User talk:Drew.einhorn: Difference between revisions

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Drew: I am John Stout in Denver Colorado, email johnstout@aol.com. My questions may not be of interest to your chatroom, so it may be best to reply to this address.
== My Neighborhood ==


Apparently you have several XO users in the Seattle area. Did they buy theirs through last year's G1G1 program as I did? I have heard there is now a "GiveSome/GetSome" program. Can we designate where these XOs will go? And can we order less than blocks of 100?
I have 2 G1G1 XO.
I don't know any XO users in Denver. I have two XOs, but I have a group of earth scientists who are interested to invest in a critical mass of a dozen more XOs for training K-12 kids in Colorado. Can you advise me or do you know of a contact in Denverwho will help us?


My Brother-in-law lived on Bainbridge Island for years until he passed away late last fall. We plan another trip out there sometime next fall.
My 3 year old grandson shares one with his mother, my daughter.
My grandson is Spanish/English bilingual.
My daughter teaches English in Mexico.
My daughter, and my grandson took theirs to Zacatecas, Zacatecas, Mexico.


John Stout
They need access to communities and libraries in both languages.
Adjunct Associate Professor of Geology

Colorado School of Mines, Golden
My wife, an educator shares one with me.

I'm getting the infrastructure in place for a learning community with two sites.

'''Cool!!!''' we configure presence service from xochat.org

I STILL think I'll need my own school server.

=== Wish list ===

Structure My Neighborhood into zones. Want to be able to easily see
things of interest. Not yet thought whether this needs tweaking to
harmonize it with the Human Interface Guidlines

*'''Connection Zone'''
**Access points and mesh networks compactly displayed in a small corner of the display.


*'''Radio Zone'''
**Folks in the G1G1 community want to see strangers who appear in their physical neigborhood.


*'''Internet Community Zon'''e
**Students with a local mesh communities need to clearly see guests who are joining the from remote locations.


Hmm. Could create filters for all of the above.

*'''Filter Zone''' hides folks
**not participating in any activity
**not participating in an activity I'm sharing
**not a member of a group I belong to
**not a member of specific group
**etc.


Distinguish these zones using
*Shading of the background
*Spatial arrangement

== Learning Communities ==

organized by:

*Geographic regions
*Age groups
*XO activity
*Language
*Curricular Topics
*etc.

== Sugar on Conventional Desktop/Laptop ==

There are several ways to do it.
I have downloaded XO-LiveCD_071206.iso. I think I know most of what I need to know to do it with vmware. But I don't have the time energy.

And Matt Price says that's the wrong way to do it!
Glad I didn't waste the time and energy.
LiveCD

=== Sugar as application from repositories ===

This is probably the easiest from the user perspective,
kept up to date by the same processes that maintain the
rest of the user's system.

==== Packages from jani's personal archive ====

I distilled the following '''Gutsy Gibbon 7.10: command line''' example
from his posts in a Dec 29 OLPC emulation NEED LINK thread on the sugar mail list.
We need similar incantations for other tools and operating systems.
Adding '''Gutsy Gibbon 7.10: Synaptic Package Manager'''

Add jani's "repository" to your list of package sources.

Using your favorite editor add two lines to the file /etc/apt/sources.list

deb http://ppa.launchpad.net/jani/ubuntu gutsy main
deb-src http://ppa.launchpad.net/jani/ubuntu gutsy main

you also need to be sure that gutsy-updates is enabled, so make sure this line
is uncommented in the file:

deb http://archive.ubuntu.com/ubuntu gutsy-updates main restricted universe

Hmm!! I have:

deb http://us.archive.ubuntu.com/ubuntu/ gutsy-updates main restricted
deb http://us.archive.ubuntu.com/ubuntu/ gutsy-updates multiverse
deb http://us.archive.ubuntu.com/ubuntu/ gutsy-updates universe

not the same syntax and it enables the multiverse, too! I don't recall the provenance of my sources.list file, lots of things have been added for multimedia,
etc.

Gutsy: Command line

update the packages list:

sudo apt-get update

then install the whole environment with

sudo apt-get install sugar-emulator sugar-activities

Gutsy: Synaptic Package Manager

click the reload button

search for "sugar" (name and description) using Synaptic Package Manager,
check sugar-emulator and sugar-activities most everything else is selected to
satisfy dependencies. You may see other sugar activities you want to check.

note: In either case the update or reload takes a long time. Lots of failures NEED to understand and cleanup my sources.list.

look through the comments of jani's blog entries

http://janimo.blogspot.com/2007/11/try-sugar-xo-laptops-interface.html
https://edge.launchpad.net/~jani/+archive

remember there were some comments about additional packages that
needed to be installed for use on ubuntu. Maybe the ones indicated as prerequisites in the sugar-jhbuild instructions below.

=== Sugar jhbuild ===

My impression is that this technique is more likely to
result in broken, bleeding edge.

if that doesn't seem to work for you, you can build sugar yourself
without too much trouble;

in a terminal first execute the following:

sudo apt-get remove sugar
sudo apt-get build-dep sugar

then follow the build instructions from the olpc website:

http://wiki.laptop.org/go/Sugar_on_Ubuntu_Linux
http://wiki.laptop.org/go/Sugar_with_sugar-jhbuild

you may need to

sudo apt-get install git

to get things started.

I did this once a long time ago after PyCon 2007,
I'm sure it's much easier now.

remote desktop access on real XO using freenx.

=== Live CDs ===

In the short term this may be the easiest.

So far I have not found the right image

* stale
* bleeding edge
* worst of all bleeding edge and stale

Looking for release and pre-release versions:
* Ship.2
* Update.1
* etc.

Run on real hardware or in Virtual Machines.

== My School Server ==

my own school server
I have downloaded OLPC_XS_LATEST.iso

would be great if there were service providers for most of the below

=== Services ===

==== Presence ====
We want to be part of larger community.

Presence service doesn't scale well.
See OLPC News (Excerpts)

Will the scaling issues be solved, and
will there be large servers to support the entire G1G1 community?

Or, will smaller communities have to form to spread out the load?

If so individual laptops will need connect to multiple presence servers?

In the meantime we are getting presence service from [http://xochat.org xochat.org]

==== Backup ====

on local server for privacy?

==== Library/Publishing ====

hierarchy:
school, district, region, country, global.

community based:
different levels of peer and/or expert review.

what libraries will the G1G1 community have access to?

==== Cache ====

bandwidth:
*Have cable modem in MX,
*Qwest ISDN in New Mexico, US.
*cache might help even with only a couple users over a congested 128K link.
*probably put school server at friend's with cable modem.
*no bottleneck when all laptops are connecting via dsl or better.

== OLPC News (Excerpts) ==
I want to move this to a personal pre-publication page and
just leave links here in the User Discussion page.

=== 2007-12-15 ===

==== 9. Presence ====

Morgan has also continued to educate
G1G1 recipients on the lack of a single Jabber server that can handle
100s of thousands of them: we are hoping that people will point to
local Jabber servers that are set up for communities and special
interest groups (See
http://wiki.laptop.org/go/Ejabberd_Configuration).

=== 2007-12-22 ===

==== 8. School Server ====

We have encountered scaling problem with the XMPP service on the
server. The eJabber software runs out of memory over time as the
number of active users exceeds a hundred. Collabra is looking into
alternative server implementations. We had thought eJabber has used by
large instant-messaging services, but probably not with all the bells
and whistles we use. The XMPP service is crucial to the efficient
provision of presence information to laptops in a school through a
centralized method.

==== 21. Presence/sharing ====

Morgan helped some community people with Jabber questions
on the forums. There has been confusion about why the
ship2.jabber.laptop.org server doesn't work: Robert McQueen spoke with
people on IRC who were interested in trying ejabberd and helping us
work out why it was failing so badly. (There is now a server at
xochat.org that can be used instead of the default at
ship2.jabber.laptop.org. See the Sugar control panel page in the wiki
for instructions on how to configure your Jabber server.)

== VistA Monograph ==

The VistA Monograph .doc file was
*opened with Open Office
*saved as html
*cleaned up with Dave Raggett's HTML Tidy
*conveted to MediaWiki format using ???

No wonder there a glitches. Starting to clean things up

=== INTRODUCTION ===

VistA AND HEALTHeVET-VistAs CURRENT AND FUTURE COMPUTERIZED PATIENT RECORD SYSTEM (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.



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

* <font face="Arial, sans-serif"><font size="2">Ensuring that appropriate
clinical interventions are provided on a timely basis;</font></font>

* <font face="Arial, sans-serif"><font size="2">Ensuring that clinical
notifications are processed on a timely basis;</font></font> * <font
face="Arial, sans-serif"><font size="2">Reducing the amount of time
primary care providers spend reviewing individual patient records;
and</font></font> * <font face="Arial, sans-serif"><font size="2">Reducing
the risk of erroneous data entry</font></font>



<font size="3">'''Health'''</font><font
size="3">''<u>'''e'''</u>''</font><font size="3">'''Vet-VistA
(Future)'''</font>



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 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
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.



<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif">'''Graphical Illustration of the Health'''</font><font
face="Arial, sans-serif">''<u>'''e'''</u>''</font><font face="Arial,
sans-serif">'''Vet â€" VistA Strategy'''</font></font></font>



<font face="Arial, sans-serif"><font
size="3">([[Image:vista_monograph2005_06_html_3c0d9bc8.gif]]<br
clear="left" /> Veterans Health Information System, including
VistA)</font></font>





=== VistA SOFTWARE PACKAGES ===





==== Health Data Systems ====





<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>

















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



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

<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>



<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>



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

* 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 =====



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

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>

* Provides options to simplify the setup of the software. * <font
face="Arial, sans-serif"><font size="2">Allows for the entry of all
required incident information plus descriptive data and actions taken
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 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

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

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

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





===== Lexicon Utility =====



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

<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>



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



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

* 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 =====



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

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



* 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 =====



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

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.



<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.
* 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) =====



<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) =====



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

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.



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

* 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 =====



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

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:

* <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>



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

* <font size="2">Uses bar code technology, prints bar code labels for
the charts, and uses bar code equipment to charge records.</font> *
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. * <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>













===== Resident Assessment Instrument/Minimum Data Set (RAI/MDS) =====



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

<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>



<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>



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



<font color="red"><font color="black"><font
size="3">'''Overview'''</font></font></font>

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.



<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>

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

<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>

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

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

* <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>

</div>

* <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>



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

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



* <font face="Arial, sans-serif"><font size="2">Clinical
Reminders</font></font> * <font face="Arial, sans-serif"><font
size="2">Adverse Reactions</font></font> * <font face="Arial,
sans-serif"><font size="2">Discharge Summary</font></font> * <font
face="Arial, sans-serif"><font size="2">Progress Notes</font></font> *
<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>



<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>

* <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>



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

* <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.











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





'''CPRS Cover Sheet Example'''



[[Image:vista_monograph2005_06_html_me4ce41f.png]]



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



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

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).



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

* 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) =====



<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 â€" 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:

* 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) =====



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

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



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

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



* <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:

* 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) =====



<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>

* 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).



<u>Processing</u>

* 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.



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

* 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.



<u>Reports</u>

* Produces supervisory management, audit trail, data integrity, and
quality management and utilization review reports.

<font size="3">'''Laboratoryâ€"continued'''</font>



* 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.



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

* 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 =====



<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:

* 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:

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

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

</div>

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



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

<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>



<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:

* 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) =====



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

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.



<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>



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

* 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 =====



<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>

* <font face="Arial, sans-serif"><font size="2">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></font> * <font
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 Mental Health Assistant (MHA) Graphical User Interface (GUI):</u>

* 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.

<font face="Arial, sans-serif"><font size="3">'''Mental
Healthâ€"continued'''</font></font>

* <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>

<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>



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

The nursing software includes the following functionalities:

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

* <font face="Arial, sans-serif"><font size="2">Tracks staff
information.</font></font> * <font face="Arial, sans-serif"><font
size="2">Generates management reports on employees.</font></font> * <font
face="Arial, sans-serif"><font size="2">Accumulates daily statistics
on the number of patients treated.</font></font> * <font face="Arial,
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>



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

* <font face="Arial, sans-serif"><font size="2">Contains a patient
classification system which generates reports by bed section
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>



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

* <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>





===== Nutrition and Food Service (N&amp;FS) =====



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

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

* <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>

===== Oncology =====



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

<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>



<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>



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

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

* <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>









===== 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:

* 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 =====



<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>



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

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

* <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>

* <font face="Times New Roman, serif"><font size="3"><font
color="black"><font face="Arial, sans-serif"><font size="2">After
receiving invoice data into the warehouse,</font></font></font> <font
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>

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



* <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>

<font face="Arial, sans-serif"><font size="2">Both Interfaces include
the following features:</font></font>

* <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>





===== 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:

* 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 =====



<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>



* 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) =====





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

<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>



<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>



<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>



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

<font face="Arial, sans-serif"><font size="2">Pharmacy Benefits Management
contains the following:</font></font>

* <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>









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



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

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.



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

<font size="2">Pharmacy Data Management provides:</font>

* <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>







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



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



<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>



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

The Pharmacy Prescription Practices package:

* <font face="Arial, sans-serif"><font size="2">Alerts pharmacy personnel
to the existence of medications that may have been prescribed at other
facilities.</font></font> * <font face="Arial, sans-serif"><font
size="2">Builds a file of all patients currently registered at the
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>





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

</div>















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



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

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







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



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

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.



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

<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>



===== Scheduling =====



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

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.



<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.













===== Spinal Cord Dysfunction =====



<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.
* 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 =====



<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.

* 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) =====



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

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



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



<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>



<font face="Times New Roman, serif"><font size="3"><font face="Arial,
sans-serif"><font size="2">Data from encounter forms can be
inputted (into</font></font> <font face="Arial, sans-serif"><font
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>



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

* <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.



===== Beneficiary Travel =====



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

<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>



<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>



<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>



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

* 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) =====



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

<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>



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



<font face="Arial, sans-serif"><font size="2">CAPRI handles most
administrative aspects of the examination process.</font></font>



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

===== Current Procedural Terminology (CPT) =====



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

<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>



<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>



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

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

===== Decision Support System (DSS) Extracts =====



<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</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>



<font face="Times New Roman, serif"><font size="3"><font face="Arial,
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>



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

* <font size="3"><font size="2">Extracts data from the
following</font> <font size="2">VistA</font> <font size="2">software
packages:</font></font>

* 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 =====



<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 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>



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">'''Features'''</font>

* <font size="2">Provides annual updates that conform to the latest
release of the commercial grouper.</font> * 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 =====



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

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



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



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

* <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:

* 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 =====



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

<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 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) =====



<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.

* 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 =====



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

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.



<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.
* 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) =====



<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.





===== Personnel and Accounting Integrated Data (PAID) =====



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

<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.



<u>Education Tracking</u>

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.



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

<u>Enhanced Time and Attendance</u>

* 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. * Payroll may also manage
T&amp;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.



<u>Education Tracking</u>

* 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) =====



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

<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>



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



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



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

* <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>

==== Information and Education Systems ====





<font face="Times New Roman, serif"><font size="3"><font
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>

* <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>







===== 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:

* 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 =====



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

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.



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

* <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>













==== Cross-Cutting Monographs ====





<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>











































===== 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'''

* <font face="Arial, sans-serif"><font size="2">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></font> * <font face="Arial, sans-serif"><font
size="2">Produce system status reports and usage statistics.</font></font>
* <font face="Arial, sans-serif"><font size="2">Provide system
response time logging for performance management.</font></font> *
<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'''

* <font face="Arial, sans-serif"><font size="2">Customize and
tune site parameters for local requirements.</font></font> *
<font face="Arial, sans-serif"><font size="2">Provide a Kermit file
transfer utility.</font></font> * <font face="Arial, sans-serif"><font
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>

<font face="Arial, sans-serif"><font size="3">'''Kernel Toolkit â€"
continued'''</font></font>





<font face="Arial, sans-serif"><font size="3">'''Sample Capacity Planning
Report'''</font></font>

[[Image:vista_monograph2005_06_html_m4c39157b.gif]]<br clear="left"
/>













===== List Manager =====



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

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:

* <font face="Arial, sans-serif"><font size="2">Display a list of items
to the user.</font></font>

* <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>

* <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>



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



<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>



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

<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>

* <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>









===== MailMan =====



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

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



<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>



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

* <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>

=== Master Patient Index (MPI) and Master Patient Index/Patient
Demographics (MPI/PD) ===



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

<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>



<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>



<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>

* <font face="Arial, sans-serif"><font size="2">Master Patient Index
Austin Automation Center (AAC)</font></font> * <font face="Times New
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>



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

<font face="Arial, sans-serif"><font size="2">'''Master Patient Index
Austin Automation Center (AAC)'''</font></font>

* <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>



<font face="Arial, sans-serif"><font size="3">'''MPI and MPI/PD â€"
continued'''</font></font>



<font face="Times New 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">'''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>



<font face="Arial, sans-serif"><font size="2">'''Patient Demographics
(MPI/PD)'''</font></font>

* <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>





===== My Health''<u>e</u>''Vet =====



<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">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>



<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>



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

<font face="Arial, sans-serif"><font size="2"><u>Fall 2003
Release</u></font></font>

* <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>



<font face="Arial, sans-serif"><u>Summer 2004 Release</u></font>

* <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>



<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>



<font face="Arial, sans-serif"><font size="2"><u>Winter 2005
Release</u></font></font>

* <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>

===== Network Health Exchange (NHE) =====



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

<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>



<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>



<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>



<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>



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

* <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>

* <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>



===== Patient Data Exchange (PDX) =====



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

<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>



<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>



<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>



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

* <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>

* <font face="Arial, sans-serif"><font size="2">Allows
sending/requesting data for a patient from multiple sites for multiple
segments.</font></font>





===== Remote Procedure Call (RPC) Broker =====



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

<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>



<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>

* <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>



<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>



<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>



<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>

<font face="Arial, sans-serif"><font size="2">RPCs can:</font></font>

* <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>



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

* <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>

<font face="Arial, sans-serif"><font size="3">'''Remote Call Procedure
â€" continued'''</font></font>



* <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>

<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>

<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>

<font face="Arial, sans-serif"><font size="2">3. The RPC must itself be
authorized to the specified application context.</font></font>

* <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">

[#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>

</div><div>





</div>

== XO icons ==

[[Image:xo_s.png]]

Latest revision as of 18:29, 19 April 2008

Drew: I am John Stout in Denver Colorado, email johnstout@aol.com. My questions may not be of interest to your chatroom, so it may be best to reply to this address.

Apparently you have several XO users in the Seattle area. Did they buy theirs through last year's G1G1 program as I did? I have heard there is now a "GiveSome/GetSome" program. Can we designate where these XOs will go? And can we order less than blocks of 100?

I don't know any XO users in Denver. I have two XOs, but I have a group of earth scientists who are interested to invest in a critical mass of a dozen more XOs for training K-12 kids in Colorado. Can you advise me or do you know of a contact in Denverwho will help us?

My Brother-in-law lived on Bainbridge Island for years until he passed away late last fall. We plan another trip out there sometime next fall.

John Stout Adjunct Associate Professor of Geology Colorado School of Mines, Golden

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