HEC 2014 / James Peake: The Quality Journey of the U.S. Department of Veterans Affairs
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Health Quality Journey US Department of Veterans Affairs James B. Peake, M.D. Lieutenant General, USA (Ret) 6 th Secretary of Veterans Affairs President, CGI Federal CGI Healthcare Executive Circle 6 February 2014
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The presentation Dr. James Peake gave in the Healthcare Executive Circle 2014 -seminar in 6th of February, 2014. http://hec2014.fi/
Transcript of HEC 2014 / James Peake: The Quality Journey of the U.S. Department of Veterans Affairs
Health Quality Journey US
Department of Veterans
Affairs
James B Peake MD
Lieutenant General USA (Ret)
6th Secretary of Veterans Affairs
President CGI Federal
CGI
Healthcare
Executive
Circle
6 February
2014
THE ROAD TO A QUALITY HEALTH SYSTEM
LONG amp WINDING
bullMemorials amp Burials
bull Headstones amp
Markers
bull National Shrines
bull State Grants
bull Life Insurance
bull Home Mortgage
bull Education (GI Bill)
bull Comp amp Pension
bull Vocational Rehab
bull Employment Services
bull PrimarySpecialty Care
bull Long-Term Care
bull Rehabilitative Care
bull Health Promotion
bull Mental Health Services
bull Prosthetics Services
bull Medical Research
VA Major Business Lines
National Cemetery Administration
(NCA)
Veterans Benefits Administration
(VBA)
Veterans Health Administration
(VHA)
FY12 Total VA Funding $127 Billion
4
HEALTH amp
FIT
RETURN
TO
DUTY
SPECIALIZED
RECOVERY
LONG
TERM
REHAB
Two GREAT Systems
Two GREAT Missions
MILITARY HEALTH SYSTEM
DEPT OF DEFENSE
VETERANS HEALTH ADMIN
DEPT OF VETERANS AFFAIRS
FY 2012 End-of-Year Totals
Source FY 2012 End-of-Year Pocket Card 7
Enrolleeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip876 Million
Unique Patients Treatedhelliphelliphelliphelliphellip633 Million
Outpatient Visitshelliphelliphelliphelliphelliphelliphelliphelliphelliphellip836 Million
Outpatient Surgerieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip292500
Inpatient Admissionshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip703500
Lab Tests (Inpatient amp Outpatient)helliphelliphelliphelliphellip2683 Million
Prescriptions Dispensed (30-Day Equivalent)hellip2662 Million
Prosthetic Services Performedhelliphelliphelliphelliphelliphelliphellip145 Million
VArsquos Health Care Expertise VA is one of the largest civilian employers in the federal
government and one of the largest health care employers in
the world
277000+ Total VHA Employees
8 Includes registered nurses licensed practical
nurses and licensed vocational nurses
84000+ Veteran Employees
21000+ Physicians
67000+ Nurses
Academic Affiliations
May 1970
PREVENTION
WELLNESS
SURGICAL CARE
PATIENT SATISFACTION
EQUALITY OF CARE
TECHNOLOGY INNOVATION
HARVARD TO CBO
PREVENTION
WELLNESS
SURGICAL CARE
PATIENT SATISFACTION
EQUALITY OF CARE
TECHNOLOGY INNOVATION January 2007
Hospital System to Health System
In 1996 VA began the creation of
Veterans Integrated Service Networks
(VISNs)
Source FY 2012 End-of-Year Pocket Card 14
bull 134 Community Living
Centers
bull 300 Vet Centers
bull 152 Medical Centers
bull990 Outpatient Clinics 821 Community-Based
152 Hospital-Based
11 Mobile
6 Independent
bull 102 Domiciliary Residential
Rehabilitation Programs
bull 70 Mobile Vet Centers
Hospital System to Health System
N Engl J Med 2003 3482218-2227 May 29 2003
The VA Southeast Network proudly serves veterans in the tri-state area
which includes Alabama Georgia and South Carolina
Community Based Outpatient Clinics (Cbocs)
Shift To Ambulatory And Primary Care-
With Mental Health-
Augmented With Telemedicine
O M E T O W N S H
WOMENrsquoS HEALTH CLINIC
Better Access Better Care
Before After
Only Hospitals Hospitals
Outpatient Clinics
Mobile Clinics
Vet Centers
Mobile Vet
Centers
My HealtheVet
Hospital System Health System
20
ldquoKizer had cut more than half
of the 52000 hospital beds in
order to open 300 new
community clinics helping the
agency treat 700000 more
patientsrdquo
PATIENT CENTERED MEDICAL HOME
Continuity Through Team-based Care
Patient Access to Care
Care Management and Coordination
Patient Partnership
Patient Centered Medical Home
Patient Aligned Care Teams
The Evolution of VistA
24
bull 1977 ndash ANSI Standardization of MUMPS
bull 1977-78 ndash CASS ndash Computer Assisted System Staff
bull 1979-81 ndash Underground in the VA
bull 1981-82 Becoming
ldquoLegalrdquo
bull Decentralized Hospital Computer Program ndash DHCP lsquo82
VistA lsquo94
VistA Value
Open Source
25 Confidential
26
2009 VHA Quality and Safety Metrics
Metric 2009 2008 Benchmark
Unadjusted Mortality Acute Care 23 30 No national benchmark
2008 Kaiser-P study = 45
Unadjusted Mortality ICU 80 80 No national number- 2008
Kaiser-P study = 89 (other studies up
to 20 mortality)
Catheter Line Associated Bacteremia
(CLAB)
17 1000
Line days
215 1000
line days
No national benchmark recent
Nosocomial Infections Survey
Rate approx 18-2
Ventilator Associated Pneumonia (VAP) 2461000
Vent days
342 1000
Vent days
No benchmark in Q1 2004 VHA =
881000 vent days (72 decrease)
MRSA infections ndash Acute Care 037 1000
Bed days
No Data No benchmark in Oct 2007
VHA=0531000 days (32 decrease)
MRSA Infections ndash ICU 061 1000
Bed days
No Data No benchmark in Oct 2007
VHA=1821000 days (67 decrease)
MRSA Screening ndash ICU Acute Care 94 93 No Data None
DVT prevention (high risk non-
operative acute care)
68 57 Literature approx 30-40
ICU non-operative DVT prevention 763 680 Literature approx 30-40
Acute care Length of Stay 421 days 439 days Medicare average approx 49 days
Areas in Green highlight substantial improvement
The Value Continues 2012
Clinical Indicator VA Average Percent (1) HEDIS 2011 (2) DELTA
2012 (6) 2011 (6) 2010 (6)
Commercial (7)
Medicare (7)
Medicaid (7)
RAW Breast Cancer Screening 87 85 87 71 69 50 16 23 Cervical Cancer Screening 93 93 94 77 na 67 16 21 Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Control (lt100 mgdL) 70 71 69 59 57 42
11 19
Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Screening 96 96 96 88 89 82 8 9
Colorectal Cancer Screening 82 82 82 62 60 na 20 32 Comprehensive Diabetes Care - Blood Pressure Control
(lt14090) 80 81 82 66 63 61 14 21
Comprehensive Diabetes Care - Eye Exams 90 90 91 57 66 53 33 58 Comprehensive Diabetes Care - HbA1c Testing 98 99 90 91 83 8 9 Comprehensive Diabetes Care - LDL-C Controlled (LDL-Clt100
mgdL) 68 69 70 48 53 35 20 42
Comprehensive Diabetes Care - LDL-C Screening 97 97 97 85 88 75 12 14 Comprehensive Diabetes Care - Medical Attention for
Nephropathy 95 95 96 84 90 78 11 13
Comprehensive Diabetes Care - Poor HbA1c Control (8) 19 17 15 28 27 43 (9) -32 Controlling High Blood Pressure - Total 77 78 79 65 64 57 12 18 Medical Assistance with Smoking Cessation - Advising
Smokers To Quit 3 96 97 97 77 na 76 19 25
Medical Assistance with Smoking Cessation - Discussing
Medications 94 94 94 53 na 44 41 77
Medical Assistance with Smoking Cessation - Discussing
Strategies 3 96 97 97 48 na 40 48 100
Flu Shots for Adults (50-64) 3 65 65 71 53 na na 12 23 Flu Shots for Adults (65 and older) 3 4 5 76 79 82 na 69 na 7 10 Immunizations Pneumococcal 34 5 93 94 95 na 69 na 24 35
SOURCE Office of Analytics and Business Intelligence Updated 11282012
Power of
Information
What we donrsquot know WILL hurt us
Act Decisively
Knowledge Data
TIME
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
THE ROAD TO A QUALITY HEALTH SYSTEM
LONG amp WINDING
bullMemorials amp Burials
bull Headstones amp
Markers
bull National Shrines
bull State Grants
bull Life Insurance
bull Home Mortgage
bull Education (GI Bill)
bull Comp amp Pension
bull Vocational Rehab
bull Employment Services
bull PrimarySpecialty Care
bull Long-Term Care
bull Rehabilitative Care
bull Health Promotion
bull Mental Health Services
bull Prosthetics Services
bull Medical Research
VA Major Business Lines
National Cemetery Administration
(NCA)
Veterans Benefits Administration
(VBA)
Veterans Health Administration
(VHA)
FY12 Total VA Funding $127 Billion
4
HEALTH amp
FIT
RETURN
TO
DUTY
SPECIALIZED
RECOVERY
LONG
TERM
REHAB
Two GREAT Systems
Two GREAT Missions
MILITARY HEALTH SYSTEM
DEPT OF DEFENSE
VETERANS HEALTH ADMIN
DEPT OF VETERANS AFFAIRS
FY 2012 End-of-Year Totals
Source FY 2012 End-of-Year Pocket Card 7
Enrolleeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip876 Million
Unique Patients Treatedhelliphelliphelliphelliphellip633 Million
Outpatient Visitshelliphelliphelliphelliphelliphelliphelliphelliphelliphellip836 Million
Outpatient Surgerieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip292500
Inpatient Admissionshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip703500
Lab Tests (Inpatient amp Outpatient)helliphelliphelliphelliphellip2683 Million
Prescriptions Dispensed (30-Day Equivalent)hellip2662 Million
Prosthetic Services Performedhelliphelliphelliphelliphelliphelliphellip145 Million
VArsquos Health Care Expertise VA is one of the largest civilian employers in the federal
government and one of the largest health care employers in
the world
277000+ Total VHA Employees
8 Includes registered nurses licensed practical
nurses and licensed vocational nurses
84000+ Veteran Employees
21000+ Physicians
67000+ Nurses
Academic Affiliations
May 1970
PREVENTION
WELLNESS
SURGICAL CARE
PATIENT SATISFACTION
EQUALITY OF CARE
TECHNOLOGY INNOVATION
HARVARD TO CBO
PREVENTION
WELLNESS
SURGICAL CARE
PATIENT SATISFACTION
EQUALITY OF CARE
TECHNOLOGY INNOVATION January 2007
Hospital System to Health System
In 1996 VA began the creation of
Veterans Integrated Service Networks
(VISNs)
Source FY 2012 End-of-Year Pocket Card 14
bull 134 Community Living
Centers
bull 300 Vet Centers
bull 152 Medical Centers
bull990 Outpatient Clinics 821 Community-Based
152 Hospital-Based
11 Mobile
6 Independent
bull 102 Domiciliary Residential
Rehabilitation Programs
bull 70 Mobile Vet Centers
Hospital System to Health System
N Engl J Med 2003 3482218-2227 May 29 2003
The VA Southeast Network proudly serves veterans in the tri-state area
which includes Alabama Georgia and South Carolina
Community Based Outpatient Clinics (Cbocs)
Shift To Ambulatory And Primary Care-
With Mental Health-
Augmented With Telemedicine
O M E T O W N S H
WOMENrsquoS HEALTH CLINIC
Better Access Better Care
Before After
Only Hospitals Hospitals
Outpatient Clinics
Mobile Clinics
Vet Centers
Mobile Vet
Centers
My HealtheVet
Hospital System Health System
20
ldquoKizer had cut more than half
of the 52000 hospital beds in
order to open 300 new
community clinics helping the
agency treat 700000 more
patientsrdquo
PATIENT CENTERED MEDICAL HOME
Continuity Through Team-based Care
Patient Access to Care
Care Management and Coordination
Patient Partnership
Patient Centered Medical Home
Patient Aligned Care Teams
The Evolution of VistA
24
bull 1977 ndash ANSI Standardization of MUMPS
bull 1977-78 ndash CASS ndash Computer Assisted System Staff
bull 1979-81 ndash Underground in the VA
bull 1981-82 Becoming
ldquoLegalrdquo
bull Decentralized Hospital Computer Program ndash DHCP lsquo82
VistA lsquo94
VistA Value
Open Source
25 Confidential
26
2009 VHA Quality and Safety Metrics
Metric 2009 2008 Benchmark
Unadjusted Mortality Acute Care 23 30 No national benchmark
2008 Kaiser-P study = 45
Unadjusted Mortality ICU 80 80 No national number- 2008
Kaiser-P study = 89 (other studies up
to 20 mortality)
Catheter Line Associated Bacteremia
(CLAB)
17 1000
Line days
215 1000
line days
No national benchmark recent
Nosocomial Infections Survey
Rate approx 18-2
Ventilator Associated Pneumonia (VAP) 2461000
Vent days
342 1000
Vent days
No benchmark in Q1 2004 VHA =
881000 vent days (72 decrease)
MRSA infections ndash Acute Care 037 1000
Bed days
No Data No benchmark in Oct 2007
VHA=0531000 days (32 decrease)
MRSA Infections ndash ICU 061 1000
Bed days
No Data No benchmark in Oct 2007
VHA=1821000 days (67 decrease)
MRSA Screening ndash ICU Acute Care 94 93 No Data None
DVT prevention (high risk non-
operative acute care)
68 57 Literature approx 30-40
ICU non-operative DVT prevention 763 680 Literature approx 30-40
Acute care Length of Stay 421 days 439 days Medicare average approx 49 days
Areas in Green highlight substantial improvement
The Value Continues 2012
Clinical Indicator VA Average Percent (1) HEDIS 2011 (2) DELTA
2012 (6) 2011 (6) 2010 (6)
Commercial (7)
Medicare (7)
Medicaid (7)
RAW Breast Cancer Screening 87 85 87 71 69 50 16 23 Cervical Cancer Screening 93 93 94 77 na 67 16 21 Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Control (lt100 mgdL) 70 71 69 59 57 42
11 19
Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Screening 96 96 96 88 89 82 8 9
Colorectal Cancer Screening 82 82 82 62 60 na 20 32 Comprehensive Diabetes Care - Blood Pressure Control
(lt14090) 80 81 82 66 63 61 14 21
Comprehensive Diabetes Care - Eye Exams 90 90 91 57 66 53 33 58 Comprehensive Diabetes Care - HbA1c Testing 98 99 90 91 83 8 9 Comprehensive Diabetes Care - LDL-C Controlled (LDL-Clt100
mgdL) 68 69 70 48 53 35 20 42
Comprehensive Diabetes Care - LDL-C Screening 97 97 97 85 88 75 12 14 Comprehensive Diabetes Care - Medical Attention for
Nephropathy 95 95 96 84 90 78 11 13
Comprehensive Diabetes Care - Poor HbA1c Control (8) 19 17 15 28 27 43 (9) -32 Controlling High Blood Pressure - Total 77 78 79 65 64 57 12 18 Medical Assistance with Smoking Cessation - Advising
Smokers To Quit 3 96 97 97 77 na 76 19 25
Medical Assistance with Smoking Cessation - Discussing
Medications 94 94 94 53 na 44 41 77
Medical Assistance with Smoking Cessation - Discussing
Strategies 3 96 97 97 48 na 40 48 100
Flu Shots for Adults (50-64) 3 65 65 71 53 na na 12 23 Flu Shots for Adults (65 and older) 3 4 5 76 79 82 na 69 na 7 10 Immunizations Pneumococcal 34 5 93 94 95 na 69 na 24 35
SOURCE Office of Analytics and Business Intelligence Updated 11282012
Power of
Information
What we donrsquot know WILL hurt us
Act Decisively
Knowledge Data
TIME
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
bullMemorials amp Burials
bull Headstones amp
Markers
bull National Shrines
bull State Grants
bull Life Insurance
bull Home Mortgage
bull Education (GI Bill)
bull Comp amp Pension
bull Vocational Rehab
bull Employment Services
bull PrimarySpecialty Care
bull Long-Term Care
bull Rehabilitative Care
bull Health Promotion
bull Mental Health Services
bull Prosthetics Services
bull Medical Research
VA Major Business Lines
National Cemetery Administration
(NCA)
Veterans Benefits Administration
(VBA)
Veterans Health Administration
(VHA)
FY12 Total VA Funding $127 Billion
4
HEALTH amp
FIT
RETURN
TO
DUTY
SPECIALIZED
RECOVERY
LONG
TERM
REHAB
Two GREAT Systems
Two GREAT Missions
MILITARY HEALTH SYSTEM
DEPT OF DEFENSE
VETERANS HEALTH ADMIN
DEPT OF VETERANS AFFAIRS
FY 2012 End-of-Year Totals
Source FY 2012 End-of-Year Pocket Card 7
Enrolleeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip876 Million
Unique Patients Treatedhelliphelliphelliphelliphellip633 Million
Outpatient Visitshelliphelliphelliphelliphelliphelliphelliphelliphelliphellip836 Million
Outpatient Surgerieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip292500
Inpatient Admissionshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip703500
Lab Tests (Inpatient amp Outpatient)helliphelliphelliphelliphellip2683 Million
Prescriptions Dispensed (30-Day Equivalent)hellip2662 Million
Prosthetic Services Performedhelliphelliphelliphelliphelliphelliphellip145 Million
VArsquos Health Care Expertise VA is one of the largest civilian employers in the federal
government and one of the largest health care employers in
the world
277000+ Total VHA Employees
8 Includes registered nurses licensed practical
nurses and licensed vocational nurses
84000+ Veteran Employees
21000+ Physicians
67000+ Nurses
Academic Affiliations
May 1970
PREVENTION
WELLNESS
SURGICAL CARE
PATIENT SATISFACTION
EQUALITY OF CARE
TECHNOLOGY INNOVATION
HARVARD TO CBO
PREVENTION
WELLNESS
SURGICAL CARE
PATIENT SATISFACTION
EQUALITY OF CARE
TECHNOLOGY INNOVATION January 2007
Hospital System to Health System
In 1996 VA began the creation of
Veterans Integrated Service Networks
(VISNs)
Source FY 2012 End-of-Year Pocket Card 14
bull 134 Community Living
Centers
bull 300 Vet Centers
bull 152 Medical Centers
bull990 Outpatient Clinics 821 Community-Based
152 Hospital-Based
11 Mobile
6 Independent
bull 102 Domiciliary Residential
Rehabilitation Programs
bull 70 Mobile Vet Centers
Hospital System to Health System
N Engl J Med 2003 3482218-2227 May 29 2003
The VA Southeast Network proudly serves veterans in the tri-state area
which includes Alabama Georgia and South Carolina
Community Based Outpatient Clinics (Cbocs)
Shift To Ambulatory And Primary Care-
With Mental Health-
Augmented With Telemedicine
O M E T O W N S H
WOMENrsquoS HEALTH CLINIC
Better Access Better Care
Before After
Only Hospitals Hospitals
Outpatient Clinics
Mobile Clinics
Vet Centers
Mobile Vet
Centers
My HealtheVet
Hospital System Health System
20
ldquoKizer had cut more than half
of the 52000 hospital beds in
order to open 300 new
community clinics helping the
agency treat 700000 more
patientsrdquo
PATIENT CENTERED MEDICAL HOME
Continuity Through Team-based Care
Patient Access to Care
Care Management and Coordination
Patient Partnership
Patient Centered Medical Home
Patient Aligned Care Teams
The Evolution of VistA
24
bull 1977 ndash ANSI Standardization of MUMPS
bull 1977-78 ndash CASS ndash Computer Assisted System Staff
bull 1979-81 ndash Underground in the VA
bull 1981-82 Becoming
ldquoLegalrdquo
bull Decentralized Hospital Computer Program ndash DHCP lsquo82
VistA lsquo94
VistA Value
Open Source
25 Confidential
26
2009 VHA Quality and Safety Metrics
Metric 2009 2008 Benchmark
Unadjusted Mortality Acute Care 23 30 No national benchmark
2008 Kaiser-P study = 45
Unadjusted Mortality ICU 80 80 No national number- 2008
Kaiser-P study = 89 (other studies up
to 20 mortality)
Catheter Line Associated Bacteremia
(CLAB)
17 1000
Line days
215 1000
line days
No national benchmark recent
Nosocomial Infections Survey
Rate approx 18-2
Ventilator Associated Pneumonia (VAP) 2461000
Vent days
342 1000
Vent days
No benchmark in Q1 2004 VHA =
881000 vent days (72 decrease)
MRSA infections ndash Acute Care 037 1000
Bed days
No Data No benchmark in Oct 2007
VHA=0531000 days (32 decrease)
MRSA Infections ndash ICU 061 1000
Bed days
No Data No benchmark in Oct 2007
VHA=1821000 days (67 decrease)
MRSA Screening ndash ICU Acute Care 94 93 No Data None
DVT prevention (high risk non-
operative acute care)
68 57 Literature approx 30-40
ICU non-operative DVT prevention 763 680 Literature approx 30-40
Acute care Length of Stay 421 days 439 days Medicare average approx 49 days
Areas in Green highlight substantial improvement
The Value Continues 2012
Clinical Indicator VA Average Percent (1) HEDIS 2011 (2) DELTA
2012 (6) 2011 (6) 2010 (6)
Commercial (7)
Medicare (7)
Medicaid (7)
RAW Breast Cancer Screening 87 85 87 71 69 50 16 23 Cervical Cancer Screening 93 93 94 77 na 67 16 21 Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Control (lt100 mgdL) 70 71 69 59 57 42
11 19
Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Screening 96 96 96 88 89 82 8 9
Colorectal Cancer Screening 82 82 82 62 60 na 20 32 Comprehensive Diabetes Care - Blood Pressure Control
(lt14090) 80 81 82 66 63 61 14 21
Comprehensive Diabetes Care - Eye Exams 90 90 91 57 66 53 33 58 Comprehensive Diabetes Care - HbA1c Testing 98 99 90 91 83 8 9 Comprehensive Diabetes Care - LDL-C Controlled (LDL-Clt100
mgdL) 68 69 70 48 53 35 20 42
Comprehensive Diabetes Care - LDL-C Screening 97 97 97 85 88 75 12 14 Comprehensive Diabetes Care - Medical Attention for
Nephropathy 95 95 96 84 90 78 11 13
Comprehensive Diabetes Care - Poor HbA1c Control (8) 19 17 15 28 27 43 (9) -32 Controlling High Blood Pressure - Total 77 78 79 65 64 57 12 18 Medical Assistance with Smoking Cessation - Advising
Smokers To Quit 3 96 97 97 77 na 76 19 25
Medical Assistance with Smoking Cessation - Discussing
Medications 94 94 94 53 na 44 41 77
Medical Assistance with Smoking Cessation - Discussing
Strategies 3 96 97 97 48 na 40 48 100
Flu Shots for Adults (50-64) 3 65 65 71 53 na na 12 23 Flu Shots for Adults (65 and older) 3 4 5 76 79 82 na 69 na 7 10 Immunizations Pneumococcal 34 5 93 94 95 na 69 na 24 35
SOURCE Office of Analytics and Business Intelligence Updated 11282012
Power of
Information
What we donrsquot know WILL hurt us
Act Decisively
Knowledge Data
TIME
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
HEALTH amp
FIT
RETURN
TO
DUTY
SPECIALIZED
RECOVERY
LONG
TERM
REHAB
Two GREAT Systems
Two GREAT Missions
MILITARY HEALTH SYSTEM
DEPT OF DEFENSE
VETERANS HEALTH ADMIN
DEPT OF VETERANS AFFAIRS
FY 2012 End-of-Year Totals
Source FY 2012 End-of-Year Pocket Card 7
Enrolleeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip876 Million
Unique Patients Treatedhelliphelliphelliphelliphellip633 Million
Outpatient Visitshelliphelliphelliphelliphelliphelliphelliphelliphelliphellip836 Million
Outpatient Surgerieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip292500
Inpatient Admissionshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip703500
Lab Tests (Inpatient amp Outpatient)helliphelliphelliphelliphellip2683 Million
Prescriptions Dispensed (30-Day Equivalent)hellip2662 Million
Prosthetic Services Performedhelliphelliphelliphelliphelliphelliphellip145 Million
VArsquos Health Care Expertise VA is one of the largest civilian employers in the federal
government and one of the largest health care employers in
the world
277000+ Total VHA Employees
8 Includes registered nurses licensed practical
nurses and licensed vocational nurses
84000+ Veteran Employees
21000+ Physicians
67000+ Nurses
Academic Affiliations
May 1970
PREVENTION
WELLNESS
SURGICAL CARE
PATIENT SATISFACTION
EQUALITY OF CARE
TECHNOLOGY INNOVATION
HARVARD TO CBO
PREVENTION
WELLNESS
SURGICAL CARE
PATIENT SATISFACTION
EQUALITY OF CARE
TECHNOLOGY INNOVATION January 2007
Hospital System to Health System
In 1996 VA began the creation of
Veterans Integrated Service Networks
(VISNs)
Source FY 2012 End-of-Year Pocket Card 14
bull 134 Community Living
Centers
bull 300 Vet Centers
bull 152 Medical Centers
bull990 Outpatient Clinics 821 Community-Based
152 Hospital-Based
11 Mobile
6 Independent
bull 102 Domiciliary Residential
Rehabilitation Programs
bull 70 Mobile Vet Centers
Hospital System to Health System
N Engl J Med 2003 3482218-2227 May 29 2003
The VA Southeast Network proudly serves veterans in the tri-state area
which includes Alabama Georgia and South Carolina
Community Based Outpatient Clinics (Cbocs)
Shift To Ambulatory And Primary Care-
With Mental Health-
Augmented With Telemedicine
O M E T O W N S H
WOMENrsquoS HEALTH CLINIC
Better Access Better Care
Before After
Only Hospitals Hospitals
Outpatient Clinics
Mobile Clinics
Vet Centers
Mobile Vet
Centers
My HealtheVet
Hospital System Health System
20
ldquoKizer had cut more than half
of the 52000 hospital beds in
order to open 300 new
community clinics helping the
agency treat 700000 more
patientsrdquo
PATIENT CENTERED MEDICAL HOME
Continuity Through Team-based Care
Patient Access to Care
Care Management and Coordination
Patient Partnership
Patient Centered Medical Home
Patient Aligned Care Teams
The Evolution of VistA
24
bull 1977 ndash ANSI Standardization of MUMPS
bull 1977-78 ndash CASS ndash Computer Assisted System Staff
bull 1979-81 ndash Underground in the VA
bull 1981-82 Becoming
ldquoLegalrdquo
bull Decentralized Hospital Computer Program ndash DHCP lsquo82
VistA lsquo94
VistA Value
Open Source
25 Confidential
26
2009 VHA Quality and Safety Metrics
Metric 2009 2008 Benchmark
Unadjusted Mortality Acute Care 23 30 No national benchmark
2008 Kaiser-P study = 45
Unadjusted Mortality ICU 80 80 No national number- 2008
Kaiser-P study = 89 (other studies up
to 20 mortality)
Catheter Line Associated Bacteremia
(CLAB)
17 1000
Line days
215 1000
line days
No national benchmark recent
Nosocomial Infections Survey
Rate approx 18-2
Ventilator Associated Pneumonia (VAP) 2461000
Vent days
342 1000
Vent days
No benchmark in Q1 2004 VHA =
881000 vent days (72 decrease)
MRSA infections ndash Acute Care 037 1000
Bed days
No Data No benchmark in Oct 2007
VHA=0531000 days (32 decrease)
MRSA Infections ndash ICU 061 1000
Bed days
No Data No benchmark in Oct 2007
VHA=1821000 days (67 decrease)
MRSA Screening ndash ICU Acute Care 94 93 No Data None
DVT prevention (high risk non-
operative acute care)
68 57 Literature approx 30-40
ICU non-operative DVT prevention 763 680 Literature approx 30-40
Acute care Length of Stay 421 days 439 days Medicare average approx 49 days
Areas in Green highlight substantial improvement
The Value Continues 2012
Clinical Indicator VA Average Percent (1) HEDIS 2011 (2) DELTA
2012 (6) 2011 (6) 2010 (6)
Commercial (7)
Medicare (7)
Medicaid (7)
RAW Breast Cancer Screening 87 85 87 71 69 50 16 23 Cervical Cancer Screening 93 93 94 77 na 67 16 21 Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Control (lt100 mgdL) 70 71 69 59 57 42
11 19
Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Screening 96 96 96 88 89 82 8 9
Colorectal Cancer Screening 82 82 82 62 60 na 20 32 Comprehensive Diabetes Care - Blood Pressure Control
(lt14090) 80 81 82 66 63 61 14 21
Comprehensive Diabetes Care - Eye Exams 90 90 91 57 66 53 33 58 Comprehensive Diabetes Care - HbA1c Testing 98 99 90 91 83 8 9 Comprehensive Diabetes Care - LDL-C Controlled (LDL-Clt100
mgdL) 68 69 70 48 53 35 20 42
Comprehensive Diabetes Care - LDL-C Screening 97 97 97 85 88 75 12 14 Comprehensive Diabetes Care - Medical Attention for
Nephropathy 95 95 96 84 90 78 11 13
Comprehensive Diabetes Care - Poor HbA1c Control (8) 19 17 15 28 27 43 (9) -32 Controlling High Blood Pressure - Total 77 78 79 65 64 57 12 18 Medical Assistance with Smoking Cessation - Advising
Smokers To Quit 3 96 97 97 77 na 76 19 25
Medical Assistance with Smoking Cessation - Discussing
Medications 94 94 94 53 na 44 41 77
Medical Assistance with Smoking Cessation - Discussing
Strategies 3 96 97 97 48 na 40 48 100
Flu Shots for Adults (50-64) 3 65 65 71 53 na na 12 23 Flu Shots for Adults (65 and older) 3 4 5 76 79 82 na 69 na 7 10 Immunizations Pneumococcal 34 5 93 94 95 na 69 na 24 35
SOURCE Office of Analytics and Business Intelligence Updated 11282012
Power of
Information
What we donrsquot know WILL hurt us
Act Decisively
Knowledge Data
TIME
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
FY 2012 End-of-Year Totals
Source FY 2012 End-of-Year Pocket Card 7
Enrolleeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip876 Million
Unique Patients Treatedhelliphelliphelliphelliphellip633 Million
Outpatient Visitshelliphelliphelliphelliphelliphelliphelliphelliphelliphellip836 Million
Outpatient Surgerieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip292500
Inpatient Admissionshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip703500
Lab Tests (Inpatient amp Outpatient)helliphelliphelliphelliphellip2683 Million
Prescriptions Dispensed (30-Day Equivalent)hellip2662 Million
Prosthetic Services Performedhelliphelliphelliphelliphelliphelliphellip145 Million
VArsquos Health Care Expertise VA is one of the largest civilian employers in the federal
government and one of the largest health care employers in
the world
277000+ Total VHA Employees
8 Includes registered nurses licensed practical
nurses and licensed vocational nurses
84000+ Veteran Employees
21000+ Physicians
67000+ Nurses
Academic Affiliations
May 1970
PREVENTION
WELLNESS
SURGICAL CARE
PATIENT SATISFACTION
EQUALITY OF CARE
TECHNOLOGY INNOVATION
HARVARD TO CBO
PREVENTION
WELLNESS
SURGICAL CARE
PATIENT SATISFACTION
EQUALITY OF CARE
TECHNOLOGY INNOVATION January 2007
Hospital System to Health System
In 1996 VA began the creation of
Veterans Integrated Service Networks
(VISNs)
Source FY 2012 End-of-Year Pocket Card 14
bull 134 Community Living
Centers
bull 300 Vet Centers
bull 152 Medical Centers
bull990 Outpatient Clinics 821 Community-Based
152 Hospital-Based
11 Mobile
6 Independent
bull 102 Domiciliary Residential
Rehabilitation Programs
bull 70 Mobile Vet Centers
Hospital System to Health System
N Engl J Med 2003 3482218-2227 May 29 2003
The VA Southeast Network proudly serves veterans in the tri-state area
which includes Alabama Georgia and South Carolina
Community Based Outpatient Clinics (Cbocs)
Shift To Ambulatory And Primary Care-
With Mental Health-
Augmented With Telemedicine
O M E T O W N S H
WOMENrsquoS HEALTH CLINIC
Better Access Better Care
Before After
Only Hospitals Hospitals
Outpatient Clinics
Mobile Clinics
Vet Centers
Mobile Vet
Centers
My HealtheVet
Hospital System Health System
20
ldquoKizer had cut more than half
of the 52000 hospital beds in
order to open 300 new
community clinics helping the
agency treat 700000 more
patientsrdquo
PATIENT CENTERED MEDICAL HOME
Continuity Through Team-based Care
Patient Access to Care
Care Management and Coordination
Patient Partnership
Patient Centered Medical Home
Patient Aligned Care Teams
The Evolution of VistA
24
bull 1977 ndash ANSI Standardization of MUMPS
bull 1977-78 ndash CASS ndash Computer Assisted System Staff
bull 1979-81 ndash Underground in the VA
bull 1981-82 Becoming
ldquoLegalrdquo
bull Decentralized Hospital Computer Program ndash DHCP lsquo82
VistA lsquo94
VistA Value
Open Source
25 Confidential
26
2009 VHA Quality and Safety Metrics
Metric 2009 2008 Benchmark
Unadjusted Mortality Acute Care 23 30 No national benchmark
2008 Kaiser-P study = 45
Unadjusted Mortality ICU 80 80 No national number- 2008
Kaiser-P study = 89 (other studies up
to 20 mortality)
Catheter Line Associated Bacteremia
(CLAB)
17 1000
Line days
215 1000
line days
No national benchmark recent
Nosocomial Infections Survey
Rate approx 18-2
Ventilator Associated Pneumonia (VAP) 2461000
Vent days
342 1000
Vent days
No benchmark in Q1 2004 VHA =
881000 vent days (72 decrease)
MRSA infections ndash Acute Care 037 1000
Bed days
No Data No benchmark in Oct 2007
VHA=0531000 days (32 decrease)
MRSA Infections ndash ICU 061 1000
Bed days
No Data No benchmark in Oct 2007
VHA=1821000 days (67 decrease)
MRSA Screening ndash ICU Acute Care 94 93 No Data None
DVT prevention (high risk non-
operative acute care)
68 57 Literature approx 30-40
ICU non-operative DVT prevention 763 680 Literature approx 30-40
Acute care Length of Stay 421 days 439 days Medicare average approx 49 days
Areas in Green highlight substantial improvement
The Value Continues 2012
Clinical Indicator VA Average Percent (1) HEDIS 2011 (2) DELTA
2012 (6) 2011 (6) 2010 (6)
Commercial (7)
Medicare (7)
Medicaid (7)
RAW Breast Cancer Screening 87 85 87 71 69 50 16 23 Cervical Cancer Screening 93 93 94 77 na 67 16 21 Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Control (lt100 mgdL) 70 71 69 59 57 42
11 19
Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Screening 96 96 96 88 89 82 8 9
Colorectal Cancer Screening 82 82 82 62 60 na 20 32 Comprehensive Diabetes Care - Blood Pressure Control
(lt14090) 80 81 82 66 63 61 14 21
Comprehensive Diabetes Care - Eye Exams 90 90 91 57 66 53 33 58 Comprehensive Diabetes Care - HbA1c Testing 98 99 90 91 83 8 9 Comprehensive Diabetes Care - LDL-C Controlled (LDL-Clt100
mgdL) 68 69 70 48 53 35 20 42
Comprehensive Diabetes Care - LDL-C Screening 97 97 97 85 88 75 12 14 Comprehensive Diabetes Care - Medical Attention for
Nephropathy 95 95 96 84 90 78 11 13
Comprehensive Diabetes Care - Poor HbA1c Control (8) 19 17 15 28 27 43 (9) -32 Controlling High Blood Pressure - Total 77 78 79 65 64 57 12 18 Medical Assistance with Smoking Cessation - Advising
Smokers To Quit 3 96 97 97 77 na 76 19 25
Medical Assistance with Smoking Cessation - Discussing
Medications 94 94 94 53 na 44 41 77
Medical Assistance with Smoking Cessation - Discussing
Strategies 3 96 97 97 48 na 40 48 100
Flu Shots for Adults (50-64) 3 65 65 71 53 na na 12 23 Flu Shots for Adults (65 and older) 3 4 5 76 79 82 na 69 na 7 10 Immunizations Pneumococcal 34 5 93 94 95 na 69 na 24 35
SOURCE Office of Analytics and Business Intelligence Updated 11282012
Power of
Information
What we donrsquot know WILL hurt us
Act Decisively
Knowledge Data
TIME
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
VArsquos Health Care Expertise VA is one of the largest civilian employers in the federal
government and one of the largest health care employers in
the world
277000+ Total VHA Employees
8 Includes registered nurses licensed practical
nurses and licensed vocational nurses
84000+ Veteran Employees
21000+ Physicians
67000+ Nurses
Academic Affiliations
May 1970
PREVENTION
WELLNESS
SURGICAL CARE
PATIENT SATISFACTION
EQUALITY OF CARE
TECHNOLOGY INNOVATION
HARVARD TO CBO
PREVENTION
WELLNESS
SURGICAL CARE
PATIENT SATISFACTION
EQUALITY OF CARE
TECHNOLOGY INNOVATION January 2007
Hospital System to Health System
In 1996 VA began the creation of
Veterans Integrated Service Networks
(VISNs)
Source FY 2012 End-of-Year Pocket Card 14
bull 134 Community Living
Centers
bull 300 Vet Centers
bull 152 Medical Centers
bull990 Outpatient Clinics 821 Community-Based
152 Hospital-Based
11 Mobile
6 Independent
bull 102 Domiciliary Residential
Rehabilitation Programs
bull 70 Mobile Vet Centers
Hospital System to Health System
N Engl J Med 2003 3482218-2227 May 29 2003
The VA Southeast Network proudly serves veterans in the tri-state area
which includes Alabama Georgia and South Carolina
Community Based Outpatient Clinics (Cbocs)
Shift To Ambulatory And Primary Care-
With Mental Health-
Augmented With Telemedicine
O M E T O W N S H
WOMENrsquoS HEALTH CLINIC
Better Access Better Care
Before After
Only Hospitals Hospitals
Outpatient Clinics
Mobile Clinics
Vet Centers
Mobile Vet
Centers
My HealtheVet
Hospital System Health System
20
ldquoKizer had cut more than half
of the 52000 hospital beds in
order to open 300 new
community clinics helping the
agency treat 700000 more
patientsrdquo
PATIENT CENTERED MEDICAL HOME
Continuity Through Team-based Care
Patient Access to Care
Care Management and Coordination
Patient Partnership
Patient Centered Medical Home
Patient Aligned Care Teams
The Evolution of VistA
24
bull 1977 ndash ANSI Standardization of MUMPS
bull 1977-78 ndash CASS ndash Computer Assisted System Staff
bull 1979-81 ndash Underground in the VA
bull 1981-82 Becoming
ldquoLegalrdquo
bull Decentralized Hospital Computer Program ndash DHCP lsquo82
VistA lsquo94
VistA Value
Open Source
25 Confidential
26
2009 VHA Quality and Safety Metrics
Metric 2009 2008 Benchmark
Unadjusted Mortality Acute Care 23 30 No national benchmark
2008 Kaiser-P study = 45
Unadjusted Mortality ICU 80 80 No national number- 2008
Kaiser-P study = 89 (other studies up
to 20 mortality)
Catheter Line Associated Bacteremia
(CLAB)
17 1000
Line days
215 1000
line days
No national benchmark recent
Nosocomial Infections Survey
Rate approx 18-2
Ventilator Associated Pneumonia (VAP) 2461000
Vent days
342 1000
Vent days
No benchmark in Q1 2004 VHA =
881000 vent days (72 decrease)
MRSA infections ndash Acute Care 037 1000
Bed days
No Data No benchmark in Oct 2007
VHA=0531000 days (32 decrease)
MRSA Infections ndash ICU 061 1000
Bed days
No Data No benchmark in Oct 2007
VHA=1821000 days (67 decrease)
MRSA Screening ndash ICU Acute Care 94 93 No Data None
DVT prevention (high risk non-
operative acute care)
68 57 Literature approx 30-40
ICU non-operative DVT prevention 763 680 Literature approx 30-40
Acute care Length of Stay 421 days 439 days Medicare average approx 49 days
Areas in Green highlight substantial improvement
The Value Continues 2012
Clinical Indicator VA Average Percent (1) HEDIS 2011 (2) DELTA
2012 (6) 2011 (6) 2010 (6)
Commercial (7)
Medicare (7)
Medicaid (7)
RAW Breast Cancer Screening 87 85 87 71 69 50 16 23 Cervical Cancer Screening 93 93 94 77 na 67 16 21 Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Control (lt100 mgdL) 70 71 69 59 57 42
11 19
Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Screening 96 96 96 88 89 82 8 9
Colorectal Cancer Screening 82 82 82 62 60 na 20 32 Comprehensive Diabetes Care - Blood Pressure Control
(lt14090) 80 81 82 66 63 61 14 21
Comprehensive Diabetes Care - Eye Exams 90 90 91 57 66 53 33 58 Comprehensive Diabetes Care - HbA1c Testing 98 99 90 91 83 8 9 Comprehensive Diabetes Care - LDL-C Controlled (LDL-Clt100
mgdL) 68 69 70 48 53 35 20 42
Comprehensive Diabetes Care - LDL-C Screening 97 97 97 85 88 75 12 14 Comprehensive Diabetes Care - Medical Attention for
Nephropathy 95 95 96 84 90 78 11 13
Comprehensive Diabetes Care - Poor HbA1c Control (8) 19 17 15 28 27 43 (9) -32 Controlling High Blood Pressure - Total 77 78 79 65 64 57 12 18 Medical Assistance with Smoking Cessation - Advising
Smokers To Quit 3 96 97 97 77 na 76 19 25
Medical Assistance with Smoking Cessation - Discussing
Medications 94 94 94 53 na 44 41 77
Medical Assistance with Smoking Cessation - Discussing
Strategies 3 96 97 97 48 na 40 48 100
Flu Shots for Adults (50-64) 3 65 65 71 53 na na 12 23 Flu Shots for Adults (65 and older) 3 4 5 76 79 82 na 69 na 7 10 Immunizations Pneumococcal 34 5 93 94 95 na 69 na 24 35
SOURCE Office of Analytics and Business Intelligence Updated 11282012
Power of
Information
What we donrsquot know WILL hurt us
Act Decisively
Knowledge Data
TIME
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
Academic Affiliations
May 1970
PREVENTION
WELLNESS
SURGICAL CARE
PATIENT SATISFACTION
EQUALITY OF CARE
TECHNOLOGY INNOVATION
HARVARD TO CBO
PREVENTION
WELLNESS
SURGICAL CARE
PATIENT SATISFACTION
EQUALITY OF CARE
TECHNOLOGY INNOVATION January 2007
Hospital System to Health System
In 1996 VA began the creation of
Veterans Integrated Service Networks
(VISNs)
Source FY 2012 End-of-Year Pocket Card 14
bull 134 Community Living
Centers
bull 300 Vet Centers
bull 152 Medical Centers
bull990 Outpatient Clinics 821 Community-Based
152 Hospital-Based
11 Mobile
6 Independent
bull 102 Domiciliary Residential
Rehabilitation Programs
bull 70 Mobile Vet Centers
Hospital System to Health System
N Engl J Med 2003 3482218-2227 May 29 2003
The VA Southeast Network proudly serves veterans in the tri-state area
which includes Alabama Georgia and South Carolina
Community Based Outpatient Clinics (Cbocs)
Shift To Ambulatory And Primary Care-
With Mental Health-
Augmented With Telemedicine
O M E T O W N S H
WOMENrsquoS HEALTH CLINIC
Better Access Better Care
Before After
Only Hospitals Hospitals
Outpatient Clinics
Mobile Clinics
Vet Centers
Mobile Vet
Centers
My HealtheVet
Hospital System Health System
20
ldquoKizer had cut more than half
of the 52000 hospital beds in
order to open 300 new
community clinics helping the
agency treat 700000 more
patientsrdquo
PATIENT CENTERED MEDICAL HOME
Continuity Through Team-based Care
Patient Access to Care
Care Management and Coordination
Patient Partnership
Patient Centered Medical Home
Patient Aligned Care Teams
The Evolution of VistA
24
bull 1977 ndash ANSI Standardization of MUMPS
bull 1977-78 ndash CASS ndash Computer Assisted System Staff
bull 1979-81 ndash Underground in the VA
bull 1981-82 Becoming
ldquoLegalrdquo
bull Decentralized Hospital Computer Program ndash DHCP lsquo82
VistA lsquo94
VistA Value
Open Source
25 Confidential
26
2009 VHA Quality and Safety Metrics
Metric 2009 2008 Benchmark
Unadjusted Mortality Acute Care 23 30 No national benchmark
2008 Kaiser-P study = 45
Unadjusted Mortality ICU 80 80 No national number- 2008
Kaiser-P study = 89 (other studies up
to 20 mortality)
Catheter Line Associated Bacteremia
(CLAB)
17 1000
Line days
215 1000
line days
No national benchmark recent
Nosocomial Infections Survey
Rate approx 18-2
Ventilator Associated Pneumonia (VAP) 2461000
Vent days
342 1000
Vent days
No benchmark in Q1 2004 VHA =
881000 vent days (72 decrease)
MRSA infections ndash Acute Care 037 1000
Bed days
No Data No benchmark in Oct 2007
VHA=0531000 days (32 decrease)
MRSA Infections ndash ICU 061 1000
Bed days
No Data No benchmark in Oct 2007
VHA=1821000 days (67 decrease)
MRSA Screening ndash ICU Acute Care 94 93 No Data None
DVT prevention (high risk non-
operative acute care)
68 57 Literature approx 30-40
ICU non-operative DVT prevention 763 680 Literature approx 30-40
Acute care Length of Stay 421 days 439 days Medicare average approx 49 days
Areas in Green highlight substantial improvement
The Value Continues 2012
Clinical Indicator VA Average Percent (1) HEDIS 2011 (2) DELTA
2012 (6) 2011 (6) 2010 (6)
Commercial (7)
Medicare (7)
Medicaid (7)
RAW Breast Cancer Screening 87 85 87 71 69 50 16 23 Cervical Cancer Screening 93 93 94 77 na 67 16 21 Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Control (lt100 mgdL) 70 71 69 59 57 42
11 19
Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Screening 96 96 96 88 89 82 8 9
Colorectal Cancer Screening 82 82 82 62 60 na 20 32 Comprehensive Diabetes Care - Blood Pressure Control
(lt14090) 80 81 82 66 63 61 14 21
Comprehensive Diabetes Care - Eye Exams 90 90 91 57 66 53 33 58 Comprehensive Diabetes Care - HbA1c Testing 98 99 90 91 83 8 9 Comprehensive Diabetes Care - LDL-C Controlled (LDL-Clt100
mgdL) 68 69 70 48 53 35 20 42
Comprehensive Diabetes Care - LDL-C Screening 97 97 97 85 88 75 12 14 Comprehensive Diabetes Care - Medical Attention for
Nephropathy 95 95 96 84 90 78 11 13
Comprehensive Diabetes Care - Poor HbA1c Control (8) 19 17 15 28 27 43 (9) -32 Controlling High Blood Pressure - Total 77 78 79 65 64 57 12 18 Medical Assistance with Smoking Cessation - Advising
Smokers To Quit 3 96 97 97 77 na 76 19 25
Medical Assistance with Smoking Cessation - Discussing
Medications 94 94 94 53 na 44 41 77
Medical Assistance with Smoking Cessation - Discussing
Strategies 3 96 97 97 48 na 40 48 100
Flu Shots for Adults (50-64) 3 65 65 71 53 na na 12 23 Flu Shots for Adults (65 and older) 3 4 5 76 79 82 na 69 na 7 10 Immunizations Pneumococcal 34 5 93 94 95 na 69 na 24 35
SOURCE Office of Analytics and Business Intelligence Updated 11282012
Power of
Information
What we donrsquot know WILL hurt us
Act Decisively
Knowledge Data
TIME
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
May 1970
PREVENTION
WELLNESS
SURGICAL CARE
PATIENT SATISFACTION
EQUALITY OF CARE
TECHNOLOGY INNOVATION
HARVARD TO CBO
PREVENTION
WELLNESS
SURGICAL CARE
PATIENT SATISFACTION
EQUALITY OF CARE
TECHNOLOGY INNOVATION January 2007
Hospital System to Health System
In 1996 VA began the creation of
Veterans Integrated Service Networks
(VISNs)
Source FY 2012 End-of-Year Pocket Card 14
bull 134 Community Living
Centers
bull 300 Vet Centers
bull 152 Medical Centers
bull990 Outpatient Clinics 821 Community-Based
152 Hospital-Based
11 Mobile
6 Independent
bull 102 Domiciliary Residential
Rehabilitation Programs
bull 70 Mobile Vet Centers
Hospital System to Health System
N Engl J Med 2003 3482218-2227 May 29 2003
The VA Southeast Network proudly serves veterans in the tri-state area
which includes Alabama Georgia and South Carolina
Community Based Outpatient Clinics (Cbocs)
Shift To Ambulatory And Primary Care-
With Mental Health-
Augmented With Telemedicine
O M E T O W N S H
WOMENrsquoS HEALTH CLINIC
Better Access Better Care
Before After
Only Hospitals Hospitals
Outpatient Clinics
Mobile Clinics
Vet Centers
Mobile Vet
Centers
My HealtheVet
Hospital System Health System
20
ldquoKizer had cut more than half
of the 52000 hospital beds in
order to open 300 new
community clinics helping the
agency treat 700000 more
patientsrdquo
PATIENT CENTERED MEDICAL HOME
Continuity Through Team-based Care
Patient Access to Care
Care Management and Coordination
Patient Partnership
Patient Centered Medical Home
Patient Aligned Care Teams
The Evolution of VistA
24
bull 1977 ndash ANSI Standardization of MUMPS
bull 1977-78 ndash CASS ndash Computer Assisted System Staff
bull 1979-81 ndash Underground in the VA
bull 1981-82 Becoming
ldquoLegalrdquo
bull Decentralized Hospital Computer Program ndash DHCP lsquo82
VistA lsquo94
VistA Value
Open Source
25 Confidential
26
2009 VHA Quality and Safety Metrics
Metric 2009 2008 Benchmark
Unadjusted Mortality Acute Care 23 30 No national benchmark
2008 Kaiser-P study = 45
Unadjusted Mortality ICU 80 80 No national number- 2008
Kaiser-P study = 89 (other studies up
to 20 mortality)
Catheter Line Associated Bacteremia
(CLAB)
17 1000
Line days
215 1000
line days
No national benchmark recent
Nosocomial Infections Survey
Rate approx 18-2
Ventilator Associated Pneumonia (VAP) 2461000
Vent days
342 1000
Vent days
No benchmark in Q1 2004 VHA =
881000 vent days (72 decrease)
MRSA infections ndash Acute Care 037 1000
Bed days
No Data No benchmark in Oct 2007
VHA=0531000 days (32 decrease)
MRSA Infections ndash ICU 061 1000
Bed days
No Data No benchmark in Oct 2007
VHA=1821000 days (67 decrease)
MRSA Screening ndash ICU Acute Care 94 93 No Data None
DVT prevention (high risk non-
operative acute care)
68 57 Literature approx 30-40
ICU non-operative DVT prevention 763 680 Literature approx 30-40
Acute care Length of Stay 421 days 439 days Medicare average approx 49 days
Areas in Green highlight substantial improvement
The Value Continues 2012
Clinical Indicator VA Average Percent (1) HEDIS 2011 (2) DELTA
2012 (6) 2011 (6) 2010 (6)
Commercial (7)
Medicare (7)
Medicaid (7)
RAW Breast Cancer Screening 87 85 87 71 69 50 16 23 Cervical Cancer Screening 93 93 94 77 na 67 16 21 Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Control (lt100 mgdL) 70 71 69 59 57 42
11 19
Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Screening 96 96 96 88 89 82 8 9
Colorectal Cancer Screening 82 82 82 62 60 na 20 32 Comprehensive Diabetes Care - Blood Pressure Control
(lt14090) 80 81 82 66 63 61 14 21
Comprehensive Diabetes Care - Eye Exams 90 90 91 57 66 53 33 58 Comprehensive Diabetes Care - HbA1c Testing 98 99 90 91 83 8 9 Comprehensive Diabetes Care - LDL-C Controlled (LDL-Clt100
mgdL) 68 69 70 48 53 35 20 42
Comprehensive Diabetes Care - LDL-C Screening 97 97 97 85 88 75 12 14 Comprehensive Diabetes Care - Medical Attention for
Nephropathy 95 95 96 84 90 78 11 13
Comprehensive Diabetes Care - Poor HbA1c Control (8) 19 17 15 28 27 43 (9) -32 Controlling High Blood Pressure - Total 77 78 79 65 64 57 12 18 Medical Assistance with Smoking Cessation - Advising
Smokers To Quit 3 96 97 97 77 na 76 19 25
Medical Assistance with Smoking Cessation - Discussing
Medications 94 94 94 53 na 44 41 77
Medical Assistance with Smoking Cessation - Discussing
Strategies 3 96 97 97 48 na 40 48 100
Flu Shots for Adults (50-64) 3 65 65 71 53 na na 12 23 Flu Shots for Adults (65 and older) 3 4 5 76 79 82 na 69 na 7 10 Immunizations Pneumococcal 34 5 93 94 95 na 69 na 24 35
SOURCE Office of Analytics and Business Intelligence Updated 11282012
Power of
Information
What we donrsquot know WILL hurt us
Act Decisively
Knowledge Data
TIME
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
PREVENTION
WELLNESS
SURGICAL CARE
PATIENT SATISFACTION
EQUALITY OF CARE
TECHNOLOGY INNOVATION
HARVARD TO CBO
PREVENTION
WELLNESS
SURGICAL CARE
PATIENT SATISFACTION
EQUALITY OF CARE
TECHNOLOGY INNOVATION January 2007
Hospital System to Health System
In 1996 VA began the creation of
Veterans Integrated Service Networks
(VISNs)
Source FY 2012 End-of-Year Pocket Card 14
bull 134 Community Living
Centers
bull 300 Vet Centers
bull 152 Medical Centers
bull990 Outpatient Clinics 821 Community-Based
152 Hospital-Based
11 Mobile
6 Independent
bull 102 Domiciliary Residential
Rehabilitation Programs
bull 70 Mobile Vet Centers
Hospital System to Health System
N Engl J Med 2003 3482218-2227 May 29 2003
The VA Southeast Network proudly serves veterans in the tri-state area
which includes Alabama Georgia and South Carolina
Community Based Outpatient Clinics (Cbocs)
Shift To Ambulatory And Primary Care-
With Mental Health-
Augmented With Telemedicine
O M E T O W N S H
WOMENrsquoS HEALTH CLINIC
Better Access Better Care
Before After
Only Hospitals Hospitals
Outpatient Clinics
Mobile Clinics
Vet Centers
Mobile Vet
Centers
My HealtheVet
Hospital System Health System
20
ldquoKizer had cut more than half
of the 52000 hospital beds in
order to open 300 new
community clinics helping the
agency treat 700000 more
patientsrdquo
PATIENT CENTERED MEDICAL HOME
Continuity Through Team-based Care
Patient Access to Care
Care Management and Coordination
Patient Partnership
Patient Centered Medical Home
Patient Aligned Care Teams
The Evolution of VistA
24
bull 1977 ndash ANSI Standardization of MUMPS
bull 1977-78 ndash CASS ndash Computer Assisted System Staff
bull 1979-81 ndash Underground in the VA
bull 1981-82 Becoming
ldquoLegalrdquo
bull Decentralized Hospital Computer Program ndash DHCP lsquo82
VistA lsquo94
VistA Value
Open Source
25 Confidential
26
2009 VHA Quality and Safety Metrics
Metric 2009 2008 Benchmark
Unadjusted Mortality Acute Care 23 30 No national benchmark
2008 Kaiser-P study = 45
Unadjusted Mortality ICU 80 80 No national number- 2008
Kaiser-P study = 89 (other studies up
to 20 mortality)
Catheter Line Associated Bacteremia
(CLAB)
17 1000
Line days
215 1000
line days
No national benchmark recent
Nosocomial Infections Survey
Rate approx 18-2
Ventilator Associated Pneumonia (VAP) 2461000
Vent days
342 1000
Vent days
No benchmark in Q1 2004 VHA =
881000 vent days (72 decrease)
MRSA infections ndash Acute Care 037 1000
Bed days
No Data No benchmark in Oct 2007
VHA=0531000 days (32 decrease)
MRSA Infections ndash ICU 061 1000
Bed days
No Data No benchmark in Oct 2007
VHA=1821000 days (67 decrease)
MRSA Screening ndash ICU Acute Care 94 93 No Data None
DVT prevention (high risk non-
operative acute care)
68 57 Literature approx 30-40
ICU non-operative DVT prevention 763 680 Literature approx 30-40
Acute care Length of Stay 421 days 439 days Medicare average approx 49 days
Areas in Green highlight substantial improvement
The Value Continues 2012
Clinical Indicator VA Average Percent (1) HEDIS 2011 (2) DELTA
2012 (6) 2011 (6) 2010 (6)
Commercial (7)
Medicare (7)
Medicaid (7)
RAW Breast Cancer Screening 87 85 87 71 69 50 16 23 Cervical Cancer Screening 93 93 94 77 na 67 16 21 Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Control (lt100 mgdL) 70 71 69 59 57 42
11 19
Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Screening 96 96 96 88 89 82 8 9
Colorectal Cancer Screening 82 82 82 62 60 na 20 32 Comprehensive Diabetes Care - Blood Pressure Control
(lt14090) 80 81 82 66 63 61 14 21
Comprehensive Diabetes Care - Eye Exams 90 90 91 57 66 53 33 58 Comprehensive Diabetes Care - HbA1c Testing 98 99 90 91 83 8 9 Comprehensive Diabetes Care - LDL-C Controlled (LDL-Clt100
mgdL) 68 69 70 48 53 35 20 42
Comprehensive Diabetes Care - LDL-C Screening 97 97 97 85 88 75 12 14 Comprehensive Diabetes Care - Medical Attention for
Nephropathy 95 95 96 84 90 78 11 13
Comprehensive Diabetes Care - Poor HbA1c Control (8) 19 17 15 28 27 43 (9) -32 Controlling High Blood Pressure - Total 77 78 79 65 64 57 12 18 Medical Assistance with Smoking Cessation - Advising
Smokers To Quit 3 96 97 97 77 na 76 19 25
Medical Assistance with Smoking Cessation - Discussing
Medications 94 94 94 53 na 44 41 77
Medical Assistance with Smoking Cessation - Discussing
Strategies 3 96 97 97 48 na 40 48 100
Flu Shots for Adults (50-64) 3 65 65 71 53 na na 12 23 Flu Shots for Adults (65 and older) 3 4 5 76 79 82 na 69 na 7 10 Immunizations Pneumococcal 34 5 93 94 95 na 69 na 24 35
SOURCE Office of Analytics and Business Intelligence Updated 11282012
Power of
Information
What we donrsquot know WILL hurt us
Act Decisively
Knowledge Data
TIME
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
Hospital System to Health System
In 1996 VA began the creation of
Veterans Integrated Service Networks
(VISNs)
Source FY 2012 End-of-Year Pocket Card 14
bull 134 Community Living
Centers
bull 300 Vet Centers
bull 152 Medical Centers
bull990 Outpatient Clinics 821 Community-Based
152 Hospital-Based
11 Mobile
6 Independent
bull 102 Domiciliary Residential
Rehabilitation Programs
bull 70 Mobile Vet Centers
Hospital System to Health System
N Engl J Med 2003 3482218-2227 May 29 2003
The VA Southeast Network proudly serves veterans in the tri-state area
which includes Alabama Georgia and South Carolina
Community Based Outpatient Clinics (Cbocs)
Shift To Ambulatory And Primary Care-
With Mental Health-
Augmented With Telemedicine
O M E T O W N S H
WOMENrsquoS HEALTH CLINIC
Better Access Better Care
Before After
Only Hospitals Hospitals
Outpatient Clinics
Mobile Clinics
Vet Centers
Mobile Vet
Centers
My HealtheVet
Hospital System Health System
20
ldquoKizer had cut more than half
of the 52000 hospital beds in
order to open 300 new
community clinics helping the
agency treat 700000 more
patientsrdquo
PATIENT CENTERED MEDICAL HOME
Continuity Through Team-based Care
Patient Access to Care
Care Management and Coordination
Patient Partnership
Patient Centered Medical Home
Patient Aligned Care Teams
The Evolution of VistA
24
bull 1977 ndash ANSI Standardization of MUMPS
bull 1977-78 ndash CASS ndash Computer Assisted System Staff
bull 1979-81 ndash Underground in the VA
bull 1981-82 Becoming
ldquoLegalrdquo
bull Decentralized Hospital Computer Program ndash DHCP lsquo82
VistA lsquo94
VistA Value
Open Source
25 Confidential
26
2009 VHA Quality and Safety Metrics
Metric 2009 2008 Benchmark
Unadjusted Mortality Acute Care 23 30 No national benchmark
2008 Kaiser-P study = 45
Unadjusted Mortality ICU 80 80 No national number- 2008
Kaiser-P study = 89 (other studies up
to 20 mortality)
Catheter Line Associated Bacteremia
(CLAB)
17 1000
Line days
215 1000
line days
No national benchmark recent
Nosocomial Infections Survey
Rate approx 18-2
Ventilator Associated Pneumonia (VAP) 2461000
Vent days
342 1000
Vent days
No benchmark in Q1 2004 VHA =
881000 vent days (72 decrease)
MRSA infections ndash Acute Care 037 1000
Bed days
No Data No benchmark in Oct 2007
VHA=0531000 days (32 decrease)
MRSA Infections ndash ICU 061 1000
Bed days
No Data No benchmark in Oct 2007
VHA=1821000 days (67 decrease)
MRSA Screening ndash ICU Acute Care 94 93 No Data None
DVT prevention (high risk non-
operative acute care)
68 57 Literature approx 30-40
ICU non-operative DVT prevention 763 680 Literature approx 30-40
Acute care Length of Stay 421 days 439 days Medicare average approx 49 days
Areas in Green highlight substantial improvement
The Value Continues 2012
Clinical Indicator VA Average Percent (1) HEDIS 2011 (2) DELTA
2012 (6) 2011 (6) 2010 (6)
Commercial (7)
Medicare (7)
Medicaid (7)
RAW Breast Cancer Screening 87 85 87 71 69 50 16 23 Cervical Cancer Screening 93 93 94 77 na 67 16 21 Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Control (lt100 mgdL) 70 71 69 59 57 42
11 19
Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Screening 96 96 96 88 89 82 8 9
Colorectal Cancer Screening 82 82 82 62 60 na 20 32 Comprehensive Diabetes Care - Blood Pressure Control
(lt14090) 80 81 82 66 63 61 14 21
Comprehensive Diabetes Care - Eye Exams 90 90 91 57 66 53 33 58 Comprehensive Diabetes Care - HbA1c Testing 98 99 90 91 83 8 9 Comprehensive Diabetes Care - LDL-C Controlled (LDL-Clt100
mgdL) 68 69 70 48 53 35 20 42
Comprehensive Diabetes Care - LDL-C Screening 97 97 97 85 88 75 12 14 Comprehensive Diabetes Care - Medical Attention for
Nephropathy 95 95 96 84 90 78 11 13
Comprehensive Diabetes Care - Poor HbA1c Control (8) 19 17 15 28 27 43 (9) -32 Controlling High Blood Pressure - Total 77 78 79 65 64 57 12 18 Medical Assistance with Smoking Cessation - Advising
Smokers To Quit 3 96 97 97 77 na 76 19 25
Medical Assistance with Smoking Cessation - Discussing
Medications 94 94 94 53 na 44 41 77
Medical Assistance with Smoking Cessation - Discussing
Strategies 3 96 97 97 48 na 40 48 100
Flu Shots for Adults (50-64) 3 65 65 71 53 na na 12 23 Flu Shots for Adults (65 and older) 3 4 5 76 79 82 na 69 na 7 10 Immunizations Pneumococcal 34 5 93 94 95 na 69 na 24 35
SOURCE Office of Analytics and Business Intelligence Updated 11282012
Power of
Information
What we donrsquot know WILL hurt us
Act Decisively
Knowledge Data
TIME
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
N Engl J Med 2003 3482218-2227 May 29 2003
The VA Southeast Network proudly serves veterans in the tri-state area
which includes Alabama Georgia and South Carolina
Community Based Outpatient Clinics (Cbocs)
Shift To Ambulatory And Primary Care-
With Mental Health-
Augmented With Telemedicine
O M E T O W N S H
WOMENrsquoS HEALTH CLINIC
Better Access Better Care
Before After
Only Hospitals Hospitals
Outpatient Clinics
Mobile Clinics
Vet Centers
Mobile Vet
Centers
My HealtheVet
Hospital System Health System
20
ldquoKizer had cut more than half
of the 52000 hospital beds in
order to open 300 new
community clinics helping the
agency treat 700000 more
patientsrdquo
PATIENT CENTERED MEDICAL HOME
Continuity Through Team-based Care
Patient Access to Care
Care Management and Coordination
Patient Partnership
Patient Centered Medical Home
Patient Aligned Care Teams
The Evolution of VistA
24
bull 1977 ndash ANSI Standardization of MUMPS
bull 1977-78 ndash CASS ndash Computer Assisted System Staff
bull 1979-81 ndash Underground in the VA
bull 1981-82 Becoming
ldquoLegalrdquo
bull Decentralized Hospital Computer Program ndash DHCP lsquo82
VistA lsquo94
VistA Value
Open Source
25 Confidential
26
2009 VHA Quality and Safety Metrics
Metric 2009 2008 Benchmark
Unadjusted Mortality Acute Care 23 30 No national benchmark
2008 Kaiser-P study = 45
Unadjusted Mortality ICU 80 80 No national number- 2008
Kaiser-P study = 89 (other studies up
to 20 mortality)
Catheter Line Associated Bacteremia
(CLAB)
17 1000
Line days
215 1000
line days
No national benchmark recent
Nosocomial Infections Survey
Rate approx 18-2
Ventilator Associated Pneumonia (VAP) 2461000
Vent days
342 1000
Vent days
No benchmark in Q1 2004 VHA =
881000 vent days (72 decrease)
MRSA infections ndash Acute Care 037 1000
Bed days
No Data No benchmark in Oct 2007
VHA=0531000 days (32 decrease)
MRSA Infections ndash ICU 061 1000
Bed days
No Data No benchmark in Oct 2007
VHA=1821000 days (67 decrease)
MRSA Screening ndash ICU Acute Care 94 93 No Data None
DVT prevention (high risk non-
operative acute care)
68 57 Literature approx 30-40
ICU non-operative DVT prevention 763 680 Literature approx 30-40
Acute care Length of Stay 421 days 439 days Medicare average approx 49 days
Areas in Green highlight substantial improvement
The Value Continues 2012
Clinical Indicator VA Average Percent (1) HEDIS 2011 (2) DELTA
2012 (6) 2011 (6) 2010 (6)
Commercial (7)
Medicare (7)
Medicaid (7)
RAW Breast Cancer Screening 87 85 87 71 69 50 16 23 Cervical Cancer Screening 93 93 94 77 na 67 16 21 Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Control (lt100 mgdL) 70 71 69 59 57 42
11 19
Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Screening 96 96 96 88 89 82 8 9
Colorectal Cancer Screening 82 82 82 62 60 na 20 32 Comprehensive Diabetes Care - Blood Pressure Control
(lt14090) 80 81 82 66 63 61 14 21
Comprehensive Diabetes Care - Eye Exams 90 90 91 57 66 53 33 58 Comprehensive Diabetes Care - HbA1c Testing 98 99 90 91 83 8 9 Comprehensive Diabetes Care - LDL-C Controlled (LDL-Clt100
mgdL) 68 69 70 48 53 35 20 42
Comprehensive Diabetes Care - LDL-C Screening 97 97 97 85 88 75 12 14 Comprehensive Diabetes Care - Medical Attention for
Nephropathy 95 95 96 84 90 78 11 13
Comprehensive Diabetes Care - Poor HbA1c Control (8) 19 17 15 28 27 43 (9) -32 Controlling High Blood Pressure - Total 77 78 79 65 64 57 12 18 Medical Assistance with Smoking Cessation - Advising
Smokers To Quit 3 96 97 97 77 na 76 19 25
Medical Assistance with Smoking Cessation - Discussing
Medications 94 94 94 53 na 44 41 77
Medical Assistance with Smoking Cessation - Discussing
Strategies 3 96 97 97 48 na 40 48 100
Flu Shots for Adults (50-64) 3 65 65 71 53 na na 12 23 Flu Shots for Adults (65 and older) 3 4 5 76 79 82 na 69 na 7 10 Immunizations Pneumococcal 34 5 93 94 95 na 69 na 24 35
SOURCE Office of Analytics and Business Intelligence Updated 11282012
Power of
Information
What we donrsquot know WILL hurt us
Act Decisively
Knowledge Data
TIME
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
The VA Southeast Network proudly serves veterans in the tri-state area
which includes Alabama Georgia and South Carolina
Community Based Outpatient Clinics (Cbocs)
Shift To Ambulatory And Primary Care-
With Mental Health-
Augmented With Telemedicine
O M E T O W N S H
WOMENrsquoS HEALTH CLINIC
Better Access Better Care
Before After
Only Hospitals Hospitals
Outpatient Clinics
Mobile Clinics
Vet Centers
Mobile Vet
Centers
My HealtheVet
Hospital System Health System
20
ldquoKizer had cut more than half
of the 52000 hospital beds in
order to open 300 new
community clinics helping the
agency treat 700000 more
patientsrdquo
PATIENT CENTERED MEDICAL HOME
Continuity Through Team-based Care
Patient Access to Care
Care Management and Coordination
Patient Partnership
Patient Centered Medical Home
Patient Aligned Care Teams
The Evolution of VistA
24
bull 1977 ndash ANSI Standardization of MUMPS
bull 1977-78 ndash CASS ndash Computer Assisted System Staff
bull 1979-81 ndash Underground in the VA
bull 1981-82 Becoming
ldquoLegalrdquo
bull Decentralized Hospital Computer Program ndash DHCP lsquo82
VistA lsquo94
VistA Value
Open Source
25 Confidential
26
2009 VHA Quality and Safety Metrics
Metric 2009 2008 Benchmark
Unadjusted Mortality Acute Care 23 30 No national benchmark
2008 Kaiser-P study = 45
Unadjusted Mortality ICU 80 80 No national number- 2008
Kaiser-P study = 89 (other studies up
to 20 mortality)
Catheter Line Associated Bacteremia
(CLAB)
17 1000
Line days
215 1000
line days
No national benchmark recent
Nosocomial Infections Survey
Rate approx 18-2
Ventilator Associated Pneumonia (VAP) 2461000
Vent days
342 1000
Vent days
No benchmark in Q1 2004 VHA =
881000 vent days (72 decrease)
MRSA infections ndash Acute Care 037 1000
Bed days
No Data No benchmark in Oct 2007
VHA=0531000 days (32 decrease)
MRSA Infections ndash ICU 061 1000
Bed days
No Data No benchmark in Oct 2007
VHA=1821000 days (67 decrease)
MRSA Screening ndash ICU Acute Care 94 93 No Data None
DVT prevention (high risk non-
operative acute care)
68 57 Literature approx 30-40
ICU non-operative DVT prevention 763 680 Literature approx 30-40
Acute care Length of Stay 421 days 439 days Medicare average approx 49 days
Areas in Green highlight substantial improvement
The Value Continues 2012
Clinical Indicator VA Average Percent (1) HEDIS 2011 (2) DELTA
2012 (6) 2011 (6) 2010 (6)
Commercial (7)
Medicare (7)
Medicaid (7)
RAW Breast Cancer Screening 87 85 87 71 69 50 16 23 Cervical Cancer Screening 93 93 94 77 na 67 16 21 Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Control (lt100 mgdL) 70 71 69 59 57 42
11 19
Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Screening 96 96 96 88 89 82 8 9
Colorectal Cancer Screening 82 82 82 62 60 na 20 32 Comprehensive Diabetes Care - Blood Pressure Control
(lt14090) 80 81 82 66 63 61 14 21
Comprehensive Diabetes Care - Eye Exams 90 90 91 57 66 53 33 58 Comprehensive Diabetes Care - HbA1c Testing 98 99 90 91 83 8 9 Comprehensive Diabetes Care - LDL-C Controlled (LDL-Clt100
mgdL) 68 69 70 48 53 35 20 42
Comprehensive Diabetes Care - LDL-C Screening 97 97 97 85 88 75 12 14 Comprehensive Diabetes Care - Medical Attention for
Nephropathy 95 95 96 84 90 78 11 13
Comprehensive Diabetes Care - Poor HbA1c Control (8) 19 17 15 28 27 43 (9) -32 Controlling High Blood Pressure - Total 77 78 79 65 64 57 12 18 Medical Assistance with Smoking Cessation - Advising
Smokers To Quit 3 96 97 97 77 na 76 19 25
Medical Assistance with Smoking Cessation - Discussing
Medications 94 94 94 53 na 44 41 77
Medical Assistance with Smoking Cessation - Discussing
Strategies 3 96 97 97 48 na 40 48 100
Flu Shots for Adults (50-64) 3 65 65 71 53 na na 12 23 Flu Shots for Adults (65 and older) 3 4 5 76 79 82 na 69 na 7 10 Immunizations Pneumococcal 34 5 93 94 95 na 69 na 24 35
SOURCE Office of Analytics and Business Intelligence Updated 11282012
Power of
Information
What we donrsquot know WILL hurt us
Act Decisively
Knowledge Data
TIME
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
O M E T O W N S H
WOMENrsquoS HEALTH CLINIC
Better Access Better Care
Before After
Only Hospitals Hospitals
Outpatient Clinics
Mobile Clinics
Vet Centers
Mobile Vet
Centers
My HealtheVet
Hospital System Health System
20
ldquoKizer had cut more than half
of the 52000 hospital beds in
order to open 300 new
community clinics helping the
agency treat 700000 more
patientsrdquo
PATIENT CENTERED MEDICAL HOME
Continuity Through Team-based Care
Patient Access to Care
Care Management and Coordination
Patient Partnership
Patient Centered Medical Home
Patient Aligned Care Teams
The Evolution of VistA
24
bull 1977 ndash ANSI Standardization of MUMPS
bull 1977-78 ndash CASS ndash Computer Assisted System Staff
bull 1979-81 ndash Underground in the VA
bull 1981-82 Becoming
ldquoLegalrdquo
bull Decentralized Hospital Computer Program ndash DHCP lsquo82
VistA lsquo94
VistA Value
Open Source
25 Confidential
26
2009 VHA Quality and Safety Metrics
Metric 2009 2008 Benchmark
Unadjusted Mortality Acute Care 23 30 No national benchmark
2008 Kaiser-P study = 45
Unadjusted Mortality ICU 80 80 No national number- 2008
Kaiser-P study = 89 (other studies up
to 20 mortality)
Catheter Line Associated Bacteremia
(CLAB)
17 1000
Line days
215 1000
line days
No national benchmark recent
Nosocomial Infections Survey
Rate approx 18-2
Ventilator Associated Pneumonia (VAP) 2461000
Vent days
342 1000
Vent days
No benchmark in Q1 2004 VHA =
881000 vent days (72 decrease)
MRSA infections ndash Acute Care 037 1000
Bed days
No Data No benchmark in Oct 2007
VHA=0531000 days (32 decrease)
MRSA Infections ndash ICU 061 1000
Bed days
No Data No benchmark in Oct 2007
VHA=1821000 days (67 decrease)
MRSA Screening ndash ICU Acute Care 94 93 No Data None
DVT prevention (high risk non-
operative acute care)
68 57 Literature approx 30-40
ICU non-operative DVT prevention 763 680 Literature approx 30-40
Acute care Length of Stay 421 days 439 days Medicare average approx 49 days
Areas in Green highlight substantial improvement
The Value Continues 2012
Clinical Indicator VA Average Percent (1) HEDIS 2011 (2) DELTA
2012 (6) 2011 (6) 2010 (6)
Commercial (7)
Medicare (7)
Medicaid (7)
RAW Breast Cancer Screening 87 85 87 71 69 50 16 23 Cervical Cancer Screening 93 93 94 77 na 67 16 21 Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Control (lt100 mgdL) 70 71 69 59 57 42
11 19
Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Screening 96 96 96 88 89 82 8 9
Colorectal Cancer Screening 82 82 82 62 60 na 20 32 Comprehensive Diabetes Care - Blood Pressure Control
(lt14090) 80 81 82 66 63 61 14 21
Comprehensive Diabetes Care - Eye Exams 90 90 91 57 66 53 33 58 Comprehensive Diabetes Care - HbA1c Testing 98 99 90 91 83 8 9 Comprehensive Diabetes Care - LDL-C Controlled (LDL-Clt100
mgdL) 68 69 70 48 53 35 20 42
Comprehensive Diabetes Care - LDL-C Screening 97 97 97 85 88 75 12 14 Comprehensive Diabetes Care - Medical Attention for
Nephropathy 95 95 96 84 90 78 11 13
Comprehensive Diabetes Care - Poor HbA1c Control (8) 19 17 15 28 27 43 (9) -32 Controlling High Blood Pressure - Total 77 78 79 65 64 57 12 18 Medical Assistance with Smoking Cessation - Advising
Smokers To Quit 3 96 97 97 77 na 76 19 25
Medical Assistance with Smoking Cessation - Discussing
Medications 94 94 94 53 na 44 41 77
Medical Assistance with Smoking Cessation - Discussing
Strategies 3 96 97 97 48 na 40 48 100
Flu Shots for Adults (50-64) 3 65 65 71 53 na na 12 23 Flu Shots for Adults (65 and older) 3 4 5 76 79 82 na 69 na 7 10 Immunizations Pneumococcal 34 5 93 94 95 na 69 na 24 35
SOURCE Office of Analytics and Business Intelligence Updated 11282012
Power of
Information
What we donrsquot know WILL hurt us
Act Decisively
Knowledge Data
TIME
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
WOMENrsquoS HEALTH CLINIC
Better Access Better Care
Before After
Only Hospitals Hospitals
Outpatient Clinics
Mobile Clinics
Vet Centers
Mobile Vet
Centers
My HealtheVet
Hospital System Health System
20
ldquoKizer had cut more than half
of the 52000 hospital beds in
order to open 300 new
community clinics helping the
agency treat 700000 more
patientsrdquo
PATIENT CENTERED MEDICAL HOME
Continuity Through Team-based Care
Patient Access to Care
Care Management and Coordination
Patient Partnership
Patient Centered Medical Home
Patient Aligned Care Teams
The Evolution of VistA
24
bull 1977 ndash ANSI Standardization of MUMPS
bull 1977-78 ndash CASS ndash Computer Assisted System Staff
bull 1979-81 ndash Underground in the VA
bull 1981-82 Becoming
ldquoLegalrdquo
bull Decentralized Hospital Computer Program ndash DHCP lsquo82
VistA lsquo94
VistA Value
Open Source
25 Confidential
26
2009 VHA Quality and Safety Metrics
Metric 2009 2008 Benchmark
Unadjusted Mortality Acute Care 23 30 No national benchmark
2008 Kaiser-P study = 45
Unadjusted Mortality ICU 80 80 No national number- 2008
Kaiser-P study = 89 (other studies up
to 20 mortality)
Catheter Line Associated Bacteremia
(CLAB)
17 1000
Line days
215 1000
line days
No national benchmark recent
Nosocomial Infections Survey
Rate approx 18-2
Ventilator Associated Pneumonia (VAP) 2461000
Vent days
342 1000
Vent days
No benchmark in Q1 2004 VHA =
881000 vent days (72 decrease)
MRSA infections ndash Acute Care 037 1000
Bed days
No Data No benchmark in Oct 2007
VHA=0531000 days (32 decrease)
MRSA Infections ndash ICU 061 1000
Bed days
No Data No benchmark in Oct 2007
VHA=1821000 days (67 decrease)
MRSA Screening ndash ICU Acute Care 94 93 No Data None
DVT prevention (high risk non-
operative acute care)
68 57 Literature approx 30-40
ICU non-operative DVT prevention 763 680 Literature approx 30-40
Acute care Length of Stay 421 days 439 days Medicare average approx 49 days
Areas in Green highlight substantial improvement
The Value Continues 2012
Clinical Indicator VA Average Percent (1) HEDIS 2011 (2) DELTA
2012 (6) 2011 (6) 2010 (6)
Commercial (7)
Medicare (7)
Medicaid (7)
RAW Breast Cancer Screening 87 85 87 71 69 50 16 23 Cervical Cancer Screening 93 93 94 77 na 67 16 21 Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Control (lt100 mgdL) 70 71 69 59 57 42
11 19
Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Screening 96 96 96 88 89 82 8 9
Colorectal Cancer Screening 82 82 82 62 60 na 20 32 Comprehensive Diabetes Care - Blood Pressure Control
(lt14090) 80 81 82 66 63 61 14 21
Comprehensive Diabetes Care - Eye Exams 90 90 91 57 66 53 33 58 Comprehensive Diabetes Care - HbA1c Testing 98 99 90 91 83 8 9 Comprehensive Diabetes Care - LDL-C Controlled (LDL-Clt100
mgdL) 68 69 70 48 53 35 20 42
Comprehensive Diabetes Care - LDL-C Screening 97 97 97 85 88 75 12 14 Comprehensive Diabetes Care - Medical Attention for
Nephropathy 95 95 96 84 90 78 11 13
Comprehensive Diabetes Care - Poor HbA1c Control (8) 19 17 15 28 27 43 (9) -32 Controlling High Blood Pressure - Total 77 78 79 65 64 57 12 18 Medical Assistance with Smoking Cessation - Advising
Smokers To Quit 3 96 97 97 77 na 76 19 25
Medical Assistance with Smoking Cessation - Discussing
Medications 94 94 94 53 na 44 41 77
Medical Assistance with Smoking Cessation - Discussing
Strategies 3 96 97 97 48 na 40 48 100
Flu Shots for Adults (50-64) 3 65 65 71 53 na na 12 23 Flu Shots for Adults (65 and older) 3 4 5 76 79 82 na 69 na 7 10 Immunizations Pneumococcal 34 5 93 94 95 na 69 na 24 35
SOURCE Office of Analytics and Business Intelligence Updated 11282012
Power of
Information
What we donrsquot know WILL hurt us
Act Decisively
Knowledge Data
TIME
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
Better Access Better Care
Before After
Only Hospitals Hospitals
Outpatient Clinics
Mobile Clinics
Vet Centers
Mobile Vet
Centers
My HealtheVet
Hospital System Health System
20
ldquoKizer had cut more than half
of the 52000 hospital beds in
order to open 300 new
community clinics helping the
agency treat 700000 more
patientsrdquo
PATIENT CENTERED MEDICAL HOME
Continuity Through Team-based Care
Patient Access to Care
Care Management and Coordination
Patient Partnership
Patient Centered Medical Home
Patient Aligned Care Teams
The Evolution of VistA
24
bull 1977 ndash ANSI Standardization of MUMPS
bull 1977-78 ndash CASS ndash Computer Assisted System Staff
bull 1979-81 ndash Underground in the VA
bull 1981-82 Becoming
ldquoLegalrdquo
bull Decentralized Hospital Computer Program ndash DHCP lsquo82
VistA lsquo94
VistA Value
Open Source
25 Confidential
26
2009 VHA Quality and Safety Metrics
Metric 2009 2008 Benchmark
Unadjusted Mortality Acute Care 23 30 No national benchmark
2008 Kaiser-P study = 45
Unadjusted Mortality ICU 80 80 No national number- 2008
Kaiser-P study = 89 (other studies up
to 20 mortality)
Catheter Line Associated Bacteremia
(CLAB)
17 1000
Line days
215 1000
line days
No national benchmark recent
Nosocomial Infections Survey
Rate approx 18-2
Ventilator Associated Pneumonia (VAP) 2461000
Vent days
342 1000
Vent days
No benchmark in Q1 2004 VHA =
881000 vent days (72 decrease)
MRSA infections ndash Acute Care 037 1000
Bed days
No Data No benchmark in Oct 2007
VHA=0531000 days (32 decrease)
MRSA Infections ndash ICU 061 1000
Bed days
No Data No benchmark in Oct 2007
VHA=1821000 days (67 decrease)
MRSA Screening ndash ICU Acute Care 94 93 No Data None
DVT prevention (high risk non-
operative acute care)
68 57 Literature approx 30-40
ICU non-operative DVT prevention 763 680 Literature approx 30-40
Acute care Length of Stay 421 days 439 days Medicare average approx 49 days
Areas in Green highlight substantial improvement
The Value Continues 2012
Clinical Indicator VA Average Percent (1) HEDIS 2011 (2) DELTA
2012 (6) 2011 (6) 2010 (6)
Commercial (7)
Medicare (7)
Medicaid (7)
RAW Breast Cancer Screening 87 85 87 71 69 50 16 23 Cervical Cancer Screening 93 93 94 77 na 67 16 21 Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Control (lt100 mgdL) 70 71 69 59 57 42
11 19
Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Screening 96 96 96 88 89 82 8 9
Colorectal Cancer Screening 82 82 82 62 60 na 20 32 Comprehensive Diabetes Care - Blood Pressure Control
(lt14090) 80 81 82 66 63 61 14 21
Comprehensive Diabetes Care - Eye Exams 90 90 91 57 66 53 33 58 Comprehensive Diabetes Care - HbA1c Testing 98 99 90 91 83 8 9 Comprehensive Diabetes Care - LDL-C Controlled (LDL-Clt100
mgdL) 68 69 70 48 53 35 20 42
Comprehensive Diabetes Care - LDL-C Screening 97 97 97 85 88 75 12 14 Comprehensive Diabetes Care - Medical Attention for
Nephropathy 95 95 96 84 90 78 11 13
Comprehensive Diabetes Care - Poor HbA1c Control (8) 19 17 15 28 27 43 (9) -32 Controlling High Blood Pressure - Total 77 78 79 65 64 57 12 18 Medical Assistance with Smoking Cessation - Advising
Smokers To Quit 3 96 97 97 77 na 76 19 25
Medical Assistance with Smoking Cessation - Discussing
Medications 94 94 94 53 na 44 41 77
Medical Assistance with Smoking Cessation - Discussing
Strategies 3 96 97 97 48 na 40 48 100
Flu Shots for Adults (50-64) 3 65 65 71 53 na na 12 23 Flu Shots for Adults (65 and older) 3 4 5 76 79 82 na 69 na 7 10 Immunizations Pneumococcal 34 5 93 94 95 na 69 na 24 35
SOURCE Office of Analytics and Business Intelligence Updated 11282012
Power of
Information
What we donrsquot know WILL hurt us
Act Decisively
Knowledge Data
TIME
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
PATIENT CENTERED MEDICAL HOME
Continuity Through Team-based Care
Patient Access to Care
Care Management and Coordination
Patient Partnership
Patient Centered Medical Home
Patient Aligned Care Teams
The Evolution of VistA
24
bull 1977 ndash ANSI Standardization of MUMPS
bull 1977-78 ndash CASS ndash Computer Assisted System Staff
bull 1979-81 ndash Underground in the VA
bull 1981-82 Becoming
ldquoLegalrdquo
bull Decentralized Hospital Computer Program ndash DHCP lsquo82
VistA lsquo94
VistA Value
Open Source
25 Confidential
26
2009 VHA Quality and Safety Metrics
Metric 2009 2008 Benchmark
Unadjusted Mortality Acute Care 23 30 No national benchmark
2008 Kaiser-P study = 45
Unadjusted Mortality ICU 80 80 No national number- 2008
Kaiser-P study = 89 (other studies up
to 20 mortality)
Catheter Line Associated Bacteremia
(CLAB)
17 1000
Line days
215 1000
line days
No national benchmark recent
Nosocomial Infections Survey
Rate approx 18-2
Ventilator Associated Pneumonia (VAP) 2461000
Vent days
342 1000
Vent days
No benchmark in Q1 2004 VHA =
881000 vent days (72 decrease)
MRSA infections ndash Acute Care 037 1000
Bed days
No Data No benchmark in Oct 2007
VHA=0531000 days (32 decrease)
MRSA Infections ndash ICU 061 1000
Bed days
No Data No benchmark in Oct 2007
VHA=1821000 days (67 decrease)
MRSA Screening ndash ICU Acute Care 94 93 No Data None
DVT prevention (high risk non-
operative acute care)
68 57 Literature approx 30-40
ICU non-operative DVT prevention 763 680 Literature approx 30-40
Acute care Length of Stay 421 days 439 days Medicare average approx 49 days
Areas in Green highlight substantial improvement
The Value Continues 2012
Clinical Indicator VA Average Percent (1) HEDIS 2011 (2) DELTA
2012 (6) 2011 (6) 2010 (6)
Commercial (7)
Medicare (7)
Medicaid (7)
RAW Breast Cancer Screening 87 85 87 71 69 50 16 23 Cervical Cancer Screening 93 93 94 77 na 67 16 21 Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Control (lt100 mgdL) 70 71 69 59 57 42
11 19
Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Screening 96 96 96 88 89 82 8 9
Colorectal Cancer Screening 82 82 82 62 60 na 20 32 Comprehensive Diabetes Care - Blood Pressure Control
(lt14090) 80 81 82 66 63 61 14 21
Comprehensive Diabetes Care - Eye Exams 90 90 91 57 66 53 33 58 Comprehensive Diabetes Care - HbA1c Testing 98 99 90 91 83 8 9 Comprehensive Diabetes Care - LDL-C Controlled (LDL-Clt100
mgdL) 68 69 70 48 53 35 20 42
Comprehensive Diabetes Care - LDL-C Screening 97 97 97 85 88 75 12 14 Comprehensive Diabetes Care - Medical Attention for
Nephropathy 95 95 96 84 90 78 11 13
Comprehensive Diabetes Care - Poor HbA1c Control (8) 19 17 15 28 27 43 (9) -32 Controlling High Blood Pressure - Total 77 78 79 65 64 57 12 18 Medical Assistance with Smoking Cessation - Advising
Smokers To Quit 3 96 97 97 77 na 76 19 25
Medical Assistance with Smoking Cessation - Discussing
Medications 94 94 94 53 na 44 41 77
Medical Assistance with Smoking Cessation - Discussing
Strategies 3 96 97 97 48 na 40 48 100
Flu Shots for Adults (50-64) 3 65 65 71 53 na na 12 23 Flu Shots for Adults (65 and older) 3 4 5 76 79 82 na 69 na 7 10 Immunizations Pneumococcal 34 5 93 94 95 na 69 na 24 35
SOURCE Office of Analytics and Business Intelligence Updated 11282012
Power of
Information
What we donrsquot know WILL hurt us
Act Decisively
Knowledge Data
TIME
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
Patient Centered Medical Home
Patient Aligned Care Teams
The Evolution of VistA
24
bull 1977 ndash ANSI Standardization of MUMPS
bull 1977-78 ndash CASS ndash Computer Assisted System Staff
bull 1979-81 ndash Underground in the VA
bull 1981-82 Becoming
ldquoLegalrdquo
bull Decentralized Hospital Computer Program ndash DHCP lsquo82
VistA lsquo94
VistA Value
Open Source
25 Confidential
26
2009 VHA Quality and Safety Metrics
Metric 2009 2008 Benchmark
Unadjusted Mortality Acute Care 23 30 No national benchmark
2008 Kaiser-P study = 45
Unadjusted Mortality ICU 80 80 No national number- 2008
Kaiser-P study = 89 (other studies up
to 20 mortality)
Catheter Line Associated Bacteremia
(CLAB)
17 1000
Line days
215 1000
line days
No national benchmark recent
Nosocomial Infections Survey
Rate approx 18-2
Ventilator Associated Pneumonia (VAP) 2461000
Vent days
342 1000
Vent days
No benchmark in Q1 2004 VHA =
881000 vent days (72 decrease)
MRSA infections ndash Acute Care 037 1000
Bed days
No Data No benchmark in Oct 2007
VHA=0531000 days (32 decrease)
MRSA Infections ndash ICU 061 1000
Bed days
No Data No benchmark in Oct 2007
VHA=1821000 days (67 decrease)
MRSA Screening ndash ICU Acute Care 94 93 No Data None
DVT prevention (high risk non-
operative acute care)
68 57 Literature approx 30-40
ICU non-operative DVT prevention 763 680 Literature approx 30-40
Acute care Length of Stay 421 days 439 days Medicare average approx 49 days
Areas in Green highlight substantial improvement
The Value Continues 2012
Clinical Indicator VA Average Percent (1) HEDIS 2011 (2) DELTA
2012 (6) 2011 (6) 2010 (6)
Commercial (7)
Medicare (7)
Medicaid (7)
RAW Breast Cancer Screening 87 85 87 71 69 50 16 23 Cervical Cancer Screening 93 93 94 77 na 67 16 21 Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Control (lt100 mgdL) 70 71 69 59 57 42
11 19
Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Screening 96 96 96 88 89 82 8 9
Colorectal Cancer Screening 82 82 82 62 60 na 20 32 Comprehensive Diabetes Care - Blood Pressure Control
(lt14090) 80 81 82 66 63 61 14 21
Comprehensive Diabetes Care - Eye Exams 90 90 91 57 66 53 33 58 Comprehensive Diabetes Care - HbA1c Testing 98 99 90 91 83 8 9 Comprehensive Diabetes Care - LDL-C Controlled (LDL-Clt100
mgdL) 68 69 70 48 53 35 20 42
Comprehensive Diabetes Care - LDL-C Screening 97 97 97 85 88 75 12 14 Comprehensive Diabetes Care - Medical Attention for
Nephropathy 95 95 96 84 90 78 11 13
Comprehensive Diabetes Care - Poor HbA1c Control (8) 19 17 15 28 27 43 (9) -32 Controlling High Blood Pressure - Total 77 78 79 65 64 57 12 18 Medical Assistance with Smoking Cessation - Advising
Smokers To Quit 3 96 97 97 77 na 76 19 25
Medical Assistance with Smoking Cessation - Discussing
Medications 94 94 94 53 na 44 41 77
Medical Assistance with Smoking Cessation - Discussing
Strategies 3 96 97 97 48 na 40 48 100
Flu Shots for Adults (50-64) 3 65 65 71 53 na na 12 23 Flu Shots for Adults (65 and older) 3 4 5 76 79 82 na 69 na 7 10 Immunizations Pneumococcal 34 5 93 94 95 na 69 na 24 35
SOURCE Office of Analytics and Business Intelligence Updated 11282012
Power of
Information
What we donrsquot know WILL hurt us
Act Decisively
Knowledge Data
TIME
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
The Evolution of VistA
24
bull 1977 ndash ANSI Standardization of MUMPS
bull 1977-78 ndash CASS ndash Computer Assisted System Staff
bull 1979-81 ndash Underground in the VA
bull 1981-82 Becoming
ldquoLegalrdquo
bull Decentralized Hospital Computer Program ndash DHCP lsquo82
VistA lsquo94
VistA Value
Open Source
25 Confidential
26
2009 VHA Quality and Safety Metrics
Metric 2009 2008 Benchmark
Unadjusted Mortality Acute Care 23 30 No national benchmark
2008 Kaiser-P study = 45
Unadjusted Mortality ICU 80 80 No national number- 2008
Kaiser-P study = 89 (other studies up
to 20 mortality)
Catheter Line Associated Bacteremia
(CLAB)
17 1000
Line days
215 1000
line days
No national benchmark recent
Nosocomial Infections Survey
Rate approx 18-2
Ventilator Associated Pneumonia (VAP) 2461000
Vent days
342 1000
Vent days
No benchmark in Q1 2004 VHA =
881000 vent days (72 decrease)
MRSA infections ndash Acute Care 037 1000
Bed days
No Data No benchmark in Oct 2007
VHA=0531000 days (32 decrease)
MRSA Infections ndash ICU 061 1000
Bed days
No Data No benchmark in Oct 2007
VHA=1821000 days (67 decrease)
MRSA Screening ndash ICU Acute Care 94 93 No Data None
DVT prevention (high risk non-
operative acute care)
68 57 Literature approx 30-40
ICU non-operative DVT prevention 763 680 Literature approx 30-40
Acute care Length of Stay 421 days 439 days Medicare average approx 49 days
Areas in Green highlight substantial improvement
The Value Continues 2012
Clinical Indicator VA Average Percent (1) HEDIS 2011 (2) DELTA
2012 (6) 2011 (6) 2010 (6)
Commercial (7)
Medicare (7)
Medicaid (7)
RAW Breast Cancer Screening 87 85 87 71 69 50 16 23 Cervical Cancer Screening 93 93 94 77 na 67 16 21 Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Control (lt100 mgdL) 70 71 69 59 57 42
11 19
Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Screening 96 96 96 88 89 82 8 9
Colorectal Cancer Screening 82 82 82 62 60 na 20 32 Comprehensive Diabetes Care - Blood Pressure Control
(lt14090) 80 81 82 66 63 61 14 21
Comprehensive Diabetes Care - Eye Exams 90 90 91 57 66 53 33 58 Comprehensive Diabetes Care - HbA1c Testing 98 99 90 91 83 8 9 Comprehensive Diabetes Care - LDL-C Controlled (LDL-Clt100
mgdL) 68 69 70 48 53 35 20 42
Comprehensive Diabetes Care - LDL-C Screening 97 97 97 85 88 75 12 14 Comprehensive Diabetes Care - Medical Attention for
Nephropathy 95 95 96 84 90 78 11 13
Comprehensive Diabetes Care - Poor HbA1c Control (8) 19 17 15 28 27 43 (9) -32 Controlling High Blood Pressure - Total 77 78 79 65 64 57 12 18 Medical Assistance with Smoking Cessation - Advising
Smokers To Quit 3 96 97 97 77 na 76 19 25
Medical Assistance with Smoking Cessation - Discussing
Medications 94 94 94 53 na 44 41 77
Medical Assistance with Smoking Cessation - Discussing
Strategies 3 96 97 97 48 na 40 48 100
Flu Shots for Adults (50-64) 3 65 65 71 53 na na 12 23 Flu Shots for Adults (65 and older) 3 4 5 76 79 82 na 69 na 7 10 Immunizations Pneumococcal 34 5 93 94 95 na 69 na 24 35
SOURCE Office of Analytics and Business Intelligence Updated 11282012
Power of
Information
What we donrsquot know WILL hurt us
Act Decisively
Knowledge Data
TIME
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
VistA Value
Open Source
25 Confidential
26
2009 VHA Quality and Safety Metrics
Metric 2009 2008 Benchmark
Unadjusted Mortality Acute Care 23 30 No national benchmark
2008 Kaiser-P study = 45
Unadjusted Mortality ICU 80 80 No national number- 2008
Kaiser-P study = 89 (other studies up
to 20 mortality)
Catheter Line Associated Bacteremia
(CLAB)
17 1000
Line days
215 1000
line days
No national benchmark recent
Nosocomial Infections Survey
Rate approx 18-2
Ventilator Associated Pneumonia (VAP) 2461000
Vent days
342 1000
Vent days
No benchmark in Q1 2004 VHA =
881000 vent days (72 decrease)
MRSA infections ndash Acute Care 037 1000
Bed days
No Data No benchmark in Oct 2007
VHA=0531000 days (32 decrease)
MRSA Infections ndash ICU 061 1000
Bed days
No Data No benchmark in Oct 2007
VHA=1821000 days (67 decrease)
MRSA Screening ndash ICU Acute Care 94 93 No Data None
DVT prevention (high risk non-
operative acute care)
68 57 Literature approx 30-40
ICU non-operative DVT prevention 763 680 Literature approx 30-40
Acute care Length of Stay 421 days 439 days Medicare average approx 49 days
Areas in Green highlight substantial improvement
The Value Continues 2012
Clinical Indicator VA Average Percent (1) HEDIS 2011 (2) DELTA
2012 (6) 2011 (6) 2010 (6)
Commercial (7)
Medicare (7)
Medicaid (7)
RAW Breast Cancer Screening 87 85 87 71 69 50 16 23 Cervical Cancer Screening 93 93 94 77 na 67 16 21 Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Control (lt100 mgdL) 70 71 69 59 57 42
11 19
Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Screening 96 96 96 88 89 82 8 9
Colorectal Cancer Screening 82 82 82 62 60 na 20 32 Comprehensive Diabetes Care - Blood Pressure Control
(lt14090) 80 81 82 66 63 61 14 21
Comprehensive Diabetes Care - Eye Exams 90 90 91 57 66 53 33 58 Comprehensive Diabetes Care - HbA1c Testing 98 99 90 91 83 8 9 Comprehensive Diabetes Care - LDL-C Controlled (LDL-Clt100
mgdL) 68 69 70 48 53 35 20 42
Comprehensive Diabetes Care - LDL-C Screening 97 97 97 85 88 75 12 14 Comprehensive Diabetes Care - Medical Attention for
Nephropathy 95 95 96 84 90 78 11 13
Comprehensive Diabetes Care - Poor HbA1c Control (8) 19 17 15 28 27 43 (9) -32 Controlling High Blood Pressure - Total 77 78 79 65 64 57 12 18 Medical Assistance with Smoking Cessation - Advising
Smokers To Quit 3 96 97 97 77 na 76 19 25
Medical Assistance with Smoking Cessation - Discussing
Medications 94 94 94 53 na 44 41 77
Medical Assistance with Smoking Cessation - Discussing
Strategies 3 96 97 97 48 na 40 48 100
Flu Shots for Adults (50-64) 3 65 65 71 53 na na 12 23 Flu Shots for Adults (65 and older) 3 4 5 76 79 82 na 69 na 7 10 Immunizations Pneumococcal 34 5 93 94 95 na 69 na 24 35
SOURCE Office of Analytics and Business Intelligence Updated 11282012
Power of
Information
What we donrsquot know WILL hurt us
Act Decisively
Knowledge Data
TIME
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
26
2009 VHA Quality and Safety Metrics
Metric 2009 2008 Benchmark
Unadjusted Mortality Acute Care 23 30 No national benchmark
2008 Kaiser-P study = 45
Unadjusted Mortality ICU 80 80 No national number- 2008
Kaiser-P study = 89 (other studies up
to 20 mortality)
Catheter Line Associated Bacteremia
(CLAB)
17 1000
Line days
215 1000
line days
No national benchmark recent
Nosocomial Infections Survey
Rate approx 18-2
Ventilator Associated Pneumonia (VAP) 2461000
Vent days
342 1000
Vent days
No benchmark in Q1 2004 VHA =
881000 vent days (72 decrease)
MRSA infections ndash Acute Care 037 1000
Bed days
No Data No benchmark in Oct 2007
VHA=0531000 days (32 decrease)
MRSA Infections ndash ICU 061 1000
Bed days
No Data No benchmark in Oct 2007
VHA=1821000 days (67 decrease)
MRSA Screening ndash ICU Acute Care 94 93 No Data None
DVT prevention (high risk non-
operative acute care)
68 57 Literature approx 30-40
ICU non-operative DVT prevention 763 680 Literature approx 30-40
Acute care Length of Stay 421 days 439 days Medicare average approx 49 days
Areas in Green highlight substantial improvement
The Value Continues 2012
Clinical Indicator VA Average Percent (1) HEDIS 2011 (2) DELTA
2012 (6) 2011 (6) 2010 (6)
Commercial (7)
Medicare (7)
Medicaid (7)
RAW Breast Cancer Screening 87 85 87 71 69 50 16 23 Cervical Cancer Screening 93 93 94 77 na 67 16 21 Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Control (lt100 mgdL) 70 71 69 59 57 42
11 19
Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Screening 96 96 96 88 89 82 8 9
Colorectal Cancer Screening 82 82 82 62 60 na 20 32 Comprehensive Diabetes Care - Blood Pressure Control
(lt14090) 80 81 82 66 63 61 14 21
Comprehensive Diabetes Care - Eye Exams 90 90 91 57 66 53 33 58 Comprehensive Diabetes Care - HbA1c Testing 98 99 90 91 83 8 9 Comprehensive Diabetes Care - LDL-C Controlled (LDL-Clt100
mgdL) 68 69 70 48 53 35 20 42
Comprehensive Diabetes Care - LDL-C Screening 97 97 97 85 88 75 12 14 Comprehensive Diabetes Care - Medical Attention for
Nephropathy 95 95 96 84 90 78 11 13
Comprehensive Diabetes Care - Poor HbA1c Control (8) 19 17 15 28 27 43 (9) -32 Controlling High Blood Pressure - Total 77 78 79 65 64 57 12 18 Medical Assistance with Smoking Cessation - Advising
Smokers To Quit 3 96 97 97 77 na 76 19 25
Medical Assistance with Smoking Cessation - Discussing
Medications 94 94 94 53 na 44 41 77
Medical Assistance with Smoking Cessation - Discussing
Strategies 3 96 97 97 48 na 40 48 100
Flu Shots for Adults (50-64) 3 65 65 71 53 na na 12 23 Flu Shots for Adults (65 and older) 3 4 5 76 79 82 na 69 na 7 10 Immunizations Pneumococcal 34 5 93 94 95 na 69 na 24 35
SOURCE Office of Analytics and Business Intelligence Updated 11282012
Power of
Information
What we donrsquot know WILL hurt us
Act Decisively
Knowledge Data
TIME
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
The Value Continues 2012
Clinical Indicator VA Average Percent (1) HEDIS 2011 (2) DELTA
2012 (6) 2011 (6) 2010 (6)
Commercial (7)
Medicare (7)
Medicaid (7)
RAW Breast Cancer Screening 87 85 87 71 69 50 16 23 Cervical Cancer Screening 93 93 94 77 na 67 16 21 Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Control (lt100 mgdL) 70 71 69 59 57 42
11 19
Cholesterol Management for Patients with Cardiovascular
Conditions LDL-C Screening 96 96 96 88 89 82 8 9
Colorectal Cancer Screening 82 82 82 62 60 na 20 32 Comprehensive Diabetes Care - Blood Pressure Control
(lt14090) 80 81 82 66 63 61 14 21
Comprehensive Diabetes Care - Eye Exams 90 90 91 57 66 53 33 58 Comprehensive Diabetes Care - HbA1c Testing 98 99 90 91 83 8 9 Comprehensive Diabetes Care - LDL-C Controlled (LDL-Clt100
mgdL) 68 69 70 48 53 35 20 42
Comprehensive Diabetes Care - LDL-C Screening 97 97 97 85 88 75 12 14 Comprehensive Diabetes Care - Medical Attention for
Nephropathy 95 95 96 84 90 78 11 13
Comprehensive Diabetes Care - Poor HbA1c Control (8) 19 17 15 28 27 43 (9) -32 Controlling High Blood Pressure - Total 77 78 79 65 64 57 12 18 Medical Assistance with Smoking Cessation - Advising
Smokers To Quit 3 96 97 97 77 na 76 19 25
Medical Assistance with Smoking Cessation - Discussing
Medications 94 94 94 53 na 44 41 77
Medical Assistance with Smoking Cessation - Discussing
Strategies 3 96 97 97 48 na 40 48 100
Flu Shots for Adults (50-64) 3 65 65 71 53 na na 12 23 Flu Shots for Adults (65 and older) 3 4 5 76 79 82 na 69 na 7 10 Immunizations Pneumococcal 34 5 93 94 95 na 69 na 24 35
SOURCE Office of Analytics and Business Intelligence Updated 11282012
Power of
Information
What we donrsquot know WILL hurt us
Act Decisively
Knowledge Data
TIME
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
Power of
Information
What we donrsquot know WILL hurt us
Act Decisively
Knowledge Data
TIME
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
State of the Union Address
ldquohellipBy computerizing health
records we can avoid dangerous
medical mistakes reduce costs
and improve carerdquo
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
The award cites VAs
collaboration with the
Department of
Defense (DoD) on
electronic medical
records for patients
receiving care from
both departments
American Council For Technology
ExcellenceGov Award
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
Offic e o f the Surg eo n Genera lOffic e o f the Surg eo n Genera l
CO NU S B ASECO NU S B ASE
Activ eActiv e
Res erv eRes erv eTOamp ETOamp E TDATDA
NetworkNetwork-- Centric Centric System of SystemsSystem of Systems
AOAO
I NTE GRAT ED FR O M C ON US T O THE F OXH OLE J OINTJ OINTJ OINT
GERM ANYGERM ANY
VA
Medical Centers
Scientific Expertise
Forward
Surgical Tm
In Theater Health
Services
68W 18D
CARE IN THE AIR
INTEGRATED FROM FOX HOLE TO CONUS
PARADIGM SHIFT
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
WW II Korea
bullGeriatric Care
bullEnd Of Life
OIF OEF bullEarly in
Professional Life
bullYoung Families
bullReintegrating
Vietnam Era
bullEnd Professional Life
bull Latent Medical Issues
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
Rich 85-Year Research History The groundbreaking achievements of VA researchersmdash
60 of whom also provide direct patient caremdashhave
resulted in 3 Nobel Prizes 6 Lasker Awards and
numerous other distinctions
36
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
Million Veteran Program (MVP)
VA is partnering with Veterans to learn more about how
genes affect health by establishing a program where
Veterans can volunteer to link their DNA with their
health information
Over the next 5 to 7 years the MVP database is expected to develop new
knowledge that may eventually lead to better treatments and preventive
measures for many diseases including common illnesses such as heart
disease diabetes and cancer 37
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
Veterans Give High Marks to VA Pharmacies
VA ships 460000
prescriptions to
Veterans every
workday
JD Power and Associates a firm specializing in
consumer surveys recognized VArsquos Consolidated Mail
Outpatient Pharmacy as ldquoAmong the Bestrdquo mail order
systems in the country in 2009 2010 2011 and 2012
38
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
Evolution of Bar Code Medication Administration (BCMA) within the
Department of Veterans Affairs
Coyle GA Heinen M
Abstract
The Department of Veterans Affairs Medical Center
implemented Bar Code Medication Administration (BCMA)
between 1999 and 2000 in 161 Medical Centers or Health
SystemshellipNurses have moved from manual to electronic
medication documentation hellip A marked decrease in medication
administration errors is a result of implementing BCMA
Nurse Admin Q 2005 Jan-Mar29(1)32-8
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
PATIENTrsquoS HOME
Adam Darkins
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
Increasing Access to Care via Telehealth
41
Since FY 2009 Telehealth funding has increased by 368 to
$3348M
In 2012 VArsquos Telehealth programs
bull Provided care to half a million
Veterans
bull Provided 1429424 episodes of care
bull Supported 42699 patients to live
independently in their own homes
instead of long-term institutional care
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
My HealtheVet
A personal My HealtheVet account provides
Veterans with 247 online access to a variety
of tools to manage their health care
Communicate
with Participating
Patient Aligned
Care Team
Members
View
Appointments and
Health Information
Refill
Prescriptions Download and
Share Personal
Health Record
44
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
Expanding On-the-Go Resources
The ldquoPTSD Coachrdquo mobile app is one of the first in a series of
VA and DoD jointly-designed resources to help
Servicemembers and Veterans manage their readjustment
challenges and get anonymous assistance
Downloads via
iTunes and Android
Market
90000
+
45
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
Simulated Learning
VA is expanding simulated learning programs so training
can be held in a safe and protective environment
This provides practitioners the opportunity to master skills practice
protocols learn systems-based practices apply critical decision
making and promote improved team communications and function 47
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
1991 to 2006 VA hospitals
bull 47 percent drop in postoperative
mortality
bull 43 percent drop in morbidity rates
National VA Surgical Risk Study (NVASRS)
1991 - 1993
National Surgical
Quality Improvement
Program
(NSQIP)
1994
American College of Surgeons
2001
Today 9 of the top 10 of Americarsquos
US News amp World Report
Best Hospitals participate in ACS
NSQIP
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
Recognition Continues
2012 The Joint Commission Accreditation amp Top Performers Award All VA
medical centers are accredited by The Joint Commission In addition The Joint
Commission recognized nineteen medical centers as Top Performers on Key
Quality Measures
2012 ATA Presidentrsquos Award for Innovation The VADoD Post-traumatic Stress
Disorder (PTSD) coach mobile application marked its first anniversary with receipt
of an award for innovation in the advancement of telemedicine from the American
Telemedicine Association
2012 Fed Innovation of the Year Award FedScoop honored the VA Blue Button
initiative with an award that celebrates a new innovation that increases
accessibility to a federal service and allows citizens to more easily interact with
government
2011 Innovations in American Government Award Harvard University selected
VHArsquos IntegratedEthics program a program which handles ethic issues affecting
VHA patients as one of the ldquoTop 25 Programsrdquo in the 2011 Innovations in
American Government Award competition
2011 Global Vision Award The National Hospice Foundation presented its
Global Vision Award to VHA for its groundbreaking efforts to improve end-of-life
care for all Veterans through the We Honor Veterans Campaign
51
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
Hospitals to Health System
In-Patient to Ambulatory
CBOCs to PACTs
Ambulatory to Home
Home to Personal Devices
Technology Adoption
Quality Measurement
Information Ubiquity
JOURNEY
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
The VA Quality Journeyhellip Still
Evolvinghellip Still Changinghellip It Must
And So Must YOURS
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
Health Quality Journey US
Department of Veterans Affairs
THANK YOU
Healthcare Executive Circle
