2006 Winner
U.S. Department of Veterans Affairs
Innovations in American Government Awards
Innovations in American Government Awards
A 1999 Institute of Medicine report estimated that upwards of 98,000 Americans die each year from medical errors, with many stemming from poorly maintained records or miscommunication between providers. The U.S. Department of Veterans Affairs tackled this life-threatening problem, using today's technology to digitize and streamline medical records by introducing the Veterans Health Information Systems and Technology (VistA). With the implementation of this new electronic medical records system, American veterans now receive some of the finest patient care in the nation, and the Department of Veterans Affairs (VA) substantially improved efficiency, reduced costs, and demonstrably improved clinical decision-making.
Established in the mid-1990s, VistA enables clinicians to instantly find, organize, and analyze a patient's complete medical record electronically. Each patient's medical record includes narrative documents, radiology and procedure reports with associated diagnostic interpretations, laboratory results, medication profiles, physician orders, clinical problem summaries, vital signs and other measurements, clinical images, and scanned documents. VistA incorporates clinical information from community health centers; hospitals, including intensive care units; long-term care institutions; and some home care settings. In 1995, only 60% of paper charts for VA patients were immediately available. Ten year later, over 99% of patients' records were available at all facilities at all times. Compiling all of this information into a single electronic file that is accessible to physicians from any one of the VA's 1,300 points of care prevents unnecessary repetitive testing, duplication of unsuccessful treatments, and provides a rich set of clinical information for accurate diagnosis.
In an effort to further improve quality of care, VistA features evidence-based guidelines and an application that screens for potentially fatal drug interactions. The evidence-based guidelines remind physicians to follow a specific protocol during their clinical encounters, standardizing the care that veterans receive. Likewise, by alerting clinician to drug allergies or potential drug interactions in real time, physicians must consider alternative medications before a prescription error can occur.
VistA further reduces the frequency of medical errors by utilizing a computerized physician order entry and barcode-assisted medication administration system. As of 2005, 94% percent of all pharmacy orders in the VA were placed through the computerized physician order entry, virtually eliminating transcription and medication administration errors.
Since implementing VistA, the VA has experienced significant cost-savings. By reducing repetitive testing, preventing diagnostic and medication errors, and more effectively using existing resources, the VistA system has prevented the VA from experiencing the soaring health care costs other providers are grappling with. Even more significant than the simple cost savings are the lives saved. The true magnitude of the VistA system became apparent in the aftermath of the Hurricane Katrina disaster. While thousands of paper records were washed away with the flood waters, the medical records of veterans remained accessible to physicians across the country, allowing these individuals to receive uninterrupted medical care. By effectively employing VistA in the care of over 4.9 million veterans, the VA has shown that all other hospitals and health care providers can and should implement similar centralized electronic medical records systems to guarantee the very best care possible.