The Veterans Health Administration (VHA) is the largest integrated health care system in the U.S., providing care at 1,240 health care facilities, including 170 medical centers and 1,061 outpatient sites of care, serving 9 million enrolled veterans every year.
The VHA is advancing forward in a number of areas to leverage health IT to change the way patients experience medical care and to improve health outcomes. The VA was one of the earliest pioneers of electronic health records (EHRs), as the agency began its shift from a paper-based to a computer-based records system in the 1980s, although research into an electronic system began a decade earlier. Also in the early 1980s, the VA made its software available without restriction in the public domain to other government and private sector organizations, which offers the use of VistA as the standard-bearer for EHR implementation around the world.
Francine Sandrow, M.D., chief health information officer (CHIO) at the Corporal Michael J. Crescenz Veteran's Affairs Medical Center in Philadelphia, is involved in a number of VHA clinical informatics initiatives. Sandrow is a board-certified emergency medicine physician, and she also is boarded in clinical informatics. In her CHIO role, she works to help facilities realize their potential to help patient populations through the application of technology. Sandrow will be speaking on a panel about digitizing patient engagement at the upcoming Florida Health IT Summit, being held at the Hilton St. Petersburg Bayfront July 24-25.
Currently, Sandrow is involved with the VA’s work to standardize instances of the VA’s EHR, known as VistA, in preparation for the roll out of a new Cerner EHR platform, scheduled to be deployed at three sites in Washington state by 2020. The VA signed a contract with Cerner in May, and the entire deployment could take 10 years to complete. “We are working to standardize our tools and our workflows. When they deploy the Cerner EHR, if the workflows are similar across the VA, it will take less work for the deployment at each facility,” she says.
While the Cerner EHR deployment grabs the headlines, the VA healthcare system is moving forward with many innovative IT initiatives, both at the national and local level. Just this past June, President Donald Trump signed the Veterans Affairs’ Mission Act into law, which will provide more than $50 billion in federal investments to the VA’s healthcare system. Major provisions of that law included an expansion of telehealth services to veterans (passed by Congress as the Veterans in E-Health and Telemedicine Support Act of 2017, or VETS Act). These provisions allow a licensed healthcare professional of the VA to practice his or her profession using telemedicine at any location in any state.
“This gives the VA an incredible opportunity, as it’s allowing a veteran to have telehealth visits with any VA provider, regardless of where the patient is or where the provider is,” Sandrow says, noting that state licensing laws and policies have been a major barrier to the practice of telehealth. “Congress basically obliterated that barrier for the VA and our Office of Connected Care has developed applications to allow telehealth to be provided pretty seamlessly. I think that the VA model is actually going to be one that’s going to be looked at by community providers. It’s amazing that we now we have a network throughout the country of all these providers who can see patients anywhere.”
Sandrow notes that there are significant advantages to working in the VA healthcare system to advance health IT initiatives.
“I think I’ve had opportunities here because of the size of the organization, opportunities that you just don’t get in your typical community hospital or even academic institution,” she says. “One of the things that I think people don’t realize is that the VA is the single-largest graduate medical education provider in the country. Most of our major VA centers have academic affiliates and we have agreements where research is done across the two institutions. In Philadelphia, our academic affiliate is the University of Pennsylvania. Our research department is fairly large, and we have a lot of grants that are coming in, and that leads to unique opportunities for us.”
Sandrow points to a project she was involved in that was a collaboration between the VA and IBM Watson Health. “For that project, I was able to work with our human factors engineering team, and that project focused on identifying patients who were at-risk for post-traumatic stress disorder, but who had not actually been diagnosed with it. Through this project, they were identifying patients at-risk by simply feeding their charts into the engine of Watson. I think working within the VA, whatever your interest is in, as long as its improving veteran care, you have opportunities to grow. It’s exciting.”
In a separate collaboration, this week, the VA announced it was extending its partnership with IBM Watson Health to apply artificial intelligence to help interpret cancer data in the treatment of veteran patients. First announced two years ago as part of the National Cancer Moonshot initiative, VA oncologists have now used IBM Watson for Genomics technology to support precision oncology care for more than 2,700 veterans with cancer, according to a press release.
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