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!