VA CART and Real-Time Locator System (RTLS) Technology:

Automated Capture and Integration of structured device data

Paul D. Varosy, MD, FACC, FAHA, FHRSDirector of Cardiac Electrophysiology

VA Eastern Colorado Health Care SystemAssociate Professor of MedicineUniversity of Colorado Denver

Overview

• Beyond Meaningful Use• The CART Concept• CART Device Surveillance• VA Real-Time Locator System (RTLS) Technology

VA and Device Data:Beyond “Meaningful Use”

VA: Multiple IT applications capture device data– GIP/IFCAP – VA Logistics/Supply IT system– Cath/EP recording system– CART Program– Prosthetics system (funding for implantables)– CPRS (VA EHR)– National Cardiac Device Surveillance Program

Challenges of Device Identifier Capture in a “Pre-UDI” World

• Device-Specific Identifiers:– Manufacturer– Model Name/Number– Serial/Lot Number– Date of Manufacture– Date of Expiration– Size(s)

• Difficult to capture manually

• Non-intuitive• Non-standardized• Prone to data entry

error

VHA Cardiovascular Assessment, Reporting and Tracking (CART) Program

Integration of structured data collection into the process of care

documentation

CART SITESAll VA Cath Labs (N=76)

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Current Non-VA Post-Market FDA Device Surveillance

• Underreporting• Voluntary = Passive• Numerators, not denominators

http://www.fda.gov/cdrh/postsurv/medsunappendixa.htmlwww.fda.gov/cdrh/postsurv/medsun.pdf

J Gen Intern Med. 2006;21(9):942-948. Arch Intern Med. 2008;168(1):40-46.

BURDENSOMETIME-CONSUMING

NOT AT POINT OF CAREDIFFICULT PROCESS

CART-FDA Post-Market Device Surveillance

• Challenges pre-RTLS:– Lack of granular information on device identifiers makes

FDA reporting difficult– Difficult to capture identifiers even with CART in place

• New model:– Seamless capture of device identifiers by RTLS– Closer collaboration with FDA via MedSun program

Real-Time Locator Systems (RTLS)

• Technology to locate and track assets in real time• Many possible technologies

– Radiofrequency ID (RFID) – active vs. passive tags– Infrared– Ultrasound– Many others

• Examples:

VHA RTLS

• $543M National Contract – Total cost ~$1.6B (remainder funded by individual

VISNs/sites)

• Part of VA’s “Transformational Initiatives”• T-15: Health Care Efficiency Initiative

– Facility Automation• RTLS – 4 use cases

– Asset Tracking– Cath/EP Supply Chain– Critical Temperature Monitoring– Sterile Processing Workflow

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RTLS in VHA Cath/EP Labs

• Implementation VHA wide for inventory management in Cath/EP labs

• Rationale– Expensive tools (catheters, stents, pacemakers,

defibrillators)– Recall management/device surveillance– CART presents a unique integrative data solution

RTLS Implementation:

Smart cabinet technology with data integration solution

Single point of data entry integrated into the process of care

VA RTLS Implementation: Ann Arbor VAMC

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VA RTLS Implementation: Ann Arbor VAMC

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VA RTLS Implementation: Ann Arbor VAMC

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VA RTLS Implementation: Ann Arbor VAMC

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RTLS for Cath/EP Lab Inventory Management

RTLS for InventoryManagement

CART

GIP

PIP NCDSP

CPRS/VistA

Hemo/EP Recording System

RTLS Implementation

• Planning – (began 2010)• National RTLS Contract (2012)• Nationwide implementation (2012 – 2016)

– VISNs 10, 11 (2012)– VISN 23 (early 2014)– VISN 19 (including Denver), 20, 21, 22 (late 2014)– Remainder of VA (2015-2016)

Vision

• Collect data ONCE and multiply leverage the data for multiple purposes.

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Vision

Data Collection

Nursing Documentation Billing

and Coding

Supply Chain Management

Registries Device Surveillance Research

QI/QMPhysician Documentation

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Vision

Moving beyond Meaningful Use of HIT

to

Meaningful Integration of HIT

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Vision

Requires Meaningful Resources

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