clozapine dispensing.
* Provides finishing of orders entered through CPRS.
* Provides information for billing any applicable medication co-payment when the prescription is released.
* Allows the user to select a different action without leaving an option.
* Uses List Manager features to allow:


* Pharmacist or technician to browse through a list of actions.
* Pharmacist or technician to take action against those items.
* User to select an action that displays an action or informational profile.


* Works with Integrated Billing (IB) and Electronic Claims Management Engine (ECME) to enable and manage point of sale billing supporting the Healthcare Insurance Portability and Accountability Act (HIPAA) Electronic Claims and Code set congressional mandate.
<font size="3">'''Features'''</font>
* Allows prescription labels and Prescription Medication Information (PMI) sheets to be printed in another language if the system has the other language fields populated in Pharmacy Data Management and the individual patient is identified with the other language preference flag.
* Allows the ability to print a microchip-embedded label for a prescription. This label can then be read by ScripTalk®, thus improving patient safety for visually impaired veterans.
* Provides display of Herbal, over the counter (OTC), and Non-VA medications documented through CPRS. The data will be used for screening of Drug-Herbal and Drug-Drug Interactions with prescribed medications in VistA.


<font size="2">Pharmacy Data Management provides:</font>
==== Pharmacy: Pharmacy Benefits Management (PBM) ====


'''Overview'''
* <font size="2">Tools for managing pharmacy orderable items.</font>
* <font size="2">Centralized control of pharmacy files and frequently
used options into one location.</font> * <font size="2">A new drug
enter/edit option, which allows the user to edit fields for all
pharmacy packages.</font> * <font size="2">The ability to identify
drug interactions.</font> * <font size="2">Tools for marking drugs to
be transmitted to the Consolidated Mail Outpatient Pharmacies.</font> *
<font size="3"><font size="2">Local point-of-sale billing functionality
for Electronic Claims Management Engine (ECME) electronic claim
submission.</font></font>


The Pharmacy Benefits Management (PBM) package replaced the Drug and Pharmaceutical Products management (D&amp;PPM) application. The software extracts medication dispensing data elements from the Outpatient Pharmacy, Inpatient Medications IV and Unit Dose, Automatic Replenishment/Ward Stock, and Controlled Substance modules; Procurement information from Drug Accountability, Integrated Funds Control, Accounting and Procurement (IFCAP); and a limited amount of Laboratory data on a monthly basis.


The software makes data extraction reports available at Department of Veterans Affairs Medical Centers (VAMCs) and allows local management to use the data to project local drug usage and identify potential drug accountability problem areas. The Pharmacy Benefits Management Strategic Health Group (PBM) is able to provide information on local facility, Veterans Integrated Service Network (VISN) and national product use on monthly, quarterly, and annual intervals.


The extracted data is transmitted to the PBM using VA Mailman. The MailMan message headers display how many messages were sent for a particular module along with the facility name and number from which the data was extracted. The header easily identifies the module from which the data was extracted, and confirmation messages include the number of MailMan messages generated for each module.


'''Features'''


Pharmacy Benefits Management contains the following:


* Breakout of Inpatient Medications IV and Unit Dose, Outpatient Pharmacy, and Controlled Substance modules by dispensing occurrence.
* Breakout of procurement information by line item.
* Collection of the Prime Vendor Procurement Information (requires implementation of Drug Accountability V 3.0), Pharmacy AMIS data, Laboratory data, and Patient and Provider information.
* Capture of controlled substance dispensing to patients if electronic Controlled Substance Administration Record (CSAR) is implemented with Controlled Substance Version 3.0.
* Extraction of data and generation of drug and statistical data summary reports by inpatient division or outpatient site whenever possible.
* Inclusion of National Formulary Indicator and Restriction.
* Mechanism to monitor the successful completion of the automatic monthly extraction job and to notify users if a problem exists.


===== Pharmacy: Pharmacy Prescription Practices (PPP) =====
==== Pharmacy: Pharmacy Data Management (PDM) ====


'''Overview'''


The Pharmacy Data Management (PDM) package provides tools for managing site configurable data in pharmacy files. It includes tools for creating the Pharmacy Orderable Items and maintaining files necessary for the Computerized Patients Records Systems (CPRS). PDM consolidates tools for managing the various pharmacy software products, such as Outpatient Pharmacy and Inpatient Medications, to facilitate the maintenance of files used within these applications. Prior to the release of the Pharmacy Data Management (PDM) software, the maintenance of pharmaceutical items within the local DRUG file (#50) was accomplished using application specific options. PDM provides a single option to maintain this file to facilitate this process.


'''Features'''
<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>


The Pharmacy Prescription Practices (PPP) package provides VA medical
Pharmacy Data Management provides:
centers with the ability to determine whether a patient has been seen
at other VA facilities and to request current pharmacy information from
those facilities prior to the patient appearing for a scheduled outpatient
visit. This information alerts pharmacy personnel to the existence of
medications that may have been prescribed at other VA facilities and
prevents possible drug abuse or adverse medication interaction.


* Tools for managing pharmacy orderable items.
* Centralized control of pharmacy files and frequently used options into one location.
* A new drug enter/edit option, which allows the user to edit fields for all pharmacy packages.
* The ability to identify drug interactions.
* Tools for marking drugs to be transmitted to the Consolidated Mail Outpatient Pharmacies.
* Local point-of-sale billing functionality for Electronic Claims Management Engine (ECME) electronic claim submission.


==== Pharmacy: Pharmacy Prescription Practices (PPP) ====


'''Overview'''
<font face="Arial, sans-serif"><font size="2">The PPP software is
integrated with other VistA applications. It interfaces with the Patient
Data Exchange (PDX) module to provide a method of extracting pharmacy
data from remote hospitals, the Minimal Patient Dataset (MPD) module to
provide a history of patient visits, the Patient Information Management
System (PIMS) to provide scheduled clinic appointments, and the Pharmacy
module to provide active pharmacy data on local patients.</font></font>


The Pharmacy Prescription Practices (PPP) package provides VA medical centers with the ability to determine whether a patient has been seen at other VA facilities and to request current pharmacy information from those facilities prior to the patient appearing for a scheduled outpatient visit. This information alerts pharmacy personnel to the existence of medications that may have been prescribed at other VA facilities and prevents possible drug abuse or adverse medication interaction.


The PPP software is integrated with other VistA applications. It interfaces with the Patient Data Exchange (PDX) module to provide a method of extracting pharmacy data from remote hospitals, the Minimal Patient Dataset (MPD) module to provide a history of patient visits, the Patient Information Management System (PIMS) to provide scheduled clinic appointments, and the Pharmacy module to provide active pharmacy data on local patients.


'''Features'''
<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>


The Pharmacy Prescription Practices package:
The Pharmacy Prescription Practices package:


* Alerts pharmacy personnel to the existence of medications that may have been prescribed at other facilities.
* <font face="Arial, sans-serif"><font size="2">Alerts pharmacy personnel
* Builds a file of all patients currently registered at the medical center who have visited other VA medical centers.
to the existence of medications that may have been prescribed at other
* Allows the software to be tailored specifically to meet the needs of the various sites through a number of site-specific parameters.
facilities.</font></font> * <font face="Arial, sans-serif"><font
* Provides several outputs containing information such as the medication profile, significant events and error conditions encountered while running the software, and statistical data.
size="2">Builds a file of all patients currently registered at the
* Automatically sends a PDX request for the medication profile to all other facilities visited by a patient scheduled for a clinic appointment.
medical center who have visited other VA medical centers.</font></font>
* <font face="Arial, sans-serif"><font size="2">Allows the software
to be tailored specifically to meet the needs of the various sites
through a number of site-specific parameters.</font></font> *
<font face="Arial, sans-serif"><font size="2">Provides several
outputs containing information such as the medication profile,
significant events and error conditions encountered while running the
software, and statistical data.</font></font> * <font face="Times New
Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">A</font></font><font face="Arial, sans-serif"><font
size="2">utomatically sends a PDX request for the medication profile
to all other facilities visited by a patient scheduled for a clinic
appointment.</font></font></font></font>


<!-- file -->
==== Primary Care Management Module (PCMM) ====


'''Overview'''


In the outpatient setting, patients are assigned a primary care team and provider who are responsible for delivering essential health care, coordinating all health care services, and serving as the point of access for specialty care. Associate Primary Care Providers (APs) provide primary care to patients under the supervision of the Primary Care Provider (PCP). PCMM supports both primary care and non-primary care teams. The software allows one to create, set up, and define teams; create and assign positions to the team; assign staff to the positions; assign patients to the team; and assign patients to providers' positions.


In PCMM, primary care providers have an assigned "number of patients allowed" which is compared with the "number of patients actual" to determine if more patients may be assigned to the provider. PCMM functionality assists in maintaining accurate, active patient listings for primary care teams and panels. By unassigning patients who have not seen their primary care providers in a specified amount of time, new patients may be assigned. Unassigned patients are readily reassigned to their previous primary care team and provider if they return for care. When a patient cannot be assigned to a primary care team or position, the PCMM software asks if the patient should be placed on the Electronic Wait List. PCMM Wait List reports assist in the management of patients awaiting a primary care team or provider assignment. The amount of time the APs and PCPs spend providing direct primary care is also entered and measures the capacity of each institution (and VHA as a whole) to provide outpatient primary care. PCMM also screens staff assignments to PCP and AP positions to assure the data on providers is correct.


The primary care patient, provider, and team information captured in PCMM is sent to the Austin Automation Center and the National Patient Care Database. Some PCMM information is available in the KLF Reports. Additionally, the Office of Performance and Quality Measures utilizes PCMM data for national reporting and performance measures.
<div style="margin-left: 2em">


'''Features'''
</div>


* Uses a graphical user interface (GUI) for creating teams and provider positions as well as assigning staff to the provider positions.
* Ability to assign/unassign patients to primary care and non-primary care teams and providers both in GUI and VistA roll-and-scroll.
* Automates patient unassignment from primary care teams and providers if the patient has not seen their primary care provider for a specified time or when a patient's date of death is entered.
* Screens assignments to PCP and AP positions based on provider type and person class.
* Produces patient-oriented, practitioner-oriented, and team-oriented reports.
* Transmits data for primary care teams, providers, and patients to Austin in Health Level Seven (HL7) message format and provides the ability to receive/process transmission errors.
* Ability to control transmission of MailMan messages to team positions.


<!-- file -->
==== Prosthetics ====


'''Overview'''


The Veterans Health Information Systems and Technology Architecture (VistA) Prosthetics package automates purchasing. The Prosthetics module enhances patient care by determining what prosthetic services and devices have been provided to the veteran in the past, and decreasing the time required for the order, delivery, and/or repair of devices. The Prosthetics package provides control and auditing of expenditures and generates management reports.


'''Features'''


* The Purchasing module interfaces with IFCAP (Integrated Funds, Distribution, Control Point Activity, Accounting and Procurement). Users enter requests to purchase and repair items or services using online VA forms or Purchase Card that allows tracking of the transactions.
* The Electronic Record of Prosthetic Services (VAF 10-2319) tracks demographics, disability codes, new purchases, repairs/replacements, service cards, clothing allowance, automobile adaptive equipment, and Home Improvement Structural Alterations (HISA).
* The Lab module has Orthotic Lab, Restoration Lab, Shoe Last Clinics, Wheelchair Repair Shops, and the Denver Distribution Center.
* The Inventory module tracks quantities of prosthetic items that facilities have in stock.
* The Administrative Home Oxygen module manages vendor billing and current prescriptions.
* The Suspense module tracks patient requests for prosthetic appliances or services through Prosthetics or Computerized Patient Record System (CPRS).
* The National Prosthetics Patient Database (NPPD) module captures medical center Prosthetic patient transaction data.


<!-- file -->
==== Quality: Audiology And Speech Analysis And Reporting (QUASAR) ====


'''Overview'''


Quality: Audiology and Speech Analysis and Reporting (QUASAR) is a VistAsoftware package written for the Audiology and Speech Pathology Service. QUASAR is used to enter, edit, and retrieve data for each episode of care.


'''Features'''


* Provides automatic transmission of visit data to the Patient Care Encounter (PCE) program in order to incorporate QUASAR visit data in Ambulatory Care Reporting Program (ACRP) and in the Decision Support System (DSS).
* Produces a variety of reports useful to local managers, medical center management, and central planners.
* Contains a Department of Veterans Affairs (VA) FileMan function that permits users to generate customized reports.
* Produces an automated Cost Distribution Report (CDR) RCS-10-01 41.
* Generates and processes Audiology compensation and pension visits through an agreement with the Automated Medical Information Exchange (AMIE) package.
* Allows input of a patient's audiogram and display of audiometric data in graphical or tabular format. The audiogram may then be signed and transmitted to the VA Denver Distribution Center (DDC) for inclusion in a patient's hearing aid order. The audiogram will also be recorded in the DDC's national database of audiometric data.


<!-- file -->
==== Radiology/Nuclear Medicine ====


'''Overview'''


Radiology/Nuclear Medicine is a comprehensive software package designed to assist with the functions related to processing patients for imaging examinations. The Radiology/Nuclear Medicine package automates the entire range of diagnostic functions performed in imaging departments, including order entry of requests, registration of patients for exams, processing of exams, recording of reports/results, verification of reports on-line, displaying/printing results for clinical staff, automatic tracking of requests/exams/reports, and generation of management statistics/reports, both recurring and ad hoc.


'''Features'''
===== Primary Care Management Module (PCMM) =====


Functionality is screened by Imaging Type to make it look as if there are separate sub-packages. Many options are also screened by or allow selection by division and/or imaging location.


* There is on-line patient registration for exams, automatic printing of flash cards and jacket labels, and transcription of patient radiological/nuclear medicine reports.

* Management reports include workload, complications and ad hoc summaries, daily activity logs, examination statistics, and performance indicators.
<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>
* Health Level 7 (HL7) (e.g., voice-to-text and PACS equipment) standard for interfacing with non- VistA computer systems is supported for the exchange of radiology/nuclear medicine results.

* There is on-line physician verification of radiological/nuclear medicine exam reports using electronic signatures.
<font face="Arial, sans-serif"><font size="2">In the outpatient
* Stop codes and procedures associated with a radiological/nuclear medicine exam are automatically credited for reimbursement purposes.
setting, patients are assigned a primary care team and provider who
* It interfaces with the Computerized Patient Record System module for entry of radiology/nuclear medicine requests and display of results to clinical staff. It interfaces with the Adverse Reaction Tracking (ART) module by allowing users to add contrast media reactions to ART via the Radiology/Nuclear Medicine package. It interfaces with the Women's Health module by automatically adding mammogram and ultrasound procedures for female patients to the Women's Health database.
are responsible for delivering essential health care, coordinating all
* It supports entry of multiple diagnostic codes and multiple interpreting by residents and staff.
health care services, and serving as the point of access for specialty
* There is a single combined report for a set of related procedures. This is a "printset" mechanism for entering a single report for all descendent cases registered from a parent order.
care. Associate Primary Care Providers (APs) provide primary care to
* It provides the ability to enter and edit information specific to radiopharmaceuticals for Nuclear Medicine.
patients under the supervision of the Primary Care Provider (PCP). PCMM
* It allows on-line verification of "STAT" category requests.
supports both primary care and non-primary care teams. The software allows
one to create, set up, and define teams; create and assign positions to
the team; assign staff to the positions; assign patients to the team;
and assign patients to providers’ positions.</font></font>



<font face="Arial, sans-serif"><font size="2">In PCMM, primary care
providers have an assigned “number of patients allowed†which
is compared with the “number of patients actual†to determine
if more patients may be assigned to the provider. PCMM functionality
assists in maintaining accurate, active patient listings for primary
care teams and panels. By unassigning patients who have not seen their
primary care providers in a specified amount of time, new patients
may be assigned. Unassigned patients are readily reassigned to their
previous primary care team and provider if they return for care. When
a patient cannot be assigned to a primary care team or position, the
PCMM software asks if the patient should be placed on the Electronic
Wait List. PCMM Wait List reports assist in the management of patients
awaiting a primary care team or provider assignment. The amount of time
the APs and PCPs spend providing direct primary care is also entered and
measures the capacity of each institution (and VHA as a whole) to provide
outpatient primary care. PCMM also screens staff assignments to PCP and
AP positions to assure the data on providers is correct.</font></font>



<font face="Arial, sans-serif"><font size="2">The primary care patient,
provider, and team information captured in PCMM is sent to the Austin
Automation Center and the National Patient Care Database. Some PCMM
information is available in the KLF Reports. Additionally, the Office
of Performance and Quality Measures utilizes PCMM data for national
reporting and performance measures.</font></font>



<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>

* <font face="Arial, sans-serif"><font size="2">Uses a graphical
user interface (GUI) for creating teams and provider positions as
well as assigning staff to the provider positions.</font></font>
* <font face="Arial, sans-serif"><font size="2">Ability to
assign/unassign patients to primary care and non-primary care teams
and providers both in GUI and VistA roll-and-scroll.</font></font>
* <font face="Arial, sans-serif"><font size="2">Automates patient
unassignment from primary care teams and providers if the patient has
not seen their primary care provider for a specified time or when
a patient’s date of death is entered.</font></font> * <font
face="Arial, sans-serif"><font size="2">Screens assignments to PCP and
AP positions based on provider type and person class.</font></font> *
<font face="Arial, sans-serif"><font size="2">Produces patient-oriented,
practitioner-oriented, and team-oriented reports.</font></font>
* <font face="Arial, sans-serif"><font size="2">Transmits data for
primary care teams, providers, and patients to Austin in Health Level
Seven (HL7) message format and provides the ability to receive/process
transmission errors.</font></font> * <font face="Arial, sans-serif"><font
size="2">Ability to control transmission of MailMan messages to team
positions.</font></font>

===== Prosthetics =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">The Veterans Health Information Systems
and Technology Architecture (VistA)</font></font> <font face="Arial,
sans-serif"><font size="2">Prosthetics package automates purchasing. The
Prosthetics module enhances patient care by determining what prosthetic
services and devices have been provided to the veteran in the past,
and decreasing the time required for the order, delivery, and/or repair
of devices. The Prosthetics package provides control and auditing of
expenditures and generates management reports.</font></font></font></font>



<font color="#000088"><font
color="black">[[Image:vista_monograph2005_06_html_0.gif]]</font><font
face="Arial Unicode MS, sans-serif"><font
size="3"><font color="black"><font face="Arial,
sans-serif">'''Features'''</font></font></font></font></font>

* <font face="Arial, sans-serif"><font size="2">The Purchasing module
interfaces with IFCAP (Integrated Funds, Distribution, Control
Point Activity, Accounting and Procurement). Users enter requests
to purchase and repair items or services using online VA forms or
Purchase Card that allows tracking of the transactions.</font></font>
* <font face="Arial, sans-serif"><font size="2">The Electronic
Record of Prosthetic Services (VAF 10-2319) tracks demographics,
disability codes, new purchases, repairs/replacements, service
cards, clothing allowance, automobile adaptive equipment, and Home
Improvement Structural Alterations (HISA).</font></font> * <font
face="Arial, sans-serif"><font size="2">The Lab module has Orthotic
Lab, Restoration Lab, Shoe Last Clinics, Wheelchair Repair Shops,
and the Denver Distribution Center.</font></font> * <font face="Arial,
sans-serif"><font size="2">The Inventory module tracks quantities of
prosthetic items that facilities have in stock.</font></font> * <font
face="Arial, sans-serif"><font size="2">The Administrative Home Oxygen
module manages vendor billing and current prescriptions.</font></font>
* <font face="Arial, sans-serif"><font size="2">The Suspense module
tracks patient requests for prosthetic appliances or services through
Prosthetics or Computerized Patient Record System (CPRS).</font></font>
* <font face="Arial, sans-serif"><font size="2">The National Prosthetics
Patient Database (NPPD) module captures medical center Prosthetic patient
transaction data.</font></font>











===== Quality: Audiology And Speech Analysis And Reporting (QUASAR) =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">Quality: Audiology and Speech Analysis
and Reporting (QUASAR) is a</font></font> <font face="Arial,
sans-serif"><font size="2">VistA</font></font><font face="Arial,
sans-serif"><font size="2">software package written for the Audiology
and Speech Pathology Service. QUASAR is used to enter, edit, and retrieve
data for each episode of care.</font></font></font></font>



<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>

* <font face="Arial, sans-serif"><font size="2">Provides automatic
transmission of visit data to the Patient Care Encounter (PCE) program
in order to incorporate QUASAR visit data in Ambulatory Care Reporting
Program (ACRP) and in the Decision Support System (DSS).</font></font>
* <font face="Arial, sans-serif"><font size="2">Produces a variety
of reports useful to local managers, medical center management, and
central planners.</font></font> * <font face="Arial, sans-serif"><font
size="2">Contains a Department of Veterans Affairs (VA) FileMan function
that permits users to generate customized reports.</font></font> *
<font face="Arial, sans-serif"><font size="2">Produces an automated Cost
Distribution Report (CDR) RCS-10-01 41.</font></font> * <font face="Arial,
sans-serif"><font size="2">Generates and processes Audiology compensation
and pension visits through an agreement with the Automated Medical
Information Exchange (AMIE) package.</font></font> * <font face="Arial,
sans-serif"><font size="2">Allows input of a patient's audiogram and
display of audiometric data in graphical or tabular format. The audiogram
may then be signed and transmitted to the VA Denver Distribution Center
(DDC) for inclusion in a patient's hearing aid order. The audiogram
will also be recorded in the DDC's national database of audiometric
data.</font></font>









































===== Radiology/Nuclear Medicine =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

Radiology/Nuclear Medicine is a comprehensive software package designed
to assist with the functions related to processing patients for imaging
examinations. The Radiology/Nuclear Medicine package automates the entire
range of diagnostic functions performed in imaging departments, including
order entry of requests, registration of patients for exams, processing
of exams, recording of reports/results, verification of reports on-line,
displaying/printing results for clinical staff, automatic tracking of
requests/exams/reports, and generation of management statistics/reports,
both recurring and ad hoc.



<font size="3">'''Features'''</font>

<font size="2">Functionality is screened by Imaging Type to make it look
as if there are separate sub-packages. Many options are also screened
by or allow selection by division and/or imaging location.</font>

* <font size="2">There is on-line patient registration for exams,
automatic printing of flash cards and jacket labels, and transcription
of patient radiological/nuclear medicine reports.</font> * Management
reports include workload, complications and ad hoc summaries, daily
activity logs, examination statistics, and performance indicators. *
Health Level 7 (HL7) (e.g., voice-to-text and PACS equipment) standard
for interfacing with non- VistA computer systems is supported for the
exchange of radiology/nuclear medicine results. * There is on-line
physician verification of radiological/nuclear medicine exam reports
using electronic signatures. * Stop codes and procedures associated
with a radiological/nuclear medicine exam are automatically credited
for reimbursement purposes. * It interfaces with the Computerized
Patient Record System module for entry of radiology/nuclear medicine
requests and display of results to clinical staff. It interfaces with the
Adverse Reaction Tracking (ART) module by allowing users to add contrast
media reactions to ART via the Radiology/Nuclear Medicine package. It
interfaces with the Women's Health module by automatically adding
mammogram and ultrasound procedures for female patients to the Women's
Health database. * <font face="Arial, sans-serif"><font size="2">It
supports entry of multiple diagnostic codes and multiple interpreting by
residents and staff.</font></font> * <font face="Arial, sans-serif"><font
size="2">There is a single combined report for a set of related
procedures. This is a "printset" mechanism for entering a single report
for all descendent cases registered from a parent order.</font></font> *
<font face="Arial, sans-serif"><font size="2">It provides the ability to
enter and edit information specific to radiopharmaceuticals for Nuclear
Medicine.</font></font> * <font face="Arial, sans-serif"><font size="2">It
allows on-line verification of "STAT" category requests.</font></font>
* It allows for the selection and printing of multiple reports.
* It allows for the selection and printing of multiple reports.


<!-- file -->
==== Remote Order Entry System (ROES) ====


'''Overview'''


The Remote Order Entry System (ROES) is the front-end of the Denver Distribution Center's (DDC) supply chain/order fulfillment production system. ROES is used by Department of Veterans Affairs (VA) clinicians to place orders for certain types of medical products and services that are maintained under contract by the DDC. The most substantial product line handled through ROES is custom hearing aids. As implied by the name, custom hearing aids are highly specialized devices custom made for individual veteran patients. The ROES application and database are tailored for efficiency in ordering these unique devices and other items available from the DDC. Other product lines handled through ROES include stock hearing aids, hearing aid accessories and batteries, prosthetic items, aids for the visually impaired, and assistive devices. The hearing aid repair is a line of service provided by the DDC and facilitated by ROES. The ROES application and database integrates the DDC enterprise business functions of contracting/acquisition management, order fulfillment, distribution management, finance, and product life cycle support. Extensive order tracking, serialized device registration, patient/device history, and sales/financial reporting are also supported by the database.


'''Features'''


ROES uses advanced technologies and practices in software design, supporting hardware platform, database management, and network integration. ROES also integrates Web-based application architecture with a VistA environment, obtaining an optimum mix of decentralized VistA interfacing with centralized data management. The database is optimized for the DDC's progressive procurement and distribution practices, advanced general business practices, and current VA regulations.
<!-- file -->


==== Scheduling ====


'''Overview'''
===== Remote Order Entry System (ROES) =====


The Scheduling module automates all aspects of the outpatient appointment process, including the ability to check in/check out patients, clinic set-up and maintenance, enrollment/scheduling/discharge of patients to and from various clinics, and the generation of managerial reports, statistical reports, patient letters, and workload reporting. It provides for multiple-appointment booking, which enables the user to schedule, at one time, numerous appointments on a consecutive day/week basis. This pattern of scheduling supports requirements for clinics such as dialysis treatment and physical therapy.


The system may display numerous messages when an appointment is scheduled depending on the availability of the slot requested. These include notification that the appointment is an overbook, the patient already has an appointment scheduled for that date and time, or the appointment cannot be made due to previous inactivation of the designated clinic. In addition, certain classification questions are prompted during the check out process (if applicable) to determine if treatment rendered was connected to special circumstances (such as Agent Orange, Ionizing Radiation, Persian Gulf, etc.).


Patient Appointment Information gathers appointment data to be loaded into the National Database in Austin for statistical reporting. Patient appointments are scanned from September 1, 2002 to the present, and appointment data meeting specified criteria are transmitted to the Austin Automation Center (AAC). Subsequent transmissions will update the National Database. This additional data supplements the existing Clinic Appointment Wait Time extracts.
<font face="Times New Roman, serif"><font size="3">''''''<font
face="Arial, sans-serif">Overview</font>''''''</font></font>


The functions within Scheduling currently fall into four major categories: Appointment Scheduling, Local Reporting (outputs), National Data Collection, and Module Set-Up and Maintenance.
The Remote Order Entry System (ROES) is the front-end of the Denver
Distribution Center's (DDC) supply chain/order fulfillment production
system. ROES is used by Department of Veterans Affairs (VA) clinicians
to place orders for certain types of medical products and services that
are maintained under contract by the DDC. The most substantial product
line handled through ROES is custom hearing aids. As implied by the
name, custom hearing aids are highly specialized devices custom made
for individual veteran patients. The ROES application and database are
tailored for efficiency in ordering these unique devices and other items
available from the DDC. Other product lines handled through ROES include
stock hearing aids, hearing aid accessories and batteries, prosthetic
items, aids for the visually impaired, and assistive devices. The
hearing aid repair is a line of service provided by the DDC and
facilitated by ROES. The ROES application and database integrates the
DDC enterprise business functions of contracting/acquisition management,
order fulfillment, distribution management, finance, and product life
cycle support. Extensive order tracking, serialized device registration,
patient/device history, and sales/financial reporting are also supported
by the database.


'''Features'''


* Creates fixed or variable length clinic patterns.
* Provides on-line clinic availability and system identification of conditions such as first available appointment.
* Interacts with the Record Tracking module allowing chart request at the time of appointment scheduling.
* Generates cancellation, no-show, and pre-appointment letters.
* Provides on-line transmission of pertinent visit information to the national database at the Austin Automation Center.
* Patient Appointment Information functionality collects and formats data for Health Level Seven (HL7) batch transmission. It also utilizes new hardware technologies for transmitting data via the VA's Intranet.


<!-- file -->
<font face="Times New Roman, serif"><font size="3">''''''<font
==== Social Work ====
face="Arial, sans-serif">Features</font>''''''</font></font>


'''Overview'''
<font face="Arial, sans-serif"><font size="2">ROES uses advanced
technologies and practices in software design, supporting hardware
platform, database management, and network integration. ROES also
integrates Web-based application architecture with a VistA environment,
obtaining an optimum mix of decentralized VistA interfacing with
centralized data management. The database is optimized for the DDC's
progressive procurement and distribution practices, advanced general
business practices, and current VA regulations.</font></font>


The Social Work package is designed to facilitate the Social Work Service functions within a medical facility and is composed of Case Management, Clinical Assessment, and Community Resource. The Case Management software is used for managing social work cases (e.g., opening and closing cases, recording problems and outcomes, storing referrals) and for generation of reports that are transmitted quarterly to VA Central Office. The Clinical Assessment software provides a method of identifying, upon admission, patients most likely to require social work assistance before or after discharge. The hospital stay may be minimized with the anticipation of patients' domestic or social needs prior to discharge. The Community Resource software allows the social worker to build a network of local community agencies that can serve the veteran. The network enables the worker to expediently match the needs of the client to the existing community resources, thereby increasing productivity and viable referrals.


'''Features'''


The Social Work package:
===== Scheduling =====


* Features automatic screening that uses predetermined and site-specific criteria (e.g., veteran with no permanent address) to determine if a patient needs the services of Social Work Service prior to discharge.

* Creates networks of local community agencies (e.g., alcohol treatment, housing, health) that can serve veterans.

* Compiles a list of community resources by user-selected category (e.g., name, town, type, zip code).
<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>
* Identifies local residential care homes and maintains detailed information on the homes (e.g., rates, vacancies, residents, date home assessed by a VA social worker).

* Allows workers to track patients and homes in the residential care home program by home and patient registry printouts.
The Scheduling module automates all aspects of the outpatient appointment
* Facilitates mailings to residential care home sponsors by printing address labels.
process, including the ability to check in/check out patients, clinic
* Tracks caseloads by recording the openings and closings of cases.
set-up and maintenance, enrollment/scheduling/discharge of patients
* Compiles and produces monthly and quarterly reports. Transmits data electronically via the network MailMan module.
to and from various clinics, and the generation of managerial reports,
* Provides patient teaching and monitoring necessary for VHA-wide system of coordination/care management services.
statistical reports, patient letters, and workload reporting. It provides
* Provides for standardized Psycho-social Database/Assessment for inclusion in patient medical records. Also, provides mechanism for entering progress notes.
for multiple-appointment booking, which enables the user to schedule,
at one time, numerous appointments on a consecutive day/week basis. This
pattern of scheduling supports requirements for clinics such as dialysis
treatment and physical therapy.



The system may display numerous messages when an appointment is scheduled
depending on the availability of the slot requested. These include
notification that the appointment is an overbook, the patient already
has an appointment scheduled for that date and time, or the appointment
cannot be made due to previous inactivation of the designated clinic. In
addition, certain classification questions are prompted during the
check out process (if applicable) to determine if treatment rendered
was connected to special circumstances (such as Agent Orange, Ionizing
Radiation, Persian Gulf, etc.).



Patient Appointment Information gathers appointment data to be loaded
into the National Database in Austin for statistical reporting. Patient
appointments are scanned from September 1, 2002 to the present, and
appointment data meeting specified criteria are transmitted to the
Austin Automation Center (AAC). Subsequent transmissions will update the
National Database. This additional data supplements the existing Clinic
Appointment Wait Time extracts.



The functions within Scheduling currently fall into four major categories:
Appointment Scheduling, Local Reporting (outputs), National Data
Collection, and Module Set-Up and Maintenance.



<font size="3">'''Features'''</font>

* Creates fixed or variable length clinic patterns. * Provides on-line
clinic availability and system identification of conditions such as
first available appointment. * Interacts with the Record Tracking module
allowing chart request at the time of appointment scheduling. * Generates
cancellation, no-show, and pre-appointment letters. * Provides on-line
transmission of pertinent visit information to the national database
at the Austin Automation Center. * Patient Appointment Information
functionality collects and formats data for Health Level Seven (HL7)
batch transmission. It also utilizes new hardware technologies for
transmitting data via the VA’s Intranet.

===== Social Work =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

The Social Work package is designed to facilitate the Social Work Service
functions within a medical facility and is composed of Case Management,
Clinical Assessment, and Community Resource. The Case Management software
is used for managing social work cases (e.g., opening and closing cases,
recording problems and outcomes, storing referrals) and for generation of
reports that are transmitted quarterly to VA Central Office. The Clinical
Assessment software provides a method of identifying, upon admission,
patients most likely to require social work assistance before or after
discharge. The hospital stay may be minimized with the anticipation
of patients’ domestic or social needs prior to discharge. The
Community Resource software allows the social worker to build a network of
local community agencies that can serve the veteran. The network enables
the worker to expediently match the needs of the client to the existing
community resources, thereby increasing productivity and viable referrals.



<font size="3">'''Features'''</font>

<font size="2">The Social Work package:</font>

* <font size="2">Features automatic screening that uses predetermined
and site-specific criteria (e.g., veteran with no permanent address) to
determine if a patient needs the services of Social Work Service prior
to discharge.</font> * Creates networks of local community agencies
(e.g., alcohol treatment, housing, health) that can serve veterans. *
Compiles a list of community resources by user-selected category (e.g.,
name, town, type, zip code). * Identifies local residential care homes
and maintains detailed information on the homes (e.g., rates, vacancies,
residents, date home assessed by a VA social worker). * Allows workers to
track patients and homes in the residential care home program by home and
patient registry printouts. * Facilitates mailings to residential care
home sponsors by printing address labels. * Tracks caseloads by recording
the openings and closings of cases. * Compiles and produces monthly
and quarterly reports. Transmits data electronically via the network
MailMan module. * Provides patient teaching and monitoring necessary for
VHA-wide system of coordination/care management services. * Provides for
standardized Psycho-social Database/Assessment for inclusion in patient
medical records. Also, provides mechanism for entering progress notes.
* Provides for automated quality management monitors and reviews.
* Provides for automated quality management monitors and reviews.


<!-- file -->
==== Spinal Cord Dysfunction ====


'''Overview'''


The Spinal Cord Dysfunction (SCD) package permits the identification and tracking of patients with a spinal cord dysfunction due to trauma or disease and the medical resources utilized during their treatment. The module supports the maintenance of local and national registries. It includes features for clinical, management, and research staff. Clinicians benefit from the ability to see profiles of Spinal Cord Dysfunction patients, and the software helps them ensure that regular annual exams are completed with functionality to measure patient outcomes. Managers have a suite of reports that reflect the resources needed to care for Spinal Cord Dysfunction patients, and researchers have access to a national registry for all veteran Spinal Cord Dysfunction patients and their associated health care events.


'''Features'''


* Allows for the entry and tracking of a patient's functional measures over time. This includes the American Spinal Injury Association (ASIA) Impairment Scale, Functional Independence Measure (FIM), Craig Handicap Assessment and Reporting Technique (CHART), Functional Assessment Measure (FAM), Duke University of Illness Index (DIENER, DUSOI), and for Multiple Sclerosis patients, Kurtzke Functional Systems Scales and Expanded Disability Status Scales (EDSS).
* Generates a Health Level Seven (HL7) message to a national registry whenever a new record is created or a current record is edited. The central registry is used to provide VA-wide review of patient demographics, clinical aspects of injury and disease, and resource utilization involved in providing care to patients.
* Provides a link to the Health Summary package.
* Provides a variety of reports, including ad hoc and data filtering capabilities:


* New applications for inpatient care, current inpatient/outpatient activity, and discharges.
* Patient outcome information.
* Registrant injury reports.
* Self reported functional measures and summaries of clinician reported measures.
* Annual rehabilitation evaluations: offered, received and due.
* Mailing labels and Aggregate Outcomes Reports.


<!-- file -->
==== Surgery ====


'''Overview'''


The Surgery package is designed to be used by surgeons, surgical residents, anesthetists, operating room nurses, and other surgical staff. This software integrates scheduling surgical cases and tracking clinical patient data to provide a variety of administrative and clinical reports.


In the operating room, the software provides on-line access to the clinical record and automatically generates post-operative reports, including the Nurse Intraoperative Report. Automated scheduling provides better operating room utilization and greater ease in distributing the operating room schedule, and the software generates monthly, quarterly, and annual surgical reports, thus reducing the amount of clinical overhead associated with the management of the Surgical Service. The Surgery software facilitates morbidity and mortality tracking and other complications, providing vital information to the Chief of Surgery and to VA Central Office.


'''Features'''


The Surgery package:


* Allows a surgeon to generate requests for surgical procedures.
===== Spinal Cord Dysfunction =====
* Allows operating room scheduling managers to assign operating rooms and time slots and generates operating room schedules.



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

The Spinal Cord Dysfunction (SCD) package permits the identification
and tracking of patients with a spinal cord dysfunction due to trauma or
disease and the medical resources utilized during their treatment. The
module supports the maintenance of local and national registries. It
includes features for clinical, management, and research staff. Clinicians
benefit from the ability to see profiles of Spinal Cord Dysfunction
patients, and the software helps them ensure that regular annual exams
are completed with functionality to measure patient outcomes. Managers
have a suite of reports that reflect the resources needed to care for
Spinal Cord Dysfunction patients, and researchers have access to a
national registry for all veteran Spinal Cord Dysfunction patients and
their associated health care events.



<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>

* Allows for the entry and tracking of a patient's functional measures
over time. This includes the American Spinal Injury Association (ASIA)
Impairment Scale, Functional Independence Measure (FIM), Craig Handicap
Assessment and Reporting Technique (CHART), Functional Assessment Measure
(FAM), Duke University of Illness Index (DIENER, DUSOI), and for Multiple
Sclerosis patients, Kurtzke Functional Systems Scales and Expanded
Disability Status Scales (EDSS). * Generates a Health Level Seven
(HL7) message to a national registry whenever a new record is created
or a current record is edited. The central registry is used to provide
VA-wide review of patient demographics, clinical aspects of injury and
disease, and resource utilization involved in providing care to patients.
* Provides a link to the Health Summary package. * Provides a variety
of reports, including ad hoc and data filtering capabilities:

* New applications for inpatient care, current inpatient/outpatient
activity, and discharges. * Patient outcome information. * Registrant
injury reports. * Self reported functional measures and summaries of
clinician reported measures. * Annual rehabilitation evaluations:
offered, received and due. * Mailing labels and Aggregate Outcomes
Reports.









===== Surgery =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

<font face="Arial, sans-serif"><font size="2">The Surgery package
is designed to be used by surgeons, surgical residents, anesthetists,
operating room nurses, and other surgical staff. This software integrates
scheduling surgical cases and tracking clinical patient data to provide
a variety of administrative and clinical reports.</font></font>



<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">In the operating room, the software
provides on-line access to the clinical record and automatically
generates post-operative reports, including the Nurse Intraoperative
Report. Automated scheduling provides better operating room utilization
and greater ease in distributing the operating room schedule, and the
software generates monthly, quarterly, and annual surgical reports, thus
reducing the amount of clinical overhead associated with the management
of the Surgical Service. The Surgery software facilitates morbidity and
mortality tracking and other complications, providing vital information to
the Chief of Surgery and to VA Central Office.</font></font></font></font>



<font size="3">'''Features'''</font>

<font size="2">The Surgery package:</font>

* <font size="2">Allows a surgeon to generate requests for surgical
procedures.</font> * Allows operating room scheduling managers to assign
operating rooms and time slots and generates operating room schedules.
* Allows for the rescheduling or cancellation of operative procedures.
* Allows for the rescheduling or cancellation of operative procedures.
* Facilitates entry of information specific to an individual surgical
* Facilitates entry of information specific to an individual surgical case (e.g., staff, times, diagnoses, complications, anesthesia).
* Provides for on-line entry of data inside the operating room during the actual operative procedure.
case (e.g., staff, times, diagnoses, complications, anesthesia). *
* Generates patient records and nurse reports.
Provides for on-line entry of data inside the operating room during
* Produces management reports (e.g., Annual Report of Surgical Procedures, Attending Surgeons Report, Nurse Staffing Report, Anesthesia Management).
the actual operative procedure. * Generates patient records and
* Produces quarterly and annual reports for VA Central Office.
nurse reports. * Produces management reports (e.g., Annual Report of
* Provides secured access to lists of cancellations and the Morbidity and Mortality Report.
Surgical Procedures, Attending Surgeons Report, Nurse Staffing Report,
* Extracts data necessary to monitor risk management issues.
Anesthesia Management). * Produces quarterly and annual reports for VA
* Provides additional checks for Transfusion Error Risk Management.
Central Office. * Provides secured access to lists of cancellations and
* Includes a generic Health Level Seven (HL7) interface for use with commercial Automated Anesthesia Information Systems.
the Morbidity and Mortality Report. * Extracts data necessary to monitor
* Includes an interface to the Patient Care Encounters (PCE) software that allows ambulatory procedure workload information to be transmitted to the National Patient Care Database (NPCD) at Austin.
risk management issues. * Provides additional checks for Transfusion
* Allows for on-line electronic signature of the Nurse Intraoperative Report and the Anesthesia Report
Error Risk Management. * Includes a generic Health Level Seven (HL7)
interface for use with commercial Automated Anesthesia Information
Systems. * Includes an interface to the Patient Care Encounters (PCE)
software that allows ambulatory procedure workload information to be
transmitted to the National Patient Care Database (NPCD) at Austin.
* Allows for on-line electronic signature of the Nurse Intraoperative
Report and the Anesthesia Report

===== Surgery: Risk Assessment =====



<font size="3">'''Overview'''</font>

<font face="Arial, sans-serif"><font size="2">The Risk Assessment module
of the Surgery software provides medical facilities a mechanism to track
information relating to both surgical risk and operative mortality. This
information, once downloaded to the VA national database, supports a
program of total quality improvement in Surgery in VHA.</font></font>



<font face="Arial, sans-serif"><font size="2">The National Surgical
Quality Improvement Program (NSQIP) was established to develop
distributions of observed-to-expected (O/E) mortality and morbidity
ratios (risk-adjusted outcomes) across facilities for all operations,
for eight major sub-specialties, and for cardiac surgery. At each of
VA’s medical facilities</font></font>

performing surgery, a Surgical Clinical Nurse Reviewer, under
the direction of the Chief of Surgery, collects risk and outcome
data. All patients undergoing major surgery requiring general,
spinal, or epidural anesthesia are assessed. Completed non-cardiac
assessments are electronically transmitted to the Hines, IL Center
for Cooperative Studies in Health Services (CCSHS), while cardiac
assessments are transmitted to the Denver Cardiac Coordinating Center for
data analysis. At these centers, models are continually developed and
enhanced for the major surgical subspecialties and procedure-specific
cardiac surgeries. Managerial reports are prepared at the coordinating
centers to provide Chiefs of Surgery with their own risk-adjusted data
compared to the VA national averages.



<font size="3">'''Features'''</font>

<font face="Arial, sans-serif"><font size="2">The Risk Assessment
module:</font></font>

* <font face="Arial, sans-serif"><font size="2">Provides for entry of
non-cardiac assessment information including pre-operative information,
laboratory test results, operation information, and intraoperative
and post-operative occurrences.</font></font> * <font face="Arial,
sans-serif"><font size="2">Provides for entry of cardiac assessment
information, including clinical information, cardiac catheterization
and angiographic data, operative risk summary data, cardiac procedures
requiring cardio-pulmonary bypass, and intraoperative and post-operative
occurrences.</font></font> * <font face="Arial, sans-serif"><font
size="2">Creates a Surgery Risk Assessment report on each patient
assessed.</font></font> * <font face="Arial, sans-serif"><font
size="2">Transmits completed Surgery Risk Assessments to Hines CCSHS and
Denver Cardiac Coordinating Center.</font></font> * <font face="Arial,
sans-serif"><font size="2">Lists Surgery Risk Assessments by categories,
including complete, incomplete, and transmitted assessments, as well
as lists of major surgical cases and all surgical cases.</font></font>
* <font face="Arial, sans-serif"><font size="2">Generates a monthly
Surgical Case Workload Report.</font></font>

* <font face="Arial, sans-serif"><font size="2">Prints follow-up letters
to patients 30 days after a procedure.</font></font>

















===== '''VistA Imaging System''' =====



<font size="3">'''Overview'''</font>

The major goal of '''V'''<font style="font-size: 8pt"
size="1">''IST''</font>'''A''' Imaging is to facilitate medical
decision-making by delivering complete multimedia patient information to
the clinician’s desktop in an integrated manner. Windows-based
workstations, which are interfaced to the main hospital system in
a client-server architecture, make images and associated text data
available at all times anywhere in the hospital.



[[Image:vista_monograph2005_06_html_m5a3c1bf0.jpg]]



'''V'''<font style="font-size: 8pt" size="1">''IST''</font>'''A'''
Imaging handles high quality image data from many specialties, including
cardiology, pulmonary and gastrointestinal medicine, pathology, radiology,
hematology, and nuclear medicine. '''V'''<font style="font-size:
8pt" size="1">''IST''</font>'''A''' Imaging can also process textual
reports from the hospital information system, scanned documents and
electrocardiograms.



'''V'''<font style="font-size: 8pt" size="1">''IST''</font>'''A'''
Imaging is integrated with the Computerized Patient Record System (CPRS)
to provide a comprehensive electronic patient record. '''V'''<font
style="font-size: 8pt" size="1">''IST''</font>'''A''' Imaging improves
the quality of patient care, enhances clinicians’ communication,
and is used routinely for daily work, conferences, morning reports,
educational seminars, and during ward rounds.



'''V'''<font style="font-size: 8pt" size="1">''IST''</font>'''A'''
Imaging’s diagnostic display software ('''V'''<font
style="font-size: 8pt" size="1">''IST''</font>'''A'''Rad) can be used
for the filmless interpretation of radiology studies and for radiology
workflow management.



'''V'''<font style="font-size: 8pt" size="1">''IST''</font>'''A'''
Imaging is made up of the following components:



* Core Infrastructure * Document Imaging * Filmless Radiology * Imaging
Ancillary Systems



Each component is described in the following pages.

<font size="3">'''V'''</font><font size="3">'''istA'''</font><font
size="3">'''Imaging â€" continued'''</font>



<font size="3">'''Features'''</font>

'''V'''<font style="font-size: 8pt" size="1">''IST''</font>'''A'''
Imaging:



* Provides display, manipulation, and management functions for a wide
variety of medical images such as radiographs, sonograms, EKG tracings,
gastroenterology studies, pulmonary bronchoscope exams, podiatry,
dermatology and ophthalmology images. Images can be any sort of multimedia
data, including digital images, motion video clips, graphics, scanned
documents, and audio files.



* Is integrated with CPRS, allowing users to view images automatically
for a selected patient. When a user views a radiology report or progress
note in CPRS, the associated images are easily available.



* Provides an interface between '''V'''<font style="font-size: 8pt"
size="1">''IST''</font>'''A''' and commercial PACS systems using DICOM
Gateway software.



* Automatically acquires complete studies from DICOM-compliant modalities
(CT, MRI, digital x-ray, ultrasound, etc), associates the studies with
the correct patient and report, and stores the studies in '''V'''<font
style="font-size: 8pt" size="1">''IST''</font>'''A''' Imaging for
inclusion in the electronic patient record.



* Manages image file storage, management, and retrieval from magnetic and
optical disk servers and supports data capture, storage, and retrieval
over a local or wide area network (WAN).



* Provides access to electronic medical records from remote VA medical
facilities over the VA intranet, if appropriate access privileges are
assigned.



















===== VistA Imaging: '''Core Infrastructure''' =====



<font size="3">'''Overview'''</font>

The Core Imaging Infrastructure includes the components used to capture,
store, and display all types of images. Images can be captured using video
cameras, digital cameras, document and color scanners, x-ray scanners,
and files created by commercial capture software. Images can also be
directly acquired from DICOM-compliant devices such as CT scanners,
MR scanners and digital x-ray machines.



<font
color="gray">[[Image:vista_monograph2005_06_html_m7935ca00.jpg]]</font>



Captured images are accessible through '''V'''<font style="font-size: 8pt"
size="1">''IST''</font>'''A''' Imaging or the Computerized Patient Record
System (CPRS) graphical user interface (GUI) on the clinician’s
desktop. Viewing a procedure/exam report or progress note in CPRS allows
the user to automatically access any associated images.



Core Imaging Infrastructure is made up of the following:



* DICOM text gateways, which provide patient and order information
to medical devices (such as CT scanners and digital radiography
systems), allowing selection of the examination to be performed. The
data provided by DICOM text gateways complies with the DICOM Modality
Worklist standard. DICOM text gateways can also be used to communicate
patient and order information to commercial PACS (Picture Archiving and
Communications Systems).



* DICOM image gateways, which allow '''V'''<font style="font-size:
8pt" size="1">''IST''</font>'''A''' Imaging to receive images from
PACS systems or acquisition devices. Image gateways can also be
used to transfer images from the '''V'''<font style="font-size: 8pt"
size="1">''IST''</font>'''A''' system to any DICOM-compliant storage
devices for display, printing, or teleradiology purposes.



* Windows-based workstation software for image display and capture.



* The Background Processor, which manages image storage on various network
devices, including magnetic storage (RAID) and optical storage (jukebox)
as a long-term archive.

<font size="3">'''Core Infrastructure â€" continued'''</font>



* The '''V'''<font style="font-size: 8pt" size="1">''IST''</font>'''A'''
Imaging database, which manages the links between images and patient
electronic records.



* The commercially available equipment required by '''V'''<font
style="font-size: 8pt" size="1">''IST''</font>'''A''' Imaging, including
magnetic servers, optical disk jukeboxes, and utility workstations.



<font size="3">'''Features'''</font>

The Core Imaging Infrastructure:



* Acquires images and multimedia data. * Stores images to allow immediate
access and long-term permanent storage. * Communicates and displays
images in a timely manner. * Processes different types of images from
different specialties. * Links images to '''V'''''ist'''''A'''’s
integrated patient record so that they can be retrieved by patient or
study/progress note. * Protects security and privacy of images, and
prevents alteration of images after capture. * Enables remote viewing
and capture of images. * Uses non-proprietary hardware.

===== '''VistA Imaging: Document Imaging''' =====



<font size="3">'''Overview'''</font>

Document Imaging allows scanned and electronically generated documents
to be associated with the online patient record and displayed on clinical
workstations. The benefits of Document Imaging include:



* Online availability of all information in the electronic patient
record, including handwritten papers, drawings, signed documents, and
medical correspondence. * Linkage of paper-based patient information to
the electronic patient record, making all patient information quickly
available and easily retrievable from a single source. * Immediate
availability of critical documents, such as advance directives and
informed consent forms, at the time of need. * Elimination of lost or
misfiled medical chart information. * Potential savings due to reduced
medical records staff and file room costs. Possible benefits include
decreased retrieval, filing and delivery functions, reduced volume of
paper records, and faster retrieval time for clinicians.



Document Imaging will also provide interfaces to commercial document
scanning systems and systems that generate documents electronically.



<font size="3">'''Features'''</font>

* Scanning and indexing of black-and-white, grayscale, and color
documents, including: signed advance directives, consent forms, annotated
drawings, outside medical records documents, and administrative documents
such as Means Test forms. * Automatic transmission of signed means test
documents to the Health Eligibility Center (HEC), in compliance with VA
requirements. * Document image storage in short and long term storage
devices. * Display of images for clinical and administrative purposes.
* Printing of document images.

===== VistA Imaging: '''Filmless Radiology''' =====



<font size="3">'''Overview'''</font>

Filmless Radiology uses high-resolution workstations and high-speed
servers to allow radiology departments to operate without generating
x-ray film. Workstations running '''V'''<font style="font-size: 8pt"
size="1">''IST''</font>'''A'''Rad, '''V'''<font style="font-size:
8pt" size="1">''IST''</font>'''A''' Imaging’s diagnostic image
display software, are used by radiologists for the online interpretation
of images acquired by CR, CT, MRI, and other modalities. '''V'''<font
style="font-size: 8pt" size="1">''IST''</font>'''A'''Rad is integrated
with the '''V'''''ist'''''A''' Hospital Information System and with the
Radiology Package in particular.



[[Image:vista_monograph2005_06_html_5ad8d931.jpg]]

<font size="3">'''Features'''</font>

* Exam lists, which are based on exam status or patient name, are used to
divide the pool of available exams into useful categories. Exam lists are
created using information from the Radiology package and the '''V'''<font
style="font-size: 8pt" size="1">''IST''</font>'''A''' patient database.



* Site-specific custom lists can be created to reflect the workflow of
individual departments.



* In addition to images, other parts of a patient's medical record,
such as laboratory and pathology information, can be displayed using
the '''V'''<font style="font-size: 8pt" size="1">''IST''</font>'''A'''
Health Summary reporting capability.



<font size="3">'''VistA'''</font><font size="3">'''Imaging: Filmless
Radiology â€" continued'''</font>







* A full range of image display and manipulation features for radiology
and nuclear medicine images are provided.



* Multiple exams can be displayed concurrently, allowing for comparisons
with prior studies.



* Exam locks are used to prevent duplication of effort.



* Specialized display tools are provided for CT, MRI, and angiography
exams, including cine viewing, series linking, and series synchronization.

===== VistA Imaging: '''Imaging Ancillary Systems''' =====



<font size="3">'''Overview'''</font>

'''VistA''' Imaging’s Ancillary Systems component captures, stores,
and displays images for a particular service or specialty. This may be
accomplished using the Clinical Capture workstation or by interfaces to
commercial systems. These commercial systems are typically small systems,
and often incorporate special-purpose hardware. They often have components
that assist clinicians in creating exam or procedure reports.



<span style="background:
#00ffff">[[Image:vista_monograph2005_06_html_37e63799.gif]]</span>



<font size="3">'''Features'''</font>

* <font face="Arial, sans-serif"><font size="2">Allows direct capture
of images from a variety of sources, such as standard video outputs from
medical devices, and digital cameras.</font></font>



* <font face="Arial, sans-serif"><font size="2">Interfaces to a
commercial EKG system for display of electrocardiograms on clinical
workstations.</font></font>



* <font face="Arial, sans-serif"><font size="2">Supports automatic
DICOM interfaces for capture of specialty images from compliant systems
(DICOM Modality Worklist Conformance Requirements are provided to sites
purchasing specialty equipment).</font></font>



* <font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">In the future DICOM and Clinical Workstation
support for ophthalmology, dental, endoscopy, pathology, cardiology,
and other specialties will be included.</font></font></font></font>



* <font face="Arial, sans-serif"><font size="2">Support for
acquisition of DICOM Structured Report information is planned for the
future.</font></font>

===== Visual Impairment Service Team (VIST) =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

The Visual Impairment Service Team (VIST) program is designed to enhance
the efficiency of the Visual Impairment Service Team programs within
the Department of Veterans Affairs (VA). With this program, Visual
Impairment Service Teams are able to easily manage and track activities
and services provided to blinded veterans in their service area. This
program integrates several fields of patient data to produce a variety
of reports. The VIST patient record printout can be used in place of VA
Form 10-1371 and is a more versatile document than the card.



<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>

* <font face="Arial, sans-serif"><font size="2">Enhances the efficiency
of the Visual Impairment Service Team programs.</font></font> * <font
face="Arial, sans-serif"><font size="2">Provides a way to easily track and
manage activities and services provided to blinded veterans.</font></font>
* <font face="Arial, sans-serif"><font size="2">Provides a wide variety
of reports based on patient data.</font></font> * <font face="Arial,
sans-serif"><font size="2">Blinded veterans can be quickly added or
deleted from the rolls.</font></font>



<font face="Arial, sans-serif"><font size="2">The new Blind Rehabilitation
V.5.0 will integrate all four segments of Blind Rehabilitation Service,
which includes VA Headquarters and Visual Impairment Service Teams
(VIST), Blind Rehabilitation Outpatient Specialists (BROS), and Blind
Rehabilitation Centers (BRC). It will also store data from surveys on
patient demographics, satisfaction, and outcome. The data is expected
to determine outcome measures and provide a national information system
for the Department of Veterans Affairs.</font></font>



<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">A few of the main features will be:
A Web-based user interface following W3Chtml specifications use
of existing</font></font> <font face="Arial, sans-serif"><font
size="2">VistA</font></font> <font face="Arial, sans-serif"><font
size="2">tools, HealtheVet architecture and Data Base Integration
Agreements (DBIAs) to interface with existing</font></font>
<font face="Arial, sans-serif"><font size="2">VistA</font></font>
<font face="Arial, sans-serif"><font size="2">applications for more
streamlined data entry, and retrieval and to minimize duplicated data
entry. Multi-divisional data capture and reporting will be a new feature,
as well as a streamlined centralized database.</font></font></font></font>







































=== <font face="Arial, sans-serif"><font style="font-size: 16pt"
size="4"><span lang="en-US">'''Vitals/Measurements'''</span></font></font>

=======



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

<font face="Arial, sans-serif"><font size="2">The Vitals/Measurements
application is designed to store, in the patient's electronic medical
record, all vital signs and various measurements associated with a
patient's hospital stay or outpatient clinic visit. Data can be accessed
by several Veterans Health Information Systems and Technology Architecture
VistA applications (e.g., Health Summary and Pharmacy) that interface
with the Vitals/Measurements application.</font></font>



<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>

* <font face="Arial, sans-serif">Contains a Graphical User Interface (GUI)
to make editing and viewing of data easier.</font> * <font face="Arial,
sans-serif"><font size="2">Supports documentation of a patient's vital
signs (e.g., temperature, pulse, and respiration).</font></font> * <font
face="Arial, sans-serif"><font size="2">Tracks a patient's height, weight,
central venous pressure (CVP), circumference/girth, and oxygen saturation
via oximetry with supplemental oxygen information.</font></font> *
<font face="Arial, sans-serif"><font size="2">Supports documentation
of detailed or positional blood pressures for a patient (i.e.,
bilateral blood pressures taken in a sitting, standing, and lying
position).</font></font> * <font face="Arial, sans-serif"><font
size="2">Associates qualifiers (alpha characters appended to the
measurement's numeric value) to provide a more detailed description of
the patient's vitals/measurements.</font></font> * <font face="Arial,
sans-serif"><font size="2">Prints patient's cumulative measurements on
the Vital Signs Record and the Cumulative Vitals Report.</font></font> *
<font face="Arial, sans-serif"><font size="2">Displays latest information
on all of the patient's vitals/measurements in both metric equivalents
and U.S. customary units along with the date/time the information
was obtained.</font></font> * <font face="Arial, sans-serif"><font
size="2">Prints an expanded vitals graphic report, which includes the
patient's intake and output when present in the patient's database (refer
to the Intake and Output application).</font></font> * <font face="Arial,
sans-serif"><font size="2">Allows facilities to establish hospital-wide
high and low values for each vital sign or measurement.</font></font>
* <font face="Arial, sans-serif">Identifies abnormal patient values
on vitals/measurements reports (those values outside the high and low
range).</font> * <font face="Arial, sans-serif"><font size="2">Prints
the following patient measurements in a linear graphic format when using
a Kyocera F-800A or HP compatible (programmable) printer:</font></font>

* Temperature and pulse * Blood pressure * Weight * Pulse oximetry and
respiration * Pain

* <font face="Arial, sans-serif"><font size="2">If reports are printed
on a dot matrix printer, plotted data values are not connected
by a line.</font></font> * <font face="Arial, sans-serif"><font
size="2">Supports the archiving and purging of patient measurements,
which are no longer required on the production account, through
FileMan.</font></font> * <font face="Arial, sans-serif"><font
size="2">Passes patient vitals/measurements information (numeric
values only) within a specific date range to the Health Summary
application.</font></font> * <font face="Arial, sans-serif"><font
size="2">Records a reason for the omission of a patient's
vitals/measurements.</font></font>

===== Women’s Health =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

<font face="Arial, sans-serif"><font size="2">The purpose of the
Women's Health package is to establish a computerized tracking system
that generates aggregate data at the facility level. The product would
assist in the assessment of various aspects of care provided to women
veterans, such as efficiency of care, outcomes of care, and quality
of care for individual patients. It is intended to: provide data to
determine if there are differences in disease frequency between women
veterans and the general population; provide information for clinical
guideline development and determine if preventive health screening
guidelines developed for the general population are applicable, or need
modification in the women veteran population; and provide workload,
preventive screening, women veterans health profile, outcome measurement,
and provider profiling data.</font></font>



<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>

<font face="Arial, sans-serif"><font size="2">The Women's Health software
is composed of three main modules: Patient Management, Management Reports,
and Manager's Functions.</font></font>



<font face="Arial, sans-serif"><font size="2">Patient Management is the
portion of the software used to manage individual patient care, that
is, their procedures, due dates, and correspondence. Under the Patient
Management menu, it is possible to maintain patient data such as the
date of the next PAP smear, colposcopy or mammogram, the patient's
pregnancy and her EDC (due date), as well as the patient's current
PAP regimen. It is also possible to track the patient's individual
procedures: the date performed, the provider and clinic, the results
or diagnosis, etc. Notifications (letters and phone calls) may also be
tracked. A file of form letters has been included in the software, and
these letters may be edited and personalized for a clinic's particular
needs. Reminder letters can be queued months in advance of a future
appointment, then printed and mailed out shortly before the tentative
appointment.</font></font>



<font face="Arial, sans-serif"><font size="2">Management Reports is
the portion of the software used to print epidemiological reports, such
as the number of women who received a mammogram for the selected time
period or the number of patients having abnormal PAP results during a
selected time period. Under the Management Reports menu, it is possible
to produce lists of patients who are past their due dates for follow-up
procedures. It is also possible to store program statistics by date for
later comparison of program trends and progress.</font></font>



<font face="Arial, sans-serif"><font size="2">Manager's Functions is that
portion of the software that provides the ADPAC with a set of utilities
for configuring the software to the specific needs of the site. It
also provides utilities for other program needs, such as customizing
tables, making special edits to patient data (e.g., pregnancy log, PAP
regimen log), printing notification letters, running error reports,
and documenting laboratory results. By using the File Maintenance
options under the Manager's Functions menu, it is possible to maintain
site-specific parameters, such as the text of form letters, the types
of notifications and their synonyms, how and when letters get printed,
and several defaults relating to dates.</font></font>









==== Management and Financial Systems ====





<font face="Arial, sans-serif"><font size="3">'''Management and Financial
Systems manages portfolios for the core legacy systems, aids in the
planning, development, and implementation of enterprise-wide projects,
and provides billing and patient records management solutions to our
internal customers and end users, which results in a positive experience
for our most prized customer, the Veteran.'''</font></font>

<font face="Times New Roman, serif"><font size="3"><font
color="black"><font face="Arial, sans-serif">'''The MFS portfolio focuses
on:'''</font></font></font></font>

* <font face="Times New Roman, serif"><font size="3"><font
color="black"><font face="Arial, sans-serif">'''Patient
Financial Services Systems'''</font></font></font></font>
* <font face="Times New Roman, serif"><font size="3"><font
color="black"><font face="Arial, sans-serif">'''Fee Basis Claims
Processing'''</font></font></font></font> * <font face="Times New
Roman, serif"><font size="3"><font color="black"><font face="Arial,
sans-serif">'''Decision Support Systems'''</font></font></font></font>
* <font face="Times New Roman, serif"><font size="3"><font
color="black"><font face="Arial, sans-serif">'''Core
Financial Logistics Systems'''</font></font></font></font>
* <font face="Times New Roman, serif"><font size="3"><font
color="black"><font face="Arial, sans-serif">'''Health Revenue
Center'''</font></font></font></font> * <font face="Times New
Roman, serif"><font size="3"><font color="black"><font face="Arial,
sans-serif">'''HIPAA'''</font></font></font></font> * <font face="Arial,
sans-serif"><font size="3">'''Future Integration with Commercial
Applications'''</font></font>



===== Accounts Receivable (AR) =====



<font size="3">'''Overview'''</font>

<font face="Arial, sans-serif"><font size="2">The Accounts Receivable
(AR) package is a system of accounting and receivables management. The
AR package automates the debt collection process and a billing module is
available to create non-medical care debts. Functionality is available to
establish, follow-up on, collect against, and track all medical facility
debts.</font></font>

Some of the debts owed to a VA facility may include patient care covered
by health insurance companies, veteran copayments, pharmacy prescription
copayments, employee salary overpayments, lost or damaged property,
vendor collectibles, benefit overpayments, and services provided under
a sharing agreement with another institution.



<font size="3">'''Features'''</font>

* <font size="2">Provides a generic billing system used to generate
standardized bills.</font> * Receives patient and third party billing
information passed automatically from the Integrated Billing (IB) package.
* Sends electronic transmissions to the Consolidated Copayment Processing
Center (CCPC) in Austin, TX to generate patient statements. *
Automatically processes first party payments received from the Lockbox
Bank. * Calculates interest and administrative charges. * Records,
processes, and tracks payment information from patients, vendors,
insurance companies, employees, and institutions. * Records and tracks
credit balances if debtors have overpaid their accounts, and processes
refunds as appropriate. * Updates Financial Management System (FMS)
with Accounts Receivable data. * Updates the Medical Care Collections
Fund (MCCF) National Database with Accounts Receivable data.


==== Surgery: Risk Assessment ====
* Tracks and forwards eligible delinquent patient, vendor, and employee
{{:VistA_Monograph Wiki/Surgery:Risk_Assessment}}
debts to the Treasury Program for offset.
==== VistA Imaging System ====
===== Status: VistA Imaging: missing - Alternate Available =====
{{WorldVistA-Not}}VistA Imaging: missing - Uses proprietary components not available outside the VA.<br>
{{WorldVistA-Alt}}[http://sourceforge.net/projects/o3-dpacs O3 DPACS] IHE compliant from the [http://www.o3consortium.eu/ O3 Consortium] - Open Source - Java based


For original VistA Monograph Entries See: [[VistA Imaging Archive]]
* Tracks delinquent debts for Regional Counsel and Department of
<!-- file -->
Justice for enforced collection. * Provides the ability to set up
repayment plans. * Provides reports and inquiries for the follow-up and
maintenance of outstanding receivables. * Provides for transmission of
certain AR bills over 90 days old to be referred to the Debt Management
Center (DMC) for collection action. * Automatically processes electronic
payments and explanation of benefits documents received from third party
insurance carriers through the EDI Lockbox bank.


===== Automated Information Collection System (AICS) =====
==== Visual Impairment Service Team (VIST) ====


'''Overview'''


The Visual Impairment Service Team (VIST) program is designed to enhance the efficiency of the Visual Impairment Service Team programs within the Department of Veterans Affairs (VA). With this program, Visual Impairment Service Teams are able to easily manage and track activities and services provided to blinded veterans in their service area. This program integrates several fields of patient data to produce a variety of reports. The VIST patient record printout can be used in place of VA Form 10-1371 and is a more versatile document than the card.


'''Features'''
<font size="3">'''Overview'''</font>


* Enhances the efficiency of the Visual Impairment Service Team programs.
<font face="Arial, sans-serif"><font size="2">The Automated Information
* Provides a way to easily track and manage activities and services provided to blinded veterans.
Collection System (AICS) software supports outpatient clinical efforts
* Provides a wide variety of reports based on patient data.
through the creation and printing of encounter forms that display relevant
* Blinded veterans can be quickly added or deleted from the rolls.
clinical information, and provides for the entry of clinical encounter
data for local and national needs. These encounter forms are used to
display relevant patient data for use during the appointment (e.g.,
demographics, allergies, clinical reminders, and problems) and to collect
data about the appointment (e.g., procedures, providers, and diagnoses),
thus providing an organized method of data collection through scanning or
data entry. Many of the lists that a user sees in Computerized Patient
Record System (CPRS) for input of outpatient encounter data are based
on lists created when designing encounter forms for clinics.</font></font>


The new Blind Rehabilitation V.5.0 will integrate all four segments of Blind Rehabilitation Service, which includes VA Headquarters and Visual Impairment Service Teams (VIST), Blind Rehabilitation Outpatient Specialists (BROS), and Blind Rehabilitation Centers (BRC). It will also store data from surveys on patient demographics, satisfaction, and outcome. The data is expected to determine outcome measures and provide a national information system for the Department of Veterans Affairs.


A few of the main features will be: A Web-based user interface following W3Chtml specifications use of existing VistA tools, HealtheVet architecture and Data Base Integration Agreements (DBIAs) to interface with existing VistA applications for more streamlined data entry, and retrieval and to minimize duplicated data entry. Multi-divisional data capture and reporting will be a new feature, as well as a streamlined centralized database.


<!-- file -->
<font face="Arial, sans-serif"><font size="2">A form generator is
==== Vitals/Measurements ====
included, which allows sites to design forms which meet local medical
facility needs. There is enough flexibility in the software so sites
can build forms that meet their individual clinical, billing, and
resource requirements. The encounter form may be filed in the clinical
record.</font></font>


'''Overview'''


The Vitals/Measurements application is designed to store, in the patient's electronic medical record, all vital signs and various measurements associated with a patient's hospital stay or outpatient clinic visit. Data can be accessed by several Veterans Health Information Systems and Technology Architecture VistA applications (e.g., Health Summary and Pharmacy) that interface with the Vitals/Measurements application.


'''Features'''
<font face="Arial, sans-serif"><font size="2">A print manager is included
that allows sites to define reports to print in conjunction with the
encounter form and any supplemental forms for each appointment. Reports
can be defined to print at the division, clinic group, or clinic
level. Utilities are available to manage when and where forms may
print.</font></font>


* Contains a Graphical User Interface (GUI) to make editing and viewing of data easier.
* Supports documentation of a patient's vital signs (e.g., temperature, pulse, and respiration).
* Tracks a patient's height, weight, central venous pressure (CVP), circumference/girth, and oxygen saturation via oximetry with supplemental oxygen information.
* Supports documentation of detailed or positional blood pressures for a patient (i.e., bilateral blood pressures taken in a sitting, standing, and lying position).
* Associates qualifiers (alpha characters appended to the measurement's numeric value) to provide a more detailed description of the patient's vitals/measurements.
* Prints patient's cumulative measurements on the Vital Signs Record and the Cumulative Vitals Report.
* Displays latest information on all of the patient's vitals/measurements in both metric equivalents and U.S. customary units along with the date/time the information was obtained.
* Prints an expanded vitals graphic report, which includes the patient's intake and output when present in the patient's database (refer to the Intake and Output application).
* Allows facilities to establish hospital-wide high and low values for each vital sign or measurement.
* Identifies abnormal patient values on vitals/measurements reports (those values outside the high and low range).
* Prints the following patient measurements in a linear graphic format when using a Kyocera F-800A or HP compatible (programmable) printer:


* Temperature and pulse
* Blood pressure
* Weight
* Pulse oximetry and respiration
* Pain


* If reports are printed on a dot matrix printer, plotted data values are not connected by a line.
<font face="Times New Roman, serif"><font size="3"><font face="Arial,
* Supports the archiving and purging of patient measurements, which are no longer required on the production account, through FileMan.
sans-serif"><font size="2">Data from encounter forms can be
* Passes patient vitals/measurements information (numeric values only) within a specific date range to the Health Summary application.
inputted (into</font></font> <font face="Arial, sans-serif"><font
* Records a reason for the omission of a patient's vitals/measurements.
size="2">VistA</font></font><font face="Arial, sans-serif"><font
size="2">) in one of two ways. Forms can be scanned on client workstations
with the data is automatically transmitted to the</font></font> <font
face="Arial, sans-serif"><font size="2">VistA</font></font> <font
face="Arial, sans-serif"><font size="2">server, or clerks can key in
data from forms.</font></font></font></font>


<!-- file -->
==== Women's Health ====


'''Overview'''


The purpose of the Women's Health package is to establish a computerized tracking system that generates aggregate data at the facility level. The product would assist in the assessment of various aspects of care provided to women veterans, such as efficiency of care, outcomes of care, and quality of care for individual patients. It is intended to: provide data to determine if there are differences in disease frequency between women veterans and the general population; provide information for clinical guideline development and determine if preventive health screening guidelines developed for the general population are applicable, or need modification in the women veteran population; and provide workload, preventive screening, women veterans health profile, outcome measurement, and provider profiling data.
<font size="3">'''Features'''</font>


'''Features'''
* <font size="2">Provides a form design utility that allows creation of
attractive and easy to use forms for each clinic.</font> * Allows forms
to be designed to print with patient data displayed, such as patient
demographics, insurance information, allergies, clinical reminders that
are due, and active problems. * Allows for the creation of forms to
collect data such as procedures, diagnoses, problems, providers, progress
notes, vital signs, and PCE-related data such as exams, health factors,
patient education, skin tests, and immunizations. * Provides a print
manager that allows all clinic-specific forms to print with the encounter
form for an appointment. The print manager also provides a setup system
that, once accomplished, no longer requires daily user intervention.
* Provides an import/export utility that makes it easier for sites to
exchange forms they have already created. * Provides forms tracking to
ensure that each form printed is processed or accounted for. * Manual
data entry options are available to allow data to be key entered by a
clerk and passed to PCE to be stored.


The Women's Health software is composed of three main modules: Patient Management, Management Reports, and Manager's Functions.


Patient Management is the portion of the software used to manage individual patient care, that is, their procedures, due dates, and correspondence. Under the Patient Management menu, it is possible to maintain patient data such as the date of the next PAP smear, colposcopy or mammogram, the patient's pregnancy and her EDC (due date), as well as the patient's current PAP regimen. It is also possible to track the patient's individual procedures: the date performed, the provider and clinic, the results or diagnosis, etc. Notifications (letters and phone calls) may also be tracked. A file of form letters has been included in the software, and these letters may be edited and personalized for a clinic's particular needs. Reminder letters can be queued months in advance of a future appointment, then printed and mailed out shortly before the tentative appointment.


Management Reports is the portion of the software used to print epidemiological reports, such as the number of women who received a mammogram for the selected time period or the number of patients having abnormal PAP results during a selected time period. Under the Management Reports menu, it is possible to produce lists of patients who are past their due dates for follow-up procedures. It is also possible to store program statistics by date for later comparison of program trends and progress.
===== Beneficiary Travel =====


Manager's Functions is that portion of the software that provides the ADPAC with a set of utilities for configuring the software to the specific needs of the site. It also provides utilities for other program needs, such as customizing tables, making special edits to patient data (e.g., pregnancy log, PAP regimen log), printing notification letters, running error reports, and documenting laboratory results. By using the File Maintenance options under the Manager's Functions menu, it is possible to maintain site-specific parameters, such as the text of form letters, the types of notifications and their synonyms, how and when letters get printed, and several defaults relating to dates.


<!-- file -->
=== Management and Financial Systems ===


Management and Financial Systems manages portfolios for the core legacy systems, aids in the planning, development, and implementation of enterprise-wide projects, and provides billing and patient records management solutions to our internal customers and end users, which results in a positive experience for our most prized customer, the Veteran.
<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>


The MFS portfolio focuses on:
<font face="Arial, sans-serif"><font size="2">The Beneficiary Travel
module provides the ability to perform the functions involved in issuing
beneficiary travel pay. Travel reimbursement is provided to specified
categories of eligible veterans. It is also provided to non-employee
attendants who are eligible for such reimbursement. These attendants
will be issued travel pay under the veteran's name.</font></font>


* Patient Financial Services Systems
* Fee Basis Claims Processing
* Decision Support Systems
* Core Financial Logistics Systems
* Health Revenue Center
* HIPAA
* Future Integration with Commercial Applications


==== Accounts Receivable (AR) ====


'''Overview'''
<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">Payment for travel by special mode
(ambulance, handicapped van, etc.) may be authorized if medically
necessary and approved</font></font> <font face="Arial, sans-serif"><font
size="2">''before''</font></font><font face="Arial, sans-serif"><font
size="2">travel begins, except in cases of medical emergency where delay
would be hazardous to life or health.</font></font></font></font>


The Accounts Receivable (AR) package is a system of accounting and receivables management. The AR package automates the debt collection process and a billing module is available to create non-medical care debts. Functionality is available to establish, follow-up on, collect against, and track all medical facility debts.


Some of the debts owed to a VA facility may include patient care covered by health insurance companies, veteran copayments, pharmacy prescription copayments, employee salary overpayments, lost or damaged property, vendor collectibles, benefit overpayments, and services provided under a sharing agreement with another institution.


'''Features'''
<font face="Arial, sans-serif"><font size="2">For certain claims, the
system will compute the amount payable from factors such as account
type, parameter set-up of deductible amount per visit and per month,
one-way or round-trip mileage, and applied costs.</font></font>


* Provides a generic billing system used to generate standardized bills.
* Receives patient and third party billing information passed automatically from the Integrated Billing (IB) package.
* Sends electronic transmissions to the Consolidated Copayment Processing Center (CCPC) in Austin, TX to generate patient statements.
* Automatically processes first party payments received from the Lockbox Bank.
* Calculates interest and administrative charges.
* Records, processes, and tracks payment information from patients, vendors, insurance companies, employees, and institutions.
* Records and tracks credit balances if debtors have overpaid their accounts, and processes refunds as appropriate.
* Updates Financial Management System (FMS) with Accounts Receivable data.
* Updates the Medical Care Collections Fund (MCCF) National Database with Accounts Receivable data.


* Tracks and forwards eligible delinquent patient, vendor, and employee debts to the Treasury Program for offset.


* Tracks delinquent debts for Regional Counsel and Department of Justice for enforced collection.
<font size="3">'''Features'''</font>
* Provides the ability to set up repayment plans.
* Provides reports and inquiries for the follow-up and maintenance of outstanding receivables.
* Provides for transmission of certain AR bills over 90 days old to be referred to the Debt Management Center (DMC) for collection action.
* Automatically processes electronic payments and explanation of benefits documents received from third party insurance carriers through the EDI Lockbox bank.


<!-- file -->
* Automatically computes the amount payable for claims with an account
==== Automated Information Collection System (AICS) ====
type of Compensation and Pension. * Allows each site to define and edit
site-specific beneficiary travel parameters. * Produces a variety of
statistical reports for a specified date range. * Provides the ability
to reprint the standard pre-formatted beneficiary travel form for cash
reimbursement.


'''Overview'''
===== Compensation and Pension Records Interchange (CAPRI) =====


The Automated Information Collection System (AICS) software supports outpatient clinical efforts through the creation and printing of encounter forms that display relevant clinical information, and provides for the entry of clinical encounter data for local and national needs. These encounter forms are used to display relevant patient data for use during the appointment (e.g., demographics, allergies, clinical reminders, and problems) and to collect data about the appointment (e.g., procedures, providers, and diagnoses), thus providing an organized method of data collection through scanning or data entry. Many of the lists that a user sees in Computerized Patient Record System (CPRS) for input of outpatient encounter data are based on lists created when designing encounter forms for clinics.


A form generator is included, which allows sites to design forms which meet local medical facility needs. There is enough flexibility in the software so sites can build forms that meet their individual clinical, billing, and resource requirements. The encounter form may be filed in the clinical record.


A print manager is included that allows sites to define reports to print in conjunction with the encounter form and any supplemental forms for each appointment. Reports can be defined to print at the division, clinic group, or clinic level. Utilities are available to manage when and where forms may print.
<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>


Data from encounter forms can be inputted (into VistA) in one of two ways. Forms can be scanned on client workstations with the data is automatically transmitted to the VistA server, or clerks can key in data from forms.
<font face="Arial, sans-serif"><font size="2">The Compensation and Pension
Records Interchange (CAPRI) software was designed to promote efficient
communications between the Veterans Health Administration (VHA) and the
Veterans Benefits Administration (VBA). It offers VBA Rating Veteran
Service Representatives and Decision Review Officers help in building the
rating decision documentation through on-line access to medical data. It
creates a more efficient means of requesting compensation and pension
examinations and navigating existing patient records.</font></font>


'''Features'''


* Provides a form design utility that allows creation of attractive and easy to use forms for each clinic.
* Allows forms to be designed to print with patient data displayed, such as patient demographics, insurance information, allergies, clinical reminders that are due, and active problems.
* Allows for the creation of forms to collect data such as procedures, diagnoses, problems, providers, progress notes, vital signs, and PCE-related data such as exams, health factors, patient education, skin tests, and immunizations.
* Provides a print manager that allows all clinic-specific forms to print with the encounter form for an appointment. The print manager also provides a setup system that, once accomplished, no longer requires daily user intervention.
* Provides an import/export utility that makes it easier for sites to exchange forms they have already created.
* Provides forms tracking to ensure that each form printed is processed or accounted for.
* Manual data entry options are available to allow data to be key entered by a clerk and passed to PCE to be stored.


<!-- file -->
<font face="Arial, sans-serif"><font size="2">CAPRI provides a Graphical
==== Beneficiary Travel ====
User Interface (GUI) for the VistA Automated Medical Information Exchange
(AMIE) II application. AMIE II is a List Manager application that
automates the administrative procedures involved in sending medical
information used in determining veteran benefit payments from the VA
Medical Centers to the VA Regional Offices.</font></font>


'''Overview'''


The Beneficiary Travel module provides the ability to perform the functions involved in issuing beneficiary travel pay. Travel reimbursement is provided to specified categories of eligible veterans. It is also provided to non-employee attendants who are eligible for such reimbursement. These attendants will be issued travel pay under the veteran's name.


Payment for travel by special mode (ambulance, handicapped van, etc.) may be authorized if medically necessary and approved ''before''travel begins, except in cases of medical emergency where delay would be hazardous to life or health.
<font face="Arial, sans-serif"><font size="2">CAPRI handles most
administrative aspects of the examination process.</font></font>


For certain claims, the system will compute the amount payable from factors such as account type, parameter set-up of deductible amount per visit and per month, one-way or round-trip mileage, and applied costs.


'''Features'''


* Automatically computes the amount payable for claims with an account type of Compensation and Pension.
<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>
* Allows each site to define and edit site-specific beneficiary travel parameters.
* Produces a variety of statistical reports for a specified date range.
* Provides the ability to reprint the standard pre-formatted beneficiary travel form for cash reimbursement.


<!-- file -->
* Ability to add, edit, cancel exam requests. * Allows patient record
==== Compensation and Pension Records Interchange (CAPRI) ====
navigation to view such items as health summaries, progress notes,
lab reports, consult requests/results, etc. * Provides individual and
cumulative pending exam tracking. * Generates managerial and statistical
reports. * Integrates compensation and pension examination results into
the veteran’s medical record.


'''Overview'''
===== Current Procedural Terminology (CPT) =====


The Compensation and Pension Records Interchange (CAPRI) software was designed to promote efficient communications between the Veterans Health Administration (VHA) and the Veterans Benefits Administration (VBA). It offers VBA Rating Veteran Service Representatives and Decision Review Officers help in building the rating decision documentation through on-line access to medical data. It creates a more efficient means of requesting compensation and pension examinations and navigating existing patient records.


CAPRI provides a Graphical User Interface (GUI) for the VistA Automated Medical Information Exchange (AMIE) II application. AMIE II is a List Manager application that automates the administrative procedures involved in sending medical information used in determining veteran benefit payments from the VA Medical Centers to the VA Regional Offices.


CAPRI handles most administrative aspects of the examination process.
<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>


'''Features'''
<font face="Arial, sans-serif"><font size="2">Current Procedural
Terminology (CPT) codes are used for reporting medical services and
procedures performed by physicians. The purpose of the code is to
provide a uniform language that will accurately describe medical,
surgical, and diagnostic services, thereby providing an effective means
for reliable nationwide communication among physicians, patients, and
third parties. This system of terminology is the most widely accepted
nomenclature for the reporting of physician procedures and services
under government and private health insurance programs.</font></font>


* Ability to add, edit, cancel exam requests.
* Allows patient record navigation to view such items as health summaries, progress notes, lab reports, consult requests/results, etc.
* Provides individual and cumulative pending exam tracking.
* Generates managerial and statistical reports.
* Integrates compensation and pension examination results into the veteran's medical record.


<!-- file -->
==== Current Procedural Terminology (CPT) ====


'''Overview'''
<font face="Arial, sans-serif"><font size="2">The CPT software includes
all CPT codes to code outpatient services for reimbursement and
workload purposes (as determined by the American Medical Association)
and Health Care Financing Administration’s Current Procedural
Coding System (HCPCS) from the Health Care Financing Administration
(HCFA). These codes may also be used to report inpatient services in
certain instances.</font></font>


Current Procedural Terminology (CPT) codes are used for reporting medical services and procedures performed by physicians. The purpose of the code is to provide a uniform language that will accurately describe medical, surgical, and diagnostic services, thereby providing an effective means for reliable nationwide communication among physicians, patients, and third parties. This system of terminology is the most widely accepted nomenclature for the reporting of physician procedures and services under government and private health insurance programs.


The CPT software includes all CPT codes to code outpatient services for reimbursement and workload purposes (as determined by the American Medical Association) and Health Care Financing Administration's Current Procedural Coding System (HCPCS) from the Health Care Financing Administration (HCFA). These codes may also be used to report inpatient services in certain instances.


<font size="3">'''Features'''</font>
'''Features'''


* <font size="2">Provides annual updates for CPT and HCFA codes.</font>
* Provides annual updates for CPT and HCFA codes.
* Provides several reports to display new, revised, or inactivated codes.
* Provides several reports to display new, revised, or inactivated codes.
* Supplies detailed descriptions of CPT and HCFA codes.
* Supplies detailed descriptions of CPT and HCFA codes.


<!-- file -->
===== Decision Support System (DSS) Extracts =====
==== Decision Support System (DSS) Extracts ====


'''Overview'''


The VistA Decision Support System (DSS) Extracts software provides a means of exporting data from selected VistA software modules and transmitting it to a Decision Support System (DSS) resident at the Austin Automation Center (AAC). This transfer is accomplished through a set of extract routines, intermediate files, audit reports, transmission, and purge routines. Data from VistA packages is stored by the extract routines in the intermediate files, where it is temporarily available for local use and auditing. The data is then transmitted to the AAC where it is formatted and uploaded into commercial software. After the data has been successfully uploaded into the commercial software, it is purged from the intermediate files.


Extracts consist of the following functions: implementation of extract processes; scheduling extracts, verifying extracts against other VistA reports, transmission of extracts to the commercial software, verification of transmission, and purging extracts.
<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>


'''Features'''
<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">The</font></font> <font face="Arial,
sans-serif"><font size="2">VistA</font></font> <font face="Arial,
sans-serif"><font size="2">Decision Support System (DSS) Extracts
software provides a means of exporting data from selected</font></font>
<font face="Arial, sans-serif"><font size="2">VistA</font></font> <font
face="Arial, sans-serif"><font size="2">software modules and transmitting
it to a Decision Support System (DSS) resident at the Austin Automation
Center (AAC). This transfer is accomplished through a set of extract
routines, intermediate files, audit reports, transmission, and purge
routines. Data from</font></font> <font face="Arial, sans-serif"><font
size="2">VistA</font></font> <font face="Arial, sans-serif"><font
size="2">packages is stored by the extract routines in the intermediate
files, where it is temporarily available for local use and auditing. The
data is then transmitted to the AAC where it is formatted and uploaded
into commercial software. After the data has been successfully uploaded
into the commercial software, it is purged from the intermediate
files.</font></font></font></font>


* Extracts data from the following VistA software packages:


* Audiology and Speech Pathology (QUASAR)
* Dental
* Event Capture
* Inpatient Medications
* Laboratory
* Mental Health
* Nursing
* Pharmacy Prescriptions
* PIMS (ADT and Scheduling Modules)
* Prosthetics
* Radiology
* Surgery


* Uses a roll-and-scroll format that allows users to perform the various functions by selecting the appropriate menu options.
<font face="Times New Roman, serif"><font size="3"><font face="Arial,
* Uses VA Mailman to transmit data to commercial software resident at the AAC.
sans-serif"><font size="2">Extracts consist of the following
functions: implementation of extract processes; scheduling extracts,
verifying extracts against other</font></font> <font face="Arial,
sans-serif"><font size="2">VistA</font></font> <font face="Arial,
sans-serif"><font size="2">reports, transmission of extracts to
the commercial software, verification of transmission, and purging
extracts.</font></font></font></font>


<!-- file -->
==== Diagnostic Related Group (DRG) Grouper ====


'''Overview'''


The Diagnostic Related Group (DRG) Grouper is based on the Medicare Grouper requirements as defined by the Health Care Financing Administration and as reported in the ''Federal Register''. Each DRG represents a class of patients who are deemed medically comparable and who require approximately equal amounts of health care resources.
<font size="3">'''Features'''</font>


The module groups diagnostic and operation/procedure codes into the DRGs based on the combination of codes, age, sex, discharge status, and occurrence of death.
* <font size="3"><font size="2">Extracts data from the
following</font> <font size="2">VistA</font> <font size="2">software
packages:</font></font>


'''Features'''
* Audiology and Speech Pathology (QUASAR) * Dental * Event Capture *
Inpatient Medications * Laboratory * Mental Health * Nursing * Pharmacy
Prescriptions * PIMS (ADT and Scheduling Modules) * Prosthetics *
Radiology * Surgery


* Provides annual updates that conform to the latest release of the commercial grouper.
* Uses a roll-and-scroll format that allows users to perform the various
* Functions within or apart from other modules.
functions by selecting the appropriate menu options. * Uses VA Mailman
* Supplies detailed descriptions of DRGs, diagnostic codes, and operation/procedure codes.
to transmit data to commercial software resident at the AAC.
* Accepts one primary diagnosis and multiple secondary diagnostic codes and operation/procedure codes.
* Displays weighted work unit values as well as national and local high and low trim point values for each DRG.


<!-- file -->
===== Diagnostic Related Group (DRG) Grouper =====
==== Engineering ====


'''Overview'''


Engineering, also known as Automated Engineering Management System/Medical Equipment Reporting System (AEMS/MERS), facilitates the management of information needed to effectively discharge key operational responsibilities normally assigned to VA engineering organizations, such as:


* Equipment Management
<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>
* Work Control
* Space/Facility Management


The Engineering package was designed as a resource that can be shared by medical center administrative staff. Safeguards against unauthorized editing of key data elements of non-expendable (NX) equipment records have been designed into the system. Engineering maintains integration agreements with Integrated Funds Distribution, Control Point Activity, Accounting and Procurement (IFCAP) such that the status of work orders is automatically updated on the basis of orders for parts or service. The Engineering package is the VA's official record of inventory for capitalized personal property.
<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">The Diagnostic Related Group (DRG) Grouper
is based on the Medicare Grouper requirements as defined by the Health
Care Financing Administration and as reported in the</font></font>
<font face="Arial, sans-serif"><font size="2">''Federal
Register''</font></font><font face="Arial, sans-serif"><font
size="2">. Each DRG represents a class of patients who are deemed
medically comparable and who require approximately equal amounts of
health care resources.</font></font></font></font>


'''Features'''


* Uses bar codes for equipment inventory and preventive maintenance. Completed work orders are automatically posted to equipment histories.
* Tracks and controls work orders, maintaining annotated repair histories for medical and non-medical equipment. There is a separate menu option for display of incomplete work orders.
* Manages electronic work orders. Staff throughout a facility can enter work requests via a terminal or workstation. These requests are promptly reviewed by Engineering personnel and assigned to the appropriate maintenance shop.
* Identifies building features (square footage, floor coverings, window types, etc.) and keeps track of locks and keys.
* Provides capitalized personal property data to the Fixed Assets subsystem of the Financial Management System (FMS).


<!-- file -->
The module groups diagnostic and operation/procedure codes into the
==== Equipment/Turn-In Request ====
DRGs based on the combination of codes, age, sex, discharge status,
and occurrence of death.


'''Overview'''


The Equipment/Turn-In Request software provides additional functionality within the Integrated Funds Distribution, Control Point Activity, Accounting and Procurement (IFCAP) package, including the ability to enter an electronic request for new, non-expendable equipment and replacement equipment. It adds the functionality for tracking the request through the many stages of review, prior to its approval and becoming a permanent transaction. Users are allowed to turn in old equipment currently tracked in the Equipment Inventory file, generate an Engineering work order, and track its movement to its final disposition and removal from the inventory list. The Equipment/Turn-In Request serves as a records maintenance system, allowing the user to record important events throughout the ordering process. Such records can be printed in report format as supporting documentation about the equipment life cycle.


<font size="3">'''Features'''</font>
'''Features'''


* The software introduces a new position to the IFCAP package, the Consolidated Memorandum of Receipt (CMR) official. The CMR official is ultimately responsible for new and existing equipment located at the medical facilities.
* <font size="2">Provides annual updates that conform to the latest
* A requester can enter an electronic request for new or replacement equipment via a terminal.
release of the commercial grouper.</font> * Functions within or apart
* A requester can enter an electronic request to dispose of obsolete equipment.
from other modules. * Supplies detailed descriptions of DRGs, diagnostic
* The CMR official can approve, edit, or cancel an equipment request.
codes, and operation/procedure codes. * Accepts one primary diagnosis
* Engineering work orders can be generated for initial, additional, and replacement equipment.
and multiple secondary diagnostic codes and operation/procedure codes.
* Displays weighted work unit values as well as national and local high
and low trim point values for each DRG.


<!-- file -->
==== Event Capture ====


'''Overview'''


The Event Capture software provides a mechanism to track and account for procedures and delivered services that are not handled in any other VistA package. The procedures and services tracked through Event Capture are associated with:


* The patient to whom they were delivered.
* The provider requesting the service or procedure.
* The Decision Support System (DSS) Unit responsible for delivering the service.


DSS Units typically represent the smallest identifiable work unit in a clinical service at the medical center and are defined by the VAMCs. A DSS Unit can represent any of the following:
===== Engineering =====


* An entire service.
* A section of a service.
* A small section within a section.
* A medical equipment item used in patient procedures.


When creating or editing DSS Units, users choose what (if any) data is sent to PCE. The advantage of using Event Capture to send data to Patient Care Encounter (PCE) is that it eliminates the duplicate effort of entering the same workload data in the Scheduling software, then transmitting to PCE.


'''Features'''
<font size="3">'''Overview'''</font>


* Allows each VAMC to utilize the software for its own resource/costing needs.
Engineering, also known as Automated Engineering Management System/Medical
* Implements DSS Units.
Equipment Reporting System (AEMS/MERS), facilitates the management
* Assigns user access to all or specific DSS Units.
of information needed to effectively discharge key operational
* Sets up Event Code Screens to define relevant procedures for a DSS Unit.
responsibilities normally assigned to VA engineering organizations,
* Allows single and batch data entry for patient procedures.
such as:
* Generates reports for workload and other statistical tracking.
* Provides a Graphical User Interface to the ECS application.
* Allows user to upload patient encounter data to Event Capture from a spreadsheet.
* Files encounter records in PCE for DSS Units defined to send data to PCE.
* Generates DSS extracts.


<!-- file -->
==== Fee Basis ====


'''Overview'''


The Fee Basis package supports VHA's Fee for Service program, which is care authorized for veterans who are legally eligible and are in need of care that cannot feasibly be provided by a VA facility. A VA facility unable to meet the patient care requirements of a veteran may authorize fee basis services for short-term care, ongoing outpatient care, or home heath care from non-VA health care facilities. Bills for service are then submitted to the authorizing VA facility. The bill is reviewed by the facility and certified for payment through VA's payment center in Austin, Texas.
* Equipment Management * Work Control * Space/Facility Management


The Fee Basis package provides for more efficient and accurate operation of the fee for service program with reduction of paperwork, savings in staff hours, minimization of errors, and by allowing medical facilities to have greater control over disbursement of fee medical, pharmacy, and travel monies.


'''Features'''


* Performs entire fee for service process, both authorized and unauthorized, for Outpatient Medical Fee, Civilian Hospital, Community Nursing Home, and Pharmacy Fee.
<font face="Arial, sans-serif"><font size="2">The Engineering package was
* Automatically sends vendor updates from the central system to keep all files accurate and up-to-date.
designed as a resource that can be shared by medical center administrative
* Provides money management for all payments through the interface with the Financial Management System.
staff. Safeguards against unauthorized editing of key data elements
* Automatically receives payment confirmations from the U.S. Department of the Treasury, populating payment histories with check numbers and payment dates.
of non-expendable (NX) equipment records have been designed into the
* Outpatient Medical Fee:
system. Engineering maintains integration agreements with Integrated
Funds Distribution, Control Point Activity, Accounting and Procurement
(IFCAP) such that the status of work orders is automatically updated
on the basis of orders for parts or service. The Engineering package
is the VA's official record of inventory for capitalized personal
property.</font></font>


* Authorizes fee basis treatment.

* Enters fee providers and payments.

* Creates, closes out, and releases batches of invoices.
<font size="3">'''Features'''</font>
* Records travel payment.

* <font size="2">Uses bar codes for equipment inventory and preventive
maintenance. Completed work orders are automatically posted to
equipment histories.</font> * Tracks and controls work orders,
maintaining annotated repair histories for medical and non-medical
equipment. There is a separate menu option for display of incomplete
work orders. * Manages electronic work orders. Staff throughout a
facility can enter work requests via a terminal or workstation. These
requests are promptly reviewed by Engineering personnel and assigned
to the appropriate maintenance shop. * Identifies building features
(square footage, floor coverings, window types, etc.) and keeps track
of locks and keys. * Provides capitalized personal property data to
the Fixed Assets subsystem of the Financial Management System (FMS).



























===== Equipment/Turn-In Request =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

<font face="Arial, sans-serif"><font size="2">The Equipment/Turn-In
Request software provides additional functionality within the Integrated
Funds Distribution, Control Point Activity, Accounting and Procurement
(IFCAP) package, including the ability to enter an electronic request
for new, non-expendable equipment and replacement equipment. It adds
the functionality for tracking the request through the many stages of
review, prior to its approval and becoming a permanent transaction. Users
are allowed to turn in old equipment currently tracked in the Equipment
Inventory file, generate an Engineering work order, and track its movement
to its final disposition and removal from the inventory list. The
Equipment/Turn-In Request serves as a records maintenance system,
allowing the user to record important events throughout the ordering
process. Such records can be printed in report format as supporting
documentation about the equipment life cycle.</font></font>



<font size="3">'''Features'''</font>

* <font size="2">The software introduces a new position to the IFCAP
package, the Consolidated Memorandum of Receipt (CMR) official. The
CMR official is ultimately responsible for new and existing equipment
located at the medical facilities.</font> * <font size="2">A requester
can enter an electronic request for new or replacement equipment via a
terminal.</font> * <font size="2">A requester can enter an electronic
request to dispose of obsolete equipment.</font> * <font size="2">The
CMR official can approve, edit, or cancel an equipment request.</font>
* <font size="2">Engineering work orders can be generated for initial,
additional, and replacement equipment.</font>

















===== Event Capture =====



<font size="3">'''Overview'''</font>

The Event Capture software provides a mechanism to track and account
for procedures and delivered services that are not handled in any other
VistA package. The procedures and services tracked through Event Capture
are associated with:

* The patient to whom they were delivered. * The provider requesting
the service or procedure. * The Decision Support System (DSS) Unit
responsible for delivering the service.



DSS Units typically represent the smallest identifiable work unit in a
clinical service at the medical center and are defined by the VAMCs. A
DSS Unit can represent any of the following:

* <font face="Arial, sans-serif"><font size="2">An entire
service.</font></font> * <font face="Arial, sans-serif"><font size="2">A
section of a service.</font></font> * <font face="Arial, sans-serif"><font
size="2">A small section within a section.</font></font> * <font
face="Arial, sans-serif"><font size="2">A medical equipment item used
in patient procedures.</font></font>



When creating or editing DSS Units, users choose what (if any) data
is sent to PCE. The advantage of using Event Capture to send data
to Patient Care Encounter (PCE) is that it eliminates the duplicate
effort of entering the same workload data in the Scheduling software,
then transmitting to PCE.



<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>

* Allows each VAMC to utilize the software for its own resource/costing
needs. * <font face="Arial, sans-serif"><font size="2">Implements
DSS Units.</font></font> * <font face="Arial, sans-serif"><font
size="2">Assigns user access to all or specific DSS Units.</font></font>
* <font face="Arial, sans-serif"><font size="2">Sets up Event Code
Screens to define relevant procedures for a DSS Unit.</font></font>
* <font face="Arial, sans-serif"><font size="2">Allows single
and batch data entry for patient procedures.</font></font> * <font
face="Arial, sans-serif"><font size="2">Generates reports for workload
and other statistical tracking.</font></font> * <font face="Arial,
sans-serif"><font size="2">Provides a Graphical User Interface to the
ECS application.</font></font> * <font face="Arial, sans-serif"><font
size="2">Allows user to upload patient encounter data to Event Capture
from a spreadsheet.</font></font> * <font face="Arial, sans-serif"><font
size="2">Files encounter records in PCE for DSS Units defined to send
data to PCE.</font></font> * Generates DSS extracts.











===== Fee Basis =====



<font size="3">'''Overview'''</font>

The Fee Basis package supports VHA’s Fee for Service program,
which is care authorized for veterans who are legally eligible and are
in need of care that cannot feasibly be provided by a VA facility. A VA
facility unable to meet the patient care requirements of a veteran may
authorize fee basis services for short-term care, ongoing outpatient
care, or home heath care from non-VA health care facilities. Bills for
service are then submitted to the authorizing VA facility. The bill is
reviewed by the facility and certified for payment through VA’s
payment center in Austin, Texas.



The Fee Basis package provides for more efficient and accurate operation
of the fee for service program with reduction of paperwork, savings in
staff hours, minimization of errors, and by allowing medical facilities
to have greater control over disbursement of fee medical, pharmacy,
and travel monies.



<font size="3">'''Features'''</font>

* <font size="2">Performs entire fee for service process, both authorized
and unauthorized, for Outpatient Medical Fee, Civilian Hospital,
Community Nursing Home, and Pharmacy Fee.</font> * Automatically sends
vendor updates from the central system to keep all files accurate
and up-to-date. * Provides money management for all payments through
the interface with the Financial Management System. * Automatically
receives payment confirmations from the U.S. Department of the Treasury,
populating payment histories with check numbers and payment dates. *
Outpatient Medical Fee:

* Authorizes fee basis treatment. * Enters fee providers and payments.
* Creates, closes out, and releases batches of invoices. * Records
travel payment.


* Civilian Hospital:
* Civilian Hospital:


* Provides ability to perform complete payment process, from entering
* Provides ability to perform complete payment process, from entering patient authorizations to transmitting completed batch data (including the calculation of Medicare reimbursement).
patient authorizations to transmitting completed batch data (including
the calculation of Medicare reimbursement).


* Community Nursing Home:
* Community Nursing Home:
Line 5,470: Line 2,007:
* Pharmacy Fee:
* Pharmacy Fee:


* Provides the means to administer the Hometown Pharmacy. * Provides
* Provides the means to administer the Hometown Pharmacy.
payment for medications furnished veterans on an emergency basis. *
* Provides payment for medications furnished veterans on an emergency basis.
Facilitates the quick completion of previously repetitive actions and
* Facilitates the quick completion of previously repetitive actions and gives quick, accurate access to patient payment history.
gives quick, accurate access to patient payment history.




* State Home:
* State Home:


* Provides ability to track veterans receiving care provided by a state
* Provides ability to track veterans receiving care provided by a state home facility.
home facility.


<!-- file -->
===== Generic Code Sheet =====
==== Generic Code Sheet ====


'''Overview'''


The Generic Code Sheet module allows code sheet data to be entered and transmitted electronically from the medical facility service level to the national database. The module has eliminated the resources previously required for keypunching code sheets. Security is provided to prohibit unauthorized access to code sheets and data can easily be entered and edited via VA FileMan. Reports are available which help manage the code sheets from creation through batching and transmission and tool are included within the module to aid in the development of new code sheets at the local or national level.


'''Features'''
<font size="3">'''Overview'''</font>


* Contains approximately 250 automated code sheets.
<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">The Generic Code Sheet module allows code
sheet data to be entered and transmitted electronically from the
medical facility service level to the national database. The module
has eliminated the resources previously required for keypunching code
sheets. Security is provided to prohibit unauthorized access to code
sheets and data can easily be entered and edited via VA FileMan. Reports
are available which help manage the code sheets from creation through
batching and transmission and tool are included within the module to
aid in the development of new code sheets at the local or national
level.</font></font></font></font>



<font size="3">'''Features'''</font>

* <font size="2">Contains approximately 250 automated code sheets.</font>
* Allows new code sheets to be automated and included within the module.
* Allows new code sheets to be automated and included within the module.
* Allows easy on-line input of code sheet data from a VA FileMan or
* Allows easy on-line input of code sheet data from a VA FileMan or word processing format.
word processing format. * Eliminates keypunch and typing errors. *
* Eliminates keypunch and typing errors.
Provides code sheet security at the medical facility service or module
* Provides code sheet security at the medical facility service or module level.
level. * Allows code sheets to be grouped (batched) and transmitted to
* Allows code sheets to be grouped (batched) and transmitted to any domain connected to the VA network.
* Allows easy on-line editing and modifications to code sheets and batches.
any domain connected to the VA network. * Allows easy on-line editing
* Generates reports that detail the status of a code sheet or batch and prints the data contained within a code sheet or batch.
and modifications to code sheets and batches. * Generates reports that
detail the status of a code sheet or batch and prints the data contained
within a code sheet or batch.


<!-- file -->
==== Incomplete Records Tracking (IRT) ====


'''Overview'''


The Incomplete Records Tracking (IRT) package provides the medical center the ability to monitor incomplete records. Interim summaries, discharge summaries, and both inpatient and outpatient operation reports are tracked.


Records may be incomplete or deficient for one or more of the following reasons - not dictated, not transcribed, not signed, or not reviewed.


A list of the deficiencies each site will track is distributed with the software. These deficiency names and categories are highlighted on the screen display and are not editable. Sites may add new deficiencies. Deficiencies that are entered by the site are not highlighted on the screen display and can be edited.


'''Features'''


* Provides the ability to enter a new or edit an existing incomplete record in the IRT tracking system, edit a completed IRT record, and delete an IRT entry.
* Allows each site to establish and edit site-specific IRT parameters.
* Produces a variety of statistical reports for a specified date range.


<!-- file -->
==== Integrated Funds Distribution, Control Point Activity, Accounting and Procurement (IFCAP) ====


'''Overview'''


The Integrated Funds Distribution, Control Point Activity, Accounting and Procurement (IFCAP) module automates a spectrum of VA financial activities. VA employees use IFCAP to manage budgets, order goods and services, maintain records of available funds, determine the status of a request, compare vendors and items to determine the best purchase, record the receipt of items into the warehouse, and pay vendors. IFCAP automates the written regulations and policy for VA funding and procurement, which define the actions taken on requests for goods and services as formal transactions, orders, and payments are created for these requests.


'''Features'''






===== Incomplete Records Tracking (IRT) =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

<font face="Arial, sans-serif"><font size="2">The Incomplete Records
Tracking (IRT) package provides the medical center the ability to monitor
incomplete records. Interim summaries, discharge summaries, and both
inpatient and outpatient operation reports are tracked.</font></font>



<font face="Arial, sans-serif"><font size="2">Records may be incomplete
or deficient for one or more of the following reasons - not dictated,
not transcribed, not signed, or not reviewed.</font></font>



<font face="Arial, sans-serif"><font size="2">A list of the deficiencies
each site will track is distributed with the software. These deficiency
names and categories are highlighted on the screen display and are
not editable. Sites may add new deficiencies. Deficiencies that are
entered by the site are not highlighted on the screen display and can
be edited.</font></font>



<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>

* <font face="Arial, sans-serif"><font size="2">Provides the
ability to enter a new or edit an existing incomplete record in
the IRT tracking system, edit a completed IRT record, and delete
an IRT entry.</font></font> * <font face="Arial, sans-serif"><font
size="2">Allows each site to establish and edit site-specific IRT
parameters.</font></font> * <font face="Arial, sans-serif"><font
size="2">Produces a variety of statistical reports for a specified date
range.</font></font>

















=== Integrated Funds Distribution, Control Point Activity, Accounting
and Procurement (IFCAP) ===

====== ======

<font size="3">'''Overview'''</font>

The Integrated Funds Distribution, Control Point Activity, Accounting
and Procurement (IFCAP) module automates a spectrum of VA financial
activities. VA employees use IFCAP to manage budgets, order goods and
services, maintain records of available funds, determine the status of a
request, compare vendors and items to determine the best purchase, record
the receipt of items into the warehouse, and pay vendors. IFCAP automates
the written regulations and policy for VA funding and procurement,
which define the actions taken on requests for goods and services as
formal transactions, orders, and payments are created for these requests.



<font size="3">'''Features'''</font>


Allows users in different services to view the same document on-screen.
Allows users in different services to view the same document on-screen.


* Automates funds distribution, request for goods and services,
* Automates funds distribution, request for goods and services, purchase order, funds obligation, and the receipt process.
* Standardizes funds management. Automatically generates yearly budget elements for IFCAP control points.
purchase order, funds obligation, and the receipt process. *
* Maintains year-to-date balance for control points. Integrates service-level requisitions and facility administrative activities, and updates service-level records.
Standardizes funds management. Automatically generates yearly budget
* Shares vendor and item master data to eliminate duplicate input and promote user accuracy.
elements for IFCAP control points. * Maintains year-to-date balance
* Affixes processing status to each request at each step in the ordering cycle. Enhances security with the use of a unique electronic signature code for each user required to authorize an action.
for control points. Integrates service-level requisitions and facility
* Each record that is signed is set with an encoded value based on key fields from the record.
administrative activities, and updates service-level records. * Shares
* Transmits financial and inventory data to VA central accounting and inventory systems.
vendor and item master data to eliminate duplicate input and promote
* Automatically updates IFCAP records with central accounting system data. Provides various reports that give the current status of any request, a service fund balance, data required for budget analysis, and a listing of requests sorted according to control point specifications.
user accuracy. * Affixes processing status to each request at each
* Enables electronic transmission of purchase orders to vendors through Electronic Data Interchange (EDI).
step in the ordering cycle. Enhances security with the use of a unique
* Updates purchase order status automatically.
electronic signature code for each user required to authorize an action.
* Enables authorized users to purchase goods using Electronic Data Interchange (EDI) process for total electronic processing between vendor and buyer.
* Each record that is signed is set with an encoded value based on key
* Supports the ordering of goods under contract from specific vendors via delivery orders.
fields from the record. * Transmits financial and inventory data to VA
* Supports the payment for goods/services via the government purchase card and the subsequent on-line reconciliation.
central accounting and inventory systems. * Automatically updates IFCAP
* Inventory management functionality includes defining desired stock levels of items, autogeneration of replenishment orders, dispensing of goods to supported services or end user, identification of items via bar code technology, supporting communication of inventory information between a secondary inventory point and its associated automated supply cabinet(s), and reports displaying inventory level, distributions, and dollar values.
records with central accounting system data. Provides various reports
that give the current status of any request, a service fund balance, data
required for budget analysis, and a listing of requests sorted according
to control point specifications. * Enables electronic transmission of
purchase orders to vendors through Electronic Data Interchange (EDI).
* Updates purchase order status automatically. * Enables authorized
users to purchase goods using Electronic Data Interchange (EDI) process
for total electronic processing between vendor and buyer. * Supports
the ordering of goods under contract from specific vendors via delivery
orders. * Supports the payment for goods/services via the government
purchase card and the subsequent on-line reconciliation. * Inventory
management functionality includes defining desired stock levels of items,
autogeneration of replenishment orders, dispensing of goods to supported
services or end user, identification of items via bar code technology,
supporting communication of inventory information between a secondary
inventory point and its associated automated supply cabinet(s), and
reports displaying inventory level, distributions, and dollar values.


<!-- file -->
===== Integrated Patient Funds =====
==== Integrated Patient Funds ====


'''Overview'''


The Integrated Patient Funds software automates the mini-banking system that VA provides for patients to manage their personal funds while hospitalized in a VA medical facility.


Patient funds clerks create an individual patient account with information on a patient's psychological classification, financial status, and cash balance. Additional transactions consist of the deposit and withdrawal of funds.
<font size="3">'''Overview'''</font>


'''Features'''
The Integrated Patient Funds software automates the mini-banking system
that VA provides for patients to manage their personal funds while
hospitalized in a VA medical facility.


* Shares patient account data to eliminate duplicate input and promote accuracy.

* Records deposits and withdrawals.

<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">Patient funds clerks create an individual
patient account with information on a patient’s psychological
classification, financial status, and cash balance. Additional
transactions consist of the deposit and withdrawal of
funds.</font></font></font></font>



<font size="3">'''Features'''</font>

* <font size="2">Shares patient account data to eliminate duplicate
input and promote accuracy.</font> * Records deposits and withdrawals.
* Promotes security with the use of unique electronic signature codes.
* Promotes security with the use of unique electronic signature codes.
* Allows withdrawal restrictions for designated patients. * Allows
* Allows withdrawal restrictions for designated patients.
users (e.g., patient funds clerk and agent cashier) to view the same
* Allows users (e.g., patient funds clerk and agent cashier) to view the same information on-line.
information on-line. * Allows reconciliation of patient funds records
* Allows reconciliation of patient funds records with Fiscal Service.
with Fiscal Service. * Provides varied reports with the current status
* Provides varied reports with the current status of patient accounts, summary transaction information, restriction lists, and suspense files.
of patient accounts, summary transaction information, restriction lists,
and suspense files.


<!-- file -->
==== Integrated Billing (IB) ====


'''Overview'''


The Integrated Billing (IB) software contains all the features necessary to create bills for patients and third party carriers. It allows for the capture and storage of insurance data including policy information and related benefits. A Claims Tracking feature is available to assist utilization review staff in tracking episodes of care, completing pre-certifications, completing continued stay reviews, and processing appeals and denials. Patient charges (pharmacy, inpatient and outpatient co-payments as well, as per diems) are automatically processed. An Automated Biller is provided to assist billing clerks with billing third party carriers.


This software is highly integrated with other VistA packages. It is dependent on data from Registration, Scheduling, Outpatient Pharmacy, (Patient Care Encounter (PCE), and Prosthetics to determine billable events. Bills and charges created in IB are passed to Accounts Receivable for processing.


'''Features'''


* Tracks events requiring insurance company reviews from the time of the actual event until final payment is resolved.
* Provides the ability to establish group plans and record the annual benefits covered by the plans.
* Automates billing of patient charges for prescriptions, inpatient and outpatient co-payments, and long term care co-payments. For medication co-payments, it tracks charges billed to a veteran at all sites to ensure that the annual maximum billing cap is not exceeded.
* Automates the creation of third party billing claims forms (UB-92, HCFA-1500).
* Automates pricing of Third Party claims using Reasonable Charges based on care provided, payer, and provider.
* Provides the ability to include inpatient stays, outpatient visits, prescriptions, and prosthetic supplies on third party claims.
* Provides an Automated Biller, which automatically generates reimbursable bills identified in claims tracking that meets specific requirements as provided for in the site parameters.
* Provides insurance company-specific billing parameters so bills can better reflect local insurance company requirements.
* Includes a Charge Master, which allows facilities to load lists of billable rates into VistA.
* Includes an Output Formatter to allow sites to locally configure claims forms.
* Provides an extensive set of diagnostic reports that allow sites to monitor various aspects of the billing program.
* Provides a module for sites to track and price the services provided to out-of-network patients.
* Provides tools to maintain and/or modify the Insurance Company file.
* Provides EDI capabilities using standard transactions that are transmitted through a translator at the Austin AAC prior to being forwarded to a clearinghouse for dissemination to the appropriate payers. Supported EDI transactions include the transmission of healthcare claims and the verification of patient health insurance coverage.


<!-- file -->
==== Patient Care Encounter (PCE) ====


'''Overview'''


Patient Care Encounter (PCE) captures clinical data resulting from ambulatory care patient encounters. The captured clinical data documents "encounters" and related encounter information, such as problems treated at encounter, procedures done, immunizations, patient education, and skin tests.


PCE provides a data repository for long-term clinical data. A goal of PCE is to support many data capture methods for integrating clinical data from many environments. Pilot efforts have included population of the PCE clinical repository via scanner technologies and workstations.


The key users of this clinical data are clinicians, management, and Quality Management personnel.


'''Features'''


* Acts as VA's long-term clinical repository, documenting encounters from local and non-VA facilities.
* Provides a primary and secondary clinical visit management utility based on appointments and related services.
* Interfaces with the Health Summary package to provide components based on data captured and stored in the PCE clinical repository.
* Supports capture of outpatient encounter data. Data collection methods include:


* Interface between scanner/workstation and clinical repository.

* On-line data capture using List Manager user interface.

* Historical load utilities for lab and outpatient pharmacy.





























===== Integrated Billing (IB) =====



<font size="3">'''Overview'''</font>

<font face="Arial, sans-serif"><font size="2">The Integrated Billing
(IB) software contains all the features necessary to create bills for
patients and third party carriers. It allows for the capture and storage
of insurance data including policy information and related benefits. A
Claims Tracking feature is available to assist utilization review staff
in tracking episodes of care, completing pre-certifications, completing
continued stay reviews, and processing appeals and denials. Patient
charges (pharmacy, inpatient and outpatient co-payments as well, as per
diems) are automatically processed. An Automated Biller is provided to
assist billing clerks with billing third party carriers.</font></font>



<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">This software is highly integrated
with other</font></font> <font face="Arial, sans-serif"><font
size="2">VistA</font></font> <font face="Arial, sans-serif"><font
size="2">packages. It is dependent on data from Registration, Scheduling,
Outpatient Pharmacy, (Patient Care Encounter (PCE), and Prosthetics to
determine billable events. Bills and charges created in IB are passed
to Accounts Receivable for processing.</font></font></font></font>



<font size="3">'''Features'''</font>

* Tracks events requiring insurance company reviews from the time of the
actual event until final payment is resolved. * Provides the ability to
establish group plans and record the annual benefits covered by the plans.
* Automates billing of patient charges for prescriptions, inpatient and
outpatient co-payments, and long term care co-payments. For medication
co-payments, it tracks charges billed to a veteran at all sites to ensure
that the annual maximum billing cap is not exceeded. * Automates the
creation of third party billing claims forms (UBâ€"92, HCFAâ€"1500).
* Automates pricing of Third Party claims using Reasonable Charges
based on care provided, payer, and provider. * Provides the ability
to include inpatient stays, outpatient visits, prescriptions, and
prosthetic supplies on third party claims. * Provides an Automated
Biller, which automatically generates reimbursable bills identified in
claims tracking that meets specific requirements as provided for in the
site parameters. * Provides insurance company-specific billing parameters
so bills can better reflect local insurance company requirements. *
Includes a Charge Master, which allows facilities to load lists of
billable rates into VistA. * Includes an Output Formatter to allow
sites to locally configure claims forms. * Provides an extensive set
of diagnostic reports that allow sites to monitor various aspects of
the billing program. * Provides a module for sites to track and price
the services provided to out-of-network patients. * Provides tools to
maintain and/or modify the Insurance Company file. * <font face="Arial,
sans-serif"><font size="2">Provides EDI capabilities using standard
transactions that are transmitted through a translator at the Austin
AAC prior to being forwarded to a clearinghouse for dissemination to the
appropriate payers. Supported EDI transactions include the transmission
of healthcare claims and the verification of patient health insurance
coverage.</font></font>

===== Patient Care Encounter (PCE) =====



<font size="3">'''Overview'''</font>

<font face="Arial, sans-serif"><font size="2">Patient Care Encounter
(PCE) captures clinical data resulting from ambulatory care patient
encounters. The captured clinical data documents “encountersâ€
and related encounter information, such as problems treated at
encounter, procedures done, immunizations, patient education, and skin
tests.</font></font>



<font face="Arial, sans-serif"><font size="2">PCE provides a data
repository for long-term clinical data. A goal of PCE is to support
many data capture methods for integrating clinical data from many
environments. Pilot efforts have included population of the PCE clinical
repository via scanner technologies and workstations.</font></font>



<font face="Arial, sans-serif"><font size="2">The key users of this
clinical data are clinicians, management, and Quality Management
personnel.</font></font>



<font size="3">'''Features'''</font>

* <font face="Arial, sans-serif"><font size="2">Acts as VA’s
long-term clinical repository, documenting encounters from local and
non-VA facilities.</font></font> * <font face="Arial, sans-serif"><font
size="2">Provides a primary and secondary clinical visit management
utility based on appointments and related services.</font></font> *
<font face="Arial, sans-serif"><font size="2">Interfaces with the Health
Summary package to provide components based on data captured and stored
in the PCE clinical repository.</font></font> * <font face="Arial,
sans-serif"><font size="2">Supports capture of outpatient encounter
data. Data collection methods include:</font></font>

* Interface between scanner/workstation and clinical repository. *
On-line data capture using List Manager user interface. * Historical
load utilities for lab and outpatient pharmacy.


* Future methods will include automatic protocol event driver.
* Future methods will include automatic protocol event driver.


<!-- file -->
==== Personnel and Accounting Integrated Data (PAID) ====


'''Overview'''



===== Personnel and Accounting Integrated Data (PAID) =====



<font size="3">'''Overview'''</font>


<u>Enhanced Time and Attendance</u>
<u>Enhanced Time and Attendance</u>


The Enhanced Time and Attendance System (ETA) automates time and attendance for employees, timekeepers, payroll, and supervisors. It provides employees the ability to request leave and display both the status of pending requests and leave balances and allows payroll to manage time and leave (T&amp;L) units and tours of duty. It provides timekeeping, supervisory certification, and overtime management.
The Enhanced Time and Attendance System (ETA) automates time and
attendance for employees, timekeepers, payroll, and supervisors. It
provides employees the ability to request leave and display both the
status of pending requests and leave balances and allows payroll to
manage time and leave (T&amp;L) units and tours of duty. It provides
timekeeping, supervisory certification, and overtime management.




<u>Education Tracking</u>
<u>Education Tracking</u>


Education Tracking documents employee and student participation at
Education Tracking documents employee and student participation at mandatory and ward in-services, continuing education programs, and all other employee training. Training information is protected with varying levels of access.
mandatory and ward in-services, continuing education programs, and all
other employee training. Training information is protected with varying
levels of access.


'''Features'''


<font size="3">'''Features'''</font>


<u>Enhanced Time and Attendance</u>
<u>Enhanced Time and Attendance</u>


* Timekeepers can enter and edit employee’s time, view data
* Timekeepers can enter and edit employee's time, view data for current and prior pay periods, and view time card status for each employee.
* Payroll can view processing status of T&amp;Ls, locate uncertified or incomplete timecards.
for current and prior pay periods, and view time card status for
* Payroll may also manage T&amp;L units by enter/edit of supervisors, timekeepers and employees.
each employee. * Payroll can view processing status of T&amp;Ls,
* Payroll may view pay period data, master records, and accounting data for employees.
locate uncertified or incomplete timecards. * Payroll may also manage
* Payroll can create searches of master record and accounting data for custom local reports.
T&amp;L units by enter/edit of supervisors, timekeepers and employees.
* The payroll supervisor transmits all payroll data to the Austin Automation Center (AAC) and monitors transmission status.
* Payroll may view pay period data, master records, and accounting data
* The system automatically builds and updates employee records with AAC data.
for employees. * Payroll can create searches of master record and
* Authorized personnel may display and search master record and accounting data for all employees.
accounting data for custom local reports. * The payroll supervisor
* Employees may submit electronic leave requests and view leave balances, status of requests, and service records.
transmits all payroll data to the Austin Automation Center (AAC) and
* Supervisors can approve electronic requests and timecards and view employee leave reports.
monitors transmission status. * The system automatically builds and
updates employee records with AAC data. * Authorized personnel may
display and search master record and accounting data for all employees.
* Employees may submit electronic leave requests and view leave balances,
status of requests, and service records. * Supervisors can approve
electronic requests and timecards and view employee leave reports.




<u>Education Tracking</u>
<u>Education Tracking</u>


* Creates a class database with pertinent class information: class name,
* Creates a class database with pertinent class information: class name, presenter, location, purpose, category, type, mandatory review group, sponsoring agency, cost, accrediting organizations, employer/student expenses, contact hours, etc.
* Contains a class registration component that limits class registrants by number or service.
presenter, location, purpose, category, type, mandatory review group,
* Credits class participation to individual attendee records and allows attendance corrections.
sponsoring agency, cost, accrediting organizations, employer/student
* Provides site-configurable mandatory training groups, accrediting organizations, presentation media, supplier demographics, and class purpose.
expenses, contact hours, etc. * Contains a class registration component
* Contains reports, such as a calendar of events, a registration roster, service-based class, and a variety of employee training reports.
that limits class registrants by number or service. * Credits class
participation to individual attendee records and allows attendance
corrections. * Provides site-configurable mandatory training groups,
accrediting organizations, presentation media, supplier demographics,
and class purpose. * Contains reports, such as a calendar of events,
a registration roster, service-based class, and a variety of employee
training reports.


<!-- file -->
===== Voluntary Service System (VSS) =====
==== Voluntary Service System (VSS) ====


'''Overview'''


The Voluntary Service System (VSS) software is the first application to be developed in the current VistA Migration effort. VSS is a national-level application replacing the site-based Voluntary Timekeeping System (VTK). VTK has been used for many years at VA medical centers to track and manage the hours of service contributed by volunteers and volunteer organizations.


To improve data collection and reporting, users interact directly with a national, centralized database. Consolidated national reporting no longer requires data transmissions back and forth between sites and the Austin Automation Center. Direct access to data provides instantaneous updates and up-to-minute reporting for all users. Central Office administrators and Voluntary staff thus have broader and more reliable data for managing Volunteer services.
<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>


The VSS application helps Voluntary staff accomplish their tasks more easily through a Web-based graphical user interface. Users at the local and national level are able to generate a wider array of reports about volunteers and sponsoring organizations. In addition, volunteers are able to log their own hours and print meal tickets themselves at secure log-in "kiosks."
<font face="Arial, sans-serif"><font size="2">The Voluntary Service System
(VSS) software is the first application to be developed in the current
VistA Migration effort. VSS is a national-level application replacing
the site-based Voluntary Timekeeping System (VTK). VTK has been used for
many years at VA medical centers to track and manage the hours of service
contributed by volunteers and volunteer organizations.</font></font>


'''Features'''


* Provides multi-lingual interaction with volunteers during log-in.
* Supports and enhances security for multiple division facilities.
* Displays/prints entire master record for a single volunteer.
* Provides local printing of address labels and telephone lists.
* Reduces workload required to input mass award code changes.
* Prints individual meal ticket for volunteer after Auto Log-in.
* Provides real-time national reporting of data for all stations.


<!-- file -->
<font face="Arial, sans-serif"><font size="2">To improve data collection
=== Information and Education Systems ===
and reporting, users interact directly with a national, centralized
database. Consolidated national reporting no longer requires data
transmissions back and forth between sites and the Austin Automation
Center. Direct access to data provides instantaneous updates and
up-to-minute reporting for all users. Central Office administrators and
Voluntary staff thus have broader and more reliable data for managing
Volunteer services.</font></font>


Information and Education Systems with an emphasis on "eHealth" include prescription refills, appointments, fillable forms online, and My Health'''''<u>'''e'''</u>'''''Vet (Web-based access to health record, online health assessment tools, and high quality health information).


* Improve service to veterans and stakeholders
* Information that is accurate, up-to-date, readily available at any time, any place
* VA Internet primary gateway to trusted VA information and services for veterans and their families


<!-- file -->
<font face="Arial, sans-serif"><font size="2">The VSS application
==== Automated Safety Incident Surveillance Tracking System (ASISTS) ====
helps Voluntary staff accomplish their tasks more easily through a
Web-based graphical user interface. Users at the local and national
level are able to generate a wider array of reports about volunteers
and sponsoring organizations. In addition, volunteers are able to log
their own hours and print meal tickets themselves at secure log-in
“kiosks.â€</font></font>


'''Overview'''


Automated Safety Incident Surveillance Tracking System (ASISTS) was designed to manage the data from all employee accidents, create a Report of Accident (VA Form 2162) from the data, and produce both the Office of Worker's Compensation Programs Form CA-1 (Instructions for Completing Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation) and Form CA-2 (Federal Employee's Notice of Occupational Disease and Claim for Compensation).


Improving tracking and management of employee accidents, in general, and exposures to bloodborne pathogens from needle sticks and sharps, in particular, is a high priority of VHA. Consequently, the package contains fields specific to needle stick, sharps, and bodily fluid exposures. The data collected from ASISTS is electronically transferred to a national database and used to identify system-wide problems and opportunities for focused education and to conduct research.
<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>


The electronic submission of workers' compensation claims to the Department of Labor is improving submission rates and reducing duplicate data collection and data entry.
* <font face="Arial, sans-serif"><font size="2">Provides multi-lingual
interaction with volunteers during log-in.</font></font> * <font
face="Arial, sans-serif"><font size="2">Supports and enhances
security for multiple division facilities.</font></font> *
<font face="Arial, sans-serif"><font size="2">Displays/prints
entire master record for a single volunteer.</font></font> * <font
face="Arial, sans-serif"><font size="2">Provides local printing of
address labels and telephone lists.</font></font> * <font face="Arial,
sans-serif"><font size="2">Reduces workload required to input mass award
code changes.</font></font> * <font face="Arial, sans-serif"><font
size="2">Prints individual meal ticket for volunteer after Auto
Log-in.</font></font> * <font face="Arial, sans-serif"><font
size="2">Provides real-time national reporting of data for all
stations.</font></font>


'''Features'''
==== Information and Education Systems ====


 Electronic signature is used extensively throughout this program. All three forms (VA Form 2162, CA-1, and CA-2) require appropriate signatures including that of the employee for the CA-1 and CA-2, which is used when electronically transferring the data to the Department of Labor.


 Bulletins alert employee health and infection control of any exposures to bloodborne pathogens. The employee's supervisor, the safety officer, Human Resources Management, and union representatives are notified of every incident. Electronic signatures trigger bulletins from the employee to the supervisor and union representatives, and from the supervisor to the safety officer, alerting the recipient of action that should be taken.


* Every medical center employee has access to a menu structured specifically to the level of his/her involvement in the process: employee health, supervisor, safety officer, union representative, workers' compensation personnel, and employee.


* The graphical user interface (GUI) for ASISTS facilitates the input and processing of accident reports and claims and improves the reporting functionality, including a revised OSHA and Needlestick log and graphical representation of the incident reports.
* Future versions will include a comprehensive employee health module for tracking and following numerous health issues.


<!-- file -->
<font face="Times New Roman, serif"><font size="3"><font
==== Library ====
color="black"><font face="Arial, sans-serif">'''Information and
Education Systems with an emphasis on “eHealth†include
prescription refills, appointments, fillable forms online, and
My Health'''</font></font><font color="black"><font face="Arial,
sans-serif">''<u>'''e'''</u>''</font></font><font color="black"><font
face="Arial, sans-serif">'''Vet (Web-based access to health
record, online health assessment tools, and high quality health
information).'''</font></font></font></font>


'''Overview'''
* <font face="Arial, sans-serif"><font size="3">'''Improve service
to veterans and stakeholders'''</font></font> * <font face="Arial,
sans-serif"><font size="3">'''Information that is accurate, up-to-date,
readily available at any time, any place'''</font></font> * <font
face="Arial, sans-serif"><font size="3">'''VA Internet primary
gateway to trusted VA information and services for veterans and their
families'''</font></font>


The Library module is designed to automate the entire serials management process in VA Library Services. VA library staff spend the largest share of local materials budgets on serials. The process of ordering, tracking, claiming, and listing these titles is tedious and error-prone when done manually. Automation of serials management allows a faster and more accurate process for work simplification. Library management is assisted through improved statistics and information.


Staff is able to use Library Patron options to see whether the local Library Service owns a journal title and, if so, the holdings and location for that title.


The Serials Control module has three components. The Serials Management component creates the local library's serials database, along with retrospective holdings and purchasing information and copy information, such as location and category. The module is designed so that access to this component may be restricted, if desired, to the serials expert on the library staff, usually a medical librarian or the Chief. Access to the Serials Control component where daily actions are managed (e.g., check-ins, routing, and generation of reports) may be given to other Library Service staff members. A minor component of the module, Library Site Parameters, allows for the initialization of the module.


Library makes it possible for local sites to carry only locally active entries in their local database. When new entries are needed, they can be downloaded automatically from the national database into a site's local database.


'''Features'''


===== Automated Safety Incident Surveillance Tracking System (ASISTS) =====

<font size="3">'''Overview'''</font>

Automated Safety Incident Surveillance Tracking System (ASISTS) was
designed to manage the data from all employee accidents, create a Report
of Accident (VA Form 2162) from the data, and produce both the Office of
Worker's Compensation Programs Form CA-1 (Instructions for Completing
Employee's Notice of Traumatic Injury and Claim for Continuation of
Pay/Compensation) and Form CA-2 (Federal Employee's Notice of Occupational
Disease and Claim for Compensation).

Improving tracking and management of employee accidents, in general,
and exposures to bloodborne pathogens from needle sticks and sharps, in
particular, is a high priority of VHA. Consequently, the package contains
fields specific to needle stick, sharps, and bodily fluid exposures. The
data collected from ASISTS is electronically transferred to a national
database and used to identify system-wide problems and opportunities
for focused education and to conduct research.



The electronic submission of workers’ compensation claims to the
Department of Labor is improving submission rates and reducing duplicate
data collection and data entry.

<font color="red"><font color="black"><font
size="3">'''Features'''</font></font></font>

<font color="red"><font color="black">ï'·</font> <font
color="black">Electronic signature is used extensively throughout
this program. All three forms (VA Form 2162, CA-1, and CA-2) require
appropriate signatures including that of the employee for the CA-1 and
CA-2, which is used when electronically transferring the data to the
Department of Labor.</font></font>

<font color="red"><font color="black">ï'·</font> <font
color="black">Bulletins alert employee health and infection control of
any exposures to bloodborne pathogens. The employee's supervisor, the
safety officer, Human Resources Management, and union representatives
are notified of every incident. Electronic signatures trigger bulletins
from the employee to the supervisor and union representatives, and from
the supervisor to the safety officer, alerting the recipient of action
that should be taken.</font></font>

* <font color="red"><font color="black">Every medical center employee
has access to a menu structured specifically to the level of</font>
<font color="black">his/her involvement in the process: employee health,
supervisor, safety officer, union representative, workers’
compensation personnel, and employee.</font></font>

* The graphical user interface (GUI) for ASISTS facilitates the input
and processing of accident reports and claims and improves the reporting
functionality, including a revised OSHA and Needlestick log and graphical
representation of the incident reports. * Future versions will include a
comprehensive employee health module for tracking and following numerous
health issues.



===== Library =====



<font size="3">'''Overview'''</font>

<font face="Arial, sans-serif"><font size="2">The Library module
is designed to automate the entire serials management process in VA
Library Services. VA library staff spend the largest share of local
materials budgets on serials. The process of ordering, tracking,
claiming, and listing these titles is tedious and error-prone when done
manually. Automation of serials management allows a faster and more
accurate process for work simplification. Library management is assisted
through improved statistics and information.</font></font>



<font face="Arial, sans-serif"><font size="2">Staff is able to use Library
Patron options to see whether the local Library Service owns a journal
title and, if so, the holdings and location for that title.</font></font>



<font face="Arial, sans-serif"><font size="2">The Serials Control module
has three components. The Serials Management component creates the local
library’s serials database, along with retrospective holdings
and purchasing information and copy information, such as location and
category. The module is designed so that access to this component may
be restricted, if desired, to the serials expert on the library staff,
usually a medical librarian or the Chief. Access to the Serials Control
component where daily actions are managed (e.g., check-ins, routing,
and generation of reports) may be given to other Library Service staff
members. A minor component of the module, Library Site Parameters,
allows for the initialization of the module.</font></font>



<font face="Arial, sans-serif"><font size="2">Library makes it
possible for local sites to carry only locally active entries in their
local database. When new entries are needed, they can be downloaded
automatically from the national database into a site’s local
database.</font></font>



<font size="3">'''Features'''</font>


The Serials Control module:
The Serials Control module:


* Creates a local serials database. * Provides acquisition and retention
* Creates a local serials database.
information. * Provides purchasing and vendor information. * Provides
* Provides acquisition and retention information.
holdings information and shelving location information. * Categorizes
* Provides purchasing and vendor information.
* Provides holdings information and shelving location information.
by type and subject. * Provides check-in with next issue prediction.
* Categorizes by type and subject.
* Generates routing slips. * Tracks materials returned from routing.
* Provides check-in with next issue prediction.
* Generates routing slips.
* Tracks materials returned from routing.
* Displays check-in history.
* Displays check-in history.


Generates 20 management reports (e.g., listings, monthly check-in statistics, monthly routing statistics, tracking of unreturned routed issues, missing issue reports for claiming replacements or reports, etc.).


A centrally produced Title Authority file, a database of over 9,477 serials titles owned by VALNET (VA Library Network) libraries, was preloaded with standard bibliographic data and provided as a part of this module.


<!-- file -->
Generates 20 management reports (e.g., listings, monthly check-in
==== Police and Security ====
statistics, monthly routing statistics, tracking of unreturned routed
issues, missing issue reports for claiming replacements or reports, etc.).


'''Overview'''


The Police and Security module supports the VA Police in their responsibilities of crime prevention, preliminary investigation of crimes, apprehension, legally correct handling of suspected offenders, and the transfer of suspected offenders to appropriate authorities.


'''Features'''
A centrally produced Title Authority file, a database of over 9,477
serials titles owned by VALNET (VA Library Network) libraries, was
preloaded with standard bibliographic data and provided as a part of
this module.


* Serves as the repository file for the names, addresses, and other demographic data of persons who come in contact with the VA Police and Security staff.
===== Police and Security =====
* Allows for the retrieval and display of stored information for a selected person.
* Stores electronic data normally entered on the VA Police Uniform Offense Report, Investigative Notes, Case Log, and other documentation assembled during an investigation.
* Contains all violation information on US District Court Violations Notices and Courtesy Warnings issued by VA Police Officers at the medical facility.
* Assembles selective data into a standardized report format documenting the numbers and types of criminal incidents that are occurring at the site.
* Records information necessary for the Vehicle Registration program.
* Records any data pertinent to individuals currently under any type of criminal proceedings or other legal restraining document.
* Provides a system to record all information contained on the Evidence Property Custody Record (VA Form 10-3524).
* Allows each police officer to record the specific activities performed during a shift and the time required to complete the activities.
* Stores all information relative to training completed by staff members assigned to the Police and Security Service.
* Stores all information entered on the VA Police Daily Operations Journal (VA Form 10-1433) and Continuation Sheet (VA Form 10-1433a).
* Transmits Monthly Crime Reports and selected Offense Reports through MailMan to VA Headquarters.
* Produces supervisory management, quality management, and crime trend studies; a standardized Uniform Offense Report, Uniform Crime Report, and Evidence Register Report; and Case Progress Notes and Case Assignment Register.


<!-- file -->
=== Cross-Cutting Monographs ===


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.


==== Duplicate Record Merge ====
<font size="3">'''Overview'''</font>


'''Overview'''
The Police and Security module supports the VA Police in their
responsibilities of crime prevention, preliminary investigation of
crimes, apprehension, legally correct handling of suspected offenders,
and the transfer of suspected offenders to appropriate authorities.


Since the inception of automated medical information management within the Department of Veterans Affairs medical facilities, and as entries have been made in the PATIENT file (#2), a number of duplicate records have been introduced. Estimates of the number of duplicate entries currently present range as high as one to two percent of the VHA total record base. Past attempts to consolidate duplicate records have resulted in the loss of valid data. Invalid records were simply deleted and real data was lost through incomplete conversion of pointers.


The Duplicate Record Merge application enhances the ability to associate appropriate data with a single patient identifier. It provides the tools necessary to automatically identify patient records identified as being duplicates.


<font size="3">'''Features'''</font>
'''Features'''


The overall process consists of three modules: the search for potential duplicate record pairs, review and verification of those pairs, and the merge process. The search and identification of potential duplicate records is based on the Duplicate Record Merge features of Kernel Toolkit. Once the search has been completed, the process of verifying record pairs begins. Reviewers view data associated with the potential duplicate pairs and determine a status. Once verified, the merge process may be initiated.
* <font size="2">Serves as the repository file for the names, addresses,
and other demographic data of persons who come in contact with the
VA Police and Security staff.</font> * Allows for the retrieval
and display of stored information for a selected person. * Stores
electronic data normally entered on the VA Police Uniform Offense Report,
Investigative Notes, Case Log, and other documentation assembled during
an investigation. * Contains all violation information on US District
Court Violations Notices and Courtesy Warnings issued by VA Police
Officers at the medical facility. * Assembles selective data into a
standardized report format documenting the numbers and types of criminal
incidents that are occurring at the site. * Records information necessary
for the Vehicle Registration program. * Records any data pertinent to
individuals currently under any type of criminal proceedings or other
legal restraining document. * Provides a system to record all information
contained on the Evidence Property Custody Record (VA Form 10-3524).
* Allows each police officer to record the specific activities performed
during a shift and the time required to complete the activities. * Stores
all information relative to training completed by staff members assigned
to the Police and Security Service. * Stores all information entered
on the VA Police Daily Operations Journal (VA Form 10â€"1433) and
Continuation Sheet (VA Form 10-1433a). * Transmits Monthly Crime Reports
and selected Offense Reports through MailMan to VA Headquarters. * <font
face="Arial, sans-serif"><font size="2">Produces supervisory management,
quality management, and crime trend studies; a standardized Uniform
Offense Report, Uniform Crime Report, and Evidence Register Report;
and Case Progress Notes and Case Assignment Register.</font></font>


* '''Search for Potential Duplicate Record Pairs'''


* Comparisons made on key fields; i.e., Name, SSN, Date of Birth, Date of Death, Last Separation Date (Last Discharge Date), Mother's Maiden Name, and Claim Number.
* Comparison results in computed value.
* Resulting value measured against the Potential Duplicate Threshold Percentage. (When record pair scores evaluate above this percentage, they are considered to be potential duplicates.)
* Review and verification may begin while search is running.


* '''Review and Verification'''


* Site-designated reviewers: Primary reviewer(s) for the Patient File, Ancillary reviewer(s) for other files (e.g., Laboratory).
* Reviewers view screens of patient data for comparisons.
* Reviewers resolve potential duplicate pairs: Verified Duplicate, Verified Not Duplicate, Unable to Determine.
* Notification of review actions via alerts and/or e-mail messages.


* '''Merge Process'''


* User-initiated process.
* Runs as a single process merging multiple pairs. One or more jobs may be designated to run in parallel to reduce processing time (i.e., threads).
* Halt/Restart merge process maximizes site control.
* Three phases within merge: 1) merge records in main file, 2) DINUMed pointers and cross-references, and 3) all other pointers.


<!-- file -->
==== Health Level Seven (HL7) ====


'''Overview'''


In today's health care environment, computer systems from multiple vendors and at geographically dispersed sites are used in conjunction with core facility computer systems to create integrated delivery of information to the end-user. Linking such systems to exchange data and work together is a non-trivial task, particularly given the complexity of health care data.


Health Level Seven (HL7) is an American National Standards Institute (ANSI) standard messaging protocol that specifies the set of transactions and encoding rules for electronic data exchange between health care computer systems. HL7 provides an open, standards-based framework that computer systems can use to exchange health care data with each other. The HL7 standards development group is directly focused on health care informatics standards and cooperates closely with developers of other standards.


The Veterans Health Information Systems and Technology Architecture(VistA)HL7 package enables M-based (VistA)applications running on core facility computer systems to exchange health care information with other computer systems. It provides messaging services and a single toolset for M-based VistA applications to create, send, receive, and process HL7 messages.


Many VistA applications use VistA HL7 to exchange data in HL7 format with other facilities and/or applications, including Anesthesiology, Mater Patient Index/Patient Demographics (MPI/PD), Laboratory, Outpatient Pharmacy, Patient Management System (PMS), Radiology, and Veteran ID Card (VIC).


The VistA HL7 package is also used to integrate commercial off-the-shelf (COTS) health care applications with M-based core facility computer systems.
==== Cross-Cutting Monographs ====


'''Features'''


* '''Communication'''-Facilitates Point-to-Point and Publish-and-Subscribe messaging between two or more applications; and provides the transport mechanism using HL7-supported lower level transmission protocols (e.g., Hybrid Lower Level Protocol [HLLP], X3.28, or Minimum Lower Level Protocol [MLLP] over Transmission Control Protocol / Internet Protocol [TCP/IP]), which provide error detection and session control; provides dynamic routing of messages.
* '''Processing'''-Queues incoming and outgoing messages for reliable messaging; validates HL7 Message Header (MSH) information for all incoming messages; and sends HL7 acknowledgment (ACK) messages back to sending applications upon message receipt.
* '''Message Administration'''-Provides functionality to assist the application developer in setting up HL7 interfaces by hiding the complex lower level communication; monitors message transmissions statuses; and provides reports on pending transmissions and those with errors.
* '''Programming Utilities'''-Provides the developer with a rich collection of Application Programmer Interfaces (API) to facilitate the creation, exchange, and transmission of messages; provides a set of predefined variables to use for building HL7 messages/segments; automatically creates all HL7 Message Header (MSH) segments; and invokes the appropriate application routine to process message data when a message is received.


<!-- file -->
==== Kernel ====


'''Overview'''


Kernel provides a '''portability layer'''between the underlying operating system and application code. This results in the entire Veterans Health Information Systems and Technology Architecture(VistA)system being portable among different computers, operating systems, and M implementations. This, together with the database portability provided by VA FileMan, eliminates the cost of application conversions each time VHA changes its computing platforms.
<font size="3">'''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.'''</font>


Kernel also offers '''shared services'''for VistA applications, resulting in reduced development costs and a common user interface, and provides '''system management tools'''for managing VistA computer systems.


Integrated Single Sign-on-The RPC Broker supports a ''single''sign-on point from a client workstation to the server. Users need only sign on once when accessing multiple VistA applications on the same workstation.


'''Features'''


* '''ZOSF/ZOSV Operating System Interface'''-The core of Kernel's portability layer. Insulates applications from being tied to any particular hardware platform, operating system, or M implementation.
* '''Sign-On and Security Management'''-Controls user access by device, time, and day of week; controls user access to programs, menus, files, fields, and devices; audits by user, device, program, file, and field; and provides electronic signature capability.
* '''Menu Manager'''-Manages all application menus to provide a standard user environment; customizes menus for individual users; shares or restricts menus to a user or a set of users; provides secure delegation of menu management authority; and delivers priority system alerts.
* '''Error Processing'''-Provides a consistent method for recording and processing application errors.
* '''Device Handler'''-Defines generic terminal types to reuse for similar peripherals; supports host files in layered operating system environments; insulates programmers from device- and operating system-specific coding; and provides standard user device selection across different environments.
* '''Task Manager'''-Provides flexible background job scheduling; allows users to control their own tasks; and permits specification of device, priority, and time of execution.
* '''Kernel Installation and Distribution System (KIDS)'''-Provides a mechanism to create a distribution of packages and patches; allows distribution via a MailMan message or a host file; and allows queuing the installation of a distribution for off-hours.
* '''Library Functions'''-Provides Date, String, Mathematical, Hyperbolic Trigonometric, Measurement, and Utility Functions.
* '''Domain Name Resolution'''-Provides an Application Programmer Interface (API) to resolve domain names into an Internet Protocol (IP) address.


==== Kernel ToolKit ====


'''Overview'''


Kernel Toolkit (also referred to as "Toolkit") supplements the Kernel software package. It provides Development and Quality Assessment Tools, Capacity Planning Tools, and System Management Utilities.


'''Features'''


'''Development and Quality Assessment Tools'''


* Promote standard programmer interfaces.

* Provide programmer and systems management.

* Provide a portable routine and global editor.

* Check adherence to programming standards and correct syntax with %INDEX tool.

* Provide standard error trapping, storing, and reporting.

* Support quality assessment tools for the comparison of routines and data dictionaries.

* Provide software project management utilities.

* Provide tools to work with data in Extensible Markup Language (XML).


























===== Duplicate Record Merge =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

Since the inception of automated medical information management within the
Department of Veterans Affairs medical facilities, and as entries have
been made in the PATIENT file (#2), a number of duplicate records have
been introduced. Estimates of the number of duplicate entries currently
present range as high as one to two percent of the VHA total record
base. Past attempts to consolidate duplicate records have resulted in
the loss of valid data. Invalid records were simply deleted and real
data was lost through incomplete conversion of pointers.



<font face="Arial, sans-serif"><font size="2">The Duplicate Record
Merge application enhances the ability to associate appropriate data
with a single patient identifier. It provides the tools necessary
to automatically identify patient records identified as being
duplicates.</font></font>



<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>

<font face="Arial, sans-serif"><font size="2">The overall process
consists of three modules: the search for potential duplicate record
pairs, review and verification of those pairs, and the merge process. The
search and identification of potential duplicate records is based on the
Duplicate Record Merge features of Kernel Toolkit. Once the search has
been completed, the process of verifying record pairs begins. Reviewers
view data associated with the potential duplicate pairs and determine
a status. Once verified, the merge process may be initiated.</font></font>



* <font face="Arial, sans-serif"><font size="2">'''Search for Potential
Duplicate Record Pairs'''</font></font>

* <font face="Arial, sans-serif"><font size="2">Comparisons made
on key fields; i.e., Name, SSN, Date of Birth, Date of Death, Last
Separation Date (Last Discharge Date), Mother's Maiden Name, and
Claim Number.</font></font> * <font face="Arial, sans-serif"><font
size="2">Comparison results in computed value.</font></font> * <font
face="Arial, sans-serif"><font size="2">Resulting value measured
against the Potential Duplicate Threshold Percentage. (When record
pair scores evaluate above this percentage, they are considered
to be potential duplicates.)</font></font> * <font face="Arial,
sans-serif"><font size="2">Review and verification may begin while search
is running.</font></font>



* <font face="Arial, sans-serif"><font size="2">'''Review and
Verification'''</font></font>

* <font face="Arial, sans-serif"><font size="2">Site-designated reviewers:
Primary reviewer(s) for the Patient File, Ancillary reviewer(s) for
other files (e.g., Laboratory).</font></font> * <font face="Arial,
sans-serif"><font size="2">Reviewers view screens of patient data
for comparisons.</font></font> * <font face="Arial, sans-serif"><font
size="2">Reviewers resolve potential duplicate pairs: Verified Duplicate,
Verified Not Duplicate, Unable to Determine.</font></font> * <font
face="Arial, sans-serif"><font size="2">Notification of review actions
via alerts and/or e-mail messages.</font></font>



* <font face="Arial, sans-serif"><font size="2">'''Merge
Process'''</font></font>

* <font face="Arial, sans-serif"><font size="2">User-initiated
process.</font></font> * <font face="Arial, sans-serif"><font
size="2">Runs as a single process merging multiple pairs. One or more
jobs may be designated to run in parallel to reduce processing time
(i.e., threads).</font></font> * <font face="Arial, sans-serif"><font
size="2">Halt/Restart merge process maximizes site control.</font></font>
* <font face="Arial, sans-serif"><font size="2">Three phases within merge:
1) merge records in main file, 2) DINUMed pointers and cross-references,
and 3) all other pointers.</font></font>

===== Health Level Seven (HL7) =====



<font size="3">'''Overview'''</font>

In today's health care environment, computer systems from multiple vendors
and at geographically dispersed sites are used in conjunction with core
facility computer systems to create integrated delivery of information to
the end-user. Linking such systems to exchange data and work together is
a non-trivial task, particularly given the complexity of health care data.



<font face="Arial, sans-serif"><font size="2">Health Level Seven (HL7)
is an American National Standards Institute (ANSI) standard messaging
protocol that specifies the set of transactions and encoding rules
for electronic data exchange between health care computer systems. HL7
provides an open, standards-based framework that computer systems can
use to exchange health care data with each other. The HL7 standards
development group is directly focused on health care informatics standards
and cooperates closely with developers of other standards.</font></font>



<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">The Veterans Health Information Systems
and Technology Architecture</font></font><font face="Arial,
sans-serif"><font size="2">(</font></font><font face="Arial,
sans-serif"><font size="2">VistA</font></font><font face="Arial,
sans-serif"><font size="2">)</font></font><font face="Arial,
sans-serif"><font size="2">HL7 package enables M-based</font></font>
<font face="Arial, sans-serif"><font size="2">(</font></font><font
face="Arial, sans-serif"><font size="2">VistA</font></font><font
face="Arial, sans-serif"><font size="2">)</font></font><font face="Arial,
sans-serif"><font size="2">applications running on core facility
computer systems to exchange health care information with other
computer systems. It provides messaging services and a single toolset
for M-based VistA applications to create, send, receive, and process
HL7 messages.</font></font></font></font>



<font face="Arial, sans-serif"><font size="2">Many VistA applications use
VistA HL7 to exchange data in HL7 format with other facilities and/or
applications, including Anesthesiology, Mater Patient Index/Patient
Demographics (MPI/PD), Laboratory, Outpatient Pharmacy, Patient Management
System (PMS), Radiology, and Veteran ID Card (VIC).</font></font>



<font face="Arial, sans-serif"><font size="2">The VistA HL7 package
is also used to integrate commercial off-the-shelf (COTS) health care
applications with M-based core facility computer systems.</font></font>



<font size="3">'''Features'''</font>

* <font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">'''Communication'''</font></font><font
face="Arial, sans-serif"><font size="2">â€"Facilitates Point-to-Point
and Publish-and-Subscribe messaging between two or more applications;
and provides the transport mechanism using HL7-supported lower level
transmission protocols (e.g., Hybrid Lower Level Protocol [HLLP], X3.28,
or Minimum Lower Level Protocol [MLLP] over Transmission Control Protocol
/ Internet Protocol [TCP/IP]), which provide error detection and session
control; provides dynamic routing of messages.</font></font></font></font>
* <font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">'''Processing'''</font></font><font
face="Arial, sans-serif"><font size="2">â€"Queues incoming and
outgoing messages for reliable messaging; validates HL7 Message
Header (MSH) information for all incoming messages; and sends HL7
acknowledgment (ACK) messages back to sending applications upon
message receipt.</font></font></font></font> * <font face="Times New
Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">'''Message Administration'''</font></font><font face="Arial,
sans-serif"><font size="2">â€"Provides functionality to assist
the application developer in setting up HL7 interfaces by hiding the
complex lower level communication; monitors message transmissions
statuses; and provides reports on pending transmissions and those
with errors.</font></font></font></font> * <font face="Times New
Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">'''Programming Utilities'''</font></font><font face="Arial,
sans-serif"><font size="2">â€"Provides the developer with a rich
collection of Application Programmer Interfaces (API) to facilitate
the creation, exchange, and transmission of messages; provides a set
of predefined variables to use for building HL7 messages/segments;
automatically creates all HL7 Message Header (MSH) segments; and invokes
the appropriate application routine to process message data when a
message is received.</font></font></font></font>

===== Kernel =====



<font size="3">'''Overview'''</font>

<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">Kernel provides a</font></font>
<font face="Arial, sans-serif"><font size="2">'''portability
layer'''</font></font><font face="Arial, sans-serif"><font
size="2">between the underlying operating system and application
code. This results in the entire Veterans Health Information
Systems and Technology Architecture</font></font><font face="Arial,
sans-serif"><font size="2">(VistA)</font></font><font face="Arial,
sans-serif"><font size="2">system being portable among different
computers, operating systems, and M implementations. This, together
with the database portability provided by VA FileMan, eliminates the
cost of application conversions each time VHA changes its computing
platforms.</font></font></font></font>



<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">Kernel also offers</font></font>
<font face="Arial, sans-serif"><font size="2">'''shared
services'''</font></font><font face="Arial, sans-serif"><font
size="2">for</font></font> <font face="Arial, sans-serif"><font
size="2">VistA</font></font> <font face="Arial, sans-serif"><font
size="2">applications, resulting in reduced development costs
and a common user interface, and provides</font></font> <font
face="Arial, sans-serif"><font size="2">'''system management
tools'''</font></font><font face="Arial, sans-serif"><font size="2">for
managing</font></font> <font face="Arial, sans-serif"><font
size="2">VistA</font></font> <font face="Arial, sans-serif"><font
size="2">computer systems.</font></font></font></font>



<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">Integrated Single Sign-onâ€"The RPC
Broker supports a</font></font> <font face="Arial, sans-serif"><font
size="2">''single''</font></font><font face="Arial, sans-serif"><font
size="2">sign-on point from a client workstation to the server. Users
need only sign on once when accessing multiple</font></font> <font
face="Arial, sans-serif"><font size="2">VistA</font></font> <font
face="Arial, sans-serif"><font size="2">applications on the same
workstation.</font></font></font></font>



<font size="3">'''Features'''</font>

* <font face="Times New Roman, serif"><font size="3"><font
face="Arial, sans-serif"><font size="2">'''ZOSF/ZOSV Operating System
Interface'''</font></font><font face="Arial, sans-serif"><font
size="2">â€"The core of Kernel's portability layer. Insulates
applications from being tied to any particular hardware platform,
operating system, or M implementation.</font></font></font></font>
* <font face="Times New Roman, serif"><font size="3"><font
face="Arial, sans-serif"><font size="2">'''Sign-On and Security
Management'''</font></font><font face="Arial, sans-serif"><font
size="2">â€"Controls user access by device, time, and day of week;
controls user access to programs, menus, files, fields, and devices;
audits by user, device, program, file, and field; and provides
electronic signature capability.</font></font></font></font> * <font
face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">'''Menu Manager'''</font></font><font
face="Arial, sans-serif"><font size="2">â€"Manages all application
menus to provide a standard user environment; customizes menus for
individual users; shares or restricts menus to a user or a set of users;
provides secure delegation of menu management authority; and delivers
priority system alerts.</font></font></font></font> * <font face="Times
New Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">'''Error Processing'''</font></font><font face="Arial,
sans-serif"><font size="2">â€"Provides a consistent method for
recording and processing application errors.</font></font></font></font>
* <font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">'''Device Handler'''</font></font><font
face="Arial, sans-serif"><font size="2">â€"Defines generic terminal
types to reuse for similar peripherals; supports host files in layered
operating system environments; insulates programmers from device- and
operating system-specific coding; and provides standard user device
selection across different environments.</font></font></font></font> *
<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">'''Task Manager'''</font></font><font
face="Arial, sans-serif"><font size="2">â€"Provides flexible
background job scheduling; allows users to control their
own tasks; and permits specification of device, priority,
and time of execution.</font></font></font></font> * <font
face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">'''Kernel Installation and Distribution
System (KIDS)'''</font></font><font face="Arial, sans-serif"><font
size="2">â€"Provides a mechanism to create a distribution
of packages and patches; allows distribution via a MailMan
message or a host file; and allows queuing the installation of a
distribution for off-hours.</font></font></font></font> * <font
face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">'''Library Functions'''</font></font><font
face="Arial, sans-serif"><font size="2">â€"Provides Date, String,
Mathematical, Hyperbolic Trigonometric, Measurement, and Utility
Functions.</font></font></font></font> * <font face="Times New
Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">'''Domain Name Resolution'''</font></font><font face="Arial,
sans-serif"><font size="2">â€"Provides an Application Programmer
Interface (API) to resolve domain names into an Internet Protocol (IP)
address.</font></font></font></font>

===== Kernel ToolKit =====



<font size="3">'''Overview'''</font>

<font face="Arial, sans-serif"><font size="2">Kernel Toolkit (also
referred to as “Toolkitâ€) supplements the Kernel software
package. It provides Development and Quality Assessment Tools, Capacity
Planning Tools, and System Management Utilities.</font></font>



<font size="3">'''Features'''</font>

<font size="2">'''Development and Quality Assessment Tools'''</font>

* <font face="Arial, sans-serif"><font size="2">Promote standard
programmer interfaces.</font></font> * <font face="Arial,
sans-serif"><font size="2">Provide programmer and systems
management.</font></font> * <font face="Arial, sans-serif"><font
size="2">Provide a portable routine and global editor.</font></font>
* <font face="Arial, sans-serif"><font size="2">Check adherence to
programming standards and correct syntax with %INDEX tool.</font></font>
* <font face="Arial, sans-serif"><font size="2">Provide standard error
trapping, storing, and reporting.</font></font> * <font face="Arial,
sans-serif"><font size="2">Support quality assessment tools for
the comparison of routines and data dictionaries.</font></font> *
<font face="Arial, sans-serif"><font size="2">Provide software project
management utilities.</font></font> * <font face="Arial, sans-serif"><font
size="2">Provide tools to work with data in Extensible Markup Language
(XML).</font></font>




'''Capacity Planning Tools'''
'''Capacity Planning Tools'''


* Collect accurate site data for review and monitoring of database, software, option workload, and file size information, which is useful in determining future growth rates and trends.
* <font face="Arial, sans-serif"><font size="2">Collect accurate site
* Produce system status reports and usage statistics.
data for review and monitoring of database, software, option workload,
* Provide system response time logging for performance management.
and file size information, which is useful in determining future growth
* Provide automated system monitoring and reporting tools.
rates and trends.</font></font> * <font face="Arial, sans-serif"><font
* Perform automated performance analysis tools.
size="2">Produce system status reports and usage statistics.</font></font>
* Alert system managers to dangerous or unusual conditions.
* <font face="Arial, sans-serif"><font size="2">Provide system
* Deliver reports automatically via MailMan.
response time logging for performance management.</font></font> *
* Provide tools for software optimization and application sizing.
<font face="Arial, sans-serif"><font size="2">Provide automated system
monitoring and reporting tools.</font></font> * <font face="Arial,
sans-serif"><font size="2">Perform automated performance analysis
tools.</font></font> * <font face="Arial, sans-serif"><font size="2">Alert
system managers to dangerous or unusual conditions.</font></font> * <font
face="Arial, sans-serif"><font size="2">Deliver reports automatically
via MailMan.</font></font> * <font face="Arial, sans-serif"><font
size="2">Provide tools for software optimization and application
sizing.</font></font>




'''System Management Utilities'''
'''System Management Utilities'''


* Customize and tune site parameters for local requirements.
* <font face="Arial, sans-serif"><font size="2">Customize and
* Provide a Kermit file transfer utility.
tune site parameters for local requirements.</font></font> *
* Provide a Multi-Term Lookup Utility for enhanced VA FileMan lookups.
<font face="Arial, sans-serif"><font size="2">Provide a Kermit file
* Provide Duplicate Resolution utilities for the creation of file maintenance applications.
transfer utility.</font></font> * <font face="Arial, sans-serif"><font
* Provide PARAMETERS file (#8989.5) for user-specific to system-level tracking of parameter values.
size="2">Provide a Multi-Term Lookup Utility for enhanced VA FileMan
lookups.</font></font> * <font face="Arial, sans-serif"><font
size="2">Provide Duplicate Resolution utilities for the creation of
file maintenance applications.</font></font> * <font face="Arial,
sans-serif"><font size="2">Provide PARAMETERS file (#8989.5) for
user-specific to system-level tracking of parameter values.</font></font>


===== Image: Sample Capacity Planning Report =====
<font face="Arial, sans-serif"><font size="3">'''Kernel Toolkit â€"
continued'''</font></font>


[[Image:vista_monograph2005_06_html_m4c39157b.gif|650px]]<br clear="left" />
<!-- file -->


==== List Manager ====


'''Overview'''


The List Manager was developed to provide an efficient way for applications to present a list of items to the user for action. It is a developmental tool that enables programmers to:


* Display a list of items to the user.
<font face="Arial, sans-serif"><font size="3">'''Sample Capacity Planning
Report'''</font></font>


* Allow the user to browse back and forth through the items one at a time or by screen.
[[Image:vista_monograph2005_06_html_m4c39157b.gif]]<br clear="left"
/>


* Allow the user to select items from the list.
* Specify the actions that can be applied to selected items from the list.
* Call List Manager again as part of an action.


Protocols are the "actions" that users can take against items on the list. A number of standard protocols come as part of the List Manager utility. Most of these are actions that allow the user to browse the list of items.


The List Manager contains the Workbench programmer utility, which allows the development of a List Manager application without having to move from one development tool to another.


'''Features'''


List Manager provides a generic method of presenting lists of items to terminal users. Its core features are:


* Displays a list of items in a screen format and allows users to browse through the list, select items that need action, and take action against those items.
* In addition to the various actions that are specific to the option being worked in, provides generic actions applicable to any List Manager screen (i.e., Up a Line, Next Screen, First Screen, Search List).
* Provides a list of available menu functions that can be performed from the screen without having to exit and enter a new menu option for each one.
* Allows action pre-selection and list entry pre-selection by user.
* Provides programmer Workbench for application development.


<!-- file -->
==== MailMan ====


'''Overview'''


MailMan is an electronic messaging system that transmits messages, computer programs, data dictionaries, and data between users and applications located at the same or at different facilities. Network MailMan disseminates information across any communications medium.


When MailMan is integrated into an application, it notifies individuals and groups about important events. From VA FileMan, a change in the value of a field can trigger a message called a bulletin. MailMan is easy for the user to learn and to use and provides extensive online help. There is also an extensive set of MailMan Application Programmer Interfaces (API) for the developer.


'''Features'''


* '''Delivery Options-'''Users can send messages to individuals, mail groups, and devices. Users can also stagger delivery of messages and specify to what basket a message should be delivered.
* '''Chained Responses-'''Message response chains are managed automatically. Responses are threaded in sequence following the original message and are instantly available to anyone currently reading the message, providing a "real-time" conversation among message recipients. All responses are available for review at any time by all recipients.
* '''Configurable Interface-'''Users can customize and configure the MailMan reader interface and set other personal properties best suited to their needs.
* '''Mail Basket Organization-'''Users can organize mail into any number of user-specified mail baskets.
* '''Mail Filtering-'''Users can filter their mail based on one or several filter criteria.
* '''Search Capabilities-'''Users can search for messages based on one or several search criteria.
* '''Reminders/Notifications-'''Messages can be used as a tickler file to remind/notify you of specific events (e.g., bulletins and alerts).
* '''Secure Messages-'''Messages can be secured (scrambled), requiring a key to unlock them. MailMan provides multiple layers of local and network security.
* '''Surrogate Capability-'''Users can designate a surrogate to read and/or answer their own messages.
* '''Software Message Processing-'''Messages can be sent and processed by software. All application outputs can be directed into MailMan messages.
* '''Software Code Transport-'''Veterans Health Information Systems and Technology Architecture (VistA) software can be conveniently transported via messages. Whole modules and patches for installation at a remote site are sent in Kernel Installation and Distribution System (KIDS)/PackMan messages.
* '''Network Transmissions Over TCP/IP-'''Network transmissions can be made across Transmission Control Protocol / Internet Protocol (TCP/IP) channels to any Simple Mail Transfer Protocol (SMTP)-compatible mail system.
* '''Statistics Collection-'''Extensive mail system statistics can be collected.
* '''Dom''''''ain Name Service (DNS)-aware''''''-'''It creates automatic replication of IP address changes to every VistA MailMan system as a result of only one central database edit (i.e., performs DNS lookups).


<!-- file -->
===== List Manager =====
==== Master Patient Index (MPI) and Master Patient Index/Patient Demographics (MPI/PD) ====


'''Overview'''


There are approximately 140 Veterans Health Administration (VHA) databases in use across the country in VA facilities that are accessible via VistA systems. Because of this wide distribution of information, there is great potential for individual patient data to be kept under more than one identification number. The Master Patient Index (MPI) has been created to support maintenance of a unique patient identifier and a single master index of all VA patients, and to allow messaging of patient information among the institutional partners [i.e., VHA, Veterans Benefits Administration (VBA), Board of Veterans Appeals (BVA), and National Cemetery Administration (NCA)].


The ability to uniquely identify a patient and the facilities where that patient receives care is a key asset in the delivery of quality care. It is upon this foundation that the CPRS Remote Data Views project is able to allow the clinician to retrieve clinical information from wherever the patient has received care. As the Integration Control Number (ICN) is populated at the Health Eligibility Center (HEC) and other national databases, this ability to uniquely identify patients assists in the elimination of duplicate records throughout the systems. The need also exists between the Department of Veterans Affairs (VA) and other agencies such as Indian Health Service (IHS) and Department of Defense (DoD), to uniquely identify and share information regarding any patient that has received care from more than one facility/agency.
<font size="3">'''Overview'''</font>


There is a suite of applications that make up the VHA MPI. The suite contains the following three modules:
The List Manager was developed to provide an efficient way for
applications to present a list of items to the user for action. It is
a developmental tool that enables programmers to:


* Master Patient Index Austin Automation Center (AAC)
* <font face="Arial, sans-serif"><font size="2">Display a list of items
* Master Patient Index (MPI) VistA
to the user.</font></font>
* Patient Demographics (MPI/PD)


'''Features'''
* <font face="Arial, sans-serif"><font size="2">Allow the user to browse
back and forth through the items one at a time or by screen.</font></font>


'''Master Patient Index Austin Automation Center (AAC)'''
* <font face="Arial, sans-serif"><font size="2">Allow the user to select
items from the list.</font></font> * <font face="Arial, sans-serif"><font
size="2">Specify the actions that can be applied to selected items
from the list.</font></font> * <font face="Arial, sans-serif"><font
size="2">Call List Manager again as part of an action.</font></font>


* '''Create Unique Patient Index-'''The MPI, located at the AAC in Austin, Texas, maintains a unique patient index by establishing a correlation between each unique system record and the MPI's unique identifier (ICN). The correlated list is maintained to enable the sharing of patient data between operationally diverse systems and to maintain the integrity of the correlations to the ICN.
* '''Assign ICN and CMOR-'''VA medical centers send local patient entries to the MPI for Integration Control Number (ICN) assignment via an initialization process or during daily operations at the VAMC.
* '''Maintain/Update Index-'''The Index is maintained and updated as patients are added or their data is updated at VA medical facilities.
* '''Manage/Mitigate Data Quality Issues-'''Houses the resolution journal and related applications, used to manage and mitigate data quality issues that are identified by the system or users.


'''Master Patient Index (MPI)''' '''VistA'''


* '''Request Patient ICN''''''-'''This software resides in VistA at a site and sends local patient entries to the MPI in Austin for ICN assignment.
<font face="Arial, sans-serif"><font size="2">Protocols are the "actions"
* '''Maintain/Update Patient Data''''''-'''The MPI-VistA, Master Patient Index/Patient Demographics (MPI/PD), and Patient Information Management System (PIMS) keeps the data in the MPI (AAC) up-to-date. [NOTE: The initialization of the MPI (AAC) consisted of each VAMC sending batch Health Level Seven (HL7) messages to the MPI in Austin requesting ICNs for all of the patients whose records reflected activity in the past three fiscal years (i.e., patient records that contain CMOR Activity Scores).]
that users can take against items on the list. A number of standard
* '''Provide Site Query Capability-'''MPI-VistA enables sites to query MPI (AAC) for known data, to request the assignment of an ICN. When a new patient is created or an existing patient record becomes active at the local VAMC, a query is sent to the MPI in Austin to see if this patient has an ICN already on the MPI. If the MPI already has an ICN assigned for this patient, the ICN, CMOR, and the Treating Facility List (a list of all locations that know of this ICN) are returned to the local VAMC. If the MPI doesn't know of this patient, a new ICN is created and the local VAMC is made the CMOR. The ICN and CMOR are then returned to the local VAMC.
protocols come as part of the List Manager utility. Most of these are
* '''Inactivate Patient from MPI''''''-'''The site has the ability to inactivate an ICN on the MPI if the patient was inappropriately added to the MPI (i.e., a Test patient) or to allow the patient to be matched with another existing ICN.
actions that allow the user to browse the list of items.</font></font>
* '''Request/Manage CMOR Updates-'''The CMOR is initially the first site to notify the MPI of a patient. The VAMCs have an array of options that allow them to request to be the CMOR as well as "push" their current CMOR assignment for a patient to another site in the treating facility list. The Change of CMOR options also allow for the management of these requests.


'''Patient Demographics (MPI/PD)'''


* '''Act as Authoritative Source of Patient Demographics-'''The function of the Coordinating Master of Record (CMOR) site (one VAMC) is to be the authoritative source of the patient's demographic data.
* '''Utilize CMOR-'''Uses the patient's CMOR as the single source of current key demographic information on the MPI and at the patient's other treating facilities.
* '''Support Demographic Changes-'''Supports the review of demographic changes that occur at other facilities for patients at which your site is the CMOR.
* '''Synchronize Key Data-'''Synchronizes key patient demographic data at all sites where the patient is treated.
* '''Support Duplicate Record Merge-'''Provides support to the duplicate record merge software for the merging of MPI/PD related data.
* '''Manage Exceptions-'''Allows the management of Exceptions that prevent a patient from getting an ICN assignment.
<!-- file -->


==== My Health''<u>e</u>''Vet ====
<font face="Arial, sans-serif"><font size="2">The List Manager contains
the Workbench programmer utility, which allows the development of a
List Manager application without having to move from one development
tool to another.</font></font>


'''Overview'''


My Health''<u>'''e'''</u>''Vet (MHV) is a Web-based application that creates a new, on-line environment where veterans, family, and clinicians may come together to optimize veterans' health care. Web technology combines essential health record information enhanced by online health resources to enable and encourage patient/clinician collaboration. It is the first web-based application created by the Office of Information for the exclusive use by veterans.


MHV provides one-stop shopping for information on VA benefits, special programs, and health information and services. MHV also provides services and tools to enable veterans to increase their knowledge about health conditions, better record their health status and communicate with their care providers, and become better-informed participants in improving their health. Veterans can now partner with their clinicians to gain a better understanding of their health status and take a more active role in self-management and in shared health care decision-making.
<font size="3">'''Features'''</font>


'''Features'''
<font face="Arial, sans-serif"><font size="2">List Manager provides a
generic method of presenting lists of items to terminal users. Its core
features are:</font></font>


<u>Fall 2003 Release</u>
* <font face="Arial, sans-serif"><font size="2">Displays a list of items
in a screen format and allows users to browse through the list, select
items that need action, and take action against those items.</font></font>
* <font face="Arial, sans-serif"><font size="2">In addition to the
various actions that are specific to the option being worked in,
provides generic actions applicable to any List Manager screen (i.e.,
Up a Line, Next Screen, First Screen, Search List).</font></font>
* <font face="Arial, sans-serif"><font size="2">Provides a list of
available menu functions that can be performed from the screen without
having to exit and enter a new menu option for each one.</font></font> *
<font face="Arial, sans-serif"><font size="2">Allows action pre-selection
and list entry pre-selection by user.</font></font> * <font face="Arial,
sans-serif"><font size="2">Provides programmer Workbench for application
development.</font></font>


* Enables all veterans to participate voluntarily and have access to and control of his/her customizable online environment.
* Provides a commercial Health Education Library that contains information on medical conditions, medications, health news, and preventive health.
* Makes the library available to clinicians; addressable from the CPRS toolbar and included in order sets.
* Showcases education and program information developed by VHA program offices.
* Contains the latest VA/VHA news.
* Contains a prescription checker, health calculators, and self-assessment tools.
* Maps to benefits and resources available in VA and other federal sources.


<u>Summer 2004 Release</u>


* Provides online prescription refills for veterans enrolled in VA health care.
* Provides ability to view next appointment date and time at a VA health care facility.
* Provides ability to see total co-payment balance.
* Enables ability to enter and store personal information in a secure eVAult.
* Provides ability to format and print reports, such as information cards and medication profiles.
* Enables veterans to journal readings and chart progress in five self-entered metrics (elogs)-blood pressure, blood sugar, cholesterol, weight, and heart rate.
* Enables veterans to define additional elogs, journal readings, and chart progress.


<u>Winter 2005 Release</u>


* Allows veterans to request and store key portions of their VA health record in a secure, unique, and personal repository.
* Enables veterans to let a delegate access and manage all or some of their health information to others, such as family or veteran advocates, and VA and non-VA providers.
* Allows veterans to receive wellness reminders ,written specifically for the patient, to provide effective delivery of preventive medicine serves through standardized reminders.
<!-- file -->


==== Network Health Exchange (NHE) ====


'''Overview'''


Network Health Exchange (NHE) is a Veterans Health Information Systems and Technology Architecture (VistA)module that provides clinicians quick and easy access to patients' information from any VA medical facility where a patients has received care. NHE provides the computer mechanism for clinicians to retrieve this patient data.


The NHE package accesses information concerning clinic visits, diagnoses, prescriptions, laboratory tests, radiology exams, and hospital admissions. It enables clinicians to request medical or pharmacy records for a patient from a single site or several sites. NHE obtains Health Summary information through an interface with the Health Summary VistA module.
===== MailMan =====


NHE uses predefined formats, thus requiring less input by the user and resulting in simpler, faster access to patient data. Patient data is displayed in a format similar to that of Health Summary and can be viewed on-screen or printed.


NHE is an interim bridge to a more fully integrated clinical patient data exchange system in the future.


'''Features'''
<font size="3">'''Overview'''</font>


* Simple User Interface: Users simply select the data type (Clinical or only Pharmacy data) and the amount of patient data they would like returned (all data or 12 months only), then enter the patient's name or Social Security Number in order to initiate the request for data from another VA facility.
<font face="Arial, sans-serif"><font size="2">MailMan is an electronic
* Retrieval and Printing of Patient Data-Retrieved patient data (Clinical Record or Pharmacy information, either a comprehensive history or activity only within the last 12 months) can be printed or viewed on-screen.
messaging system that transmits messages, computer programs, data
* Quick Response-NHE is fully automated and user requests are generally fulfilled in a matter of minutes.
dictionaries, and data between users and applications located at the
* Data Returned in Health Summary Format-Patient data is returned in an NHE mail message, formatted similarly to the Health Summary, beginning with patient demographics, followed by categorized medical information, and indicating the name of the VA facility where the data resides.
same or at different facilities. Network MailMan disseminates information
* User Notification with Alerts-The user requesting patient data via NHE is notified of data receipt through an alert that appears within the menu system.
across any communications medium.</font></font>
* Purging Retrieved Patient Data-In order to allow sites to control disk space usage, NHE provides an option to purge the retrieved patient data messages nightly.
* Special Security Features-This system is intended for use by health professionals who have direct patient care responsibilities and have need for clinical information. NHE generates a bulletin if data is requested from a ''sensitive'' patient record. The bulletin is directed to the same user group that currently reviews notices about access to ''sensitive'' patient records.


* Package Management-The availability of NHE options is based on the level of menu access granted to each user.


<!-- file -->
==== Patient Data Exchange (PDX) ====


'''Overview'''
<font face="Arial, sans-serif"><font size="2">When MailMan is integrated
into an application, it notifies individuals and groups about important
events. From VA FileMan, a change in the value of a field can trigger
a message called a bulletin. MailMan is easy for the user to learn
and to use and provides extensive online help. There is also an
extensive set of MailMan Application Programmer Interfaces (API) for
the developer.</font></font>


Patient Data Exchange (PDX) is a VistA module designed to electronically request and receive patient demographics, episodes of care, medications, and diagnostic evaluations from other VA facilities. Data is retrieved from files at a remote site and is assembled into a coherent, composite record, greatly enhancing the quality of care provided for the patient.


PDX allows for the setup of a work group of selected facilities that agree to an automatic data exchange. For facilities in the work group, data is returned automatically, within minutes after a request is entered. There are exceptions, however, such as records that have been flagged as sensitive. Any record that does not meet the criteria for automatic processing is reviewed and processed manually.


Once the request is processed, the patient's record is forwarded to the requesting facility. The requests and data are moved from one facility to another using MailMan, VA's electronic mail utility. The requesting facility receives administrative, pharmaceutical, and clinical information that is stored in its files and is available for terminal display or printing.
<font size="3">'''Features'''</font>


'''Features'''
* <font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">'''Delivery Optionsâ€"'''</font></font><font
face="Arial, sans-serif"><font size="2">Users can send messages
to individuals, mail groups, and devices. Users can also stagger
delivery of messages and specify to what basket a message should
be delivered.</font></font></font></font> * <font face="Times New
Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">'''Chained Responsesâ€"'''</font></font><font face="Arial,
sans-serif"><font size="2">Message response chains are managed
automatically. Responses are threaded in sequence following the
original message and are instantly available to anyone currently
reading the message, providing a "real-time" conversation among message
recipients. All responses are available for review at any time by
all recipients.</font></font></font></font> * <font face="Times New
Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">'''Configurable Interfaceâ€"'''</font></font><font
face="Arial, sans-serif"><font size="2">Users can customize and
configure the MailMan reader interface and set other personal
properties best suited to their needs.</font></font></font></font>
* <font face="Times New Roman, serif"><font size="3"><font
face="Arial, sans-serif"><font size="2">'''Mail Basket
Organizationâ€"'''</font></font><font face="Arial, sans-serif"><font
size="2">Users can organize mail into any number of user-specified
mail baskets.</font></font></font></font> * <font face="Times New
Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">'''Mail Filteringâ€"'''</font></font><font face="Arial,
sans-serif"><font size="2">Users can filter their mail based on one or
several filter criteria.</font></font></font></font> * <font face="Times
New Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">'''Search Capabilitiesâ€"'''</font></font><font face="Arial,
sans-serif"><font size="2">Users can search for messages based on one or
several search criteria.</font></font></font></font> * <font face="Times
New Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">'''Reminders/Notificationsâ€"'''</font></font><font
face="Arial, sans-serif"><font size="2">Messages can be used as a
tickler file to remind/notify you of specific events (e.g., bulletins
and alerts).</font></font></font></font> * <font face="Times New
Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">'''Secure Messagesâ€"'''</font></font><font face="Arial,
sans-serif"><font size="2">Messages can be secured (scrambled), requiring
a key to unlock them. MailMan provides multiple layers of local and
network security.</font></font></font></font> * <font face="Times
New Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">'''Surrogate Capabilityâ€"'''</font></font><font face="Arial,
sans-serif"><font size="2">Users can designate a surrogate to read and/or
answer their own messages.</font></font></font></font> * <font face="Times
New Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">'''Software Message Processingâ€"'''</font></font><font
face="Arial, sans-serif"><font size="2">Messages can be sent and
processed by software. All application outputs can be directed into
MailMan messages.</font></font></font></font> * <font face="Times New
Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">'''Software Code Transportâ€"'''</font></font><font
face="Arial, sans-serif"><font size="2">Veterans Health Information
Systems and Technology Architecture</font></font> <font face="Arial,
sans-serif"><font size="2">(</font></font><font face="Arial,
sans-serif"><font size="2">VistA</font></font><font face="Arial,
sans-serif"><font size="2">)</font></font> <font face="Arial,
sans-serif"><font size="2">software can be conveniently transported
via messages. Whole modules and patches for installation at a
remote site are sent in Kernel Installation and Distribution System
(KIDS)/PackMan messages.</font></font></font></font> * <font face="Times
New Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">'''Network Transmissions Over TCP/IPâ€"'''</font></font><font
face="Arial, sans-serif"><font size="2">Network transmissions can be
made across Transmission Control Protocol / Internet Protocol (TCP/IP)
channels to any Simple Mail Transfer Protocol (SMTP)-compatible
mail system.</font></font></font></font> * <font face="Times New
Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">'''Statistics Collectionâ€"'''</font></font><font face="Arial,
sans-serif"><font size="2">Extensive mail system statistics can
be collected.</font></font></font></font> * <font face="Times New
Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">'''Dom'''</font></font><font face="Arial, sans-serif"><font
size="2">'''ain Name Service (DNS)-aware'''</font></font><font
face="Arial, sans-serif"><font size="2">'''â€"'''</font></font><font
face="Arial, sans-serif"><font size="2">It creates automatic replication
of IP address changes to every</font></font> <font face="Arial,
sans-serif"><font size="2">VistA</font></font> <font face="Arial,
sans-serif"><font size="2">MailMan system as a result of only one central
database edit (i.e., performs DNS lookups).</font></font></font></font>


* Requests data electronically for a selected patient from another facility.
=== Master Patient Index (MPI) and Master Patient Index/Patient
* Allows automatic processing of requests from selected facilities.
Demographics (MPI/PD) ===
* Allows for manual processing of requests from facilities outside the work group or of certain records, such as those flagged as sensitive.
* Allows sending information to a remote site without first receiving a request.
* Allows data received from the remote site to be displayed/printed.
* Allows select demographic data from a remote site file to be loaded/edited into the local site file.
* Allows checking on status of requests.
* Allows displaying/printing of statistics each time a regular or unsolicited PDX request is made or processed.
* Allows for the encryption of site-specific patient information.


* Allows sending/requesting data for a patient from multiple sites for multiple segments.


<!-- file -->
==== Remote Procedure Call (RPC) Broker ====


<font size="3">'''Overview'''</font>
'''Overview'''


A major goal for Veterans Health Information Systems and Technology Architecture(VistA)is providing Windows-based graphical user interface (GUI) software applications. This type of software application typically runs as a client in a client/server environment. One of the challenges in creating such applications is establishing communication between the client workstation and VistA's M-based servers. In a secure manner over a Transmission Control Protocol/Internet Protocol (TCP/IP) network, users need to be able to log onto a server, initiate activities on the server, and retrieve and update data on the server.
<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">There are approximately 140 Veterans Health
Administration (VHA) databases in use across the country in VA facilities
that are accessible via</font></font> <font face="Arial, sans-serif"><font
size="2">VistA</font></font> <font face="Arial, sans-serif"><font
size="2">systems. Because of this wide distribution of information,
there is great potential for individual patient data to be kept under
more than one identification number. The Master Patient Index (MPI)
has been created to support maintenance of a unique patient identifier
and a single master index of all VA patients, and to allow messaging
of patient information among the institutional partners [i.e., VHA,
Veterans Benefits Administration (VBA), Board of Veterans Appeals (BVA),
and National Cemetery Administration (NCA)].</font></font></font></font>


VistA's Remote Procedure Call (RPC) Broker software provides functionality so that GUI developers can:


* Establish a connection from a client workstation to a VistA M Server.
* Run RPCs on the VistA M Server.
* Return data to the client workstation.


The RPC Broker supports 32-bit Windows client applications (e.g., applications running under Microsoft Windows 2000 and Windows XP).
<font face="Arial, sans-serif"><font size="2">The ability to uniquely
identify a patient and the facilities where that patient receives care is
a key asset in the delivery of quality care. It is upon this foundation
that the CPRS Remote Data Views project is able to allow the clinician
to retrieve clinical information from wherever the patient has received
care. As the Integration Control Number (ICN) is populated at the Health
Eligibility Center (HEC) and other national databases, this ability to
uniquely identify patients assists in the elimination of duplicate records
throughout the systems. The need also exists between the Department of
Veterans Affairs (VA) and other agencies such as Indian Health Service
(IHS) and Department of Defense (DoD), to uniquely identify and share
information regarding any patient that has received care from more than
one facility/agency.</font></font>


The VistA M Server continuously runs an RPC Broker listener process whose purpose is to establish connections with clients. When the listener process receives a connection request from a client, it spawns a separate handler process, which then handles all communications with the client.


Once connected, the client can execute Remote Procedure Calls on the VistA M Server. RPCs are written in M and accessed through the VistA M Server's REMOTE PROCEDURE file (#8994).


RPCs can:
<font face="Arial, sans-serif"><font size="2">There is a suite of
applications that make up the VHA MPI. The suite contains the following
three modules:</font></font>


* Receive data from the client workstation.
* <font face="Arial, sans-serif"><font size="2">Master Patient Index
* Return data to the client workstation.
Austin Automation Center (AAC)</font></font> * <font face="Times New
* Execute other actions on the VistA M Server.
Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">Master Patient Index (MPI)</font></font> <font face="Arial,
sans-serif"><font size="2">VistA</font></font></font></font> *
<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">Patient Demographics (</font></font><font
face="Helvetica, sans-serif"><font size="2">MPI/PD</font></font><font
face="Arial, sans-serif"><font size="2">)</font></font></font></font>


'''Features'''


* '''Broker Developer Kit (BDK)'''-The RPC Broker Delphi components provide Delphi developers with an easy, object-based access to the Broker. When placed on a Delphi form, these components provide a connection to the VistA M Server and the ability to reference M data.
* '''Dynamic Link Library (DLL) Interface'''-The RPC Broker provides a set of DLL functions that allow applications written in ''any'' MS Windows-based development environment [e.g., Borland's Delphi, Microsoft Visual Basic, and other commercial-off-the-shelf (COTS)/Hybrid Open System Technology (HOST) products] to take advantage of all the features offered by the RPC Broker Delphi components.


'''Remote Call Procedure - continued'''
<font size="3">'''Features'''</font>


* '''Client/Server Security'''-For security purposes, to execute an RPC on the VistA M Server all of the following conditions must be met:
<font face="Arial, sans-serif"><font size="2">'''Master Patient Index
Austin Automation Center (AAC)'''</font></font>


1. The user must be an authorized user on the VistA M Server.
* <font face="Times New Roman, serif"><font size="3"><font
face="Helvetica, sans-serif"><font size="2">'''Create Unique Patient
Indexâ€"'''</font></font><font face="Helvetica, sans-serif"><font
size="2">The MPI, located at the AAC in Austin, Texas, maintains a unique
patient index by establishing a correlation between each unique system
record and the MPI’s unique identifier (ICN). The correlated list
is maintained to enable the sharing of patient data between operationally
diverse systems and to maintain the integrity of the correlations to
the ICN.</font></font></font></font> * <font face="Times New Roman,
serif"><font size="3"><font face="Helvetica, sans-serif"><font
size="2">'''Assign ICN and CMORâ€"'''</font></font><font
face="Helvetica, sans-serif"><font size="2">VA medical centers
send</font></font> <font face="Helvetica, sans-serif"><font size="2">local
patient entries to the MPI for Integration Control Number (ICN)
assignment via an initialization process or during daily operations at
the VAMC.</font></font></font></font> * <font face="Times New Roman,
serif"><font size="3"><font face="Helvetica, sans-serif"><font
size="2">'''Maintain/Update Indexâ€"'''</font></font><font
face="Helvetica, sans-serif"><font size="2">The Index is maintained
and updated as patients are added or their data is updated
at VA medical facilities.</font></font></font></font> * <font
face="Times New Roman, serif"><font size="3"><font face="Helvetica,
sans-serif"><font size="2">'''Manage/Mitigate Data Quality
Issuesâ€"'''</font></font><font face="Helvetica, sans-serif"><font
size="2">Houses the resolution journal and related applications, used
to manage and mitigate data quality issues that are identified by the
system or users.</font></font></font></font>


2. The client workstation application must invoke a supported application context authorized to the user.


3. The RPC must itself be authorized to the specified application context.


* '''Integrated Single Sign-on'''-The RPC Broker supports a ''single'' sign-on point from a client workstation to the server. Users need only sign on once when accessing multiple VistA applications on the same client workstation.
<font face="Arial, sans-serif"><font size="3">'''MPI and MPI/PD â€"
* '''Silent Sign-on'''-The RPC Broker provides silent login functionality. Any GUI application that uses the Broker can log in to a VistA M Server silently (i.e., without any user dialogue).
continued'''</font></font>


* '''Shared''' '''Broker'''-Broker applications running on the same server and port can share the same connection, resulting in a single job running on the server. This functionality is available for Broker applications compiled with the TSharedRPCBroker component. Only connections associated with the first application must log in.


* '''Non-callback Connection'''-The RPC Broker provides a non-callback connection, which results in less problems for applications using the Broker for connections across firewalls.
* '''CCOW-enabled'''-The RPC Broker supports CCOW, which allows Delphi-based applications to incorporate Single Sign-On/User Context (SSO/UC) functionality into their applications. This functionality is available for Broker applications compiled with the TCCOWRPCBroker component.


<!-- file -->
<font face="Times New Roman, serif"><font size="3"><font
==== VA FileMan ====
face="Arial, sans-serif"><font size="2">'''Master Patient Index
(MPI)'''</font></font> <font face="Arial, sans-serif"><font
size="2">'''VistA'''</font></font></font></font>


'''Overview'''
* <font face="Times New Roman, serif"><font size="3"><font
face="Arial, sans-serif"><font size="2">'''Request Patient
ICN'''</font></font><font face="Helvetica, sans-serif"><font
size="2">'''â€"'''</font></font><font face="Arial, sans-serif"><font
size="2">This software resides in</font></font> <font face="Arial,
sans-serif"><font size="2">VistA</font></font> <font face="Arial,
sans-serif"><font size="2">at a site and sends local patient</font></font>
<font face="Arial, sans-serif"><font size="2">entries to the
MPI in Austin for ICN assignment.</font></font></font></font>
* <font face="Times New Roman, serif"><font size="3"><font
face="Arial, sans-serif"><font size="2">'''Maintain/Update Patient
Data'''</font></font><font face="Helvetica, sans-serif"><font
size="2">'''â€"'''</font></font><font face="Helvetica,
sans-serif"><font size="2">The</font></font> <font face="Arial,
sans-serif"><font size="2">MPI-</font></font><font face="Arial,
sans-serif"><font size="2">VistA</font></font><font face="Arial,
sans-serif"><font size="2">, Master Patient Index/Patient Demographics
(MPI/PD), and Patient Information Management System (PIMS) keeps
the data in the MPI (AAC) up-to-date. [NOTE: The
initialization of the MPI (AAC) consisted of each VAMC sending batch
Health Level Seven (HL7) messages to the MPI in Austin requesting
ICNs for all of the patients whose records reflected activity in
the past three fiscal years (i.e., patient records that contain CMOR
Activity Scores).]</font></font></font></font> * <font face="Times
New Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">'''Provide Site Query Capabilityâ€"'''</font></font><font
face="Arial, sans-serif"><font size="2">MPI-</font></font><font
face="Arial, sans-serif"><font size="2">VistA</font></font> <font
face="Arial, sans-serif"><font size="2">enables sites to query MPI (AAC)
for known data, to request the assignment of an ICN. When a new patient
is created or an existing patient record becomes active at the local
VAMC, a query is sent to the MPI in Austin to see if this patient has
an ICN already on the MPI. If the MPI already has an ICN assigned for
this patient, the ICN, CMOR, and the Treating Facility List (a list
of all locations that know of this ICN) are returned to the local
VAMC. If the MPI doesn't know of this patient, a new ICN is created
and the local VAMC is made the CMOR. The ICN and CMOR are then returned
to the local VAMC.</font></font></font></font> * <font face="Times New
Roman, serif"><font size="3"><font face="Helvetica, sans-serif"><font
size="2">'''Inactivate Patient from MPI'''</font></font><font
face="Arial, sans-serif"><font size="2">'''â€"'''</font></font><font
face="Helvetica, sans-serif"><font size="2">The site has the ability to
inactivate an ICN on the MPI if the patient was inappropriately added to
the MPI (i.e., a Test patient) or to allow the patient to be matched with
another existing ICN.</font></font></font></font> * <font face="Times
New Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">'''Request/Manage CMOR Updatesâ€"'''</font></font><font
face="Arial, sans-serif"><font size="2">The CMOR is initially the first
site to notify the MPI of a patient. The VAMCs have an array of options
that allow them to request to be the CMOR as well as "push" their current
CMOR assignment for a patient to another site in the treating facility
list. The Change of CMOR options also allow for the management of these
requests.</font></font></font></font>


VA FileMan is Veterans Health Information Systems and Technology Architecture's (VistA) database management system (DBMS). It runs in any American National Standards Institute (ANSI) M environment. The majority of Veterans Health Administration (VHA) clinical data is stored in VA FileMan files and is retrieved and accessed through VA FileMan Application Programmer Interfaces (API) and user interfaces.


'''Features'''


{| width="615" cellpadding="7"
<font face="Arial, sans-serif"><font size="2">'''Patient Demographics
|- valign="bottom"
(MPI/PD)'''</font></font>
| width="278" height="7" |
<u>'''For Users'''</u>
| width="309" |
<u>'''For Developers'''</u>
|- valign="top"
| width="278" |
* Standalone user interface for adding, editing, printing, and searching data.
* Form-based editing (ScreenMan).
* Easy terminal-based editing of word processing database fields (Screen Editor).
* Flexible, extensive report module.
* Scrollable onscreen output of any report (Browser device).
* Data interchange with outside applications such as PC spreadsheets and databases (Import and Export Tools).
| width="309" |
* Full support for forms-based interfaces to the database (ScreenMan API, Form Editor).
* Full database access for client-server applications (Database Server API).
* Easy scrolling-mode interfaces to the database (Classic API).
* Full database access in Delphi-based applications via FileMan Delphi Components.
* Data archiving and transport tools.
* Comprehensive file creation and management utilities.
* SQL Interface (SQLI) projects all of the information needed by M-to-SQL vendors to access VA FileMan through M-to-SQL products.
* Supports Keys and compound cross-references (Indexes).
|}


===== Performance =====
* <font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">'''Act as Authoritative Source of Patient
Demographicsâ€"'''</font></font><font face="Arial, sans-serif"><font
size="2">The function of the Coordinating Master of Record (CMOR)
site (one VAMC) is to be the authoritative source of the patient's
demographic data.</font></font></font></font> * <font face="Times New
Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">'''Utilize CMORâ€"'''</font></font><font face="Arial,
sans-serif"><font size="2">Uses the patient’s CMOR as the single
source of current key demographic information on the MPI and at the
patient’s other treating facilities.</font></font></font></font>
* <font face="Times New Roman, serif"><font size="3"><font
face="Arial, sans-serif"><font size="2">'''Support Demographic
Changesâ€"'''</font></font><font face="Arial, sans-serif"><font
size="2">Supports the review of demographic changes that
occur at other facilities for patients at which your site is
the CMOR.</font></font></font></font> * <font face="Times New
Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">'''Synchronize Key Dataâ€"'''</font></font><font face="Arial,
sans-serif"><font size="2">Synchronizes key patient demographic data at
all sites where the patient is treated.</font></font></font></font>
* <font face="Times New Roman, serif"><font size="3"><font
face="Arial, sans-serif"><font size="2">'''Support Duplicate Record
Mergeâ€"'''</font></font><font face="Arial, sans-serif"><font
size="2">Provides support to the duplicate record merge software for
the merging of MPI/PD related data.</font></font></font></font>
* <font face="Times New Roman, serif"><font size="3"><font
face="Arial, sans-serif"><font size="2">'''Manage
Exceptionsâ€"'''</font></font><font face="Arial, sans-serif"><font
size="2">Allows the management of Exceptions that prevent a patient from
getting an ICN assignment.</font></font></font></font>


Over the years, demand on VHA systems has grown. The compactness and efficiency of M and VA FileMan provide fast database performance and high utilization of our computer systems.


===== Portability =====


Portable, platform-independent database services provided to applications by VA FileMan, combined with the operating system portability layer of Kernel, allow VHA to upgrade its hospital computing platforms without significant changes to application code. Thus, VHA has not encountered the kinds of problems normally associated with computer platform changes and is free to competitively bid out for new systems.


===== Openness =====


VA FileMan is open; it facilitates data access from outside applications. The Database Server (DBS) API enables client/server access to VA FileMan data. The FileMan Delphi Components take advantage of the DBS API to encapsulate the details of retrieving, validating, and updating VA FileMan data within a Delphi application. VA FileMan's Import and Export tools support data interchange with outside applications such as PC spreadsheets and database programs. SQLI helps make VA FileMan data available to outside applications. It also includes native support for Keys and compound cross references (Indexes), and thus, helps pave the way for the opening of VistA even further to outside software.
===== My Health''<u>e</u>''Vet =====


<!-- file -->
==== VistALink ====


'''Overview'''


VistALink provides a synchronous communication mechanism between MUMPS or M applications and rehosted applications, supporting Veterans Health Administration's (VHA's) ongoing transition to Health''<u>'''e'''</u>''Vet-VistA.
<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>


Technically, VistALink is a transport layer between M and Java. It consists of an M-side listener and Java-side adapter libraries compliant with the J2EE Connectors specification for Enterprise Information System (EIS) adapters. "The Connector architecture is an integral part of the J2EE platform, and, as a key component in J2EE's support for application integration, it ensures that J2EE applications can connect to and use a multitude of EIS and legacy systems."<sup>1</sup>[#sdfootnote1]
<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">My Health</font></font><font face="Arial,
sans-serif"><font size="2">''<u>'''e'''</u>''</font></font><font
face="Arial, sans-serif"><font size="2">Vet (MHV) is a Web-based
application that creates a new, on-line environment where veterans,
family, and clinicians may come together to optimize veterans’
health care. Web technology combines essential health record
information enhanced by online health resources to enable and
encourage patient/clinician collaboration. It is the first web-based
application created by the Office of Information for the exclusive use
by veterans.</font></font></font></font>


<div id="sdfootnote1">
<sup>1</sup>Sharma, Rahul; Stearns, Beth; Ng, Tony, ''J2EE Connector Architecture and Enterprise Application Integration'' - Addison-Wesley, 2001.
</div>


===== Reasons for VistALink =====


While alternatives for communication between Java and M applications have been produced, the needs of applications for robust, synchronous communication have not been met by these alternatives. The limitations of each of these alternatives are described below:
<font face="Arial, sans-serif"><font size="2">MHV provides one-stop
shopping for information on VA benefits, special programs, and health
information and services. MHV also provides services and tools to enable
veterans to increase their knowledge about health conditions, better
record their health status and communicate with their care providers, and
become better-informed participants in improving their health. Veterans
can now partner with their clinicians to gain a better understanding of
their health status and take a more active role in self-management and
in shared health care decision-making.</font></font>


* Remote Prodcedure Call Broker-The RPC Broker is COM-based, rather than Java-based. Wrapping the COM-based Broker was proven by the Care Management team to have unacceptable performance limitations. Also, the RPC Broker was not designed for n-tier applications.
* Vitria-Vitria is used as an HL7 interface engine by the VHA. HL7 messaging is an effective tool for asynchronous communication. But in many instances, applications need synchronous access to RPCs, as they are run while a user is waiting for results.
* Cache-Cache provides a number of connectivity mechanisms between itself and Java that initially showed potential for use. However, the Cache-specific features have proved not to have all the functionality needed by rehosted applications.
* Third-Party J2EE Connector-Compliant Adapters-At least one company markets an adapter for J2EE-M connectivity that is J2EE Connector compliant (as is VistALink). This adapter, however, is for Development Standard MUMPS (DSM) systems only and has other limitations when measured against VHA application requirements.


'''Features'''


* v1.0: Client/Server connectivity from Java client to M-Officially released. This version of VistALink was designed to meet the needs of Care Management (CM). It is for Java rich client applications connecting to M servers and executing RPCs on those servers. VistALink v1.0 provides the equivalent of RPC Broker functionality for Java.
<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>
* v1.5. J2EE Application Server connectivity to M-This version will allow applications and services running on a J2EE application server to initiate a call to an M server and execute RPCs. This version fully implements the Java 2 Enterprise Edition (J2EE) Connectors specification. Applications requesting this version include Patient Advocate Tracking System (PATS), Veterans Personal Finance System (VPFS), Computerized Patient Record System - Reengineering (CPRS-R), Scheduling, Standard Data Service (SDS), Blind Rehabilitation and Spinal Cord. Scheduled for release in mid-2004.
* v2.0: Connectivity from M to J2EE-This version will add bi-directional connectivity, that is, allow applications and services running on M to initiate a call to resources on a J2EE application server. Release is tentatively planned for late 2004. Applications requesting this version include Scheduling and CPRS-R.


<!-- file -->
<font face="Arial, sans-serif"><font size="2"><u>Fall 2003
Release</u></font></font>


== VistA Development History ==
* <font face="Arial, sans-serif"><font size="2">Enables all
veterans to participate voluntarily and have access to and control
of his/her customizable online environment.</font></font> * <font
face="Arial, sans-serif"><font size="2">Provides a commercial Health
Education Library that contains information on medical conditions,
medications, health news, and preventive health.</font></font> * <font
face="Arial, sans-serif"><font size="2">Makes the library available
to clinicians; addressable from the CPRS toolbar and included in
order sets.</font></font> * <font face="Arial, sans-serif"><font
size="2">Showcases education and program information developed by VHA
program offices.</font></font> * <font face="Arial, sans-serif"><font
size="2">Contains the latest VA/VHA news.</font></font> * <font
face="Arial, sans-serif"><font size="2">Contains a prescription checker,
health calculators, and self-assessment tools.</font></font> * <font
face="Arial, sans-serif"><font size="2">Maps to benefits and resources
available in VA and other federal sources.</font></font>


In 1982, VHA committed to building an electronic health care architecture called DHCP (Decentralized Hospital Computer Program). The focus was the implementation of software applications easily integrated into a complete hospital information system. VA selected MUMPS (Massachusetts General Hospital Utility Multi-Programming System) as the primary programming language for DHCP, and began developing applications using VHA programmers who worked directly with user groups in software prototyping environments. MUMPS, now known simply as "M", is an American National Standards Institute (ANSI) and Federal Information Processing Standards (FIPS) standard language. By 1990, VHA had upgraded computer capacity at all medical facilities, and now implements software on a national scale supporting integrated health care delivery.


In 1996, VHA introduced VistA...Veterans Health Information Systems and Technology Architecture, a rich automated environment that supports day-to-day operations at local VA health care facilities. VistA is built on a client-server architecture, which ties together workstations and personal computers with graphical user interfaces at VHA facilities, as well as software developed by local medical facility staff. VistA also includes the links that allow commercial off-the-shelf software and products to be used with existing and future technologies. The Decision Support System (DSS) and other national databases that might be derived from locally generated data lie outside the scope of VistA.


When development began on the Decentralized Hospital Computer Program (DHCP) in the early 1980s, information systems were in their infancy in VA medical facilities and emphasized primarily hospital-based activities. DHCP grew rapidly and is used by many private and public health care facilities throughout the United States and the world. Although DHCP represented the total automation activity at most VA medical centers in 1985, DHCP is now only one part of the overall information resources at the local facility level. VistA incorporates all of the benefits of DHCP as well as including the rich array of other information resources that are becoming vital to the day-to-day operations at VA medical facilities.
<font face="Arial, sans-serif"><u>Summer 2004 Release</u></font>


=== On The Horizon ===
* <font face="Arial, sans-serif"><font size="2">Provides
online prescription refills for veterans enrolled in VA health
care.</font></font> * <font face="Arial, sans-serif"><font
size="2">Provides ability to view next appointment date and time at a VA
health care facility.</font></font> * <font face="Arial, sans-serif"><font
size="2">Provides ability to see total co-payment balance.</font></font>
* <font face="Arial, sans-serif"><font size="2">Enables ability to
enter and store personal information in a secure eVAult.</font></font>
* <font face="Arial, sans-serif"><font size="2">Provides ability to
format and print reports, such as information cards and medication
profiles.</font></font> * <font face="Arial, sans-serif"><font
size="2">Enables veterans to journal readings and chart progress in
five self-entered metrics (elogs)â€"blood pressure, blood sugar,
cholesterol, weight, and heart rate.</font></font> * <font face="Arial,
sans-serif"><font size="2">Enables veterans to define additional elogs,
journal readings, and chart progress.</font></font>


* '''Pharmacy Re-Engineering…'''


The Pharmacy Re-Engineering (PRE) project is a key component in the implementation of the overall HealtheVet VistA effort. Two important results in the long term will be access to up-to-date drug information and VA-developed custom screens for all medication orders.


By 2005, the PRE team expects to release Application Program Interfaces (APIs) for all current references to the various VistA Drug files and for all non-order specific Pharmacy files, such as Medication Routes, Schedules, and Dosage Forms. All other applications accessing these files will be required to use the released APIs.
<font face="Times New Roman, serif"><font size="3"><font
face="Arial, sans-serif">'''My Health'''</font><font face="Arial,
sans-serif"><u>'''e'''</u></font><font face="Arial, sans-serif">'''Vet
â€" continued'''</font></font></font>


* '''Upcoming Outpatient and PDM Enhancements…'''


The Outpatient Pharmacy portion of the Laser Labels Phase II project allows Prescription Medication Information (PMI) sheets and warning labels to be printed in another language if the system has the other language fields populated in Pharmacy Data Management and the individual patient is identified with the other language preference flag. The Pharmacy Data Management portion of this project allows for warning label combinations from the old warning label file and/or the new commercial data source. These warnings can also be gender specific when certain flags are set accordingly.


* '''Upcoming BCMA Enhancements…'''
<font face="Arial, sans-serif"><font size="2"><u>Winter 2005
Release</u></font></font>


The '''BCMA Read-Only''' option will allow clinical staff not authorized to administer medications to view information from the BCMA GUI. The Read-Only GUI will have the same look and feel of the current GUI, except will not allow users to take an action on a medication.
* <font face="Arial, sans-serif"><font size="2">Allows veterans to request
and store key portions of their VA health record in a secure, unique, and
personal repository.</font></font> * <font face="Arial, sans-serif"><font
size="2">Enables veterans to let a delegate access and manage all or
some of their health information to others, such as family or veteran
advocates, and VA and non-VA providers.</font></font> * <font face="Arial,
sans-serif"><font size="2">Allows veterans to receive wellness reminders
,written specifically for the patient, to provide effective delivery of
preventive medicine serves through standardized reminders.</font></font>


The '''BCMA Coversheet''' will display and allow access to all medication orders over a 24 hour period. In addition, visual queues will aid in the quick and accurate review of all medication administration data presented.
===== Network Health Exchange (NHE) =====


The '''BCMA Reports Re-design''' will allow a user to customize reports via selectable fields and filters. The report re-design will provide both User and Manager reports, with definable reports at each site. All data will be pulled from the BCMA Medication Log File.
<!-- file -->


== Other Resources ==


* '''VistA''' '''Documentation Library:''' <u>[http://www.va.gov/vdl http://www.va.gov/vdl]</u>
<font size="3">'''Overview'''</font>


This library contains a collection of available end-user documentation for all current applications (software packages), and also includes some tools not listed in the monograph. All documents can be viewed, downloaded, and printed. Some documents have links to a Web version, and may optionally have an archive file (.ZIP or .EXE) containing the Web pages for download.
<font face="Times New Roman, serif"><font size="3"><font
face="Arial, sans-serif"><font size="2">Network Health Exchange
(NHE) is a Veterans Health Information Systems and Technology
Architecture (</font></font><font face="Arial, sans-serif"><font
size="2">VistA)</font></font><font face="Arial, sans-serif"><font
size="2">module that provides clinicians quick and easy access to
patients' information from any VA medical facility where a patients has
received care. NHE provides the computer mechanism for clinicians to
retrieve this patient data.</font></font></font></font>


* '''Request for New Information Technology Services:''' <u>[http://vista.med.va.gov/pas/NewITRequestForm.asp http://vista.med.va.gov/pas/NewITRequestForm.asp]</u>


Dead Link --[[User:Drew.einhorn|Drew.einhorn]] 19:19, 23 February 2008 (EST)


Requests for new software or software enhancements must be endorsed by and submitted to the VHA NLB Information Data Management Committee (IDMC). The initial review and recommendation must go through the IDMC Screening Committee prior to submitting to IDMC for final approval. This site provides an on-line request form along with guidance on submissions.
<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">The NHE package accesses information
concerning clinic visits, diagnoses, prescriptions, laboratory tests,
radiology exams, and hospital admissions. It enables clinicians to
request medical or pharmacy records for a patient from a single site
or several sites. NHE obtains Health Summary information through an
interface with the Health Summary</font></font> <font face="Arial,
sans-serif"><font size="2">VistA</font></font> <font face="Arial,
sans-serif"><font size="2">module.</font></font></font></font>


* '''VHA Enterprise Architecture:''' <u>[http://www.va.gov/vha-ita/ita-p.html http://www.va.gov/vha-ita/ita-p.html]</u>


Dead Link --[[User:Drew.einhorn|Drew.einhorn]] 19:19, 23 February 2008 (EST)


VHA has developed and Enterprise Architecture that provides a technical framework to promote a one technology vision across the VHA so that corporate systems and systems across Veterans Integrated Service Networks are interoperable.
<font face="Arial, sans-serif"><font size="2">NHE uses predefined
formats, thus requiring less input by the user and resulting in simpler,
faster access to patient data. Patient data is displayed in a format
similar to that of Health Summary and can be viewed on-screen or
printed.</font></font>


* '''Capital Investment Planning:''' <u>[http://www.va.gov/budget/capital/ http://www.va.gov/budget/capital/]</u>


VA seems to have reorganized since this was written, but link appears to take us to the new part of the VA bureaucracy. --[[User:Drew.einhorn|Drew.einhorn]] 19:16, 23 February 2008 (EST)


Planned IT capital asset expenditures that exceed $10 million acquisition or $30 million life cycle costs, or have high levels of risk or visibility, must apply to the Capital Investment Board for approval.
<font face="Arial, sans-serif"><font size="2">NHE is an interim bridge
to a more fully integrated clinical patient data exchange system in
the future.</font></font>


The VA Capital Investment Board (VACIB) oversees the approval of all capital investment proposals that exceed certain threshold requirements, represent a high risk or high visibility or are cross-cutting. Approved proposals constitute the VA Capital Plan and support annual budget requests.


* '''Corporate Database Monograph:''' <u>[http://vaww.va.gov/../nds/CorporateDatabasesMonograph.asp http://vaww.va.gov/../nds/CorporateDatabasesMonograph.asp]</u>


Dead Link --[[User:Drew.einhorn|Drew.einhorn]] 19:19, 23 February 2008 (EST)
<font size="3">'''Features'''</font>


The Corporate Database Monograph provides an overview of the active VHA national databases. Information contained in this monograph allows stakeholders to identify opportunities for database consolidations, determine authoritative data sources, and work with VHA Data Quality committees to implement data standardization and quality control processes for corporate databases.
* <font face="Arial, sans-serif"><font size="2">Simple User Interface:
Users simply select the data type (Clinical or only Pharmacy data)
and the amount of patient data they would like returned (all data
or 12 months only), then enter the patient’s name or Social
Security Number in order to initiate the request for data from another
VA facility.</font></font> * <font face="Arial, sans-serif"><font
size="2">Retrieval and Printing of Patient Dataâ€"Retrieved patient
data (Clinical Record or Pharmacy information, either a comprehensive
history or activity only within the last 12 months) can be printed or
viewed on-screen.</font></font> * <font face="Arial, sans-serif"><font
size="2">Quick Responseâ€"NHE is fully automated and user requests
are generally fulfilled in a matter of minutes.</font></font> * <font
face="Arial, sans-serif"><font size="2">Data Returned in Health Summary
Formatâ€"Patient data is returned in an NHE mail message, formatted
similarly to the Health Summary, beginning with patient demographics,
followed by categorized medical information, and indicating the
name of the VA facility where the data resides.</font></font> *
<font face="Arial, sans-serif"><font size="2">User Notification
with Alertsâ€"The user requesting patient data via NHE is
notified of data receipt through an alert that appears within the
menu system.</font></font> * <font face="Arial, sans-serif"><font
size="2">Purging Retrieved Patient Dataâ€"In order to allow
sites to control disk space usage, NHE provides an option to purge
the retrieved patient data messages nightly.</font></font> * <font
face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">Special Security Featuresâ€"This system
is intended for use by health professionals who have direct patient
care responsibilities and have need for clinical information. NHE
generates a bulletin if data is requested from a</font></font> <font
face="Arial, sans-serif"><font size="2">''sensitive''</font></font>
<font face="Arial, sans-serif"><font size="2">patient record. The
bulletin is directed to the same user group that currently reviews
notices about access to</font></font> <font face="Arial, sans-serif"><font
size="2">''sensitive''</font></font> <font face="Arial, sans-serif"><font
size="2">patient records.</font></font></font></font>


* '''VA Information Technology Strategic Plans:''' <u>[http://vista.med.va.gov/vistaarch/itstrategy.htm http://vista.med.va.gov/vistaarch/itstrategy.htm]</u>
* <font face="Arial, sans-serif"><font size="2">Package
Managementâ€"The availability of NHE options is based on the level
of menu access granted to each user.</font></font>


Dead Link --[[User:Drew.einhorn|Drew.einhorn]] 19:19, 23 February 2008 (EST)


* '''VistA''' '''Monograph on the Internet'''<nowiki>:</nowiki> <u>[http://www.va.gov/vista_monograph/ http://www.va.gov/vista_monograph/]</u>


''For additional information related to'' VistA ''software, you may contact the VHA Office of Information National Help Desk by E-mail at'' <u>[mailto:VHAOICONHD@med.va.gov ''VHACIONHD@med.va.gov'']</u>''or by phone at 1-888-596-4357.''
===== Patient Data Exchange (PDX) =====


<!-- file -->
== Acronyms ==


ADT Admission, Discharge, Transfer


AICS Automated Information Collection System
<font size="3">'''Overview'''</font>


AMIE Automated Medical Information Exchange
<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">Patient Data Exchange (PDX) is a</font></font>
<font face="Arial, sans-serif"><font size="2">VistA</font></font>
<font face="Arial, sans-serif"><font size="2">module designed to
electronically request and receive patient demographics, episodes of care,
medications, and diagnostic evaluations from other VA facilities. Data is
retrieved from files at a remote site and is assembled into a coherent,
composite record, greatly enhancing the quality of care provided for
the patient.</font></font></font></font>


AR Accounts Receivable


ART Adverse Reaction Tracking


AR/WS Automatic Replenishment/Ward Stock
<font face="Arial, sans-serif"><font size="2">PDX allows for the setup
of a work group of selected facilities that agree to an automatic
data exchange. For facilities in the work group, data is returned
automatically, within minutes after a request is entered. There
are exceptions, however, such as records that have been flagged as
sensitive. Any record that does not meet the criteria for automatic
processing is reviewed and processed manually.</font></font>


ASISTS Automated Safety Incident Surveillance Tracking System


ASU Authorization/Subscription Utility


BCMA Bar Code Medication Administration
<font face="Arial, sans-serif"><font size="2">Once the request is
processed, the patient’s record is forwarded to the requesting
facility. The requests and data are moved from one facility to another
using MailMan, VA’s electronic mail utility. The requesting
facility receives administrative, pharmaceutical, and clinical information
that is stored in its files and is available for terminal display or
printing.</font></font>


CMOP Consolidated Mail Outpatient Pharmacy


COTS Commercial Off The Shelf


CPRS Computerized Patient Record System
<font size="3">'''Features'''</font>


CPT Current Procedural Terminology
* <font face="Arial, sans-serif"><font size="2">Requests data
electronically for a selected patient from another facility.</font></font>
* <font face="Arial, sans-serif"><font size="2">Allows automatic
processing of requests from selected facilities.</font></font> * <font
face="Arial, sans-serif"><font size="2">Allows for manual processing
of requests from facilities outside the work group or of certain
records, such as those flagged as sensitive.</font></font> * <font
face="Arial, sans-serif"><font size="2">Allows sending information to
a remote site without first receiving a request.</font></font> * <font
face="Arial, sans-serif"><font size="2">Allows data received from the
remote site to be displayed/printed.</font></font> * <font face="Arial,
sans-serif"><font size="2">Allows select demographic data from a remote
site file to be loaded/edited into the local site file.</font></font>
* <font face="Arial, sans-serif"><font size="2">Allows checking on
status of requests.</font></font> * <font face="Arial, sans-serif"><font
size="2">Allows displaying/printing of statistics each time a regular
or unsolicited PDX request is made or processed.</font></font> * <font
face="Arial, sans-serif"><font size="2">Allows for the encryption of
site-specific patient information.</font></font>


CS Controlled Substances
* <font face="Arial, sans-serif"><font size="2">Allows
sending/requesting data for a patient from multiple sites for multiple
segments.</font></font>


DA Drug Accountability/Inventory Interface


DRG Diagnostic Related Group


DSS Decision Support System


EPI Emerging Pathogens Initiative


FOIA Freedom of Information Act
===== Remote Procedure Call (RPC) Broker =====


GIP Generic Inventory Package


HBPC Hospital Based Patient Care


HEC Health Eligibility Center
<font size="3">'''Overview'''</font>


HINQ Hospital Inquiry
<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">A major goal for Veterans Health Information
Systems and Technology Architecture</font></font><font face="Arial,
sans-serif"><font size="2">(VistA)</font></font><font face="Arial,
sans-serif"><font size="2">is providing Windows-based graphical user
interface (GUI) software applications. This type of software application
typically runs as a client in a client/server environment. One of the
challenges in creating such applications is establishing communication
between the client workstation and</font></font> <font face="Arial,
sans-serif"><font size="2">VistA</font></font><font face="Arial,
sans-serif"><font size="2">'s M-based servers. In a secure manner over a
Transmission Control Protocol/Internet Protocol (TCP/IP) network, users
need to be able to log onto a server, initiate activities on the server,
and retrieve and update data on the server.</font></font></font></font>


HL7 Health Level Seven


IB Integrated Billing


ICR Immunology Case Registry
<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">VistA</font></font><font face="Arial,
sans-serif"><font size="2">'s Remote Procedure Call (RPC)
Broker software provides functionality so that GUI developers
can:</font></font></font></font>


IFCAP Integrated Funds Distribution, Control Point Activity, Accounting and Procurement
* <font face="Arial, sans-serif"><font size="2">Establish a connection
from a client workstation to a VistA M Server.</font></font> *
<font face="Arial, sans-serif"><font size="2">Run RPCs on the VistA
M Server.</font></font> * <font face="Arial, sans-serif"><font
size="2">Return data to the client workstation.</font></font>


IV Intravenous


IVM Income Verification Match


KIDS Kernel Installation and Distribution System
<font face="Arial, sans-serif"><font size="2">The RPC Broker supports
32-bit Windows client applications (e.g., applications running under
Microsoft Windows 2000 and Windows XP).</font></font>


LEDI Laboratory Electronic Data Interchange


MCCR Medical Care Cost Recovery


MPD Minimal Patient Dataset
<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">The</font></font> <font face="Arial,
sans-serif"><font size="2">VistA</font></font> <font face="Arial,
sans-serif"><font size="2">M Server continuously runs an RPC Broker
listener process whose purpose is to establish connections with
clients. When the listener process receives a connection request from
a client, it spawns a separate handler process, which then handles all
communications with the client.</font></font></font></font>


MPI Master Patient Index


NDF National Drug File


NHE Network Health Exchange
<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">Once connected, the client can execute
Remote Procedure Calls on the</font></font> <font face="Arial,
sans-serif"><font size="2">VistA</font></font> <font face="Arial,
sans-serif"><font size="2">M Server. RPCs are written in
M and accessed through the</font></font> <font face="Arial,
sans-serif"><font size="2">VistA</font></font> <font face="Arial,
sans-serif"><font size="2">M Server's REMOTE PROCEDURE file
(#8994).</font></font></font></font>


NOIS National On-Line Information Sharing
<font face="Arial, sans-serif"><font size="2">RPCs can:</font></font>


OE/RR Order Entry/Results Reporting
* <font face="Arial, sans-serif"><font size="2">Receive data from the
client workstation.</font></font> * <font face="Arial, sans-serif"><font
size="2">Return data to the client workstation.</font></font> * <font
face="Arial, sans-serif"><font size="2">Execute other actions on the
VistA M Server.</font></font>


PAID Personnel and Accounting Integrated Data


PBM Pharmacy Benefits Management


PCE Patient Care Encounter
<font size="3">'''Features'''</font>


PCMM Primary Care Management Module
* <font face="Times New Roman, serif"><font size="3"><font
face="Arial, sans-serif"><font size="2">'''Broker Developer
Kit (BDK)'''</font></font><font face="Arial, sans-serif"><font
size="2">â€"The RPC Broker Delphi components provide Delphi developers
with an easy, object-based access to the Broker. When placed on a
Delphi form, these components provide a connection to the</font></font>
<font face="Arial, sans-serif"><font size="2">VistA</font></font>
<font face="Arial, sans-serif"><font size="2">M Server and the ability
to reference M data.</font></font></font></font> * <font face="Times
New Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">'''Dynamic Link Library (DLL) Interface'''</font></font><font
face="Arial, sans-serif"><font size="2">â€"The RPC Broker provides
a set of DLL functions that allow applications written in</font></font>
<font face="Arial, sans-serif"><font size="2">''any''</font></font> <font
face="Arial, sans-serif"><font size="2">MS Windows-based development
environment [e.g., Borland's Delphi, Microsoft Visual Basic, and other
commercial-off-the-shelf (COTS)/Hybrid Open System Technology (HOST)
products] to take advantage of all the features offered by the RPC Broker
Delphi components.</font></font></font></font>


PDM Pharmacy Data Management
<font face="Arial, sans-serif"><font size="3">'''Remote Call Procedure
â€" continued'''</font></font>


PDX Patient Data Exchange


PPP Pharmacy Prescription Practices


QUASAR Quality Audiology and Speech Pathology Audit and Review
* <font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">'''Client/Server Security'''</font></font><font
face="Arial, sans-serif"><font size="2">â€"For security
purposes, to execute an RPC on the</font></font> <font face="Arial,
sans-serif"><font size="2">VistA</font></font> <font face="Arial,
sans-serif"><font size="2">M Server all of the following conditions must
be met:</font></font></font></font>


RAI/MDS Resident Assessment Instrument/Minimum Data Set
<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">1. The user must be an authorized
user on the</font></font> <font face="Arial, sans-serif"><font
size="2">VistA</font></font> <font face="Arial, sans-serif"><font
size="2">M Server</font></font><font face="Arial, sans-serif"><font
size="2">.</font></font></font></font>


ROES Remote Order Entry System
<font face="Arial, sans-serif"><font size="2">2. The client workstation
application must invoke a supported application context authorized to
the user.</font></font>


RPC Remote Procedure Call
<font face="Arial, sans-serif"><font size="2">3. The RPC must itself be
authorized to the specified application context.</font></font>


SCD Spinal Cord Dysfunction
* <font face="Times New Roman, serif"><font size="3"><font
face="Arial, sans-serif"><font size="2">'''Integrated Single
Sign-on'''</font></font><font face="Arial, sans-serif"><font
size="2">â€"The RPC Broker supports a</font></font> <font face="Arial,
sans-serif"><font size="2">''single''</font></font> <font face="Arial,
sans-serif"><font size="2">sign-on point from a client workstation to
the server. Users need only sign on once when accessing multiple VistA
applications on the same client workstation.</font></font></font></font>
* <font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">'''Silent Sign-on'''</font></font><font
face="Arial, sans-serif"><font size="2">â€"The RPC Broker
provides silent login functionality. Any GUI application that
uses the Broker can log in to a</font></font> <font face="Arial,
sans-serif"><font size="2">VistA</font></font> <font face="Arial,
sans-serif"><font size="2">M Server silently (i.e., without any user
dialogue).</font></font></font></font>

* <font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">'''Shared'''</font></font> <font face="Arial,
sans-serif"><font size="2">'''Broker'''</font></font><font face="Arial,
sans-serif"><font size="2">â€"Broker applications running on the
same server and port can share the same</font></font> <font face="Arial,
sans-serif"><font size="2">connection, resulting in a single job running
on the server. This functionality is available for Broker applications
compiled with the TSharedRPCBroker component. Only connections associated
with the first application must log in.</font></font></font></font>

* <font face="Times New Roman, serif"><font size="3"><font
face="Arial, sans-serif"><font size="2">'''Non-callback
Connection'''</font></font><font face="Arial, sans-serif"><font
size="2">â€"</font></font><font face="Arial, sans-serif"><font
size="2">The RPC Broker provides a non-callback</font></font> <font
face="Arial, sans-serif"><font size="2">connection, which results
in less problems for applications using the Broker for connections
across firewalls.</font></font></font></font> * <font face="Times New
Roman, serif"><font size="3"><font face="Arial, sans-serif"><font
size="2">'''CCOW-enabled'''</font></font><font face="Arial,
sans-serif"><font size="2">â€"The RPC Broker supports CCOW, which
allows Delphi-based applications to incorporate Single Sign-On/User
Context (SSO/UC) functionality into their applications.</font></font>
<font face="Arial, sans-serif"><font size="2">This functionality is
available for Broker applications compiled with the TCCOWRPCBroker
component.</font></font></font></font>





===== VA FileMan =====



<font size="3">'''Overview'''</font>

<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">VA FileMan is Veterans Health Information
Systems and Technology Architecture’s (</font></font><font
face="Arial, sans-serif"><font size="2">VistA</font></font><font
face="Arial, sans-serif"><font size="2">) database management system
(DBMS). It runs in any American National Standards Institute (ANSI)
M environment. The majority of Veterans Health Administration (VHA)
clinical data is stored in VA FileMan files and is retrieved and
accessed through VA FileMan Application Programmer Interfaces (API)
and user interfaces.</font></font></font></font>



<font size="3">'''Features'''</font>

{| width="615" cellpadding="7" |- valign="bottom" | width="278"
height="7" | <font face="Arial, sans-serif"><font size="2"><u>'''For
Users'''</u></font></font> | width="309" | <font face="Arial,
sans-serif"><font size="2"><u>'''For Developers'''</u></font></font>
|- valign="top" | width="278" | * <font face="Arial, sans-serif"><font
size="2">Standalone user interface for adding, editing, printing, and
searching data.</font></font> * <font face="Arial, sans-serif"><font
size="2">Form-based editing (ScreenMan).</font></font> * <font
face="Arial, sans-serif"><font size="2">Easy terminal-based editing
of word processing database fields (Screen Editor).</font></font>
* <font face="Arial, sans-serif"><font size="2">Flexible,
extensive report module.</font></font> * <font face="Arial,
sans-serif"><font size="2">Scrollable onscreen output of any
report (Browser device).</font></font> * <font face="Arial,
sans-serif"><font size="2">Data interchange with outside
applications such as PC spreadsheets and databases (Import and
Export Tools).</font></font> | width="309" | * <font face="Arial,
sans-serif"><font size="2">Full support for forms-based interfaces
to the database (ScreenMan API, Form Editor).</font></font> * <font
face="Arial, sans-serif"><font size="2">Full database access for
client-server applications (Database Server API).</font></font> *
<font face="Arial, sans-serif"><font size="2">Easy scrolling-mode
interfaces to the database (Classic API).</font></font> * <font
face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">Full database access in Delphi-based
applications via FileMan Delphi Components.</font></font></font></font>
* <font face="Arial, sans-serif"><font size="2">Data archiving
and transport tools.</font></font> * <font face="Arial,
sans-serif"><font size="2">Comprehensive file creation and
management utilities.</font></font> * <font face="Arial,
sans-serif"><font size="2">SQL Interface (SQLI) projects all of
the information needed by M-to-SQL vendors to access VA FileMan
through M-to-SQL products.</font></font> * <font face="Arial,
sans-serif"><font size="2">Supports Keys and compound cross-references
(Indexes).</font></font> |}



======== Performance ========

<font face="Arial, sans-serif"><font size="2">Over the years, demand
on VHA systems has grown. The compactness and efficiency of M and VA
FileMan provide fast database performance and high utilization of our
computer systems.</font></font>



======== Portability ========

<font face="Arial, sans-serif"><font size="2">Portable,
platform-independent database services provided to applications by VA
FileMan, combined with the operating system portability layer of Kernel,
allow VHA to upgrade its hospital computing platforms without significant
changes to application code. Thus, VHA has not encountered the kinds of
problems normally associated with computer platform changes and is free
to competitively bid out for new systems.</font></font>



======== Openness ========

<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">VA FileMan is open; it facilitates data
access from outside applications. The Database Server (DBS) API enables
client/server access to VA FileMan data. The FileMan Delphi Components
take advantage of the DBS API to encapsulate the details of retrieving,
validating, and updating VA FileMan data within a Delphi application. VA
FileMan's Import and Export tools support data interchange with outside
applications such as PC spreadsheets and database programs. SQLI
helps make VA FileMan data available to outside applications. It
also includes native support for Keys and compound cross references
(Indexes), and thus, helps pave the way for the opening of</font></font>
<font face="Arial, sans-serif"><font size="2">VistA</font></font>
<font face="Arial, sans-serif"><font size="2">even further to outside
software.</font></font></font></font>

===== VistALink =====



<font face="Arial, sans-serif"><font size="3">'''Overview'''</font></font>

<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">VistALink provides a synchronous communication
mechanism between MUMPS or M applications and rehosted applications,
supporting Veterans Health Administration’s (VHA's) ongoing
transition to Health</font></font><font face="Arial, sans-serif"><font
size="2">''<u>'''e'''</u>''</font></font><font face="Arial,
sans-serif"><font size="2">Vet-VistA.</font></font></font></font>



<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">Technically, VistALink is a transport layer
between M and Java. It consists of an M-side listener and Java-side
adapter libraries compliant with the J2EE Connectors specification
for Enterprise Information System (EIS) adapters. "The Connector
architecture is an integral part of the J2EE platform, and, as a key
component in J2EE's support for application integration, it ensures that
J2EE applications can connect to and use a multitude of EIS and legacy
systems."[#sdfootnote1sym <sup>1</sup>]</font></font></font></font>



======== Reasons for VistALink ========

<font face="Arial, sans-serif"><font size="2">While alternatives for
communication between Java and M applications have been produced,
the needs of applications for robust, synchronous communication have
not been met by these alternatives. The limitations of each of these
alternatives are described below:</font></font>

* <font face="Arial, sans-serif"><font size="2">Remote Prodcedure Call
Brokerâ€"The RPC Broker is COM-based, rather than Java-based. Wrapping
the COM-based Broker was proven by the Care Management team to have
unacceptable performance limitations. Also, the RPC Broker was not
designed for n-tier applications.</font></font> * <font face="Arial,
sans-serif"><font size="2">Vitriaâ€"Vitria is used as an HL7
interface engine by the VHA. HL7 messaging is an effective tool for
asynchronous communication. But in many instances, applications need
synchronous access to RPCs, as they are run while a user is waiting
for results.</font></font> * <font face="Arial, sans-serif"><font
size="2">Cacheâ€"Cache provides a number of connectivity mechanisms
between itself and Java that initially showed potential for use. However,
the Cache-specific features have proved not to have all the functionality
needed by rehosted applications.</font></font> * <font face="Arial,
sans-serif"><font size="2">Third-Party J2EE Connector-Compliant
Adaptersâ€"At least one company markets an adapter for J2EE-M
connectivity that is J2EE Connector compliant (as is VistALink). This
adapter, however, is for Development Standard MUMPS (DSM) systems
only and has other limitations when measured against VHA application
requirements.</font></font>

<font face="Arial, sans-serif"><font size="3">'''Features'''</font></font>

* <font face="Arial, sans-serif"><font size="2">v1.0: Client/Server
connectivity from Java client to Mâ€"Officially released. This
version of VistALink was designed to meet the needs of Care Management
(CM). It is for Java rich client applications connecting to M servers and
executing RPCs on those servers. VistALink v1.0 provides the equivalent
of RPC Broker functionality for Java.</font></font> * <font face="Arial,
sans-serif"><font size="2">v1.5. J2EE Application Server connectivity
to Mâ€"This version will allow applications and services running on
a J2EE application server to initiate a call to an M server and execute
RPCs. This version fully implements the Java 2 Enterprise Edition (J2EE)
Connectors specification. Applications requesting this version include
Patient Advocate Tracking System (PATS), Veterans Personal Finance System
(VPFS), Computerized Patient Record System â€" Reengineering (CPRS-R),
Scheduling, Standard Data Service (SDS), Blind Rehabilitation and Spinal
Cord. Scheduled for release in mid-2004.</font></font>

<font face="Arial, sans-serif"><font size="3">'''VistALink â€"
continued'''</font></font>



* <font face="Arial, sans-serif"><font size="2">v2.0: Connectivity from
M to J2EEâ€"This version will add bi-directional connectivity, that
is, allow applications and services running on M to initiate a call to
resources on a J2EE application server. Release is tentatively planned
for late 2004. Applications requesting this version include Scheduling
and CPRS-R.</font></font>

=== VistA DEVELOPMENT HISTORY ===



<font face="Arial, sans-serif"><font size="2">In 1982, VHA committed to
building an electronic health care architecture called DHCP (Decentralized
Hospital Computer Program). The focus was the implementation of software
applications easily integrated into a complete hospital information
system. VA selected MUMPS (Massachusetts General Hospital Utility
Multi-Programming System) as the primary programming language for DHCP,
and began developing applications using VHA programmers who worked
directly with user groups in software prototyping environments. MUMPS, now
known simply as “M", is an American National Standards Institute
(ANSI) and Federal Information Processing Standards (FIPS) standard
language. By 1990, VHA had upgraded computer capacity at all medical
facilities, and now implements software on a national scale supporting
integrated health care delivery.</font></font>



<font face="Arial, sans-serif"><font size="2">In 1996, VHA introduced
VistA...Veterans Health Information Systems and Technology Architecture,
a rich automated environment that supports day-to-day operations at
local VA health care facilities. VistA is built on a client-server
architecture, which ties together workstations and personal computers
with graphical user interfaces at VHA facilities, as well as software
developed by local medical facility staff. VistA also includes the
links that allow commercial off-the-shelf software and products to be
used with existing and future technologies. The Decision Support System
(DSS) and other national databases that might be derived from locally
generated data lie outside the scope of VistA.</font></font>



<font face="Arial, sans-serif"><font size="2">When development began on
the Decentralized Hospital Computer Program (DHCP) in the early 1980s,
information systems were in their infancy in VA medical facilities and
emphasized primarily hospital-based activities. DHCP grew rapidly and
is used by many private and public health care facilities throughout
the United States and the world. Although DHCP represented the total
automation activity at most VA medical centers in 1985, DHCP is now
only one part of the overall information resources at the local facility
level. VistA incorporates all of the benefits of DHCP as well as including
the rich array of other information resources that are becoming vital
to the day-to-day operations at VA medical facilities.</font></font>

<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font style="font-size: 20pt" size="5"><span
lang="en-US">'''ON THE HORIZON'''</span></font></font></font></font>

* '''Pharmacy Re-Engineering…'''

<font face="Arial, sans-serif"><font size="2">The Pharmacy Re-Engineering
(PRE) project is a key component in the implementation of the overall
HealtheVet VistA effort. Two important results in the long term will be
access to up-to-date drug information and VA-developed custom screens
for all medication orders.</font></font>

<font face="Arial, sans-serif"><font size="2">By 2005, the PRE team
expects to release Application Program Interfaces (APIs) for all
current references to the various VistA Drug files and for all non-order
specific Pharmacy files, such as Medication Routes, Schedules, and Dosage
Forms. All other applications accessing these files will be required to
use the released APIs.</font></font>

* '''Upcoming Outpatient and PDM Enhancements…'''

The Outpatient Pharmacy portion of the Laser Labels Phase II project
allows Prescription Medication Information (PMI) sheets and warning
labels to be printed in another language if the system has the other
language fields populated in Pharmacy Data Management and the individual
patient is identified with the other language preference flag. The
Pharmacy Data Management portion of this project allows for warning label
combinations from the old warning label file and/or the new commercial
data source. These warnings can also be gender specific when certain
flags are set accordingly.

* '''Upcoming BCMA Enhancements…'''

The '''BCMA Read-Only''' option will allow clinical staff not authorized
to administer medications to view information from the BCMA GUI. The
Read-Only GUI will have the same look and feel of the current GUI,
except will not allow users to take an action on a medication.

The '''BCMA Coversheet''' will display and allow access to all medication
orders over a 24 hour period. In addition, visual queues will aid in the
quick and accurate review of all medication administration data presented.

The '''BCMA Reports Re-design''' will allow a user to customize reports
via selectable fields and filters. The report re-design will provide
both User and Manager reports, with definable reports at each site. All
data will be pulled from the BCMA Medication Log File.



=== OTHER RESOURCES ===

* <font face="Times New Roman, serif"><font size="3"><font
face="Arial, sans-serif"><font size="2"><span
lang="es-ES">'''VistA'''</span></font></font>
<font face="Arial, sans-serif"><font size="2"><span
lang="es-ES">'''Documentation Library:'''</span></font></font>
<font color="blue"><u>[http://www.va.gov/vdl <font
face="Arial, sans-serif"><font size="2"><span
lang="es-ES">http://www.va.gov/vdl</span></font></font>]</u></font></font></font>



<font face="Arial, sans-serif"><font size="2">This library contains
a collection of available end-user documentation for all current
applications (software packages), and also includes some tools not
listed in the monograph. All documents can be viewed, downloaded,
and printed. Some documents have links to a Web version, and may
optionally have an archive file (.ZIP or .EXE) containing the Web pages
for download.</font></font>



* <font face="Times New Roman, serif"><font size="3"><font
face="Arial, sans-serif"><font size="2">'''Request for
New Information Technology Services:'''</font></font> <font
color="blue"><u>[http://vista.med.va.gov/pas/NewITRequestForm.asp
<font face="Arial, sans-serif"><font
size="2">http://vista.med.va.gov/pas/NewITRequestForm.asp</font></font>]</u></font></font></font>



<font face="Arial, sans-serif"><font size="2">Requests for new software
or software enhancements must be endorsed by and submitted to the VHA
NLB Information Data Management Committee (IDMC). The initial review
and recommendation must go through the IDMC Screening Committee prior
to submitting to IDMC for final approval. This site provides an on-line
request form along with guidance on submissions.</font></font>



* <font face="Times New Roman, serif"><font size="3"><font
color="black"><font face="Arial, sans-serif"><font size="2">'''VHA
Enterprise Architecture:'''</font></font></font> <font
color="blue"><u>[http://www.va.gov/vha-ita/ita-p.html
<font face="Arial, sans-serif"><font
size="2">http://www.va.gov/vha-ita/ita-p.html</font></font>]</u></font></font></font>



<font face="Arial, sans-serif"><font size="2">VHA has developed
and Enterprise Architecture that provides a technical framework to
promote a one technology vision across the VHA so that corporate
systems and systems across Veterans Integrated Service Networks are
interoperable.</font></font>



* <font face="Times New Roman, serif"><font size="3"><font
face="Arial, sans-serif"><font size="2">'''Capital
Investment Planning:'''</font></font> <font
color="blue"><u>[http://www.va.gov/budget/capital/
<font face="Arial, sans-serif"><font
size="2">http://www.va.gov/budget/capital/</font></font>]</u></font></font></font>



Planned IT capital asset expenditures that exceed $10 million acquisition
or $30 million life cycle costs, or have high levels of risk or
visibility, must apply to the Capital Investment Board for approval.



<font face="Arial, sans-serif"><font size="2">The VA Capital Investment
Board (VACIB) oversees the approval of all capital investment proposals
that exceed certain threshold requirements, represent a high risk or
high visibility or are cross-cutting. Approved proposals constitute the
VA Capital Plan and support annual budget requests.</font></font>



* <font face="Times New Roman, serif"><font
size="3"><font face="Arial, sans-serif"><font
size="2">'''Corporate Database Monograph:'''</font></font> <font
color="blue"><u>[http://vaww.va.gov/../nds/CorporateDatabasesMonograph.asp
<font face="Arial, sans-serif"><font
size="2">http://vaww.va.gov/../nds/CorporateDatabasesMonograph.asp</font></font>]</u></font></font></font>

<div style="margin-left: 2em">

<font face="Arial, sans-serif"><font size="2">The Corporate
Database Monograph provides an overview of the active VHA national
databases. Information contained in this monograph allows stakeholders
to identify opportunities for database consolidations, determine
authoritative data sources, and work with VHA Data Quality committees
to implement data standardization and quality control processes for
corporate databases.</font></font>

</div>

* <font face="Times New Roman, serif"><font size="3"><font
face="Arial, sans-serif"><font size="2">'''VA Information
Technology Strategic Plans:'''</font></font> <font
color="blue"><u>[http://vista.med.va.gov/vistaarch/itstrategy.htm
<font face="Arial, sans-serif"><font
size="2">http://vista.med.va.gov/vistaarch/itstrategy.htm</font></font>]</u></font></font></font>



* <font face="Times New Roman, serif"><font size="3"><font
face="Arial, sans-serif"><font size="2">'''VistA'''</font></font>
<font face="Arial, sans-serif"><font size="2">'''Monograph
on the Internet'''</font></font><font face="Arial,
sans-serif"><font size="2"><nowiki>:</nowiki></font></font>
<font color="blue"><u>[http://www.va.gov/vista_monograph/
<font face="Arial, sans-serif"><font
size="2">http://www.va.gov/vista_monograph/</font></font>]</u></font></font></font>







<font face="Times New Roman, serif"><font size="3"><font
face="Arial, sans-serif"><font size="2">''For additional
information related to''</font></font> <font face="Arial,
sans-serif"><font size="2">VistA</font></font> <font face="Arial,
sans-serif"><font size="2">''software, you may contact the VHA Office
of Information National Help Desk by E-mail at''</font></font>
<font color="blue"><u>[mailto:VHAOICONHD@med.va.gov
<font face="Arial, sans-serif"><font
size="2">''VHACIONHD@med.va.gov''</font></font>]</u></font><font
face="Arial, sans-serif"><font size="2">''or by phone at
1-888-596-4357.''</font></font></font></font>

=== ACRONYMS ===



<font face="Arial, sans-serif"><font size="3">ADT Admission, Discharge,
Transfer</font></font>

<font face="Arial, sans-serif"><font size="3">AICS Automated Information
Collection System</font></font>

<font face="Arial, sans-serif"><font size="3">AMIE Automated Medical
Information Exchange</font></font>

<font face="Arial, sans-serif"><font size="3">AR Accounts
Receivable</font></font>

<font face="Arial, sans-serif"><font size="3">ART Adverse Reaction
Tracking</font></font>

<font face="Arial, sans-serif"><font size="3">AR/WS Automatic
Replenishment/Ward Stock</font></font>

<font face="Arial, sans-serif"><font size="3">ASISTS Automated Safety
Incident Surveillance Tracking System</font></font>

<font face="Arial, sans-serif"><font size="3">ASU
Authorization/Subscription Utility</font></font>

<font face="Arial, sans-serif"><font size="3">BCMA Bar Code Medication
Administration</font></font>

<font face="Arial, sans-serif"><font size="3">CMOP Consolidated Mail
Outpatient Pharmacy</font></font>

<font face="Arial, sans-serif"><font size="3">COTS Commercial Off The
Shelf</font></font>

<font face="Arial, sans-serif"><font size="3">CPRS Computerized Patient
Record System</font></font>

<font face="Arial, sans-serif"><font size="3">CPT Current Procedural
Terminology</font></font>

<font face="Arial, sans-serif"><font size="3">CS Controlled
Substances</font></font>

<font face="Arial, sans-serif"><font size="3">DA Drug
Accountability/Inventory Interface</font></font>

<font face="Arial, sans-serif"><font size="3">DRG Diagnostic Related
Group</font></font>

<font face="Arial, sans-serif"><font size="3">DSS Decision Support
System</font></font>

<font face="Arial, sans-serif"><font size="3">EPI Emerging Pathogens
Initiative</font></font>

<font face="Arial, sans-serif"><font size="3">FOIA Freedom of Information
Act</font></font>

<font face="Arial, sans-serif"><font size="3">GIP Generic Inventory
Package</font></font>

<font face="Arial, sans-serif"><font size="3">HBPC Hospital Based Patient
Care</font></font>

<font face="Arial, sans-serif"><font size="3">HEC Health Eligibility
Center</font></font>

<font face="Arial, sans-serif"><font size="3">HINQ Hospital
Inquiry</font></font>

<font face="Arial, sans-serif"><font size="3">HL7 Health Level
Seven</font></font>

<font face="Arial, sans-serif"><font size="3">IB Integrated
Billing</font></font>

<font face="Arial, sans-serif"><font size="3">ICR Immunology Case
Registry</font></font>

<font face="Arial, sans-serif"><font size="3">IFCAP Integrated
Funds Distribution, Control Point Activity, Accounting and
Procurement</font></font>

<font face="Arial, sans-serif"><font size="3">IV Intravenous</font></font>

<font face="Arial, sans-serif"><font size="3">IVM Income Verification
Match</font></font>

<font face="Arial, sans-serif"><font size="3">KIDS Kernel Installation
and Distribution System</font></font>

<font face="Arial, sans-serif"><font size="3">LEDI Laboratory Electronic
Data Interchange</font></font>

<font face="Arial, sans-serif"><font size="3">MCCR Medical Care Cost
Recovery</font></font>

<font face="Arial, sans-serif"><font size="3">MPD Minimal Patient
Dataset</font></font>

<font face="Arial, sans-serif"><font size="3">MPI Master Patient
Index</font></font>

<font face="Arial, sans-serif"><font size="3">NDF National Drug
File</font></font>

<font face="Arial, sans-serif"><font size="3">NHE Network Health
Exchange</font></font>

<font face="Arial, sans-serif"><font size="3">NOIS National On-Line
Information Sharing</font></font>

<font face="Arial, sans-serif"><font size="3">OE/RR Order Entry/Results
Reporting</font></font>

<font face="Arial, sans-serif"><font size="3">PAID Personnel and
Accounting Integrated Data</font></font>

<font face="Arial, sans-serif"><font size="3">PBM Pharmacy Benefits
Management</font></font>

<font face="Arial, sans-serif"><font size="3">PCE Patient Care
Encounter</font></font>

<font face="Arial, sans-serif"><font size="3">PCMM Primary Care Management
Module</font></font>

<font face="Arial, sans-serif"><font size="3">PDM Pharmacy Data
Management</font></font>

<font face="Arial, sans-serif"><font size="3">PDX Patient Data
Exchange</font></font>

<font face="Arial, sans-serif"><font size="3">PPP Pharmacy Prescription
Practices</font></font>

<font face="Arial, sans-serif"><font size="3">QUASAR Quality Audiology
and Speech Pathology Audit and Review</font></font>

<font face="Arial, sans-serif"><font size="3">RAI/MDS Resident Assessment
Instrument/Minimum Data Set</font></font>

<font face="Arial, sans-serif"><font size="3">ROES Remote Order Entry
System</font></font>

<font face="Arial, sans-serif"><font size="3">RPC Remote Procedure
Call</font></font>

<font face="Arial, sans-serif"><font size="3">SCD Spinal Cord
Dysfunction</font></font>

<font face="Arial, sans-serif"><font size="3">TIU Text Integration
Utilities</font></font>

<font face="Arial, sans-serif"><font size="3">UD Unit Dose</font></font>

<font face="Arial, sans-serif"><font size="3">UI Universal
Interface</font></font>

<font face="Arial, sans-serif"><font size="3">URL Universal Record
Location</font></font>

<font face="Arial, sans-serif"><font size="3">VIC Veteran Identification
Card</font></font>

<font face="Arial, sans-serif"><font size="3">VIST Visual Impairment
Service Team</font></font>

<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif">VistA</font> <font face="Arial, sans-serif">Veterans Health
Information Systems and Technology Architecture</font></font></font>

<div id="sdfootnote1">


TIU Text Integration Utilities
[#sdfootnote1anc 1] <font face="Arial, sans-serif"><font style="font-size:
8pt" size="1">Sharma, Rahul; Stearns, Beth; Ng, Tony,</font></font>
<font face="Arial, sans-serif"><font style="font-size: 8pt"
size="1">''J2EE Connector Architecture and Enterprise Application
Integration''</font></font> <font face="Arial, sans-serif"><font
style="font-size: 8pt" size="1">â€" Addison-Wesley, 2001.</font></font>


UD Unit Dose
</div><div>


UI Universal Interface


URL Universal Record Location


VIC Veteran Identification Card


VIST Visual Impairment Service Team


VistA Veterans Health Information Systems and Technology Architecture
</div>
<!-- file -->
----
[[Category:Health]]
[[Category:Software]]

Latest revision as of 14:15, 26 October 2011



  This page is part of the OLPC Health Project. Hardware | Software | Content | Health Jam
XO Caudecus
This page is part of the WorldVistA sub-project.

Porting VistA to the OLPC. For introduction to VistA components see VistA Monograph Wiki.

WorldVista logo

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.

Introduction

VistA and HealtheVet-VistA

VA'S Current and future Computerized Patient Record System

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

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.

Graphical Illustration of the HealtheVet-VistA Strategy

Vista monograph2005 06 html 3c0d9bc8.gif
Veterans Health Information System, including VistA

Getting WorldVistA

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

WorldVistA

See the Vistapedia website for WorldVistA download and installation instructions.

FOIA

The FOIA Freedom Of Information Act release is available here.

GT.M

And you will need GT.M


VistA Software Packages

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.

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.

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

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.

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

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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

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
Care Management Clinician Dashboard running in the HealtheVet desktop

Vista monograph2005 06 html 2c0271fe.png

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.

Computerized Patient Record System (CPRS)

Status: CPRS required - Porting to XO not Complete

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.
Image: CPRS Cover Sheet Example

Vista monograph2005 06 html me4ce41f.png

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.

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.

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).
Image: Clinical Reminders Example: Reminders Resolution Dialog

Vista monograph2005 06 html 56cf5031.png

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.
Image: Consults Example

Vista monograph2005 06 html m465fd7a.png

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.

Image: Health Summary Example

Vista monograph2005 06 html m7191f48f.gif

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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).

Mental Health

Status: Mental Health supported, except ASI-MV missing

20051230 worldvista-logo-earth-3-256 fdsm.jpg Check Mental Health Features supported by WorldVistA, except:
20051230 worldvista-logo-earth-3-256 fdsm.jpg 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 Multimedia Version (ASI-MV) software.
  • Allows clinicians and patients to enter demographics and self-administered ASI-MV interviews via a workstation using video and audio technology.
  • Is a significant time-saver for clinicians, because clinicians need not be present during the interview.
  • Provides the patients with privacy and appropriate time to complete an interview.

VistA Mental Health Assistant (MHA) Graphical User Interface (GUI):

  • Provides a crash recovery file.
  • Displays patient demographics data, which can be printed, copied to the Windows clipboard, or saved to a text file.
  • Context-sensitive help is available for most items, with suggestions for test administration and interpretations.
  • Provides a user-friendly interface for entering interview data for ASI.
  • Enhances the ability of both staff and patients to enter psychological test data.
  • Creates reports and graphical displays of complex tests by sub-category or scales.
  • Creates psychological test order windows that display tests that can be ordered based on the provider privileges.
  • Provides a text report of selected tests and graphs of numeric scores.

Nursing

Overview

The Nursing application is a component of the Department of Veterans Affairs VistA program. It is comprised of multiple modules (i.e., Administration, Education, Clinical, Quality Assurance, and Package Management).

Features

The nursing software includes the following functionalities:

Administration:

  • Tracks staff information.
  • Generates management reports on employees.
  • Accumulates daily statistics on the number of patients treated.
  • Generates daily, monthly, quarterly, and yearly AMIS Reports.
  • Provides workload statistics based on AMIS data.
  • Provides miscellaneous patient acuity reports.

Clinical:

  • Contains a patient classification system which generates reports by bed section and ward.
  • Includes nationally developed standard nursing care plans for initiating patient care plan generation.
  • Allows nurses to generate a patient care plan based on patient problems, identified goals, and specified nursing interventions.
  • Allows a staff nurse to update a patient's nursing ward location and/or nursing AMIS bed section to insure accurate patient classification entries.
  • Allows users to enter vital signs, height, and weight for patients.
  • Allows users to generate Intake and Output reports, an End of Shift Report, and a Health Summary Report by patient or ward.

Package Management:

  • Allows sites to modify data in specified nursing files.
  • Provides special ADP Coordinator functions for executing nursing options that affect patient acuity, manhours, FTEE status, etc.
  • Provides ADP Coordinator options for admitting/transferring/discharging patients within the Nursing system when the MAS System is off-line.

Nutrition and Food Service (N&FS)

Overview

The Nutrition and Food Service (N&FS) software integrates the automation of many Clinical Nutrition, Food Management, and Management Reports functions. The Clinical N&FS activities of Nutrition Screening, Nutrition Assessment, Diet Order Entry, Tube Feeding and Supplemental Feeding Orders, Patient Food Preferences, Specific Diet Pattern Calculations, Nutrient Analysis of meals, Consult Reporting, Encounter Tracking, and Quality Care Monitoring are all available in this program. The Food Management function has complete automation of food production activities; Service and Distribution, Inventory and Cost Management, Recipe Expansion, Menu and Recipe Nutrient Analysis, Meal and Diet Pattern Development and Implementation, Diet Card and Tray Ticket Printing, and Quality Service Tracking are available. The Management Reports include the Served Meals, Additional Meals, Cost Per Meal, Tube Feeding Cost, Supplemental Feeding Cost, Staffing Data, Encounter Data and Annual Management Reports.

Features

  • Allows the building of a site-specific listing of patient food preferences that can be incorporated in meal production calculations and the printed diet card and tray tickets programs.
  • Manages patients' requests or dietary requirements for specific food items or utensils, allowing the selection of standing orders for any patient, for any meal or quantity.
  • Controls all aspects of ingredient usage.
  • Develops a list of site-specific recipes that includes portion size, preparation area and time, equipment and serving utensils, recipe category, ingredients, and directions for preparation. Recipes can be quickly analyzed for their nutrient value.
  • Creates multiple meals and menu cycles. Meals can be used in different patterns by creating menu cycles or by creating special holiday dates within a cycle. It allows for the nutrient analysis of meals or daily/weekly menus.
  • Controls quantities produced in the Food Management program. Specific patient diet orders are reorganized into production diets and diet patterns that reflect the foods to be served. This information is used along with data from the meal file to generate production reports, diet cards and/or tray tickets. A forecasting tool also exists in this section that allows the manager to anticipate, by percentage of total census, the type and quantity of various production diets that will be needed by any selected service point.
  • Allows the entry of information required by the Annual Report that is not automatically retrieved from the program.
  • Prints a patient-specific record of all diet order entry information.
  • Controls the order entry activity.
  • Manages food items and their nutrients using the latest USDA data, food items from Bowes and Church, and additional data from research.
  • Handles N&FS consults and allows the reassignment of active consults from one staff member to another.
  • Manages the supplemental feeding food items and menus. A supplemental feeding menu automatically goes into effect at the time of diet order entry and changes automatically with new orders.

Oncology

Overview

The Oncology module automates the tumor registry and supports tumor registrars in abstracting cancer cases, following up on cancer patients and producing the Hospital Annual Report. Functions are grouped according to order of use: Case Finding and Suspense; Abstracting, Printing and Quality Management; Follow-up; Registry Lists; Annual Reports; Statistical Reports; and Utilities.

The Oncology application functions in accordance with the current editions of American College of Surgeons (ACOS). It contains required data standards and data sets necessary to bring the tumor registry module into compliance with the Facility Oncology Registry Data Standards (FORDS) 2003 specifications approved by the Commission on Cancer (COC); Surveillance, Epidemiology, and End Results Reporting (SEER) Extent of Disease for site-specific surgery; International Classification of Disease-Oncology 3rd Edition; and American Joint Commission on Cancer (AJCC) Manual for the Staging of Cancer, 1st through 6th Editions.

Features

  • The software supports multi-divisional sites.
  • The program automatically finds cases by searching the database from Anatomical Pathology (Surgery, Cytology, Electron Microscopy, and Autopsy), Radiology, and Patient Treatment File (PTF). Cases can be entered into the Suspense File by date of diagnosis, and chart request pull lists can be printed.
  • Demographics are drawn directly from Patient Information Management System (PIMS) patient file and stored permanently. Cancer identification data is obtained from the local database (e.g., laboratory and radiology test results).
  • The program accessions and abstracts with extensive on-line help and stages extent of disease automatically.
  • It produces a wide range of follow-up lists and registry lists needed for accreditation and allows entry of contacts directly into Oncology Contact File.
  • Professional letters covering diverse situations and customization of letters are available.
  • Predefined annual reports can be generated and the user can create specialized reports using VA FileMan.
  • Reports to the Associate Chief of Staff (ACOS) can be generated using special routines that extract data onto floppy disk. The same functionality is available for state reporting.
  • The database can be customized to suit the individual hospital.
  • The full set of TNM codes is included from the appropriate edition of the AJCC Manual on Staging of Cancer.
  • The program allows on-line completion of Patient Care Evaluations (PCEs) during the abstracting function if the case being abstracted fulfills the selection criteria for the PCE.

Pharmacy: Automatic Replenishment/Ward Stock (AR/WS)

Overview

The Automatic Replenishment/Ward Stock (AR/WS) package provides a method to track drug distribution and inventory management within a medical center. The AR/WS module is designed to allow each medical center to adapt the system to its own needs.

Features

The AR/WS package:

  • Provides inventory management capabilities for clinical care locations and drug crash carts.
  • Allows easy drug item inactivation for inventory locations.
  • Provides tools to develop medication storage areas with lists of drugs to be maintained in that area. Drugs are classified by inventory type and assigned storage location and stock level.
  • Groups medication storage areas together by inventory group name. Grouping may be by location, date (time or frequency of inventory), or inventory type.
  • Provides tools to conduct inventory: prints inventory sheets and/or pick lists to determine stock to be replenished in medication storage areas and, by a selected method, replaces needed inventory items.
  • Maintains backorder totals if a physical inventory is conducted and entered into AR/WS software.
  • Provides inventory management reporting capabilities for clinical care locations and drug crash carts.
  • Provides ability to select by inventory group on all reports.
  • Supplies a report to fill on-demand requests for out-of-stock items or items not part of the standard inventory.
  • Provides various printouts as well as several management statistical reports for the creation and maintenance of the system.

Pharmacy: Bar Code Medication Administration (BCMA)

Overview

Bar Code Medication Administration (BCMA) software provides a real-time, point-of-care solution for validating the administration of Unit Dose (UD) and Intravenous (IV) medications to inpatients in Veterans Administration Medical Centers (VAMCs). BCMA uses a Graphical User Interface (GUI), MS Windows-based Client/Server architecture, designed to improve the accuracy of the medication administration process, and to increase the efficiency of the administration documentation process. The end result is enhanced patient safety and patient care at VAMCs. As a clinician scans each patient wristband and medication using a bar code scanner, BCMA immediately validates the patient and their medication, and that the medication is ordered, timely, and in the correct dosage. At the same time, BCMA electronically updates the patient's Medication Administration History (MAH). The software is fully compatible with other VistA applications.

Features

The BCMA software provides the following features:

  • Medication Tabs on a patient's Virtual Due List (VDL) are designed for separating and viewing the different types of active Unit Dose, IV Push, IV Piggyback, and large-volume IV medication orders. Each Tab provides an "alert" light, which turns green only when the patient has active medication orders for that Tab.
  • Patient safety tools include a Missed Medications Report, an alert when due medications are not administered, a notification when a patient is transferred, and an alert light to indicate that a medication order exists for the Schedule Type and Start/Stop Date and Time selected on the VDL. Other tools include a listing of Allergies and Adverse Drug Reactions (ADRs) that are documented for a patient in the Allergy/Adverse Reaction Tracking (ART) package.
  • A Computerized Patient Record System (CPRS) Med Order Button (or "Hot Button") on the BCMA Tool Bar streamlines the workflow in ICU-type environments. This button links nurses directly to CPRS for electronically ordering, documenting, reviewing and signing verbal and telephone STAT and NOW (One-Time) medication orders already administered to patients.
  • BCMA increases the amount and type of information available to nurses at the point of care, improves communications between Nursing and Pharmacy staff, records Missing Doses for patients, sends an electronic Missing Dose Request to the Pharmacy, and supports Health Level Seven (HL7) messaging.
  • Management and accountability tools identify PRN entries that require effectiveness comments and pain scores, list medications that were not scanned as administered during an administration time window, list early/late administration variances, and allow nurses to set site-specific parameters and defaults on their systems.
  • Compiles reports by Patient or by Ward for Nursing, Pharmacy, and Information Resources Management (IRM). Reports available for printing include: a Medication Administration History, Medication Log, Missed Medications, Missing Dose Request, PRN Effectiveness Log, Medication Due List, Medication History, Medication Variance Report, Cumulative Vitals/Measurement Report, and Administration Times Report.

Pharmacy: Consolidated Mail Outpatient Pharmacy (CMOP)

Overview

The Consolidated Mail Outpatient Pharmacy (CMOP) package provides a regional system resource to expedite the distribution of mail-out prescriptions to veteran patients. CMOP host facilities, regionally located, receive data from medical centers within the area of service. Current CMOPs are designed to handle the dispensing and mailing of between 20,000 and 40,000 prescriptions in an 8-hour workday.

Features

The CMOP package provides the following features:

  • Patients submit medication requests via telephone, mail, or in person at each medical facility. When necessary, pharmacy personnel enter the orders into the patient database.
  • Each area CMOP host facility establishes a schedule for the electronic transmission of the prescription data.
  • Prescriptions are transmitted electronically from the medical facility to the automated prescription dispensing equipment, checked by a pharmacist, mailed to the patient, and information on the prescription filled is returned to update the medical center database.
  • The process is highly integrated with the Outpatient Pharmacy software and requires no additional processing by pharmacy personnel responsible for entering the prescription.
  • All prescriptions are automatically screened by the CMOP software and set for transmission if appropriate.
  • The user is then notified that the prescription will be dispensed by the CMOP. Once the prescription is processed by the CMOP, the prescription file at the medical center is updated accordingly.
  • Pharmacy staff may view the prescription at any time to determine if it has been transmitted to CMOP, dispensed, not dispensed, etc.
  • Upon fulfillment of the medication order by the CMOP, any applicable pharmacy prescription co-payment is billed as the medical center files are updated with the release information.
  • The software provides order tracking and operational data for the CMOPs.
  • The software allows prescriptions written for schedule III-V controlled substances to be electronically transmitted to the CMOP facilities.

Pharmacy: Controlled Substances

Overview

The Controlled Substances package provides functionality to monitor and track the receipt, inventory, and dispensing of all controlled substances. This software provides the pharmacy with the capability to define a controlled substance location and a list of controlled substances to maintain a perpetual inventory. The capability for Pharmacy personnel to receive a controlled substance order, which automatically updates the quantity on hand and receipt history, is also available. Nursing personnel can request orders for controlled substances via on-demand requests and receive these orders when delivered from Pharmacy. Pharmacy may dispense controlled substances, using the automated VA forms 10-2321 and 10-2638, to complete an order request.

Features

The Controlled Substances package provides the following features:

  • Monitors/tracks the receipt, inventory, and dispensing of controlled substances.
  • Allows management inspections to automatically identify discrepancies in stock levels.
  • Allows nursing to place orders for controlled substances via on-demand requests.
  • Provides AMIS and cost reporting data.
  • Maintains perpetual vault inventory balances.
  • Provides the functionality to return to stock, transfer between locations, cancel orders, and log outpatient prescriptions.
  • Automates current inventory requirements that allow medical facilities to detect discrepancies or diversions of controlled substances, thereby improving overall drug accountability.

Pharmacy: Drug Accountability/Inventory Interface

Overview

The Drug Accountability/Inventory Interface works toward perpetual inventory for each VA medical facility pharmacy by tracking all drugs through pharmacy locations. Drugs are added to the pharmacy location as they are received from the Prime Vendor and CoreFLS. Both methods allow sites to receive invoice information containing data for confirmed orders. The files are uploaded into Drug Accountability, processed, and upon verification, the pharmacy locations or master vaults are updated. Dispensing data is collected from pharmacy packages to decrement balances. Drug Accountability also provides the capability for Pharmacy personnel to display or print procurement history, drug balance adjustments, and order data.

Features

There are two primary methods of receiving invoice data into Drug Accountability:

  • Prime Vendor Data
  • CoreFLS Data

Both methods involve having the user place the invoice orders with the appropriate company. With the prime vendor, the data is uploaded into VistAusing a Graphical User Interface to perform the upload. With CoreFLS, the data is automatically shipped to VistA upon receipt at the warehouse.

The Prime Vendor Interface includes the following features:

  • It automatically updates the Drug Accountability pharmacy locations based on dispensing and receiving information, and it also updates master vaults based on receiving information.
  • Drugs are added as the invoice data is received.
  • If the invoiced drug's order unit and dispense units per order unit are the same as the information currently contained in the local DRUG file, the NDC field in the DRUG file is overwritten with the most recent National Drug Code (NDC) number.
  • The reorder quantities for the pharmacy locations and master vaults are provided on a daily basis by way of a mail message.

CoreFLS Interface includes the following features:

  • When a pharmacy order invoice is received and entered into the CoreFLS purchasing system, the receipt data will be collected and compiled to an Health Level Seven (HL7) message and transmitted 'real time' to VistA Drug Accountability. Upon receiving the message, the receipt data will be stored in a temporary global, and Drug Accountability will alert the user about the Pharmacy receipt.
  • After receiving invoice data into the warehouse, the transmission from CoreFLS will place data into a temporary global.
  • When Pharmacy personnel sign into the Drug Accountability package, the program will check for the existence of orders to process.
  • If the orders exist, and the user has the proper security key, the data can then be received into Drug Accountability.
  • Each Purchase Order received will be for a specific pharmacy location. If items are to be shipped/received at different pharmacy locations, a different purchase order will be created/shipped for each location.

Both Interfaces include the following features:

  • Vendor-specific information and procurement history is displayed for a selected drug.
  • Pharmacy locations are established and populated.
  • A purge capability with scheduling queuing is provided.
  • Supports NDC code set and pricing for Electronic Claims Management Engine pharmacy electronic billing.

Pharmacy: Electronic Claims Management Engine (ECME)

Overview

The Electronic Claims Management Engine (ECME) package provides the ability to create and distribute electronic Outpatient Pharmacy claims to insurance companies on behalf of VHA Pharmacy prescription beneficiaries in a real-time environment. The application does not impact first party co-payments and minimizes the impact on legacy pharmacy workflow. This system meets the Health Insurance Portability and Accountability Act (HIPAA) of 1996 mandate, specific to the Electronic Transactions and Code Sets rule. The rule mandates VHA must submit claims electronically to insurance companies via the National Council for Prescription Drug Programs(NCPDP) v5.1 standard transmission format. The system, developed from a version currently utilized by Indian Health Service, has been modified to support the VHA Pharmacy Order Entry model.

ECME receives a billing determination by Integrated Billing (IB) if an Outpatient Pharmacy order is billable. If so, ECME builds a NCPDP v5.1 electronic claim transaction using data required by the insurance company for claim adjudication, as defined within the company's individual payer sheet. Claims are submitted during the Outpatient Pharmacy finish process, and again during the Outpatient Pharmacy release process if the claim was initially rejected. If any additional edits or other events occur to the prescription, such as a return to stock, ECME generates additional electronic claims to payers updating them on the prescription billable status and updates IB with any claim specific information.

Features

The ECME application provides the following features:

  • Creation of outpatient pharmacy electronic claims for real-time submission to third party insurance companies for adjudication utilizing billing activities within the VHA prescription fill process.
  • Utilization of information provided by a subscription with First DataBank to create electronic claims.
  • Support and integrated functionality for TRICARE/CHAMPUS, ChampVA, and itemized charging methods for prescription pricing.
  • Enhancements to VHA revenue cycle management by submitting claims at the point of service while building claim segments using payer-provided transaction formats compliant with the NCPDP v5.1 standard.
  • Collection and presentation of DUR information to application users based on information received from payer claim responses.
  • Reporting and on-line worklist presentation formats supporting VHA claims adjudication requirements.
  • Integration with VistA IB for prescription billing determination and claims tracking.
  • Integration with VistA Pharmacy applications when creating claims based on Pharmacy workflow.
  • Communication with the VistA Health Level Seven (HL7) application and Vitria BusinessWare to store and forward electronic pharmacy claims for third party insurance adjudication.

Pharmacy: Inpatient Medications

Overview

The Inpatient Medications package integrates functions from the Intravenous (IV) and Unit Dose (UD) modules (described on the following page). This integration provides a comprehensive record of medications utilized during hospitalization of the veteran, the functionality for clinician order entry through Computerized Patient Record System (CPRS), and tailors processes by facility, user, and/or medication.

Features

The Integrated software allows these features, via the List Manager interface, for both IV and Unit Dose:

  • Provides the user the capability to
  • Browse through a list of orders and take action(s) against those items.
  • Print 7-day, 14-day, and 24-hour MARs, labels, and profiles from within the options.
  • Select a detailed allergy report, document new allergies or adverse drug reactions.
  • Update the Patient's Record from within List Manager.
  • Provides Drug/Drug Interaction, Drug/Class Interaction, Duplicate Drug, and Duplicate Class Order checks.
  • Allows easier drug selection using Orderable Item.
  • Provides on-line order maintenance (for example: edit, renewal, cancellation) and marks orders that need attention.
  • Provides on-line order entry with an integrity check for each order type.
  • Generates labels containing order and patient information upon the entry/maintenance of an order.
  • Provides on-line or printed patient profiles that include a history of medication orders for the current or last medical center visit.
  • Displays patient order information and histories of all actions taken on active orders.
  • Provides an Action Profile of patient medication orders for use by physicians to cancel or continue medications.
  • Provides a Stop Order Notice report to notify users of orders near expiration.
  • Cancels/holds medication orders for patients transferred between wards and/or services.
  • Provides dispensing cost reports by patient, ward, service, drug, and providers.
  • Provides reports and forms by patient, ward, and selected groups of wards.
  • Allows electronic entry and inpatient processing of medication orders for an outpatient receiving treatment via a clinic or ancillary service.

Pharmacy: Inpatient Medications - Intravenous (IV)

Overview

Inpatient Medications' Intravenous (IV) module provides pharmacists and their staffs with IV labels, manufacturing worksheets, ward lists for order updates, and management reports. It permits the Pharmacy staff to track the manufacture of IV formulas with greater control than manual procedures allow. Through order entry and ward list updating, the staff can easily establish and maintain an accurate and timely data set of IV orders. A carefully designed set of checks and balances has been incorporated to ensure that the patient is supplied IV solutions quickly and accurately.

Features

The IV module:

  • Generates Manufacturing Lists to facilitate maximum efficiency in the preparation and delivery of IV products.
  • Generates IV labels containing all necessary patient, drug, and schedule information. Labels provide a bar-coded identifier which when used in conjunction with Bar Code Med Administration greatly enhances patient safety.
  • Generates management reports designed to track drug costs and workload by ward, provider, IV room, and patient.
  • Provides on-line generation of production reports such as renewal lists, active order lists, and formulary drug reports.
  • Discontinues/holds orders for patients transferred between wards and/or services.

Pharmacy: Inpatient Medications - Unit Dose (UD)

Overview

The Unit Dose (UD) module of Inpatient Medications provides a standard computerized system for dispensing and managing inpatient medications. Timely, accurate, accessible, and up-to-date patient medication information is available from any terminal within the facility. Computer-generated working forms allow personnel to dedicate more time to patient care.

Features

The Unit Dose module:

  • Allows immediate entry of pre-defined sets of unit dose orders.
  • Provides computerized pick lists, which include pre-calculated doses for pharmacists.
  • Provides an interface to automated dispensing equipment.

Pharmacy: National Drug File (NDF)

Overview

The National Drug File (NDF) package provides standardization of the local drug files in all VA medical facilities. Standardization includes the adoption of new drug nomenclature and drug classification, as well as linking the local drug file entries to data in the National Drug files. For drugs approved by the Food and Drug Administration (FDA), NDF provides VA medical facilities with the ability to access information concerning dosage form, strength and unit, package size and type, manufacturer's trade name, and National Drug Code (NDC) information. The NDF software also lays the foundation for sharing prescription information among medical facilities.

Features

The National Drug File:

  • Standardizes drug file information.
  • Standardizes drug classifications.
  • Adopts standard nomenclature.
  • Provides up-to-date prescription and over-the-counter information.
  • Provides available sources for drugs manufactured and approved by the FDA.
  • Provides a base for implementation of drug inventory control and management throughout VA (i.e., Consolidated Mail Outpatient Pharmacy and Pharmacy Benefits Management).
  • Allows file access by NDC, manufacturer's trade name, ingredient, dosage form, dosage strength, route of administration, and VA drug classification.
  • Allows management of drug information, including reports on drugs by classification, ingredient, NDC, trade name, and/or active/inactive status.
  • Matches additions to medical center drug files with the national drug database.
  • Provides an ingredient file that is an integral component of the Allergy Tracking and Outpatient Pharmacy (drug-drug interactions) modules.
  • Provides an enhanced formulary report listing local, VISN, and National Formulary information.
  • Includes the Patient Medication Information Sheets that feature the following:
  • An explanation of how and why to take a medication and the possible side effects.
  • Information supplied by commercial sources.
  • Information that is copyrighted and periodically updated.
  • Utilizes data provided and standardized by First DataBank for point of sale electronic billing using Electronic Claims Management Engine (ECME).

Pharmacy: Outpatient Pharmacy

Overview

The Outpatient Pharmacy package provides a way to manage the medication regimen of veterans seen in outpatient clinics and to monitor and manage the workload and costs in the Outpatient Pharmacy.

The primary benefits to the veteran are the assurance that he or she is receiving the proper medication and the convenience of obtaining refills easily. The clinicians and pharmacists responsible for patient care benefit from a complete, accurate, and current medication profile available at any time to allow professional evaluation of treatment plans. Utilization, cost, and workload reports provide management cost-controlling tools while maintaining the highest level of patient care.

Features

The Outpatient Pharmacy package:

  • Checks new prescriptions against existing prescriptions (for the same medication, therapeutic class, reported allergies, reactions, or drug interactions).
  • Allows pharmacists to verify data entered by technicians prior to the printing of labels.
  • Allows for the renewal of prescriptions that have no remaining refills. Prints labels for new, renewed, and refilled prescriptions.
  • Auto-cancels individual prescriptions for a patient after admission for inpatient treatment.
  • Creates medication profiles for patient charts to meet the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requirements for a current medication list. Profiles are suitable for counseling patients.
  • Allows the Action Profile to be used as a quick renew/cancel request form by clinic providers, which allows for rapid entry of request by Pharmacy staff.
  • Provides the Screen Profile for review at several points in the order/entry process.
  • Provides basic Drug Use Evaluation (DUE) template generator.
  • Provides necessary laboratory checks and reports to meet national requirements for Clozapine dispensing.
  • Provides finishing of orders entered through CPRS.
  • Provides information for billing any applicable medication co-payment when the prescription is released.
  • Allows the user to select a different action without leaving an option.
  • Uses List Manager features to allow:
  • Pharmacist or technician to browse through a list of actions.
  • Pharmacist or technician to take action against those items.
  • User to select an action that displays an action or informational profile.
  • Works with Integrated Billing (IB) and Electronic Claims Management Engine (ECME) to enable and manage point of sale billing supporting the Healthcare Insurance Portability and Accountability Act (HIPAA) Electronic Claims and Code set congressional mandate.
  • Allows prescription labels and Prescription Medication Information (PMI) sheets to be printed in another language if the system has the other language fields populated in Pharmacy Data Management and the individual patient is identified with the other language preference flag.
  • Allows the ability to print a microchip-embedded label for a prescription. This label can then be read by ScripTalk®, thus improving patient safety for visually impaired veterans.
  • Provides display of Herbal, over the counter (OTC), and Non-VA medications documented through CPRS. The data will be used for screening of Drug-Herbal and Drug-Drug Interactions with prescribed medications in VistA.

Pharmacy: Pharmacy Benefits Management (PBM)

Overview

The Pharmacy Benefits Management (PBM) package replaced the Drug and Pharmaceutical Products management (D&PPM) application. The software extracts medication dispensing data elements from the Outpatient Pharmacy, Inpatient Medications IV and Unit Dose, Automatic Replenishment/Ward Stock, and Controlled Substance modules; Procurement information from Drug Accountability, Integrated Funds Control, Accounting and Procurement (IFCAP); and a limited amount of Laboratory data on a monthly basis.

The software makes data extraction reports available at Department of Veterans Affairs Medical Centers (VAMCs) and allows local management to use the data to project local drug usage and identify potential drug accountability problem areas. The Pharmacy Benefits Management Strategic Health Group (PBM) is able to provide information on local facility, Veterans Integrated Service Network (VISN) and national product use on monthly, quarterly, and annual intervals.

The extracted data is transmitted to the PBM using VA Mailman. The MailMan message headers display how many messages were sent for a particular module along with the facility name and number from which the data was extracted. The header easily identifies the module from which the data was extracted, and confirmation messages include the number of MailMan messages generated for each module.

Features

Pharmacy Benefits Management contains the following:

  • Breakout of Inpatient Medications IV and Unit Dose, Outpatient Pharmacy, and Controlled Substance modules by dispensing occurrence.
  • Breakout of procurement information by line item.
  • Collection of the Prime Vendor Procurement Information (requires implementation of Drug Accountability V 3.0), Pharmacy AMIS data, Laboratory data, and Patient and Provider information.
  • Capture of controlled substance dispensing to patients if electronic Controlled Substance Administration Record (CSAR) is implemented with Controlled Substance Version 3.0.
  • Extraction of data and generation of drug and statistical data summary reports by inpatient division or outpatient site whenever possible.
  • Inclusion of National Formulary Indicator and Restriction.
  • Mechanism to monitor the successful completion of the automatic monthly extraction job and to notify users if a problem exists.

Pharmacy: Pharmacy Data Management (PDM)

Overview

The Pharmacy Data Management (PDM) package provides tools for managing site configurable data in pharmacy files. It includes tools for creating the Pharmacy Orderable Items and maintaining files necessary for the Computerized Patients Records Systems (CPRS). PDM consolidates tools for managing the various pharmacy software products, such as Outpatient Pharmacy and Inpatient Medications, to facilitate the maintenance of files used within these applications. Prior to the release of the Pharmacy Data Management (PDM) software, the maintenance of pharmaceutical items within the local DRUG file (#50) was accomplished using application specific options. PDM provides a single option to maintain this file to facilitate this process.

Features

Pharmacy Data Management provides:

  • Tools for managing pharmacy orderable items.
  • Centralized control of pharmacy files and frequently used options into one location.
  • A new drug enter/edit option, which allows the user to edit fields for all pharmacy packages.
  • The ability to identify drug interactions.
  • Tools for marking drugs to be transmitted to the Consolidated Mail Outpatient Pharmacies.
  • Local point-of-sale billing functionality for Electronic Claims Management Engine (ECME) electronic claim submission.

Pharmacy: Pharmacy Prescription Practices (PPP)

Overview

The Pharmacy Prescription Practices (PPP) package provides VA medical centers with the ability to determine whether a patient has been seen at other VA facilities and to request current pharmacy information from those facilities prior to the patient appearing for a scheduled outpatient visit. This information alerts pharmacy personnel to the existence of medications that may have been prescribed at other VA facilities and prevents possible drug abuse or adverse medication interaction.

The PPP software is integrated with other VistA applications. It interfaces with the Patient Data Exchange (PDX) module to provide a method of extracting pharmacy data from remote hospitals, the Minimal Patient Dataset (MPD) module to provide a history of patient visits, the Patient Information Management System (PIMS) to provide scheduled clinic appointments, and the Pharmacy module to provide active pharmacy data on local patients.

Features

The Pharmacy Prescription Practices package:

  • Alerts pharmacy personnel to the existence of medications that may have been prescribed at other facilities.
  • Builds a file of all patients currently registered at the medical center who have visited other VA medical centers.
  • Allows the software to be tailored specifically to meet the needs of the various sites through a number of site-specific parameters.
  • Provides several outputs containing information such as the medication profile, significant events and error conditions encountered while running the software, and statistical data.
  • Automatically sends a PDX request for the medication profile to all other facilities visited by a patient scheduled for a clinic appointment.

Primary Care Management Module (PCMM)

Overview

In the outpatient setting, patients are assigned a primary care team and provider who are responsible for delivering essential health care, coordinating all health care services, and serving as the point of access for specialty care. Associate Primary Care Providers (APs) provide primary care to patients under the supervision of the Primary Care Provider (PCP). PCMM supports both primary care and non-primary care teams. The software allows one to create, set up, and define teams; create and assign positions to the team; assign staff to the positions; assign patients to the team; and assign patients to providers' positions.

In PCMM, primary care providers have an assigned "number of patients allowed" which is compared with the "number of patients actual" to determine if more patients may be assigned to the provider. PCMM functionality assists in maintaining accurate, active patient listings for primary care teams and panels. By unassigning patients who have not seen their primary care providers in a specified amount of time, new patients may be assigned. Unassigned patients are readily reassigned to their previous primary care team and provider if they return for care. When a patient cannot be assigned to a primary care team or position, the PCMM software asks if the patient should be placed on the Electronic Wait List. PCMM Wait List reports assist in the management of patients awaiting a primary care team or provider assignment. The amount of time the APs and PCPs spend providing direct primary care is also entered and measures the capacity of each institution (and VHA as a whole) to provide outpatient primary care. PCMM also screens staff assignments to PCP and AP positions to assure the data on providers is correct.

The primary care patient, provider, and team information captured in PCMM is sent to the Austin Automation Center and the National Patient Care Database. Some PCMM information is available in the KLF Reports. Additionally, the Office of Performance and Quality Measures utilizes PCMM data for national reporting and performance measures.

Features

  • Uses a graphical user interface (GUI) for creating teams and provider positions as well as assigning staff to the provider positions.
  • Ability to assign/unassign patients to primary care and non-primary care teams and providers both in GUI and VistA roll-and-scroll.
  • Automates patient unassignment from primary care teams and providers if the patient has not seen their primary care provider for a specified time or when a patient's date of death is entered.
  • Screens assignments to PCP and AP positions based on provider type and person class.
  • Produces patient-oriented, practitioner-oriented, and team-oriented reports.
  • Transmits data for primary care teams, providers, and patients to Austin in Health Level Seven (HL7) message format and provides the ability to receive/process transmission errors.
  • Ability to control transmission of MailMan messages to team positions.

Prosthetics

Overview

The Veterans Health Information Systems and Technology Architecture (VistA) Prosthetics package automates purchasing. The Prosthetics module enhances patient care by determining what prosthetic services and devices have been provided to the veteran in the past, and decreasing the time required for the order, delivery, and/or repair of devices. The Prosthetics package provides control and auditing of expenditures and generates management reports.

Features

  • The Purchasing module interfaces with IFCAP (Integrated Funds, Distribution, Control Point Activity, Accounting and Procurement). Users enter requests to purchase and repair items or services using online VA forms or Purchase Card that allows tracking of the transactions.
  • The Electronic Record of Prosthetic Services (VAF 10-2319) tracks demographics, disability codes, new purchases, repairs/replacements, service cards, clothing allowance, automobile adaptive equipment, and Home Improvement Structural Alterations (HISA).
  • The Lab module has Orthotic Lab, Restoration Lab, Shoe Last Clinics, Wheelchair Repair Shops, and the Denver Distribution Center.
  • The Inventory module tracks quantities of prosthetic items that facilities have in stock.
  • The Administrative Home Oxygen module manages vendor billing and current prescriptions.
  • The Suspense module tracks patient requests for prosthetic appliances or services through Prosthetics or Computerized Patient Record System (CPRS).
  • The National Prosthetics Patient Database (NPPD) module captures medical center Prosthetic patient transaction data.

Quality: Audiology And Speech Analysis And Reporting (QUASAR)

Overview

Quality: Audiology and Speech Analysis and Reporting (QUASAR) is a VistAsoftware package written for the Audiology and Speech Pathology Service. QUASAR is used to enter, edit, and retrieve data for each episode of care.

Features

  • Provides automatic transmission of visit data to the Patient Care Encounter (PCE) program in order to incorporate QUASAR visit data in Ambulatory Care Reporting Program (ACRP) and in the Decision Support System (DSS).
  • Produces a variety of reports useful to local managers, medical center management, and central planners.
  • Contains a Department of Veterans Affairs (VA) FileMan function that permits users to generate customized reports.
  • Produces an automated Cost Distribution Report (CDR) RCS-10-01 41.
  • Generates and processes Audiology compensation and pension visits through an agreement with the Automated Medical Information Exchange (AMIE) package.
  • Allows input of a patient's audiogram and display of audiometric data in graphical or tabular format. The audiogram may then be signed and transmitted to the VA Denver Distribution Center (DDC) for inclusion in a patient's hearing aid order. The audiogram will also be recorded in the DDC's national database of audiometric data.

Radiology/Nuclear Medicine

Overview

Radiology/Nuclear Medicine is a comprehensive software package designed to assist with the functions related to processing patients for imaging examinations. The Radiology/Nuclear Medicine package automates the entire range of diagnostic functions performed in imaging departments, including order entry of requests, registration of patients for exams, processing of exams, recording of reports/results, verification of reports on-line, displaying/printing results for clinical staff, automatic tracking of requests/exams/reports, and generation of management statistics/reports, both recurring and ad hoc.

Features

Functionality is screened by Imaging Type to make it look as if there are separate sub-packages. Many options are also screened by or allow selection by division and/or imaging location.

  • There is on-line patient registration for exams, automatic printing of flash cards and jacket labels, and transcription of patient radiological/nuclear medicine reports.
  • Management reports include workload, complications and ad hoc summaries, daily activity logs, examination statistics, and performance indicators.
  • Health Level 7 (HL7) (e.g., voice-to-text and PACS equipment) standard for interfacing with non- VistA computer systems is supported for the exchange of radiology/nuclear medicine results.
  • There is on-line physician verification of radiological/nuclear medicine exam reports using electronic signatures.
  • Stop codes and procedures associated with a radiological/nuclear medicine exam are automatically credited for reimbursement purposes.
  • It interfaces with the Computerized Patient Record System module for entry of radiology/nuclear medicine requests and display of results to clinical staff. It interfaces with the Adverse Reaction Tracking (ART) module by allowing users to add contrast media reactions to ART via the Radiology/Nuclear Medicine package. It interfaces with the Women's Health module by automatically adding mammogram and ultrasound procedures for female patients to the Women's Health database.
  • It supports entry of multiple diagnostic codes and multiple interpreting by residents and staff.
  • There is a single combined report for a set of related procedures. This is a "printset" mechanism for entering a single report for all descendent cases registered from a parent order.
  • It provides the ability to enter and edit information specific to radiopharmaceuticals for Nuclear Medicine.
  • It allows on-line verification of "STAT" category requests.
  • It allows for the selection and printing of multiple reports.

Remote Order Entry System (ROES)

Overview

The Remote Order Entry System (ROES) is the front-end of the Denver Distribution Center's (DDC) supply chain/order fulfillment production system. ROES is used by Department of Veterans Affairs (VA) clinicians to place orders for certain types of medical products and services that are maintained under contract by the DDC. The most substantial product line handled through ROES is custom hearing aids. As implied by the name, custom hearing aids are highly specialized devices custom made for individual veteran patients. The ROES application and database are tailored for efficiency in ordering these unique devices and other items available from the DDC. Other product lines handled through ROES include stock hearing aids, hearing aid accessories and batteries, prosthetic items, aids for the visually impaired, and assistive devices. The hearing aid repair is a line of service provided by the DDC and facilitated by ROES. The ROES application and database integrates the DDC enterprise business functions of contracting/acquisition management, order fulfillment, distribution management, finance, and product life cycle support. Extensive order tracking, serialized device registration, patient/device history, and sales/financial reporting are also supported by the database.

Features

ROES uses advanced technologies and practices in software design, supporting hardware platform, database management, and network integration. ROES also integrates Web-based application architecture with a VistA environment, obtaining an optimum mix of decentralized VistA interfacing with centralized data management. The database is optimized for the DDC's progressive procurement and distribution practices, advanced general business practices, and current VA regulations.

Scheduling

Overview

The Scheduling module automates all aspects of the outpatient appointment process, including the ability to check in/check out patients, clinic set-up and maintenance, enrollment/scheduling/discharge of patients to and from various clinics, and the generation of managerial reports, statistical reports, patient letters, and workload reporting. It provides for multiple-appointment booking, which enables the user to schedule, at one time, numerous appointments on a consecutive day/week basis. This pattern of scheduling supports requirements for clinics such as dialysis treatment and physical therapy.

The system may display numerous messages when an appointment is scheduled depending on the availability of the slot requested. These include notification that the appointment is an overbook, the patient already has an appointment scheduled for that date and time, or the appointment cannot be made due to previous inactivation of the designated clinic. In addition, certain classification questions are prompted during the check out process (if applicable) to determine if treatment rendered was connected to special circumstances (such as Agent Orange, Ionizing Radiation, Persian Gulf, etc.).

Patient Appointment Information gathers appointment data to be loaded into the National Database in Austin for statistical reporting. Patient appointments are scanned from September 1, 2002 to the present, and appointment data meeting specified criteria are transmitted to the Austin Automation Center (AAC). Subsequent transmissions will update the National Database. This additional data supplements the existing Clinic Appointment Wait Time extracts.

The functions within Scheduling currently fall into four major categories: Appointment Scheduling, Local Reporting (outputs), National Data Collection, and Module Set-Up and Maintenance.

Features

  • Creates fixed or variable length clinic patterns.
  • Provides on-line clinic availability and system identification of conditions such as first available appointment.
  • Interacts with the Record Tracking module allowing chart request at the time of appointment scheduling.
  • Generates cancellation, no-show, and pre-appointment letters.
  • Provides on-line transmission of pertinent visit information to the national database at the Austin Automation Center.
  • Patient Appointment Information functionality collects and formats data for Health Level Seven (HL7) batch transmission. It also utilizes new hardware technologies for transmitting data via the VA's Intranet.

Social Work

Overview

The Social Work package is designed to facilitate the Social Work Service functions within a medical facility and is composed of Case Management, Clinical Assessment, and Community Resource. The Case Management software is used for managing social work cases (e.g., opening and closing cases, recording problems and outcomes, storing referrals) and for generation of reports that are transmitted quarterly to VA Central Office. The Clinical Assessment software provides a method of identifying, upon admission, patients most likely to require social work assistance before or after discharge. The hospital stay may be minimized with the anticipation of patients' domestic or social needs prior to discharge. The Community Resource software allows the social worker to build a network of local community agencies that can serve the veteran. The network enables the worker to expediently match the needs of the client to the existing community resources, thereby increasing productivity and viable referrals.

Features

The Social Work package:

  • Features automatic screening that uses predetermined and site-specific criteria (e.g., veteran with no permanent address) to determine if a patient needs the services of Social Work Service prior to discharge.
  • Creates networks of local community agencies (e.g., alcohol treatment, housing, health) that can serve veterans.
  • Compiles a list of community resources by user-selected category (e.g., name, town, type, zip code).
  • Identifies local residential care homes and maintains detailed information on the homes (e.g., rates, vacancies, residents, date home assessed by a VA social worker).
  • Allows workers to track patients and homes in the residential care home program by home and patient registry printouts.
  • Facilitates mailings to residential care home sponsors by printing address labels.
  • Tracks caseloads by recording the openings and closings of cases.
  • Compiles and produces monthly and quarterly reports. Transmits data electronically via the network MailMan module.
  • Provides patient teaching and monitoring necessary for VHA-wide system of coordination/care management services.
  • Provides for standardized Psycho-social Database/Assessment for inclusion in patient medical records. Also, provides mechanism for entering progress notes.
  • Provides for automated quality management monitors and reviews.

Spinal Cord Dysfunction

Overview

The Spinal Cord Dysfunction (SCD) package permits the identification and tracking of patients with a spinal cord dysfunction due to trauma or disease and the medical resources utilized during their treatment. The module supports the maintenance of local and national registries. It includes features for clinical, management, and research staff. Clinicians benefit from the ability to see profiles of Spinal Cord Dysfunction patients, and the software helps them ensure that regular annual exams are completed with functionality to measure patient outcomes. Managers have a suite of reports that reflect the resources needed to care for Spinal Cord Dysfunction patients, and researchers have access to a national registry for all veteran Spinal Cord Dysfunction patients and their associated health care events.

Features

  • Allows for the entry and tracking of a patient's functional measures over time. This includes the American Spinal Injury Association (ASIA) Impairment Scale, Functional Independence Measure (FIM), Craig Handicap Assessment and Reporting Technique (CHART), Functional Assessment Measure (FAM), Duke University of Illness Index (DIENER, DUSOI), and for Multiple Sclerosis patients, Kurtzke Functional Systems Scales and Expanded Disability Status Scales (EDSS).
  • Generates a Health Level Seven (HL7) message to a national registry whenever a new record is created or a current record is edited. The central registry is used to provide VA-wide review of patient demographics, clinical aspects of injury and disease, and resource utilization involved in providing care to patients.
  • Provides a link to the Health Summary package.
  • Provides a variety of reports, including ad hoc and data filtering capabilities:
  • New applications for inpatient care, current inpatient/outpatient activity, and discharges.
  • Patient outcome information.
  • Registrant injury reports.
  • Self reported functional measures and summaries of clinician reported measures.
  • Annual rehabilitation evaluations: offered, received and due.
  • Mailing labels and Aggregate Outcomes Reports.

Surgery

Overview

The Surgery package is designed to be used by surgeons, surgical residents, anesthetists, operating room nurses, and other surgical staff. This software integrates scheduling surgical cases and tracking clinical patient data to provide a variety of administrative and clinical reports.

In the operating room, the software provides on-line access to the clinical record and automatically generates post-operative reports, including the Nurse Intraoperative Report. Automated scheduling provides better operating room utilization and greater ease in distributing the operating room schedule, and the software generates monthly, quarterly, and annual surgical reports, thus reducing the amount of clinical overhead associated with the management of the Surgical Service. The Surgery software facilitates morbidity and mortality tracking and other complications, providing vital information to the Chief of Surgery and to VA Central Office.

Features

The Surgery package:

  • Allows a surgeon to generate requests for surgical procedures.
  • Allows operating room scheduling managers to assign operating rooms and time slots and generates operating room schedules.
  • Allows for the rescheduling or cancellation of operative procedures.
  • Facilitates entry of information specific to an individual surgical case (e.g., staff, times, diagnoses, complications, anesthesia).
  • Provides for on-line entry of data inside the operating room during the actual operative procedure.
  • Generates patient records and nurse reports.
  • Produces management reports (e.g., Annual Report of Surgical Procedures, Attending Surgeons Report, Nurse Staffing Report, Anesthesia Management).
  • Produces quarterly and annual reports for VA Central Office.
  • Provides secured access to lists of cancellations and the Morbidity and Mortality Report.
  • Extracts data necessary to monitor risk management issues.
  • Provides additional checks for Transfusion Error Risk Management.
  • Includes a generic Health Level Seven (HL7) interface for use with commercial Automated Anesthesia Information Systems.
  • Includes an interface to the Patient Care Encounters (PCE) software that allows ambulatory procedure workload information to be transmitted to the National Patient Care Database (NPCD) at Austin.
  • Allows for on-line electronic signature of the Nurse Intraoperative Report and the Anesthesia Report

Surgery: Risk Assessment

Overview

The Risk Assessment module of the Surgery software provides medical facilities a mechanism to track information relating to both surgical risk and operative mortality. This information, once downloaded to the VA national database, supports a program of total quality improvement in Surgery in VHA.

The National Surgical Quality Improvement Program (NSQIP) was established to develop distributions of observed-to-expected (O/E) mortality and morbidity ratios (risk-adjusted outcomes) across facilities for all operations, for eight major sub-specialties, and for cardiac surgery. At each of VA's medical facilities

performing surgery, a Surgical Clinical Nurse Reviewer, under the direction of the Chief of Surgery, collects risk and outcome data. All patients undergoing major surgery requiring general, spinal, or epidural anesthesia are assessed. Completed non-cardiac assessments are electronically transmitted to the Hines, IL Center for Cooperative Studies in Health Services (CCSHS), while cardiac assessments are transmitted to the Denver Cardiac Coordinating Center for data analysis. At these centers, models are continually developed and enhanced for the major surgical subspecialties and procedure-specific cardiac surgeries. Managerial reports are prepared at the coordinating centers to provide Chiefs of Surgery with their own risk-adjusted data compared to the VA national averages.

Features

The Risk Assessment module:

  • Provides for entry of non-cardiac assessment information including pre-operative information, laboratory test results, operation information, and intraoperative and post-operative occurrences.
  • Provides for entry of cardiac assessment information, including clinical information, cardiac catheterization and angiographic data, operative risk summary data, cardiac procedures requiring cardio-pulmonary bypass, and intraoperative and post-operative occurrences.
  • Creates a Surgery Risk Assessment report on each patient assessed.
  • Transmits completed Surgery Risk Assessments to Hines CCSHS and Denver Cardiac Coordinating Center.
  • Lists Surgery Risk Assessments by categories, including complete, incomplete, and transmitted assessments, as well as lists of major surgical cases and all surgical cases.
  • Generates a monthly Surgical Case Workload Report.
  • Prints follow-up letters to patients 30 days after a procedure.


VistA Imaging System

Status: VistA Imaging: missing - Alternate Available

20051230 worldvista-logo-earth-3-256 fdsm.jpg Not VistA Imaging: missing - Uses proprietary components not available outside the VA.
20051230 worldvista-logo-earth-3-256 fdsm.jpg Alt O3 DPACS IHE compliant from the O3 Consortium - Open Source - Java based

For original VistA Monograph Entries See: VistA Imaging Archive

Visual Impairment Service Team (VIST)

Overview

The Visual Impairment Service Team (VIST) program is designed to enhance the efficiency of the Visual Impairment Service Team programs within the Department of Veterans Affairs (VA). With this program, Visual Impairment Service Teams are able to easily manage and track activities and services provided to blinded veterans in their service area. This program integrates several fields of patient data to produce a variety of reports. The VIST patient record printout can be used in place of VA Form 10-1371 and is a more versatile document than the card.

Features

  • Enhances the efficiency of the Visual Impairment Service Team programs.
  • Provides a way to easily track and manage activities and services provided to blinded veterans.
  • Provides a wide variety of reports based on patient data.
  • Blinded veterans can be quickly added or deleted from the rolls.

The new Blind Rehabilitation V.5.0 will integrate all four segments of Blind Rehabilitation Service, which includes VA Headquarters and Visual Impairment Service Teams (VIST), Blind Rehabilitation Outpatient Specialists (BROS), and Blind Rehabilitation Centers (BRC). It will also store data from surveys on patient demographics, satisfaction, and outcome. The data is expected to determine outcome measures and provide a national information system for the Department of Veterans Affairs.

A few of the main features will be: A Web-based user interface following W3Chtml specifications use of existing VistA tools, HealtheVet architecture and Data Base Integration Agreements (DBIAs) to interface with existing VistA applications for more streamlined data entry, and retrieval and to minimize duplicated data entry. Multi-divisional data capture and reporting will be a new feature, as well as a streamlined centralized database.

Vitals/Measurements

Overview

The Vitals/Measurements application is designed to store, in the patient's electronic medical record, all vital signs and various measurements associated with a patient's hospital stay or outpatient clinic visit. Data can be accessed by several Veterans Health Information Systems and Technology Architecture VistA applications (e.g., Health Summary and Pharmacy) that interface with the Vitals/Measurements application.

Features

  • Contains a Graphical User Interface (GUI) to make editing and viewing of data easier.
  • Supports documentation of a patient's vital signs (e.g., temperature, pulse, and respiration).
  • Tracks a patient's height, weight, central venous pressure (CVP), circumference/girth, and oxygen saturation via oximetry with supplemental oxygen information.
  • Supports documentation of detailed or positional blood pressures for a patient (i.e., bilateral blood pressures taken in a sitting, standing, and lying position).
  • Associates qualifiers (alpha characters appended to the measurement's numeric value) to provide a more detailed description of the patient's vitals/measurements.
  • Prints patient's cumulative measurements on the Vital Signs Record and the Cumulative Vitals Report.
  • Displays latest information on all of the patient's vitals/measurements in both metric equivalents and U.S. customary units along with the date/time the information was obtained.
  • Prints an expanded vitals graphic report, which includes the patient's intake and output when present in the patient's database (refer to the Intake and Output application).
  • Allows facilities to establish hospital-wide high and low values for each vital sign or measurement.
  • Identifies abnormal patient values on vitals/measurements reports (those values outside the high and low range).
  • Prints the following patient measurements in a linear graphic format when using a Kyocera F-800A or HP compatible (programmable) printer:
  • Temperature and pulse
  • Blood pressure
  • Weight
  • Pulse oximetry and respiration
  • Pain
  • If reports are printed on a dot matrix printer, plotted data values are not connected by a line.
  • Supports the archiving and purging of patient measurements, which are no longer required on the production account, through FileMan.
  • Passes patient vitals/measurements information (numeric values only) within a specific date range to the Health Summary application.
  • Records a reason for the omission of a patient's vitals/measurements.

Women's Health

Overview

The purpose of the Women's Health package is to establish a computerized tracking system that generates aggregate data at the facility level. The product would assist in the assessment of various aspects of care provided to women veterans, such as efficiency of care, outcomes of care, and quality of care for individual patients. It is intended to: provide data to determine if there are differences in disease frequency between women veterans and the general population; provide information for clinical guideline development and determine if preventive health screening guidelines developed for the general population are applicable, or need modification in the women veteran population; and provide workload, preventive screening, women veterans health profile, outcome measurement, and provider profiling data.

Features

The Women's Health software is composed of three main modules: Patient Management, Management Reports, and Manager's Functions.

Patient Management is the portion of the software used to manage individual patient care, that is, their procedures, due dates, and correspondence. Under the Patient Management menu, it is possible to maintain patient data such as the date of the next PAP smear, colposcopy or mammogram, the patient's pregnancy and her EDC (due date), as well as the patient's current PAP regimen. It is also possible to track the patient's individual procedures: the date performed, the provider and clinic, the results or diagnosis, etc. Notifications (letters and phone calls) may also be tracked. A file of form letters has been included in the software, and these letters may be edited and personalized for a clinic's particular needs. Reminder letters can be queued months in advance of a future appointment, then printed and mailed out shortly before the tentative appointment.

Management Reports is the portion of the software used to print epidemiological reports, such as the number of women who received a mammogram for the selected time period or the number of patients having abnormal PAP results during a selected time period. Under the Management Reports menu, it is possible to produce lists of patients who are past their due dates for follow-up procedures. It is also possible to store program statistics by date for later comparison of program trends and progress.

Manager's Functions is that portion of the software that provides the ADPAC with a set of utilities for configuring the software to the specific needs of the site. It also provides utilities for other program needs, such as customizing tables, making special edits to patient data (e.g., pregnancy log, PAP regimen log), printing notification letters, running error reports, and documenting laboratory results. By using the File Maintenance options under the Manager's Functions menu, it is possible to maintain site-specific parameters, such as the text of form letters, the types of notifications and their synonyms, how and when letters get printed, and several defaults relating to dates.

Management and Financial Systems

Management and Financial Systems manages portfolios for the core legacy systems, aids in the planning, development, and implementation of enterprise-wide projects, and provides billing and patient records management solutions to our internal customers and end users, which results in a positive experience for our most prized customer, the Veteran.

The MFS portfolio focuses on:

  • Patient Financial Services Systems
  • Fee Basis Claims Processing
  • Decision Support Systems
  • Core Financial Logistics Systems
  • Health Revenue Center
  • HIPAA
  • Future Integration with Commercial Applications

Accounts Receivable (AR)

Overview

The Accounts Receivable (AR) package is a system of accounting and receivables management. The AR package automates the debt collection process and a billing module is available to create non-medical care debts. Functionality is available to establish, follow-up on, collect against, and track all medical facility debts.

Some of the debts owed to a VA facility may include patient care covered by health insurance companies, veteran copayments, pharmacy prescription copayments, employee salary overpayments, lost or damaged property, vendor collectibles, benefit overpayments, and services provided under a sharing agreement with another institution.

Features

  • Provides a generic billing system used to generate standardized bills.
  • Receives patient and third party billing information passed automatically from the Integrated Billing (IB) package.
  • Sends electronic transmissions to the Consolidated Copayment Processing Center (CCPC) in Austin, TX to generate patient statements.
  • Automatically processes first party payments received from the Lockbox Bank.
  • Calculates interest and administrative charges.
  • Records, processes, and tracks payment information from patients, vendors, insurance companies, employees, and institutions.
  • Records and tracks credit balances if debtors have overpaid their accounts, and processes refunds as appropriate.
  • Updates Financial Management System (FMS) with Accounts Receivable data.
  • Updates the Medical Care Collections Fund (MCCF) National Database with Accounts Receivable data.
  • Tracks and forwards eligible delinquent patient, vendor, and employee debts to the Treasury Program for offset.
  • Tracks delinquent debts for Regional Counsel and Department of Justice for enforced collection.
  • Provides the ability to set up repayment plans.
  • Provides reports and inquiries for the follow-up and maintenance of outstanding receivables.
  • Provides for transmission of certain AR bills over 90 days old to be referred to the Debt Management Center (DMC) for collection action.
  • Automatically processes electronic payments and explanation of benefits documents received from third party insurance carriers through the EDI Lockbox bank.

Automated Information Collection System (AICS)

Overview

The Automated Information Collection System (AICS) software supports outpatient clinical efforts through the creation and printing of encounter forms that display relevant clinical information, and provides for the entry of clinical encounter data for local and national needs. These encounter forms are used to display relevant patient data for use during the appointment (e.g., demographics, allergies, clinical reminders, and problems) and to collect data about the appointment (e.g., procedures, providers, and diagnoses), thus providing an organized method of data collection through scanning or data entry. Many of the lists that a user sees in Computerized Patient Record System (CPRS) for input of outpatient encounter data are based on lists created when designing encounter forms for clinics.

A form generator is included, which allows sites to design forms which meet local medical facility needs. There is enough flexibility in the software so sites can build forms that meet their individual clinical, billing, and resource requirements. The encounter form may be filed in the clinical record.

A print manager is included that allows sites to define reports to print in conjunction with the encounter form and any supplemental forms for each appointment. Reports can be defined to print at the division, clinic group, or clinic level. Utilities are available to manage when and where forms may print.

Data from encounter forms can be inputted (into VistA) in one of two ways. Forms can be scanned on client workstations with the data is automatically transmitted to the VistA server, or clerks can key in data from forms.

Features

  • Provides a form design utility that allows creation of attractive and easy to use forms for each clinic.
  • Allows forms to be designed to print with patient data displayed, such as patient demographics, insurance information, allergies, clinical reminders that are due, and active problems.
  • Allows for the creation of forms to collect data such as procedures, diagnoses, problems, providers, progress notes, vital signs, and PCE-related data such as exams, health factors, patient education, skin tests, and immunizations.
  • Provides a print manager that allows all clinic-specific forms to print with the encounter form for an appointment. The print manager also provides a setup system that, once accomplished, no longer requires daily user intervention.
  • Provides an import/export utility that makes it easier for sites to exchange forms they have already created.
  • Provides forms tracking to ensure that each form printed is processed or accounted for.
  • Manual data entry options are available to allow data to be key entered by a clerk and passed to PCE to be stored.

Beneficiary Travel

Overview

The Beneficiary Travel module provides the ability to perform the functions involved in issuing beneficiary travel pay. Travel reimbursement is provided to specified categories of eligible veterans. It is also provided to non-employee attendants who are eligible for such reimbursement. These attendants will be issued travel pay under the veteran's name.

Payment for travel by special mode (ambulance, handicapped van, etc.) may be authorized if medically necessary and approved beforetravel begins, except in cases of medical emergency where delay would be hazardous to life or health.

For certain claims, the system will compute the amount payable from factors such as account type, parameter set-up of deductible amount per visit and per month, one-way or round-trip mileage, and applied costs.

Features

  • Automatically computes the amount payable for claims with an account type of Compensation and Pension.
  • Allows each site to define and edit site-specific beneficiary travel parameters.
  • Produces a variety of statistical reports for a specified date range.
  • Provides the ability to reprint the standard pre-formatted beneficiary travel form for cash reimbursement.

Compensation and Pension Records Interchange (CAPRI)

Overview

The Compensation and Pension Records Interchange (CAPRI) software was designed to promote efficient communications between the Veterans Health Administration (VHA) and the Veterans Benefits Administration (VBA). It offers VBA Rating Veteran Service Representatives and Decision Review Officers help in building the rating decision documentation through on-line access to medical data. It creates a more efficient means of requesting compensation and pension examinations and navigating existing patient records.

CAPRI provides a Graphical User Interface (GUI) for the VistA Automated Medical Information Exchange (AMIE) II application. AMIE II is a List Manager application that automates the administrative procedures involved in sending medical information used in determining veteran benefit payments from the VA Medical Centers to the VA Regional Offices.

CAPRI handles most administrative aspects of the examination process.

Features

  • Ability to add, edit, cancel exam requests.
  • Allows patient record navigation to view such items as health summaries, progress notes, lab reports, consult requests/results, etc.
  • Provides individual and cumulative pending exam tracking.
  • Generates managerial and statistical reports.
  • Integrates compensation and pension examination results into the veteran's medical record.

Current Procedural Terminology (CPT)

Overview

Current Procedural Terminology (CPT) codes are used for reporting medical services and procedures performed by physicians. The purpose of the code is to provide a uniform language that will accurately describe medical, surgical, and diagnostic services, thereby providing an effective means for reliable nationwide communication among physicians, patients, and third parties. This system of terminology is the most widely accepted nomenclature for the reporting of physician procedures and services under government and private health insurance programs.

The CPT software includes all CPT codes to code outpatient services for reimbursement and workload purposes (as determined by the American Medical Association) and Health Care Financing Administration's Current Procedural Coding System (HCPCS) from the Health Care Financing Administration (HCFA). These codes may also be used to report inpatient services in certain instances.

Features

  • Provides annual updates for CPT and HCFA codes.
  • Provides several reports to display new, revised, or inactivated codes.
  • Supplies detailed descriptions of CPT and HCFA codes.

Decision Support System (DSS) Extracts

Overview

The VistA Decision Support System (DSS) Extracts software provides a means of exporting data from selected VistA software modules and transmitting it to a Decision Support System (DSS) resident at the Austin Automation Center (AAC). This transfer is accomplished through a set of extract routines, intermediate files, audit reports, transmission, and purge routines. Data from VistA packages is stored by the extract routines in the intermediate files, where it is temporarily available for local use and auditing. The data is then transmitted to the AAC where it is formatted and uploaded into commercial software. After the data has been successfully uploaded into the commercial software, it is purged from the intermediate files.

Extracts consist of the following functions: implementation of extract processes; scheduling extracts, verifying extracts against other VistA reports, transmission of extracts to the commercial software, verification of transmission, and purging extracts.

Features

  • Extracts data from the following VistA software packages:
  • Audiology and Speech Pathology (QUASAR)
  • Dental
  • Event Capture
  • Inpatient Medications
  • Laboratory
  • Mental Health
  • Nursing
  • Pharmacy Prescriptions
  • PIMS (ADT and Scheduling Modules)
  • Prosthetics
  • Radiology
  • Surgery
  • Uses a roll-and-scroll format that allows users to perform the various functions by selecting the appropriate menu options.
  • Uses VA Mailman to transmit data to commercial software resident at the AAC.

Diagnostic Related Group (DRG) Grouper

Overview

The Diagnostic Related Group (DRG) Grouper is based on the Medicare Grouper requirements as defined by the Health Care Financing Administration and as reported in the Federal Register. Each DRG represents a class of patients who are deemed medically comparable and who require approximately equal amounts of health care resources.

The module groups diagnostic and operation/procedure codes into the DRGs based on the combination of codes, age, sex, discharge status, and occurrence of death.

Features

  • Provides annual updates that conform to the latest release of the commercial grouper.
  • Functions within or apart from other modules.
  • Supplies detailed descriptions of DRGs, diagnostic codes, and operation/procedure codes.
  • Accepts one primary diagnosis and multiple secondary diagnostic codes and operation/procedure codes.
  • Displays weighted work unit values as well as national and local high and low trim point values for each DRG.

Engineering

Overview

Engineering, also known as Automated Engineering Management System/Medical Equipment Reporting System (AEMS/MERS), facilitates the management of information needed to effectively discharge key operational responsibilities normally assigned to VA engineering organizations, such as:

  • Equipment Management
  • Work Control
  • Space/Facility Management

The Engineering package was designed as a resource that can be shared by medical center administrative staff. Safeguards against unauthorized editing of key data elements of non-expendable (NX) equipment records have been designed into the system. Engineering maintains integration agreements with Integrated Funds Distribution, Control Point Activity, Accounting and Procurement (IFCAP) such that the status of work orders is automatically updated on the basis of orders for parts or service. The Engineering package is the VA's official record of inventory for capitalized personal property.

Features

  • Uses bar codes for equipment inventory and preventive maintenance. Completed work orders are automatically posted to equipment histories.
  • Tracks and controls work orders, maintaining annotated repair histories for medical and non-medical equipment. There is a separate menu option for display of incomplete work orders.
  • Manages electronic work orders. Staff throughout a facility can enter work requests via a terminal or workstation. These requests are promptly reviewed by Engineering personnel and assigned to the appropriate maintenance shop.
  • Identifies building features (square footage, floor coverings, window types, etc.) and keeps track of locks and keys.
  • Provides capitalized personal property data to the Fixed Assets subsystem of the Financial Management System (FMS).

Equipment/Turn-In Request

Overview

The Equipment/Turn-In Request software provides additional functionality within the Integrated Funds Distribution, Control Point Activity, Accounting and Procurement (IFCAP) package, including the ability to enter an electronic request for new, non-expendable equipment and replacement equipment. It adds the functionality for tracking the request through the many stages of review, prior to its approval and becoming a permanent transaction. Users are allowed to turn in old equipment currently tracked in the Equipment Inventory file, generate an Engineering work order, and track its movement to its final disposition and removal from the inventory list. The Equipment/Turn-In Request serves as a records maintenance system, allowing the user to record important events throughout the ordering process. Such records can be printed in report format as supporting documentation about the equipment life cycle.

Features

  • The software introduces a new position to the IFCAP package, the Consolidated Memorandum of Receipt (CMR) official. The CMR official is ultimately responsible for new and existing equipment located at the medical facilities.
  • A requester can enter an electronic request for new or replacement equipment via a terminal.
  • A requester can enter an electronic request to dispose of obsolete equipment.
  • The CMR official can approve, edit, or cancel an equipment request.
  • Engineering work orders can be generated for initial, additional, and replacement equipment.

Event Capture

Overview

The Event Capture software provides a mechanism to track and account for procedures and delivered services that are not handled in any other VistA package. The procedures and services tracked through Event Capture are associated with:

  • The patient to whom they were delivered.
  • The provider requesting the service or procedure.
  • The Decision Support System (DSS) Unit responsible for delivering the service.

DSS Units typically represent the smallest identifiable work unit in a clinical service at the medical center and are defined by the VAMCs. A DSS Unit can represent any of the following:

  • An entire service.
  • A section of a service.
  • A small section within a section.
  • A medical equipment item used in patient procedures.

When creating or editing DSS Units, users choose what (if any) data is sent to PCE. The advantage of using Event Capture to send data to Patient Care Encounter (PCE) is that it eliminates the duplicate effort of entering the same workload data in the Scheduling software, then transmitting to PCE.

Features

  • Allows each VAMC to utilize the software for its own resource/costing needs.
  • Implements DSS Units.
  • Assigns user access to all or specific DSS Units.
  • Sets up Event Code Screens to define relevant procedures for a DSS Unit.
  • Allows single and batch data entry for patient procedures.
  • Generates reports for workload and other statistical tracking.
  • Provides a Graphical User Interface to the ECS application.
  • Allows user to upload patient encounter data to Event Capture from a spreadsheet.
  • Files encounter records in PCE for DSS Units defined to send data to PCE.
  • Generates DSS extracts.

Fee Basis

Overview

The Fee Basis package supports VHA's Fee for Service program, which is care authorized for veterans who are legally eligible and are in need of care that cannot feasibly be provided by a VA facility. A VA facility unable to meet the patient care requirements of a veteran may authorize fee basis services for short-term care, ongoing outpatient care, or home heath care from non-VA health care facilities. Bills for service are then submitted to the authorizing VA facility. The bill is reviewed by the facility and certified for payment through VA's payment center in Austin, Texas.

The Fee Basis package provides for more efficient and accurate operation of the fee for service program with reduction of paperwork, savings in staff hours, minimization of errors, and by allowing medical facilities to have greater control over disbursement of fee medical, pharmacy, and travel monies.

Features

  • Performs entire fee for service process, both authorized and unauthorized, for Outpatient Medical Fee, Civilian Hospital, Community Nursing Home, and Pharmacy Fee.
  • Automatically sends vendor updates from the central system to keep all files accurate and up-to-date.
  • Provides money management for all payments through the interface with the Financial Management System.
  • Automatically receives payment confirmations from the U.S. Department of the Treasury, populating payment histories with check numbers and payment dates.
  • Outpatient Medical Fee:
  • Authorizes fee basis treatment.
  • Enters fee providers and payments.
  • Creates, closes out, and releases batches of invoices.
  • Records travel payment.
  • Civilian Hospital:
  • Provides ability to perform complete payment process, from entering patient authorizations to transmitting completed batch data (including the calculation of Medicare reimbursement).
  • Community Nursing Home:
  • Provides ability to perform complete payment process.
  • Pharmacy Fee:
  • Provides the means to administer the Hometown Pharmacy.
  • Provides payment for medications furnished veterans on an emergency basis.
  • Facilitates the quick completion of previously repetitive actions and gives quick, accurate access to patient payment history.
  • State Home:
  • Provides ability to track veterans receiving care provided by a state home facility.

Generic Code Sheet

Overview

The Generic Code Sheet module allows code sheet data to be entered and transmitted electronically from the medical facility service level to the national database. The module has eliminated the resources previously required for keypunching code sheets. Security is provided to prohibit unauthorized access to code sheets and data can easily be entered and edited via VA FileMan. Reports are available which help manage the code sheets from creation through batching and transmission and tool are included within the module to aid in the development of new code sheets at the local or national level.

Features

  • Contains approximately 250 automated code sheets.
  • Allows new code sheets to be automated and included within the module.
  • Allows easy on-line input of code sheet data from a VA FileMan or word processing format.
  • Eliminates keypunch and typing errors.
  • Provides code sheet security at the medical facility service or module level.
  • Allows code sheets to be grouped (batched) and transmitted to any domain connected to the VA network.
  • Allows easy on-line editing and modifications to code sheets and batches.
  • Generates reports that detail the status of a code sheet or batch and prints the data contained within a code sheet or batch.

Incomplete Records Tracking (IRT)

Overview

The Incomplete Records Tracking (IRT) package provides the medical center the ability to monitor incomplete records. Interim summaries, discharge summaries, and both inpatient and outpatient operation reports are tracked.

Records may be incomplete or deficient for one or more of the following reasons - not dictated, not transcribed, not signed, or not reviewed.

A list of the deficiencies each site will track is distributed with the software. These deficiency names and categories are highlighted on the screen display and are not editable. Sites may add new deficiencies. Deficiencies that are entered by the site are not highlighted on the screen display and can be edited.

Features

  • Provides the ability to enter a new or edit an existing incomplete record in the IRT tracking system, edit a completed IRT record, and delete an IRT entry.
  • Allows each site to establish and edit site-specific IRT parameters.
  • Produces a variety of statistical reports for a specified date range.

Integrated Funds Distribution, Control Point Activity, Accounting and Procurement (IFCAP)

Overview

The Integrated Funds Distribution, Control Point Activity, Accounting and Procurement (IFCAP) module automates a spectrum of VA financial activities. VA employees use IFCAP to manage budgets, order goods and services, maintain records of available funds, determine the status of a request, compare vendors and items to determine the best purchase, record the receipt of items into the warehouse, and pay vendors. IFCAP automates the written regulations and policy for VA funding and procurement, which define the actions taken on requests for goods and services as formal transactions, orders, and payments are created for these requests.

Features

Allows users in different services to view the same document on-screen.

  • Automates funds distribution, request for goods and services, purchase order, funds obligation, and the receipt process.
  • Standardizes funds management. Automatically generates yearly budget elements for IFCAP control points.
  • Maintains year-to-date balance for control points. Integrates service-level requisitions and facility administrative activities, and updates service-level records.
  • Shares vendor and item master data to eliminate duplicate input and promote user accuracy.
  • Affixes processing status to each request at each step in the ordering cycle. Enhances security with the use of a unique electronic signature code for each user required to authorize an action.
  • Each record that is signed is set with an encoded value based on key fields from the record.
  • Transmits financial and inventory data to VA central accounting and inventory systems.
  • Automatically updates IFCAP records with central accounting system data. Provides various reports that give the current status of any request, a service fund balance, data required for budget analysis, and a listing of requests sorted according to control point specifications.
  • Enables electronic transmission of purchase orders to vendors through Electronic Data Interchange (EDI).
  • Updates purchase order status automatically.
  • Enables authorized users to purchase goods using Electronic Data Interchange (EDI) process for total electronic processing between vendor and buyer.
  • Supports the ordering of goods under contract from specific vendors via delivery orders.
  • Supports the payment for goods/services via the government purchase card and the subsequent on-line reconciliation.
  • Inventory management functionality includes defining desired stock levels of items, autogeneration of replenishment orders, dispensing of goods to supported services or end user, identification of items via bar code technology, supporting communication of inventory information between a secondary inventory point and its associated automated supply cabinet(s), and reports displaying inventory level, distributions, and dollar values.

Integrated Patient Funds

Overview

The Integrated Patient Funds software automates the mini-banking system that VA provides for patients to manage their personal funds while hospitalized in a VA medical facility.

Patient funds clerks create an individual patient account with information on a patient's psychological classification, financial status, and cash balance. Additional transactions consist of the deposit and withdrawal of funds.

Features

  • Shares patient account data to eliminate duplicate input and promote accuracy.
  • Records deposits and withdrawals.
  • Promotes security with the use of unique electronic signature codes.
  • Allows withdrawal restrictions for designated patients.
  • Allows users (e.g., patient funds clerk and agent cashier) to view the same information on-line.
  • Allows reconciliation of patient funds records with Fiscal Service.
  • Provides varied reports with the current status of patient accounts, summary transaction information, restriction lists, and suspense files.

Integrated Billing (IB)

Overview

The Integrated Billing (IB) software contains all the features necessary to create bills for patients and third party carriers. It allows for the capture and storage of insurance data including policy information and related benefits. A Claims Tracking feature is available to assist utilization review staff in tracking episodes of care, completing pre-certifications, completing continued stay reviews, and processing appeals and denials. Patient charges (pharmacy, inpatient and outpatient co-payments as well, as per diems) are automatically processed. An Automated Biller is provided to assist billing clerks with billing third party carriers.

This software is highly integrated with other VistA packages. It is dependent on data from Registration, Scheduling, Outpatient Pharmacy, (Patient Care Encounter (PCE), and Prosthetics to determine billable events. Bills and charges created in IB are passed to Accounts Receivable for processing.

Features

  • Tracks events requiring insurance company reviews from the time of the actual event until final payment is resolved.
  • Provides the ability to establish group plans and record the annual benefits covered by the plans.
  • Automates billing of patient charges for prescriptions, inpatient and outpatient co-payments, and long term care co-payments. For medication co-payments, it tracks charges billed to a veteran at all sites to ensure that the annual maximum billing cap is not exceeded.
  • Automates the creation of third party billing claims forms (UB-92, HCFA-1500).
  • Automates pricing of Third Party claims using Reasonable Charges based on care provided, payer, and provider.
  • Provides the ability to include inpatient stays, outpatient visits, prescriptions, and prosthetic supplies on third party claims.
  • Provides an Automated Biller, which automatically generates reimbursable bills identified in claims tracking that meets specific requirements as provided for in the site parameters.
  • Provides insurance company-specific billing parameters so bills can better reflect local insurance company requirements.
  • Includes a Charge Master, which allows facilities to load lists of billable rates into VistA.
  • Includes an Output Formatter to allow sites to locally configure claims forms.
  • Provides an extensive set of diagnostic reports that allow sites to monitor various aspects of the billing program.
  • Provides a module for sites to track and price the services provided to out-of-network patients.
  • Provides tools to maintain and/or modify the Insurance Company file.
  • Provides EDI capabilities using standard transactions that are transmitted through a translator at the Austin AAC prior to being forwarded to a clearinghouse for dissemination to the appropriate payers. Supported EDI transactions include the transmission of healthcare claims and the verification of patient health insurance coverage.

Patient Care Encounter (PCE)

Overview

Patient Care Encounter (PCE) captures clinical data resulting from ambulatory care patient encounters. The captured clinical data documents "encounters" and related encounter information, such as problems treated at encounter, procedures done, immunizations, patient education, and skin tests.

PCE provides a data repository for long-term clinical data. A goal of PCE is to support many data capture methods for integrating clinical data from many environments. Pilot efforts have included population of the PCE clinical repository via scanner technologies and workstations.

The key users of this clinical data are clinicians, management, and Quality Management personnel.

Features

  • Acts as VA's long-term clinical repository, documenting encounters from local and non-VA facilities.
  • Provides a primary and secondary clinical visit management utility based on appointments and related services.
  • Interfaces with the Health Summary package to provide components based on data captured and stored in the PCE clinical repository.
  • Supports capture of outpatient encounter data. Data collection methods include:
  • Interface between scanner/workstation and clinical repository.
  • On-line data capture using List Manager user interface.
  • Historical load utilities for lab and outpatient pharmacy.
  • Future methods will include automatic protocol event driver.

Personnel and Accounting Integrated Data (PAID)

Overview

Enhanced Time and Attendance

The Enhanced Time and Attendance System (ETA) automates time and attendance for employees, timekeepers, payroll, and supervisors. It provides employees the ability to request leave and display both the status of pending requests and leave balances and allows payroll to manage time and leave (T&L) units and tours of duty. It provides timekeeping, supervisory certification, and overtime management.

Education Tracking

Education Tracking documents employee and student participation at mandatory and ward in-services, continuing education programs, and all other employee training. Training information is protected with varying levels of access.

Features

Enhanced Time and Attendance

  • Timekeepers can enter and edit employee's time, view data for current and prior pay periods, and view time card status for each employee.
  • Payroll can view processing status of T&Ls, locate uncertified or incomplete timecards.
  • Payroll may also manage T&L units by enter/edit of supervisors, timekeepers and employees.
  • Payroll may view pay period data, master records, and accounting data for employees.
  • Payroll can create searches of master record and accounting data for custom local reports.
  • The payroll supervisor transmits all payroll data to the Austin Automation Center (AAC) and monitors transmission status.
  • The system automatically builds and updates employee records with AAC data.
  • Authorized personnel may display and search master record and accounting data for all employees.
  • Employees may submit electronic leave requests and view leave balances, status of requests, and service records.
  • Supervisors can approve electronic requests and timecards and view employee leave reports.

Education Tracking

  • Creates a class database with pertinent class information: class name, presenter, location, purpose, category, type, mandatory review group, sponsoring agency, cost, accrediting organizations, employer/student expenses, contact hours, etc.
  • Contains a class registration component that limits class registrants by number or service.
  • Credits class participation to individual attendee records and allows attendance corrections.
  • Provides site-configurable mandatory training groups, accrediting organizations, presentation media, supplier demographics, and class purpose.
  • Contains reports, such as a calendar of events, a registration roster, service-based class, and a variety of employee training reports.

Voluntary Service System (VSS)

Overview

The Voluntary Service System (VSS) software is the first application to be developed in the current VistA Migration effort. VSS is a national-level application replacing the site-based Voluntary Timekeeping System (VTK). VTK has been used for many years at VA medical centers to track and manage the hours of service contributed by volunteers and volunteer organizations.

To improve data collection and reporting, users interact directly with a national, centralized database. Consolidated national reporting no longer requires data transmissions back and forth between sites and the Austin Automation Center. Direct access to data provides instantaneous updates and up-to-minute reporting for all users. Central Office administrators and Voluntary staff thus have broader and more reliable data for managing Volunteer services.

The VSS application helps Voluntary staff accomplish their tasks more easily through a Web-based graphical user interface. Users at the local and national level are able to generate a wider array of reports about volunteers and sponsoring organizations. In addition, volunteers are able to log their own hours and print meal tickets themselves at secure log-in "kiosks."

Features

  • Provides multi-lingual interaction with volunteers during log-in.
  • Supports and enhances security for multiple division facilities.
  • Displays/prints entire master record for a single volunteer.
  • Provides local printing of address labels and telephone lists.
  • Reduces workload required to input mass award code changes.
  • Prints individual meal ticket for volunteer after Auto Log-in.
  • Provides real-time national reporting of data for all stations.

Information and Education Systems

Information and Education Systems with an emphasis on "eHealth" include prescription refills, appointments, fillable forms online, and My HealtheVet (Web-based access to health record, online health assessment tools, and high quality health information).

  • Improve service to veterans and stakeholders
  • Information that is accurate, up-to-date, readily available at any time, any place
  • VA Internet primary gateway to trusted VA information and services for veterans and their families

Automated Safety Incident Surveillance Tracking System (ASISTS)

Overview

Automated Safety Incident Surveillance Tracking System (ASISTS) was designed to manage the data from all employee accidents, create a Report of Accident (VA Form 2162) from the data, and produce both the Office of Worker's Compensation Programs Form CA-1 (Instructions for Completing Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation) and Form CA-2 (Federal Employee's Notice of Occupational Disease and Claim for Compensation).

Improving tracking and management of employee accidents, in general, and exposures to bloodborne pathogens from needle sticks and sharps, in particular, is a high priority of VHA. Consequently, the package contains fields specific to needle stick, sharps, and bodily fluid exposures. The data collected from ASISTS is electronically transferred to a national database and used to identify system-wide problems and opportunities for focused education and to conduct research.

The electronic submission of workers' compensation claims to the Department of Labor is improving submission rates and reducing duplicate data collection and data entry.

Features

 Electronic signature is used extensively throughout this program. All three forms (VA Form 2162, CA-1, and CA-2) require appropriate signatures including that of the employee for the CA-1 and CA-2, which is used when electronically transferring the data to the Department of Labor.

 Bulletins alert employee health and infection control of any exposures to bloodborne pathogens. The employee's supervisor, the safety officer, Human Resources Management, and union representatives are notified of every incident. Electronic signatures trigger bulletins from the employee to the supervisor and union representatives, and from the supervisor to the safety officer, alerting the recipient of action that should be taken.

  • Every medical center employee has access to a menu structured specifically to the level of his/her involvement in the process: employee health, supervisor, safety officer, union representative, workers' compensation personnel, and employee.
  • The graphical user interface (GUI) for ASISTS facilitates the input and processing of accident reports and claims and improves the reporting functionality, including a revised OSHA and Needlestick log and graphical representation of the incident reports.
  • Future versions will include a comprehensive employee health module for tracking and following numerous health issues.

Library

Overview

The Library module is designed to automate the entire serials management process in VA Library Services. VA library staff spend the largest share of local materials budgets on serials. The process of ordering, tracking, claiming, and listing these titles is tedious and error-prone when done manually. Automation of serials management allows a faster and more accurate process for work simplification. Library management is assisted through improved statistics and information.

Staff is able to use Library Patron options to see whether the local Library Service owns a journal title and, if so, the holdings and location for that title.

The Serials Control module has three components. The Serials Management component creates the local library's serials database, along with retrospective holdings and purchasing information and copy information, such as location and category. The module is designed so that access to this component may be restricted, if desired, to the serials expert on the library staff, usually a medical librarian or the Chief. Access to the Serials Control component where daily actions are managed (e.g., check-ins, routing, and generation of reports) may be given to other Library Service staff members. A minor component of the module, Library Site Parameters, allows for the initialization of the module.

Library makes it possible for local sites to carry only locally active entries in their local database. When new entries are needed, they can be downloaded automatically from the national database into a site's local database.

Features

The Serials Control module:

  • Creates a local serials database.
  • Provides acquisition and retention information.
  • Provides purchasing and vendor information.
  • Provides holdings information and shelving location information.
  • Categorizes by type and subject.
  • Provides check-in with next issue prediction.
  • Generates routing slips.
  • Tracks materials returned from routing.
  • Displays check-in history.

Generates 20 management reports (e.g., listings, monthly check-in statistics, monthly routing statistics, tracking of unreturned routed issues, missing issue reports for claiming replacements or reports, etc.).

A centrally produced Title Authority file, a database of over 9,477 serials titles owned by VALNET (VA Library Network) libraries, was preloaded with standard bibliographic data and provided as a part of this module.

Police and Security

Overview

The Police and Security module supports the VA Police in their responsibilities of crime prevention, preliminary investigation of crimes, apprehension, legally correct handling of suspected offenders, and the transfer of suspected offenders to appropriate authorities.

Features

  • Serves as the repository file for the names, addresses, and other demographic data of persons who come in contact with the VA Police and Security staff.
  • Allows for the retrieval and display of stored information for a selected person.
  • Stores electronic data normally entered on the VA Police Uniform Offense Report, Investigative Notes, Case Log, and other documentation assembled during an investigation.
  • Contains all violation information on US District Court Violations Notices and Courtesy Warnings issued by VA Police Officers at the medical facility.
  • Assembles selective data into a standardized report format documenting the numbers and types of criminal incidents that are occurring at the site.
  • Records information necessary for the Vehicle Registration program.
  • Records any data pertinent to individuals currently under any type of criminal proceedings or other legal restraining document.
  • Provides a system to record all information contained on the Evidence Property Custody Record (VA Form 10-3524).
  • Allows each police officer to record the specific activities performed during a shift and the time required to complete the activities.
  • Stores all information relative to training completed by staff members assigned to the Police and Security Service.
  • Stores all information entered on the VA Police Daily Operations Journal (VA Form 10-1433) and Continuation Sheet (VA Form 10-1433a).
  • Transmits Monthly Crime Reports and selected Offense Reports through MailMan to VA Headquarters.
  • Produces supervisory management, quality management, and crime trend studies; a standardized Uniform Offense Report, Uniform Crime Report, and Evidence Register Report; and Case Progress Notes and Case Assignment Register.

Cross-Cutting Monographs

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.

Duplicate Record Merge

Overview

Since the inception of automated medical information management within the Department of Veterans Affairs medical facilities, and as entries have been made in the PATIENT file (#2), a number of duplicate records have been introduced. Estimates of the number of duplicate entries currently present range as high as one to two percent of the VHA total record base. Past attempts to consolidate duplicate records have resulted in the loss of valid data. Invalid records were simply deleted and real data was lost through incomplete conversion of pointers.

The Duplicate Record Merge application enhances the ability to associate appropriate data with a single patient identifier. It provides the tools necessary to automatically identify patient records identified as being duplicates.

Features

The overall process consists of three modules: the search for potential duplicate record pairs, review and verification of those pairs, and the merge process. The search and identification of potential duplicate records is based on the Duplicate Record Merge features of Kernel Toolkit. Once the search has been completed, the process of verifying record pairs begins. Reviewers view data associated with the potential duplicate pairs and determine a status. Once verified, the merge process may be initiated.

  • Search for Potential Duplicate Record Pairs
  • Comparisons made on key fields; i.e., Name, SSN, Date of Birth, Date of Death, Last Separation Date (Last Discharge Date), Mother's Maiden Name, and Claim Number.
  • Comparison results in computed value.
  • Resulting value measured against the Potential Duplicate Threshold Percentage. (When record pair scores evaluate above this percentage, they are considered to be potential duplicates.)
  • Review and verification may begin while search is running.
  • Review and Verification
  • Site-designated reviewers: Primary reviewer(s) for the Patient File, Ancillary reviewer(s) for other files (e.g., Laboratory).
  • Reviewers view screens of patient data for comparisons.
  • Reviewers resolve potential duplicate pairs: Verified Duplicate, Verified Not Duplicate, Unable to Determine.
  • Notification of review actions via alerts and/or e-mail messages.
  • Merge Process
  • User-initiated process.
  • Runs as a single process merging multiple pairs. One or more jobs may be designated to run in parallel to reduce processing time (i.e., threads).
  • Halt/Restart merge process maximizes site control.
  • Three phases within merge: 1) merge records in main file, 2) DINUMed pointers and cross-references, and 3) all other pointers.

Health Level Seven (HL7)

Overview

In today's health care environment, computer systems from multiple vendors and at geographically dispersed sites are used in conjunction with core facility computer systems to create integrated delivery of information to the end-user. Linking such systems to exchange data and work together is a non-trivial task, particularly given the complexity of health care data.

Health Level Seven (HL7) is an American National Standards Institute (ANSI) standard messaging protocol that specifies the set of transactions and encoding rules for electronic data exchange between health care computer systems. HL7 provides an open, standards-based framework that computer systems can use to exchange health care data with each other. The HL7 standards development group is directly focused on health care informatics standards and cooperates closely with developers of other standards.

The Veterans Health Information Systems and Technology Architecture(VistA)HL7 package enables M-based (VistA)applications running on core facility computer systems to exchange health care information with other computer systems. It provides messaging services and a single toolset for M-based VistA applications to create, send, receive, and process HL7 messages.

Many VistA applications use VistA HL7 to exchange data in HL7 format with other facilities and/or applications, including Anesthesiology, Mater Patient Index/Patient Demographics (MPI/PD), Laboratory, Outpatient Pharmacy, Patient Management System (PMS), Radiology, and Veteran ID Card (VIC).

The VistA HL7 package is also used to integrate commercial off-the-shelf (COTS) health care applications with M-based core facility computer systems.

Features

  • Communication-Facilitates Point-to-Point and Publish-and-Subscribe messaging between two or more applications; and provides the transport mechanism using HL7-supported lower level transmission protocols (e.g., Hybrid Lower Level Protocol [HLLP], X3.28, or Minimum Lower Level Protocol [MLLP] over Transmission Control Protocol / Internet Protocol [TCP/IP]), which provide error detection and session control; provides dynamic routing of messages.
  • Processing-Queues incoming and outgoing messages for reliable messaging; validates HL7 Message Header (MSH) information for all incoming messages; and sends HL7 acknowledgment (ACK) messages back to sending applications upon message receipt.
  • Message Administration-Provides functionality to assist the application developer in setting up HL7 interfaces by hiding the complex lower level communication; monitors message transmissions statuses; and provides reports on pending transmissions and those with errors.
  • Programming Utilities-Provides the developer with a rich collection of Application Programmer Interfaces (API) to facilitate the creation, exchange, and transmission of messages; provides a set of predefined variables to use for building HL7 messages/segments; automatically creates all HL7 Message Header (MSH) segments; and invokes the appropriate application routine to process message data when a message is received.

Kernel

Overview

Kernel provides a portability layerbetween the underlying operating system and application code. This results in the entire Veterans Health Information Systems and Technology Architecture(VistA)system being portable among different computers, operating systems, and M implementations. This, together with the database portability provided by VA FileMan, eliminates the cost of application conversions each time VHA changes its computing platforms.

Kernel also offers shared servicesfor VistA applications, resulting in reduced development costs and a common user interface, and provides system management toolsfor managing VistA computer systems.

Integrated Single Sign-on-The RPC Broker supports a singlesign-on point from a client workstation to the server. Users need only sign on once when accessing multiple VistA applications on the same workstation.

Features

  • ZOSF/ZOSV Operating System Interface-The core of Kernel's portability layer. Insulates applications from being tied to any particular hardware platform, operating system, or M implementation.
  • Sign-On and Security Management-Controls user access by device, time, and day of week; controls user access to programs, menus, files, fields, and devices; audits by user, device, program, file, and field; and provides electronic signature capability.
  • Menu Manager-Manages all application menus to provide a standard user environment; customizes menus for individual users; shares or restricts menus to a user or a set of users; provides secure delegation of menu management authority; and delivers priority system alerts.
  • Error Processing-Provides a consistent method for recording and processing application errors.
  • Device Handler-Defines generic terminal types to reuse for similar peripherals; supports host files in layered operating system environments; insulates programmers from device- and operating system-specific coding; and provides standard user device selection across different environments.
  • Task Manager-Provides flexible background job scheduling; allows users to control their own tasks; and permits specification of device, priority, and time of execution.
  • Kernel Installation and Distribution System (KIDS)-Provides a mechanism to create a distribution of packages and patches; allows distribution via a MailMan message or a host file; and allows queuing the installation of a distribution for off-hours.
  • Library Functions-Provides Date, String, Mathematical, Hyperbolic Trigonometric, Measurement, and Utility Functions.
  • Domain Name Resolution-Provides an Application Programmer Interface (API) to resolve domain names into an Internet Protocol (IP) address.

Kernel ToolKit

Overview

Kernel Toolkit (also referred to as "Toolkit") supplements the Kernel software package. It provides Development and Quality Assessment Tools, Capacity Planning Tools, and System Management Utilities.

Features

Development and Quality Assessment Tools

  • Promote standard programmer interfaces.
  • Provide programmer and systems management.
  • Provide a portable routine and global editor.
  • Check adherence to programming standards and correct syntax with %INDEX tool.
  • Provide standard error trapping, storing, and reporting.
  • Support quality assessment tools for the comparison of routines and data dictionaries.
  • Provide software project management utilities.
  • Provide tools to work with data in Extensible Markup Language (XML).

Capacity Planning Tools

  • Collect accurate site data for review and monitoring of database, software, option workload, and file size information, which is useful in determining future growth rates and trends.
  • Produce system status reports and usage statistics.
  • Provide system response time logging for performance management.
  • Provide automated system monitoring and reporting tools.
  • Perform automated performance analysis tools.
  • Alert system managers to dangerous or unusual conditions.
  • Deliver reports automatically via MailMan.
  • Provide tools for software optimization and application sizing.

System Management Utilities

  • Customize and tune site parameters for local requirements.
  • Provide a Kermit file transfer utility.
  • Provide a Multi-Term Lookup Utility for enhanced VA FileMan lookups.
  • Provide Duplicate Resolution utilities for the creation of file maintenance applications.
  • Provide PARAMETERS file (#8989.5) for user-specific to system-level tracking of parameter values.
Image: Sample Capacity Planning Report

Vista monograph2005 06 html m4c39157b.gif

List Manager

Overview

The List Manager was developed to provide an efficient way for applications to present a list of items to the user for action. It is a developmental tool that enables programmers to:

  • Display a list of items to the user.
  • Allow the user to browse back and forth through the items one at a time or by screen.
  • Allow the user to select items from the list.
  • Specify the actions that can be applied to selected items from the list.
  • Call List Manager again as part of an action.

Protocols are the "actions" that users can take against items on the list. A number of standard protocols come as part of the List Manager utility. Most of these are actions that allow the user to browse the list of items.

The List Manager contains the Workbench programmer utility, which allows the development of a List Manager application without having to move from one development tool to another.

Features

List Manager provides a generic method of presenting lists of items to terminal users. Its core features are:

  • Displays a list of items in a screen format and allows users to browse through the list, select items that need action, and take action against those items.
  • In addition to the various actions that are specific to the option being worked in, provides generic actions applicable to any List Manager screen (i.e., Up a Line, Next Screen, First Screen, Search List).
  • Provides a list of available menu functions that can be performed from the screen without having to exit and enter a new menu option for each one.
  • Allows action pre-selection and list entry pre-selection by user.
  • Provides programmer Workbench for application development.

MailMan

Overview

MailMan is an electronic messaging system that transmits messages, computer programs, data dictionaries, and data between users and applications located at the same or at different facilities. Network MailMan disseminates information across any communications medium.

When MailMan is integrated into an application, it notifies individuals and groups about important events. From VA FileMan, a change in the value of a field can trigger a message called a bulletin. MailMan is easy for the user to learn and to use and provides extensive online help. There is also an extensive set of MailMan Application Programmer Interfaces (API) for the developer.

Features

  • Delivery Options-Users can send messages to individuals, mail groups, and devices. Users can also stagger delivery of messages and specify to what basket a message should be delivered.
  • Chained Responses-Message response chains are managed automatically. Responses are threaded in sequence following the original message and are instantly available to anyone currently reading the message, providing a "real-time" conversation among message recipients. All responses are available for review at any time by all recipients.
  • Configurable Interface-Users can customize and configure the MailMan reader interface and set other personal properties best suited to their needs.
  • Mail Basket Organization-Users can organize mail into any number of user-specified mail baskets.
  • Mail Filtering-Users can filter their mail based on one or several filter criteria.
  • Search Capabilities-Users can search for messages based on one or several search criteria.
  • Reminders/Notifications-Messages can be used as a tickler file to remind/notify you of specific events (e.g., bulletins and alerts).
  • Secure Messages-Messages can be secured (scrambled), requiring a key to unlock them. MailMan provides multiple layers of local and network security.
  • Surrogate Capability-Users can designate a surrogate to read and/or answer their own messages.
  • Software Message Processing-Messages can be sent and processed by software. All application outputs can be directed into MailMan messages.
  • Software Code Transport-Veterans Health Information Systems and Technology Architecture (VistA) software can be conveniently transported via messages. Whole modules and patches for installation at a remote site are sent in Kernel Installation and Distribution System (KIDS)/PackMan messages.
  • Network Transmissions Over TCP/IP-Network transmissions can be made across Transmission Control Protocol / Internet Protocol (TCP/IP) channels to any Simple Mail Transfer Protocol (SMTP)-compatible mail system.
  • Statistics Collection-Extensive mail system statistics can be collected.
  • Dom'ain Name Service (DNS)-aware'-It creates automatic replication of IP address changes to every VistA MailMan system as a result of only one central database edit (i.e., performs DNS lookups).

Master Patient Index (MPI) and Master Patient Index/Patient Demographics (MPI/PD)

Overview

There are approximately 140 Veterans Health Administration (VHA) databases in use across the country in VA facilities that are accessible via VistA systems. Because of this wide distribution of information, there is great potential for individual patient data to be kept under more than one identification number. The Master Patient Index (MPI) has been created to support maintenance of a unique patient identifier and a single master index of all VA patients, and to allow messaging of patient information among the institutional partners [i.e., VHA, Veterans Benefits Administration (VBA), Board of Veterans Appeals (BVA), and National Cemetery Administration (NCA)].

The ability to uniquely identify a patient and the facilities where that patient receives care is a key asset in the delivery of quality care. It is upon this foundation that the CPRS Remote Data Views project is able to allow the clinician to retrieve clinical information from wherever the patient has received care. As the Integration Control Number (ICN) is populated at the Health Eligibility Center (HEC) and other national databases, this ability to uniquely identify patients assists in the elimination of duplicate records throughout the systems. The need also exists between the Department of Veterans Affairs (VA) and other agencies such as Indian Health Service (IHS) and Department of Defense (DoD), to uniquely identify and share information regarding any patient that has received care from more than one facility/agency.

There is a suite of applications that make up the VHA MPI. The suite contains the following three modules:

  • Master Patient Index Austin Automation Center (AAC)
  • Master Patient Index (MPI) VistA
  • Patient Demographics (MPI/PD)

Features

Master Patient Index Austin Automation Center (AAC)

  • Create Unique Patient Index-The MPI, located at the AAC in Austin, Texas, maintains a unique patient index by establishing a correlation between each unique system record and the MPI's unique identifier (ICN). The correlated list is maintained to enable the sharing of patient data between operationally diverse systems and to maintain the integrity of the correlations to the ICN.
  • Assign ICN and CMOR-VA medical centers send local patient entries to the MPI for Integration Control Number (ICN) assignment via an initialization process or during daily operations at the VAMC.
  • Maintain/Update Index-The Index is maintained and updated as patients are added or their data is updated at VA medical facilities.
  • Manage/Mitigate Data Quality Issues-Houses the resolution journal and related applications, used to manage and mitigate data quality issues that are identified by the system or users.

Master Patient Index (MPI) VistA

  • Request Patient ICN'-'This software resides in VistA at a site and sends local patient entries to the MPI in Austin for ICN assignment.
  • Maintain/Update Patient Data'-'The MPI-VistA, Master Patient Index/Patient Demographics (MPI/PD), and Patient Information Management System (PIMS) keeps the data in the MPI (AAC) up-to-date. [NOTE: The initialization of the MPI (AAC) consisted of each VAMC sending batch Health Level Seven (HL7) messages to the MPI in Austin requesting ICNs for all of the patients whose records reflected activity in the past three fiscal years (i.e., patient records that contain CMOR Activity Scores).]
  • Provide Site Query Capability-MPI-VistA enables sites to query MPI (AAC) for known data, to request the assignment of an ICN. When a new patient is created or an existing patient record becomes active at the local VAMC, a query is sent to the MPI in Austin to see if this patient has an ICN already on the MPI. If the MPI already has an ICN assigned for this patient, the ICN, CMOR, and the Treating Facility List (a list of all locations that know of this ICN) are returned to the local VAMC. If the MPI doesn't know of this patient, a new ICN is created and the local VAMC is made the CMOR. The ICN and CMOR are then returned to the local VAMC.
  • Inactivate Patient from MPI'-'The site has the ability to inactivate an ICN on the MPI if the patient was inappropriately added to the MPI (i.e., a Test patient) or to allow the patient to be matched with another existing ICN.
  • Request/Manage CMOR Updates-The CMOR is initially the first site to notify the MPI of a patient. The VAMCs have an array of options that allow them to request to be the CMOR as well as "push" their current CMOR assignment for a patient to another site in the treating facility list. The Change of CMOR options also allow for the management of these requests.

Patient Demographics (MPI/PD)

  • Act as Authoritative Source of Patient Demographics-The function of the Coordinating Master of Record (CMOR) site (one VAMC) is to be the authoritative source of the patient's demographic data.
  • Utilize CMOR-Uses the patient's CMOR as the single source of current key demographic information on the MPI and at the patient's other treating facilities.
  • Support Demographic Changes-Supports the review of demographic changes that occur at other facilities for patients at which your site is the CMOR.
  • Synchronize Key Data-Synchronizes key patient demographic data at all sites where the patient is treated.
  • Support Duplicate Record Merge-Provides support to the duplicate record merge software for the merging of MPI/PD related data.
  • Manage Exceptions-Allows the management of Exceptions that prevent a patient from getting an ICN assignment.

My HealtheVet

Overview

My HealtheVet (MHV) is a Web-based application that creates a new, on-line environment where veterans, family, and clinicians may come together to optimize veterans' health care. Web technology combines essential health record information enhanced by online health resources to enable and encourage patient/clinician collaboration. It is the first web-based application created by the Office of Information for the exclusive use by veterans.

MHV provides one-stop shopping for information on VA benefits, special programs, and health information and services. MHV also provides services and tools to enable veterans to increase their knowledge about health conditions, better record their health status and communicate with their care providers, and become better-informed participants in improving their health. Veterans can now partner with their clinicians to gain a better understanding of their health status and take a more active role in self-management and in shared health care decision-making.

Features

Fall 2003 Release

  • Enables all veterans to participate voluntarily and have access to and control of his/her customizable online environment.
  • Provides a commercial Health Education Library that contains information on medical conditions, medications, health news, and preventive health.
  • Makes the library available to clinicians; addressable from the CPRS toolbar and included in order sets.
  • Showcases education and program information developed by VHA program offices.
  • Contains the latest VA/VHA news.
  • Contains a prescription checker, health calculators, and self-assessment tools.
  • Maps to benefits and resources available in VA and other federal sources.

Summer 2004 Release

  • Provides online prescription refills for veterans enrolled in VA health care.
  • Provides ability to view next appointment date and time at a VA health care facility.
  • Provides ability to see total co-payment balance.
  • Enables ability to enter and store personal information in a secure eVAult.
  • Provides ability to format and print reports, such as information cards and medication profiles.
  • Enables veterans to journal readings and chart progress in five self-entered metrics (elogs)-blood pressure, blood sugar, cholesterol, weight, and heart rate.
  • Enables veterans to define additional elogs, journal readings, and chart progress.

Winter 2005 Release

  • Allows veterans to request and store key portions of their VA health record in a secure, unique, and personal repository.
  • Enables veterans to let a delegate access and manage all or some of their health information to others, such as family or veteran advocates, and VA and non-VA providers.
  • Allows veterans to receive wellness reminders ,written specifically for the patient, to provide effective delivery of preventive medicine serves through standardized reminders.

Network Health Exchange (NHE)

Overview

Network Health Exchange (NHE) is a Veterans Health Information Systems and Technology Architecture (VistA)module that provides clinicians quick and easy access to patients' information from any VA medical facility where a patients has received care. NHE provides the computer mechanism for clinicians to retrieve this patient data.

The NHE package accesses information concerning clinic visits, diagnoses, prescriptions, laboratory tests, radiology exams, and hospital admissions. It enables clinicians to request medical or pharmacy records for a patient from a single site or several sites. NHE obtains Health Summary information through an interface with the Health Summary VistA module.

NHE uses predefined formats, thus requiring less input by the user and resulting in simpler, faster access to patient data. Patient data is displayed in a format similar to that of Health Summary and can be viewed on-screen or printed.

NHE is an interim bridge to a more fully integrated clinical patient data exchange system in the future.

Features

  • Simple User Interface: Users simply select the data type (Clinical or only Pharmacy data) and the amount of patient data they would like returned (all data or 12 months only), then enter the patient's name or Social Security Number in order to initiate the request for data from another VA facility.
  • Retrieval and Printing of Patient Data-Retrieved patient data (Clinical Record or Pharmacy information, either a comprehensive history or activity only within the last 12 months) can be printed or viewed on-screen.
  • Quick Response-NHE is fully automated and user requests are generally fulfilled in a matter of minutes.
  • Data Returned in Health Summary Format-Patient data is returned in an NHE mail message, formatted similarly to the Health Summary, beginning with patient demographics, followed by categorized medical information, and indicating the name of the VA facility where the data resides.
  • User Notification with Alerts-The user requesting patient data via NHE is notified of data receipt through an alert that appears within the menu system.
  • Purging Retrieved Patient Data-In order to allow sites to control disk space usage, NHE provides an option to purge the retrieved patient data messages nightly.
  • Special Security Features-This system is intended for use by health professionals who have direct patient care responsibilities and have need for clinical information. NHE generates a bulletin if data is requested from a sensitive patient record. The bulletin is directed to the same user group that currently reviews notices about access to sensitive patient records.
  • Package Management-The availability of NHE options is based on the level of menu access granted to each user.

Patient Data Exchange (PDX)

Overview

Patient Data Exchange (PDX) is a VistA module designed to electronically request and receive patient demographics, episodes of care, medications, and diagnostic evaluations from other VA facilities. Data is retrieved from files at a remote site and is assembled into a coherent, composite record, greatly enhancing the quality of care provided for the patient.

PDX allows for the setup of a work group of selected facilities that agree to an automatic data exchange. For facilities in the work group, data is returned automatically, within minutes after a request is entered. There are exceptions, however, such as records that have been flagged as sensitive. Any record that does not meet the criteria for automatic processing is reviewed and processed manually.

Once the request is processed, the patient's record is forwarded to the requesting facility. The requests and data are moved from one facility to another using MailMan, VA's electronic mail utility. The requesting facility receives administrative, pharmaceutical, and clinical information that is stored in its files and is available for terminal display or printing.

Features

  • Requests data electronically for a selected patient from another facility.
  • Allows automatic processing of requests from selected facilities.
  • Allows for manual processing of requests from facilities outside the work group or of certain records, such as those flagged as sensitive.
  • Allows sending information to a remote site without first receiving a request.
  • Allows data received from the remote site to be displayed/printed.
  • Allows select demographic data from a remote site file to be loaded/edited into the local site file.
  • Allows checking on status of requests.
  • Allows displaying/printing of statistics each time a regular or unsolicited PDX request is made or processed.
  • Allows for the encryption of site-specific patient information.
  • Allows sending/requesting data for a patient from multiple sites for multiple segments.

Remote Procedure Call (RPC) Broker

Overview

A major goal for Veterans Health Information Systems and Technology Architecture(VistA)is providing Windows-based graphical user interface (GUI) software applications. This type of software application typically runs as a client in a client/server environment. One of the challenges in creating such applications is establishing communication between the client workstation and VistA's M-based servers. In a secure manner over a Transmission Control Protocol/Internet Protocol (TCP/IP) network, users need to be able to log onto a server, initiate activities on the server, and retrieve and update data on the server.

VistA's Remote Procedure Call (RPC) Broker software provides functionality so that GUI developers can:

  • Establish a connection from a client workstation to a VistA M Server.
  • Run RPCs on the VistA M Server.
  • Return data to the client workstation.

The RPC Broker supports 32-bit Windows client applications (e.g., applications running under Microsoft Windows 2000 and Windows XP).

The VistA M Server continuously runs an RPC Broker listener process whose purpose is to establish connections with clients. When the listener process receives a connection request from a client, it spawns a separate handler process, which then handles all communications with the client.

Once connected, the client can execute Remote Procedure Calls on the VistA M Server. RPCs are written in M and accessed through the VistA M Server's REMOTE PROCEDURE file (#8994).

RPCs can:

  • Receive data from the client workstation.
  • Return data to the client workstation.
  • Execute other actions on the VistA M Server.

Features

  • Broker Developer Kit (BDK)-The RPC Broker Delphi components provide Delphi developers with an easy, object-based access to the Broker. When placed on a Delphi form, these components provide a connection to the VistA M Server and the ability to reference M data.
  • Dynamic Link Library (DLL) Interface-The RPC Broker provides a set of DLL functions that allow applications written in any MS Windows-based development environment [e.g., Borland's Delphi, Microsoft Visual Basic, and other commercial-off-the-shelf (COTS)/Hybrid Open System Technology (HOST) products] to take advantage of all the features offered by the RPC Broker Delphi components.

Remote Call Procedure - continued

  • Client/Server Security-For security purposes, to execute an RPC on the VistA M Server all of the following conditions must be met:

1. The user must be an authorized user on the VistA M Server.

2. The client workstation application must invoke a supported application context authorized to the user.

3. The RPC must itself be authorized to the specified application context.

  • Integrated Single Sign-on-The RPC Broker supports a single sign-on point from a client workstation to the server. Users need only sign on once when accessing multiple VistA applications on the same client workstation.
  • Silent Sign-on-The RPC Broker provides silent login functionality. Any GUI application that uses the Broker can log in to a VistA M Server silently (i.e., without any user dialogue).
  • Shared Broker-Broker applications running on the same server and port can share the same connection, resulting in a single job running on the server. This functionality is available for Broker applications compiled with the TSharedRPCBroker component. Only connections associated with the first application must log in.
  • Non-callback Connection-The RPC Broker provides a non-callback connection, which results in less problems for applications using the Broker for connections across firewalls.
  • CCOW-enabled-The RPC Broker supports CCOW, which allows Delphi-based applications to incorporate Single Sign-On/User Context (SSO/UC) functionality into their applications. This functionality is available for Broker applications compiled with the TCCOWRPCBroker component.

VA FileMan

Overview

VA FileMan is Veterans Health Information Systems and Technology Architecture's (VistA) database management system (DBMS). It runs in any American National Standards Institute (ANSI) M environment. The majority of Veterans Health Administration (VHA) clinical data is stored in VA FileMan files and is retrieved and accessed through VA FileMan Application Programmer Interfaces (API) and user interfaces.

Features

For Users

For Developers

  • Standalone user interface for adding, editing, printing, and searching data.
  • Form-based editing (ScreenMan).
  • Easy terminal-based editing of word processing database fields (Screen Editor).
  • Flexible, extensive report module.
  • Scrollable onscreen output of any report (Browser device).
  • Data interchange with outside applications such as PC spreadsheets and databases (Import and Export Tools).
  • Full support for forms-based interfaces to the database (ScreenMan API, Form Editor).
  • Full database access for client-server applications (Database Server API).
  • Easy scrolling-mode interfaces to the database (Classic API).
  • Full database access in Delphi-based applications via FileMan Delphi Components.
  • Data archiving and transport tools.
  • Comprehensive file creation and management utilities.
  • SQL Interface (SQLI) projects all of the information needed by M-to-SQL vendors to access VA FileMan through M-to-SQL products.
  • Supports Keys and compound cross-references (Indexes).
Performance

Over the years, demand on VHA systems has grown. The compactness and efficiency of M and VA FileMan provide fast database performance and high utilization of our computer systems.

Portability

Portable, platform-independent database services provided to applications by VA FileMan, combined with the operating system portability layer of Kernel, allow VHA to upgrade its hospital computing platforms without significant changes to application code. Thus, VHA has not encountered the kinds of problems normally associated with computer platform changes and is free to competitively bid out for new systems.

Openness

VA FileMan is open; it facilitates data access from outside applications. The Database Server (DBS) API enables client/server access to VA FileMan data. The FileMan Delphi Components take advantage of the DBS API to encapsulate the details of retrieving, validating, and updating VA FileMan data within a Delphi application. VA FileMan's Import and Export tools support data interchange with outside applications such as PC spreadsheets and database programs. SQLI helps make VA FileMan data available to outside applications. It also includes native support for Keys and compound cross references (Indexes), and thus, helps pave the way for the opening of VistA even further to outside software.

VistALink

Overview

VistALink provides a synchronous communication mechanism between MUMPS or M applications and rehosted applications, supporting Veterans Health Administration's (VHA's) ongoing transition to HealtheVet-VistA.

Technically, VistALink is a transport layer between M and Java. It consists of an M-side listener and Java-side adapter libraries compliant with the J2EE Connectors specification for Enterprise Information System (EIS) adapters. "The Connector architecture is an integral part of the J2EE platform, and, as a key component in J2EE's support for application integration, it ensures that J2EE applications can connect to and use a multitude of EIS and legacy systems."1[#sdfootnote1]

1Sharma, Rahul; Stearns, Beth; Ng, Tony, J2EE Connector Architecture and Enterprise Application Integration - Addison-Wesley, 2001.

Reasons for VistALink

While alternatives for communication between Java and M applications have been produced, the needs of applications for robust, synchronous communication have not been met by these alternatives. The limitations of each of these alternatives are described below:

  • Remote Prodcedure Call Broker-The RPC Broker is COM-based, rather than Java-based. Wrapping the COM-based Broker was proven by the Care Management team to have unacceptable performance limitations. Also, the RPC Broker was not designed for n-tier applications.
  • Vitria-Vitria is used as an HL7 interface engine by the VHA. HL7 messaging is an effective tool for asynchronous communication. But in many instances, applications need synchronous access to RPCs, as they are run while a user is waiting for results.
  • Cache-Cache provides a number of connectivity mechanisms between itself and Java that initially showed potential for use. However, the Cache-specific features have proved not to have all the functionality needed by rehosted applications.
  • Third-Party J2EE Connector-Compliant Adapters-At least one company markets an adapter for J2EE-M connectivity that is J2EE Connector compliant (as is VistALink). This adapter, however, is for Development Standard MUMPS (DSM) systems only and has other limitations when measured against VHA application requirements.

Features

  • v1.0: Client/Server connectivity from Java client to M-Officially released. This version of VistALink was designed to meet the needs of Care Management (CM). It is for Java rich client applications connecting to M servers and executing RPCs on those servers. VistALink v1.0 provides the equivalent of RPC Broker functionality for Java.
  • v1.5. J2EE Application Server connectivity to M-This version will allow applications and services running on a J2EE application server to initiate a call to an M server and execute RPCs. This version fully implements the Java 2 Enterprise Edition (J2EE) Connectors specification. Applications requesting this version include Patient Advocate Tracking System (PATS), Veterans Personal Finance System (VPFS), Computerized Patient Record System - Reengineering (CPRS-R), Scheduling, Standard Data Service (SDS), Blind Rehabilitation and Spinal Cord. Scheduled for release in mid-2004.
  • v2.0: Connectivity from M to J2EE-This version will add bi-directional connectivity, that is, allow applications and services running on M to initiate a call to resources on a J2EE application server. Release is tentatively planned for late 2004. Applications requesting this version include Scheduling and CPRS-R.


VistA Development History

In 1982, VHA committed to building an electronic health care architecture called DHCP (Decentralized Hospital Computer Program). The focus was the implementation of software applications easily integrated into a complete hospital information system. VA selected MUMPS (Massachusetts General Hospital Utility Multi-Programming System) as the primary programming language for DHCP, and began developing applications using VHA programmers who worked directly with user groups in software prototyping environments. MUMPS, now known simply as "M", is an American National Standards Institute (ANSI) and Federal Information Processing Standards (FIPS) standard language. By 1990, VHA had upgraded computer capacity at all medical facilities, and now implements software on a national scale supporting integrated health care delivery.

In 1996, VHA introduced VistA...Veterans Health Information Systems and Technology Architecture, a rich automated environment that supports day-to-day operations at local VA health care facilities. VistA is built on a client-server architecture, which ties together workstations and personal computers with graphical user interfaces at VHA facilities, as well as software developed by local medical facility staff. VistA also includes the links that allow commercial off-the-shelf software and products to be used with existing and future technologies. The Decision Support System (DSS) and other national databases that might be derived from locally generated data lie outside the scope of VistA.

When development began on the Decentralized Hospital Computer Program (DHCP) in the early 1980s, information systems were in their infancy in VA medical facilities and emphasized primarily hospital-based activities. DHCP grew rapidly and is used by many private and public health care facilities throughout the United States and the world. Although DHCP represented the total automation activity at most VA medical centers in 1985, DHCP is now only one part of the overall information resources at the local facility level. VistA incorporates all of the benefits of DHCP as well as including the rich array of other information resources that are becoming vital to the day-to-day operations at VA medical facilities.

On The Horizon

  • Pharmacy Re-Engineering…

The Pharmacy Re-Engineering (PRE) project is a key component in the implementation of the overall HealtheVet VistA effort. Two important results in the long term will be access to up-to-date drug information and VA-developed custom screens for all medication orders.

By 2005, the PRE team expects to release Application Program Interfaces (APIs) for all current references to the various VistA Drug files and for all non-order specific Pharmacy files, such as Medication Routes, Schedules, and Dosage Forms. All other applications accessing these files will be required to use the released APIs.

  • Upcoming Outpatient and PDM Enhancements…

The Outpatient Pharmacy portion of the Laser Labels Phase II project allows Prescription Medication Information (PMI) sheets and warning labels to be printed in another language if the system has the other language fields populated in Pharmacy Data Management and the individual patient is identified with the other language preference flag. The Pharmacy Data Management portion of this project allows for warning label combinations from the old warning label file and/or the new commercial data source. These warnings can also be gender specific when certain flags are set accordingly.

  • Upcoming BCMA Enhancements…

The BCMA Read-Only option will allow clinical staff not authorized to administer medications to view information from the BCMA GUI. The Read-Only GUI will have the same look and feel of the current GUI, except will not allow users to take an action on a medication.

The BCMA Coversheet will display and allow access to all medication orders over a 24 hour period. In addition, visual queues will aid in the quick and accurate review of all medication administration data presented.

The BCMA Reports Re-design will allow a user to customize reports via selectable fields and filters. The report re-design will provide both User and Manager reports, with definable reports at each site. All data will be pulled from the BCMA Medication Log File.

Other Resources

This library contains a collection of available end-user documentation for all current applications (software packages), and also includes some tools not listed in the monograph. All documents can be viewed, downloaded, and printed. Some documents have links to a Web version, and may optionally have an archive file (.ZIP or .EXE) containing the Web pages for download.

Dead Link --Drew.einhorn 19:19, 23 February 2008 (EST)

Requests for new software or software enhancements must be endorsed by and submitted to the VHA NLB Information Data Management Committee (IDMC). The initial review and recommendation must go through the IDMC Screening Committee prior to submitting to IDMC for final approval. This site provides an on-line request form along with guidance on submissions.

Dead Link --Drew.einhorn 19:19, 23 February 2008 (EST)

VHA has developed and Enterprise Architecture that provides a technical framework to promote a one technology vision across the VHA so that corporate systems and systems across Veterans Integrated Service Networks are interoperable.

VA seems to have reorganized since this was written, but link appears to take us to the new part of the VA bureaucracy. --Drew.einhorn 19:16, 23 February 2008 (EST)

Planned IT capital asset expenditures that exceed $10 million acquisition or $30 million life cycle costs, or have high levels of risk or visibility, must apply to the Capital Investment Board for approval.

The VA Capital Investment Board (VACIB) oversees the approval of all capital investment proposals that exceed certain threshold requirements, represent a high risk or high visibility or are cross-cutting. Approved proposals constitute the VA Capital Plan and support annual budget requests.

Dead Link --Drew.einhorn 19:19, 23 February 2008 (EST)

The Corporate Database Monograph provides an overview of the active VHA national databases. Information contained in this monograph allows stakeholders to identify opportunities for database consolidations, determine authoritative data sources, and work with VHA Data Quality committees to implement data standardization and quality control processes for corporate databases.

Dead Link --Drew.einhorn 19:19, 23 February 2008 (EST)

For additional information related to VistA software, you may contact the VHA Office of Information National Help Desk by E-mail at VHACIONHD@med.va.govor by phone at 1-888-596-4357.

Acronyms

ADT Admission, Discharge, Transfer

AICS Automated Information Collection System

AMIE Automated Medical Information Exchange

AR Accounts Receivable

ART Adverse Reaction Tracking

AR/WS Automatic Replenishment/Ward Stock

ASISTS Automated Safety Incident Surveillance Tracking System

ASU Authorization/Subscription Utility

BCMA Bar Code Medication Administration

CMOP Consolidated Mail Outpatient Pharmacy

COTS Commercial Off The Shelf

CPRS Computerized Patient Record System

CPT Current Procedural Terminology

CS Controlled Substances

DA Drug Accountability/Inventory Interface

DRG Diagnostic Related Group

DSS Decision Support System

EPI Emerging Pathogens Initiative

FOIA Freedom of Information Act

GIP Generic Inventory Package

HBPC Hospital Based Patient Care

HEC Health Eligibility Center

HINQ Hospital Inquiry

HL7 Health Level Seven

IB Integrated Billing

ICR Immunology Case Registry

IFCAP Integrated Funds Distribution, Control Point Activity, Accounting and Procurement

IV Intravenous

IVM Income Verification Match

KIDS Kernel Installation and Distribution System

LEDI Laboratory Electronic Data Interchange

MCCR Medical Care Cost Recovery

MPD Minimal Patient Dataset

MPI Master Patient Index

NDF National Drug File

NHE Network Health Exchange

NOIS National On-Line Information Sharing

OE/RR Order Entry/Results Reporting

PAID Personnel and Accounting Integrated Data

PBM Pharmacy Benefits Management

PCE Patient Care Encounter

PCMM Primary Care Management Module

PDM Pharmacy Data Management

PDX Patient Data Exchange

PPP Pharmacy Prescription Practices

QUASAR Quality Audiology and Speech Pathology Audit and Review

RAI/MDS Resident Assessment Instrument/Minimum Data Set

ROES Remote Order Entry System

RPC Remote Procedure Call

SCD Spinal Cord Dysfunction

TIU Text Integration Utilities

UD Unit Dose

UI Universal Interface

URL Universal Record Location

VIC Veteran Identification Card

VIST Visual Impairment Service Team

VistA Veterans Health Information Systems and Technology Architecture