VA a leader in electronic records

Physicians assistant Roscoe Shepherd looks over his desktop computer as he fills prescriptions at the Veterans Affairs Clinic at 2200 Harvard Road in this 2009 file photo.

Editor’s Note: This is the third in a three-part series on electronic medical records.

The Department of Veterans Affairs is a pioneer when it comes to electronic health records and is serving as an example of what a future national health information network might look like.

The VA began using its own electronic health system in the early 1980s, when the Macintosh computer was introduced.

Since then, its system has evolved to include more safety measures and user-friendly programs.

“It’s a very comprehensive, well-integrated system,” said Dr. Sudhir Hegde, chief of primary care at Colmery-O’Neil VA Medical Center in Topeka.

He sat at his computer last week and demonstrated many of the things the system allowed him to do. When it comes to patients, he can see their medications, insurance, military service information, health conditions, consults, lab work and immunizations. The system also allows him to chart their information.

“It is very interesting and revealing to the patient when you show a graph that shows, ‘OK you’ve gained weight now and see how your cholesterol is affected.’ Instead of telling them verbally, you can show them,” Hegde said. “It makes a big impact and it is very easy.”

It also has a warning system. If a doctor prescribes a medication for someone with bad kidney function, it will put out an alert.

Nationwide connection

But what really stands out is the capability for Hegde to see a veteran’s health record from anywhere in the United States. So if a patient were visiting Topeka from Florida and needed a prescription refilled or an emergency room visit, a record of information is available by computer.

“You can look at their office visits and any medications that are prescribed to them,” Hegde said. “It helps a lot in treating patients.”

The VA’s system allows health care professionals at more than 1,400 facilities — including hospitals, outpatient clinics and veterans centers — to share a patient’s record.

For veterans who receive care outside the VA system, doctors try to collect the information and enter it into their system.

“Hopefully, in the future, we are all integrated and can function much more effectively,” he said. “It would help in patient care — no doubt about it.”

The VA and the Department of Defense are setting the pace for the nation when it comes to exchanging electronic health records. They began exchanging information such as lab results, pharmacy data, consult reports and lab work in 2001. In 2004, the system was updated so that each department would receive an alert if a drug were prescribed that might have an adverse effect.

In January, the two systems and a private managed-care company, Kaiser Permanente in San Diego, plan to test a pilot project on how to share information on patients seen by the three systems.

Gail Graham, deputy chief officer of Health Information Management, said the project serves as a model for what the Obama administration hopes to achieve nationwide.

“We certainly hope that this really is kind of a nudge or impetus for accelerated private sector adoption of electronic health record,” she said.

Patient access

The VA also offers its 7 million patients, including 36,000 in the Eastern Kansas Health Care System, access to health information for free on its Web site called My HealtheVet. On the site, they can order medication refills and see parts of their records.

“We are moving to patient-centered care models,” Graham said. “It is essential that the patient and their families be empowered with information and access to the providers.”

The VA recently began testing a program that will send patients reminders, such as that they need to get a flu shot. During the next year, it will allow patients to communicate with health care providers electronically, view appointments and see lab results.

Lori Burton, clinical application coordinator for Colmery-O’Neil, has worked for the VA for 29 years and helped staff move from paper to electronics.

“It was an evolution,” she said. “It took a long time to get each step.”

Besides better health care and fewer medical errors, Burton said Hurricane Katrina showed another benefit of having electronic records.

“If you were a cancer patient and you had been receiving treatment for the last three months, every bit of the documentation for your chemo was gone. There was no one that knew what you had been given,” she said of the paper health records.

For veterans, the information was available electronically.

“For me, it was really eye-opening to see what we have really done here for our veterans,” she said.