Improve the quality, access, equity and efficiency of care by using a fully integrated electronic health record system, personal health information systems, and telemedicine.
VHA is the largest integrated health care system in the U.S. with approximately 1,300 sites providing a full continuum of health care services. VA provided mental health services to more than 750,000 veterans in 2002. All VHA medical facilities (clinics, hospitals, and nursing homes) use a fully integrated electronic medical record that is capable of supporting a paperless health record system. The VA system incorporates clinical problem lists, clinic notes, hospital summaries, laboratory, images and reports from diagnostic tests and radiological procedures, pharmacy, computerized order entry, a bar-code medication administration system, clinical practice guidelines, reminders and alerts, and a specialized package of mental health tools. In addition, VA uses innovative information technology and communication systems to give beneficiaries information on benefits and services, allow web-based enrollment, support a national electronic provider credentialing system, provide veterans and their families access to health information and support health care provider education.
Telemedicine is used to increase access to primary and specialty care for rural and underserved populations. VA provided approximately 350,000 telemedicine visits and consultations last year. Telemedicine mental health consultations and follow-up visits provide access to these services at locations where they would otherwise be unavailable.
In 2002, the Institute of Medicine reported, "VA's integrated health care information system, including its framework of performance measures, is considered to be one of the best in the nation."182 Utilizing an electronic health record with a clinical reminder system, VA screens 89% of primary care patients for depression and 81% for substance abuse. In VA, 80% of patients hospitalized for mental illnesses receive follow-up outpatient appointments within 30 days; the next best reported performance by NCQA is 73% and the Medicaid average is only 55%.
The public's lack of confidence in the privacy and security of the electronic health record and the lack of national standards for data and communications represent the biggest challenges to implementing such a system.
High-performance, reliable electronic health record and information systems are currently available for use by any provider, clinic, hospital, or health system. Incentives for adopting electronic health records would speed wider use.
All VHA clinics, hospitals, and nursing home facilities nationwide