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CPRS at CHVH
Louis V. Kaufman, MD, MS, CMD
Medical Director
Charlotte Hall Veterans Home
Charlotte Hall, Maryland
Charlotte Hall, MD
NASVH ConferenceBurlington Vermont
July 2011
Who Are We?
Medical Director
Certified Network Engineer
Programming Staff
Why VISTA/CPRS?
Physician
Nurse
Pharmacy
AncillaryServices
P
F C
TPrint
Fax Copy
Transcribe O Courier
Hand CarryH
W Write
Paper
People
M Mail
InterimPhysician
Order
ResidentChart
CourierBin
PhysicianOrderSheet
OrderRequisitions
MedicationAdminRecord
TreatmentAdminRecord
W
C
F
D Data Entry
C
O
T
C
H
T T T
D P M
R Proofread
R R
Current Order Process
280,000 Orders Per Year….Which is a lot of transcribing, writing, copying, faxing,…..
Order Volume at CHVH
Physician
Nurse
Pharmacy
AncillaryServices
P
F C
TPrint
Fax Copy
Transcribe O Courier
Hand CarryH
W Write
Paper
People
M Mail
InterimPhysician
Order
ResidentChart
CourierBin
PhysicianOrderSheet
OrderRequisitions
MedicationAdminRecord
TreatmentAdminRecord
W
C
F
D Data Entry
C
O
T
C
H
T T T
D P M
R Proofread
R R
CPRS
Current Order Process
Reengineered
Order• Order Labels
• Order Sheets• Requisitions• MARs• TARs
• Prescriptions
Current Order Process
CPRS/VISTA AdvantagesImproves Quality of Care
Increased Quality Improvement process
Increased nurse-patient hands-on interaction
Reduced medication errors
Reduced transcription errors
Reduced nurse-clinical provider communication error
Increased Efficiency of Quality Improvement process
CPRS/VISTA Advantages
CPRS is 4 times less expensive to install than commercial electronic health record systems
And costs 2/3 less to maintain over the long term
Sharing Agreement Between Washington, DC VA Medical Center and Charlotte Hall Veterans Home
Concept Initially Discussed at WVAMC in 2005
3-1/2 Years of Negotiation
Memorandum of Understanding Signed In Late 2008 Between Federal Veterans Administration and the Maryland Department of Veterans Affairs
Implementation “Nuts and Bolts”
Certified Network Engineer (CNE) Hired
Required by VA Information Technology and Security Departments
Found existing CHVH computer network to be inadequate for CPRS
Designed a new wired and wireless computer network “from the ground up” to comply with the VA’s computer hardware and IT security specifications
Implementation “Nuts and Bolts”
Certified Network Engineer
Worked closely with WVAMC telecommunications department to install redundant high speed Point To Point data lines between CHVH and WVAMC
Supervised the CPRS server move from WVAMC to CHVH for programming (Required by the VA Central Office legal team)
Implementation “Nuts and Bolts”
Certified Network Engineer
After programming completed, supervised the physical move of the CPRS server from CHVH back to the WVAMC
CPRS server will be physically located at the WVAMC and managed by WVAMC personnel with management and personnel fees paid by the Maryland Department of Veterans Affairs
Implementation in the CHVH ALF
180 bed Assisted Living facility
Implementation began in April 2009
Adjustments required to use CPRS/VISTA in a non Federal VA facility
Pharmacy
Laboratory
Implementation in the CHVH ALF
Laboratory Adjustments
LabCorp is the laboratory services provider
LabCorp has direct access to CPRS through a national agreement with the Federal VA
This agreement allows bidirectional electronic lab test ordering and reporting directly through CPRS
CHVH lab tests are performed in both Virginia and North Carolina
This led to miscommunication between the LabCorp programmers in both states and at CHVH
Hmmmm!
Implementation in the CHVH ALF
Pharmacy Adjustments
CHVH uses a commercial non-VA long-term care pharmacy
This means that the VA programmer pharmacist needed to approve all medications and treatments in 6 month time intervals
(“Real time” order checking is not currently available in a non-VA facility)
Implementation in the CHVH ALF
Staff Training
Implementation in the CHVH ALF
Staff Training
Group training
Individual “hands on” training among staff members
Computer “Screen Shot” Tutorials
Lab Order Entry
Medication Order Entry
Implementation in the CHVH ALF
Staff Training Issues
Started too soon prior to implementation of CPRS
Staff forgot user names and passwords
Tutorials need further development
Training Database
Currently being implemented to separate “test” patient files from the production database “real” patient files
Future Implementations of CPRS at CHVH
278 bed Skilled Nursing Facility
Staff training to begin in September 2011
Imaging
VISTA/CPRS imaging being implemented now to scan in documents, reports, EKGs, etc., from outside providers
Future: scan actual x-ray images into the patient chart
Future Implementations of CPRS at CHVH
Electronic Medication Administration Record (MAR)
Electronic Treatment Administration Record (TAR)
Bar Code Medication Administration (BCMA)
Conclusions
CPRS is 4 times less expensive to install than commercial electronic health record systems
CPRS Costs 2/3 less to maintain over the long term
CPRS Improves Quality of Care
Conclusions
CPRS is a great example of Federal/State Partnership
Our Tax Dollars At Work!
and
Conclusions
The Best Care Anywhere!
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