Last week, the Veterans Health Administration of the Veterans Affairs Department announced
it had succeeded in gaining a measure of the long-sought interoperability through a pilot interchange between its electronic clinical information system and that of the Defense Department.
The test sites were Walter Reed Army Medical Hospital in Washington and VA hospitals with polytrauma capabilities in Minneapolis, Palo Alto, Calif., Richmond, Va., and Tampa, Fla.
The pilot was first rolled out March 30 between 256-bed Walter Reed and 93-bed James A. Haley Veterans Hospital, Tampa, according to Brenda Stidham, the VA’s polytrauma nurse liaison stationed at Walter Reed. The other three hospitals were brought up between June and Sept. 23, according to Rob Andreev, an independent IT contractor on the project working with Northrop Grumman Corp., the prime IT support contractor for the VA’s Veterans Health Information and Systems Technology Architecture, or VistA, system, and its subcontractor at the VA, Science Applications International Corp., which developed the portal at the center of the pilot project.
Messages moving from Walter Reed will come to the VA in the situation, background, assessment and recommendation, or SBAR, format, Stidham said. SBAR is a structure for organizing a summary of medical information, akin to the subjective, objective, assessment and plan, or SOAP, note format in widespread use. SBAR is particularly well-suited for patients in critical condition.
Stidham said that the SBAR format was the consensus choice of a steering group of about 50 nurses contributing to the project from Walter Reed and the VA, a decision that received command approval at Walter Reed and with the VA leadership.
“Our nurses find this note much easier to access because they know exactly where everything is,” Stidham said.
Pre-pilot, the voluminous records of polytrauma patients transferred from Walter Reed to the VA were scanned and converted to electronic documents using the PDF document format, and then sent electronically, an improvement over shipping paper, but suboptimal in terms of efficiency on the sender’s end and usability on the recipient’s.
“That took a tremendous amount of effort when a record was 800 pages long and you had to search through that to find the information that you wanted,” Stidham said. In addition, “There were a lot of last-minute faxing and phone calls taking place.”
Now, nurses sit at a computer and, assisted by a series of computerized templates with drop-down menus, compile the electronic SBAR record, she said.
“We spent about three to four months deciding on a template,” she said.
At Walter Reed, the new pilot system automatically pulls patient demographic data from the hospital’s Composite Health Care System, and from its Essentris clinical IT system, said John Garza, system administrator for Essentris at Walter Reed.
Garza said that Essentris was modified to include a trigger when an SBAR record is created and a polytrauma patient is discharged, telling the system to send the patient summary via Health Level 7 messaging standards to what is called the Share Portal, which was created by SAIC. About 80% of the SBAR document content is formatted when the nurses use the pull-down menus in the template, Garza said, the rest is free text. Personnel at the VA pull an SBAR record across as an image in a read-only format, he said. VA clinical personnel can view the summary by clicking a tab inside VistA’s user interface, the Clinical Patient Record System, or through VistA Web, the VA’s own portal.
The system has two-way functionality, Stidham said. “The note looks exactly the same whether it was originated form the DOD or the VA,” she said. So far, she said the records from nine polytrauma patients have moved across the system between Walter Reed and Tampa.
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