Journal Issue Highlights the State of Health Information Technology in VA Healthcare
BACKGROUND:
VA helped lead the early development of health information systems in the '80s and led the first wide-scale deployment of an electronic health record — the computerized patient record system (CPRS) — in the late '90s. This Medical Care Supplement focuses on the use and impact of health information technology (HIT) in quality improvement research conducted within VHA. Articles in this Supplement highlight a range of specific HIT approaches, including innovative and interactive uses of VHA's electronic health record, databases, and information systems, as well as applications of automated systems for intervention, evaluation, and tracking patient care. The Supplement begins with an Editorial by Atkins and Cullen that addresses the state of VHA's informatics development and research plans in the context of the current healthcare environment. The lead article by Hynes and colleagues summarizes VHA's Quality Enhancement Research Initiative (QUERI) and the evolution of HIT within this program, highlighting implications that are relevant beyond the VA healthcare system.
SUMMARY FINDINGS:
- Cohen and colleagues demonstrated that data captured directly from Veterans through patient-facing kiosks resulted in increased, timely, and sustained utilization of healthcare services for overweight Veterans with schizophrenia compared with Veterans who received usual care.
- Gabrielian and colleagues discuss preliminary results of the Care Coordination Home Telehealth (CCHT) program for homeless Veterans in the U.S. Department of Housing and Urban Development-VA Supportive Housing program. Early findings indicate satisfaction with CCHT.
- McInnes and colleagues evaluated the effects of a training program for low-income Veterans infected with HIV or HCV to increase their skills using the Internet and personal health record (PHR). Results indicate that the training increased Veterans' confidence and use of the Internet and PHR.
- Nazi and colleagues examined the results of a web-based survey that elicited feedback from Veterans about their experience in the My HealtheVet Pilot Program. Veterans reported the most important features of the program were prescription history, medical records view, and appointment view, and a majority felt this access helped to improve their healthcare.
- Shimada and colleagues explored the association between facility rates of adoption of secure messaging (SM) and urgent care (UC) rates at 132 VHA facilities. They found that higher SM use was associated with lower UC rates; early adopters of SM achieved a greater decrease in UC utilization over time than later adopters.
- Spears and colleagues describe a project that used electronic clinical reminders to improve the management of Veterans at high risk for falls. Results suggest that the redesigned electronic clinical reminder positively impacted care delivery.
- Trafton and colleagues describe the integration of VHA's Mental Health Information System (MHIS) — a HIT-based system developed to support the oversight and evaluation of mental health services policy requirements. Lessons learned from the MHIS implementation included understanding the audience's needs, the emphasis of metrics as an improvement tool, providing training for staff, and seeking expert consultation.
- Tsai and colleagues explored the initial results of leveraging the national VA Clinical Assessment, Reporting, and Tracking (CART) system to document unexpected device problems at 76 VHA hospitals. Findings suggest that proactive, continuous surveillance programs such as CART can provide timely and meaningful information to monitor the safety of medical devices.
CITATIONS:
Atkins D and Cullen T. The Future of Health Information Technology: Implications for Research Foreword. Medical Care March 2013;S1.
Hynes D. Health Information Technology in VA Quality Improvement Research. Introduction. Medical Care March 2013;S4.
Hynes D, Whittier E, and Owens A. Health Information Technology and Implementation Science: Partners in Progress in the VHA. Introduction. Medical Care March 2013;S6.
Cohen A, Chinman M, Hamilton A, et al. Using Patient-Facing Kiosks to Support Quality Improvement at Mental Health Clinics. Medical Care March 2013;S13.
Shimada S, Hogan T, Rao S, et al. Patient-Provider Secure Messaging in VA: Variations in Adoption and Association with Urgent Care Utilization. Medical Care March 2013;S21.
Trafton J, Greenberg G, Harris A, et al. VHA Mental Health Information System: Applying Health Information Technology to Monitor and Facilitate the Implementation of the VHA Uniform Mental Health Services Handbook Requirements. Medical Care March 2013;S29.
Spears G, Roth C, Miake-Lye, I, et al. Redesign of an Electronic Clinical Reminder to Prevent Falls in Older Adults. Medical Care March 2013;S37.
Gabrielian S, Yuan A, Andersen R, et al. Chronic Disease Management for Recently Homeless Veterans: A Clinical Practice Improvement Program to Apply Home Telehealth Technology to a Vulnerable Population. Medical Care March 2013;S44.
Nazi K, Hogan T, McInnes K, et al. Evaluating Patient Access to Electronic Health Records: Results from a Survey of Veterans. Brief Reports. Medical Care March 2013;S52.
Tsai T, Box T, Gethhoffer H, et al. Feasibility of Proactive Medical Device Surveillance: The VA Clinical Assessment Reporting and Tracking (CART) Program. Brief Reports. Medical Care March 2013;S57.
McInnes K, Solomon J, Shimada S, et al. Development and Evaluation of an Internet and Personal Health Record Training Program for Low-Income Patients with HIV or Hepatitis C. Brief Reports. Medical Care March 2013;S62.
Health Information Technology in VHA Quality Improvement Research Medical Care March 2013
