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![Page 1: VETERANS HEALTH ADMINISTRATION Quality Improvement using the VA Electronic Health Record Matthew Bidwell Goetz, MD Chief, Infectious Diseases VA Greater.](https://reader035.fdocuments.us/reader035/viewer/2022070307/551b73b9550346a6148b509f/html5/thumbnails/1.jpg)
VETERANS HEALTH ADMINISTRATION
Quality Improvement using the VA Electronic Health RecordMatthew Bidwell Goetz, MDChief, Infectious DiseasesVA Greater Los Angeles HCS
![Page 2: VETERANS HEALTH ADMINISTRATION Quality Improvement using the VA Electronic Health Record Matthew Bidwell Goetz, MD Chief, Infectious Diseases VA Greater.](https://reader035.fdocuments.us/reader035/viewer/2022070307/551b73b9550346a6148b509f/html5/thumbnails/2.jpg)
VETERANS HEALTH ADMINISTRATION
VHA and quality of care
• VA is now recognized nationally for quality
• Transformation into a quality institution occurred in conjunction with other changes
– Reorganization to a primary care-focused system
– Quality measurement and accountability
– Independent data gathering programs
– Public availability of performance data
– Institution of an integrated, comprehensive EHR
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VETERANS HEALTH ADMINISTRATION
How did the EHR help improve quality?
• 100% access to records
• Availability of remote data (other VAs) and DoD data
• Ability to identify patients by disease or other characteristics (coding, use of data elements)
• Ability to use data to create reports, provide feedback
• Decision support tools at point of care including reminders to providers
![Page 4: VETERANS HEALTH ADMINISTRATION Quality Improvement using the VA Electronic Health Record Matthew Bidwell Goetz, MD Chief, Infectious Diseases VA Greater.](https://reader035.fdocuments.us/reader035/viewer/2022070307/551b73b9550346a6148b509f/html5/thumbnails/4.jpg)
VETERANS HEALTH ADMINISTRATION
Examples of Summary Reports
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VETERANS HEALTH ADMINISTRATION
Secure, web-based national registries for use by all VA primary care providers
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VETERANS HEALTH ADMINISTRATION
Group comparisons
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VETERANS HEALTH ADMINISTRATION
Care Managers can produce customized, team-level reports
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VETERANS HEALTH ADMINISTRATION
Provider access to information on patients not meeting indicators
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VETERANS HEALTH ADMINISTRATION
Quality Measures in the VA
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VETERANS HEALTH ADMINISTRATION
Use of the Computerized Patient Record System (CPRS) for Management of Individual Patients
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VETERANS HEALTH ADMINISTRATION
Selected views of CPRSCover Page
Imaging and Procedure Reports Laboratory Reports
Clinician Notes
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VETERANS HEALTH ADMINISTRATION
CRPS: customized patient-specific reports
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VETERANS HEALTH ADMINISTRATION
GLA HIV Viral Loads, Includes patients not on treatment
0tan
15a5
6651
5
0tan
15a5
6651
5
0tan
16a5
6651
6
0tan
16a5
6651
6
0tan
17a5
6651
7
0tan
17a5
6651
7
0tan
18a5
6651
8
0tan
18a5
6651
8
0tan
19a5
6651
9
0tan
19a5
6651
9
0tan
20a5
6652
0
0tan
20a5
6652
0
0tan
21a5
6652
1
0tan
21a5
6652
1
0tan
22a5
6652
2
0tan
22a5
6652
2
0tan
23a5
6652
3
0tan
23a5
6652
3
0tan
24a5
6652
4
0tan
24a5
6652
4
0tan
25a5
6652
5
0tan
25a5
6652
5
0tan
26a5
6652
6
0tan
26a5
6652
6
0tan
27a5
6652
7
0tan
27a5
6652
7
0tan
28a5
6652
8
0tan
28a5
6652
8
0tan
29a5
6652
9
0tan
29a5
6652
9
0tan
30a5
6653
0
0tan
30a5
6653
00%
10%20%30%40%50%60%70%80%90%
100%
<50 50 - 400 400 - < 1,000 1,000 - <100,000 >100,000
Viral Load
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VETERANS HEALTH ADMINISTRATION
System-Wide Quality Improvement in HIV - Testing
Facilitation by the VA Electronic Health Record (EHR) and the Functionality of CPRS
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VETERANS HEALTH ADMINISTRATION
How did the VA EHR and CPRS help HIV testing initiatives?
• Able to identify patients not previously tested and avoid
repeatedly offering tests the previously tested
• Able to use data to create reports, provide feedback
• Decision support tools at point of care
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VETERANS HEALTH ADMINISTRATION
Using CPRS – based decision support (Clinical Reminders)
• Used for a wide variety of purposes in the VA– Screening for depression, traumatic brain injury– Screening for Tobacco & alcohol use– Hypertension identification and management– Diabetes monitoring– Vaccination rates– Etc.
• Contributes to attainment of performance standards
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VETERANS HEALTH ADMINISTRATION
Examples of Clinical Reminders
• Sample reminders for an HIV-infected patient
• OI prophylaxis
• Hepatitis screening
• Primary care indicators
• Reminders can be determined by the status of the patient
• Reminders can be customized at each facility
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VETERANS HEALTH ADMINISTRATION
Provider – specific reminder completion rates
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VETERANS HEALTH ADMINISTRATION
Relative Increase in Testing50% 390% 556%
Pre- vs Post-Intervention Routine HIV TestingMulti- VISN QI Project – Adjusted Rates
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0tan2a56602
0tan4a56604
0tan6a56606
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5%
10%
15%
20%
25%
30%
Pre-Intervention Post-Intervention
HHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH
HIV
Tes
ting
Rate
Control Sites Local CentralNo Implementation Implementation Implementation
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VETERANS HEALTH ADMINISTRATION0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
HIV
Tes
ts (t
hous
ands
)
VA-Wide Changes in HIV Testing vs Use of HIV Testing Clinical Reminder
Sites without Clinical Reminder Sites with Clinical Reminder
2009 2010
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VETERANS HEALTH ADMINISTRATION
Acknowledgements
• VA HSR&D: QUERI core funds, SDP 06-001, SDP 08-002
• VA Clinical Public Health: moral, financial and logistical support
• QUERI-HIV/HEP colleagues: Steve Asch, Allen Gifford, Jane Burgess, Tuyen Hoang, Hersch Knapp, Henry Anaya and many, many others
• Slides on the development of clinical dashboards – Caroline Goldzweig