Records System Sets New Standard

By Dennison, Mike

HELENA – Walk into any Veterans Administration health facility in the nation as a patient, and the physician or pharmacist won’t have to ask about your medical history – they’ll already know it. If you’re diabetic, they’ll know when you had your last eye exam. If you need a prescription, they’ll know what other drugs you’re taking and any drug allergies you have. If you had an X-ray last week in Florida, the VA doctor you’re seeing anywhere in the country can look at it.

It’s all courtesy of the VA’s Computer Patient Record System, or CPRS, a 12-year-old electronic system of medical records that serves all 1,400 clinics and hospitals in the VA health system.

“It’s a fabulous computer system,” says Mike Evans, a surgeon on staff at the VA hospital in Fort Harrison, west of Helena. “It has led to better quality of care and more preventive medicine.”

Public-health systems in other countries are using CPRS, such as Germany and Finland. The system’s software, developed by the U.S. government, is in the public domain and can be purchased for a few dollars.

But in the United States, the private sector does not have a comparable, integrated medical-records system. Private hospitals, clinics and other providers have their own computerized systems, but they usually can’t talk electronically to each other.

A coalition of health care businesses in Montana has been hoping to begin work on an electronic medical-records system for the state, but has yet to secure funding.

“In the private sector, you won’t get buy-in from a private doctor’s office in town to integrate with some other hospital,” says Alex Brown, medical coordinator for CPRS at Fort Harrison. “We have an advantage in that we’re the VA, we’re a closed health-care system.”

Brown, who’s also a dentist, says he believes if a similar system served all medical providers in a single Montana community, like Helena or Billings or Missoula, it would save millions of dollars and greatly reduce medical error.

The VA health care system, which serves 5.3 million veterans in Montana and the nation, is a publicly funded, government-owned health system that has seen a remarkable turnaround in quality and focus the past 15 years.

A good deal of credit for the change goes to the VA’s computerized record system, which has become a powerful clinical tool that helps physicians, nurses and other staffers do a better job, VA officials and staffers say.

For example, before a VA hospital patient takes a prescribed drug, the attending nurse scans a bar-coded wristband worn by the patient. The drug, which has been entered into the system by the prescribing physician, must match the bar code on the wristband.

“We have cut our medication errors almost to nothing, as a result,” Brown says.

Another example is a patient with diabetes, who will have a series of “clinical reminders” in his or her electronic file. Diabetics are supposed to have periodic eye exams, foot-sensation exams, urinalyses and other tests.

When a physician sees the patient, a check of the record system will show when the diabetic patient last had those tests and when a new test is due.

VA pharmacists also have access to the system. Lori FitzGerald, director of pharmacy for the VA in Montana, says prescriptions are ordered via the computerized system, so there’s no problem reading anyone’s handwriting, and pharmacists can see the patient’s drug and medical history.

“As we’re finishing prescriptions, we have access to the doctor’s notes, the lab (results), so we can do a better job of assessing whether this drug is appropriate for the patient and whether the dose is right,” she says.

The system is accessible at every VA hospital, clinic or other site in the country.

Diana Corzine, a physician at Fort Harrison, says that fact alone can be a great time and money saver. Veterans who are traveling and get injured or sick, or forget a prescription, can stop into any VA facility and the doctor or pharmacist can call up their medical records in seconds.

“You go into (the VA pharmacy) and say, ‘I forgot my blood- pressure pills, can you get me a two-week supply?’” Corzine says. “They look it up and the say, ‘OK, I see that you’re on that medication, let me get it for you.’”

Desktop computers are ubiquitous at the VA; every physician has one and nurses carry laptop computers as they dispense drugs to hospital patients. Physicians are required to use the system, making an entry each time they meet with a patient.

Brown says there was resistance when the VA began switching to its computer-records world in the mid-1990s. Some physicians actually left the VA because they didn’t want to do everything on computers.

“If we would have asked (physicians) about this when we first brought it up 11 years ago, they would have said, ‘Get rid of this thing; I want to do it the way I’ve been doing it,’” he says. “You go around and ask them today: ‘What if we got rid of this thing and went back to paper?’ They’d say, ‘Oh, no, I don’t want to do that.’”

In Montana’s private health care sector, a group known as HealthShare Montana has been trying since 2007 to secure $1.5 million in funding to begin work on an electronic medical-records system that could serve the state.

Mike Foster, regional director of advocacy for St. Vincent Healthcare in Billings, says the group wants to work toward a system that would allow any participating health care provider to access medical information on any patient.

“We want to make sure that (electronic) systems can talk to each other, for the benefit of health care consumers in Montana,” he says. “We believe that it will cut costs and increase efficiency.”

Foster is hoping the 2009 Legislature will appropriate $1.5 million for a pilot project, or at least half the money, with the other half coming from the federal government.

Yet for now, the VA’s electronic-records system remains the gold standard in Montana and the nation.

“The advantage is that you have a total picture of a patient wherever they show, up, for whatever treatment; at any time,” says Brown. “We can pull patient medical data from anywhere, at anytime.”

FORT HARRISON – Upon returning home to Helena from active duty in Afghanistan, Army National Guard Col. Bob Sparing made a stop at the Veterans Administration hospital in Fort Harrison for a “screening” session.

“You go in there a little apprehensive,” he recalls. “But when you came out, it was a good feeling. It made you feel comfortable that they’re trying to do everything they can for you.”

Sparing is one of 3,000 Iraq and Afghanistan military veterans who’ve gone through the screening process, which was set up by VA Healthcare at Fort Harrison last year to assess any health problems they might have and acquaint them with what the health care system has to offer.

Soldiers returning from active duty in Iraq and Afghanistan are automatically eligible for VA health care for five years.

The screening process at Fort Harrison includes a medical exam, which checks for symptoms of post-traumatic stress syndrome or traumatic brain injury.

For soldiers diagnosed with either affliction, as well as other health problems, the VA staff makes sure they get the recovery care they need and arranges it, be it at Fort Harrison or in their home town.

It could involve physical therapy, mental health counseling, or standard medical care.

“We set up all the consults so that everything is in place when they get home,” says Phay Lloyd, a nurse and the VA Montana health system’s program manager for veterans returning from Iraq and Afghanistan.

The health system also follows up, to make sure the vet who needs care is going to his or her appointments and getting what they need.

“If they’re not (making appointments), we call and ask if it’s a good fit for the (health care) provider,” she says. “If not, we find another one. It’s a pretty tight-run ship.”

A visit with the VA medical staff essentially is required for any Montana soldier returning from active duty in the Middle East, be it with the regular armed forces, National Guard or armed forces reserves.

The VA also is following up with veterans who returned home several years ago, before the current program was in place, to see if they’re getting the care they need for any service-related injuries or mental-health problems.

For most soldiers going through the process, it’s a chance to see the VA health-care system for the first time and see what it has to offer.

Lt. Col. Major LaRowe, an Army National Guardsman who returned home to Helena this May after six months in Afghanistan, says he spoke for nearly two hours with a nurse practitioner who walked him through the system and talked about his health.

“I found it was extremely educational and extremely caring,” he says, adding that he has returned to the facilities at Fort Harrison for health care. “I thought it was outstanding care. They have very experienced doctors and nursing staff.”

Sparing said the physician assistant who did his screening later called him at home, to see if he needed anything else.

“To me, it was above and beyond,” he says. “When I went away (after the screening), I felt like I was covered.”

Copyright The Missoulian Aug 25, 2008

(c) 2008 Missoulian. Provided by ProQuest LLC. All rights Reserved.