Download VistA CPRS - web health

To Study The Functioning Of VistA CPRS
Project Overview
June 2012
Dr. Amit Kumar Srivastava
Dr.Garima Malik
Organizational Overview
MAX HEALTHCARE
 Country’s leading comprehensive provider of standardized, seamless and
international class healthcare services
 It is committed to the highest standards of medical and service excellence,
patient care, scientific and medical education
 Max Healthcare operates eight facilities in Delhi & NCR, offering services in
over 30 medical disciplines
 Max Healthcare has a base of over 1600 leading doctors, 4300 employees and
13,00,000 patients with number of beds growing to over 1900 in the next two
years
MARSH
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GENERAL OBJECTIVE:
To Study the functioning of VistA CPRS
SPECIFIC OBJECTIVES:
 To study the workflow involved in the module CPRS
 To identify the relationship of the CPRS with other modules of
VistA
 To reach a comprehensive training plan to the hospital customers
MARSH
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SCOPE OF STUDY:
 To study CPRS in depth, so that will be able to assist end users
( nurses & physicians) while giving hands on training
 Study can be used for creating user manual, training plan and
schedule
METHODOLOGY:
 Observational
 Interview of end users with close ended structured questionnaire
MARSH
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SUMMER TRAINING PROJECT TIMELINE
CCPRS/BCMA HANDS ON
TRAINING
TO DESIGN AND PLAN
SCHEDULE FOR TRAINING
PROGRAM
TRAINING END USERS
REFRESHER SESSIONS
PROJECT REPORT DRAFT
APRIL 9TH- APRIL 16TH- APRIL 23RD- APRIL 30TH- MAY 7TH13TH
20TH
27TH
MAY 4TH
11TH
MARSH
MAY 14TH- MAY 21ST- MAY28TH18TH
25TH
31ST
JUNE 1ST13TH
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VistA
 The Veterans Health Information Systems and Technology Architecture
(VistA)
 It is an enterprise-wide information system built around an electronic
health record, used throughout the U.S. Department of Veterans Affairs
(VA) medical system, known as the Veterans Health
Administration(VHA)
 VistA, is an integrated system of software applications that directly
supports patient care
 It has various modules, some of them include laboratory, pharmacy,
radiology, Bar Code Medical Administration and CPRS
MARSH
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VistA CPRS
It is graphical user interface for clinicians known as the
Computerized Patient Record System (CPRS), which was released in
1997
It allows health care providers to review and update a patient's
electronic medical record
It includes the ability to place orders, including those for
medications, special procedures, X-rays, nursing interventions, diets,
and laboratory tests
It provides electronic data entry, editing, and electronic signatures
for provider-patient encounters as well as provider orders
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VistA CPRS in Detail
VistA – Veterans Health Information Systems and Technology
Architecture computer application
CPRS – Computerised Patient Record System
MARSH
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To enter
Patient
Information
To review
Patient
Information
CPRS
Continuously
Update
Information
when
connected.
Analyze
Patient Data
Supports
Clinical
Decision
Making
MARSH
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Record Patient History
Enter Problems
Enter Diagnosis
Enter Treatment Plan
Enter Progress Notes
Record Allergies
Record Adverse Events
Request and track Consults
Order Lab Investigations
Order Medications
Order Diets
Order Radiology tests
Order Procedures
Enter Discharge Summaries
MARSH
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COMPUTERISED PHYSICIAN ORDER ENTRY ( CPOE )
CPOE decreases :1. Delay in order completion
2. Reduces errors related to handwriting or transcription
3. Allows order entry at point-of-care or off-site
4. Provides error-checking for duplicate or incorrect doses or tests
5. Simplifies inventory and posting of charges
MARSH
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BENEFITS OF CPOE
a. Enables doctors to enter prescription, lab test and other orders for patient care
straight into a hospital information system
b. CPOE decision support includes: automated medication checking, drug dose,
allergy, and interaction checking; duplicate order notification; recommendations for
pre- or post-administration tests etc
 Adverse Reaction Tracking
a. Documents patient allergy and adverse drug reaction data
b.Alerts the Pharmacy and Therapeutics Committee each time the signs/symptoms
are modified for a patient reaction
 Clinical Reminders
a. Allows clinicians to resolve reminders through dialogs within the CPRS GUI
(graphical user interface). Using point-and-click techniques, a clinician can
generate text for progress notes, update current and historical encounter data in
Patient Care Encounter (PCE), update vital signs, update mental health test
results/scores, and place orders
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MARSH
Difference in Workflows before and after EHR Implementation
in Client’s Hospital
Before EHR Implementation
MARSH
After EHR Implementation
Orders are sent manually
Orders will be send
electronically
Billing – Pre Consultation
Billing
Billing – Post Consultation
Billing
Patient gets Prescription
from Physician
Patient will collect the
Prescription from the front
desk after making the
payment for consultation
Manual Medication
Administration to IP patients
Bar-coded Medication
Administration
Trade Names of Medicines
Prescribed
Generic Names of Medicines
Prescribed, New Concept of
Cart fill and Unit Dose to be
introduced
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MARSH
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TRAINING NEED ANALYSIS
To get the information of number of end
users to be trained
To know who are to be trained in which
module that is CPRS, Radiology, Lab and
Pharmacy and what will be the staff
number for the training
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ROLES AND RESPONSIBILITIES OF THE
TRAINING TEAM AND THE USERS
 End User
• They should be familiar with the working of the system
• They should be able to access, retrieve and enter data in VistA
• They shall be well versed with the module
Training Coordinators
• They will coordinate the entire training process
• They will check availability of trainers , staff , training material and infrastructure
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BASIC METHODS OF
DELIVERY
1. Individual hands-on Instructor
An instructor walks to each user individually to help in
performing common tasks and clear their doubts.This is the
most expensive method, although potentially the most effective.
2. Hands on class room style instructor-led
training
MARSH
An instructor shows users how the software works and how to
perform common tasks, with users performing the tasks themselves
in a classroom/lab setting. Each user or pair of users will have a
system to practice the software. Classes of 12-15 are often
effective.
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3. Seminar Style Group Demonstration
An Instructor shows users how the software works and how to perform
common tasks in a live demonstration. Groups of 20 to 50 are often
effective.
4.Computer Based Training
CD-based or online ( Web Based )
Self-placed training allows end-users to complete interactive lessons, as per
their comfort and this makes them efficient in performing common tasks . The
software tests them on their performance and understanding.
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CHALLENGES FACED
1. The senior physicians were not co-operative and were not satisfied
with the new system
2.There were issues of change management as some providers felt that
paper based system was better
3. Problem was faced regarding time management as a lot of physicians
were not able to come on time during the training
4. Most of the providers were not happy with the amount of data entry
and the time consumption
MARSH
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RECOMMENDATIONS
The senior physicians should be counseled again and
advantages of the paper less system should be
explained to them to develop a positive attitude
Training should be scheduled such that during that time
they don’t have to see any patients and there duties are
taken care of by some other person
Location and time of the program should be such it is
comfortable for the people who have to attend
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CASE STUDY (1)
Physician Perception on
Electronic Health Record
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OBJECTIVE:
To Study the Physician’s Perception on EHR
 METHODOLOGY:
 A sample size of 30 Physicians were taken to evaluate their perception of the
CPRS/ EHR
 Only the physicians who have undergone 16 hours of hands on training were
considered
 Out of them 30 were randomly selected
A well structured questionnaire in english was used for the purpose of primary data
collection
 The questions were related to computer awareness as well as EHR
 Physician team covered were : Junior Residents, Senior Residents, Specialists,
Consultants
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 OBSERVATIONS
 64.7% of the Physicians who were sound with the computers felt that the new
EHR will increase workload and entering data will consume time
 100% of the Physicians are aware that the EHR implementation will reduce
medication errors and agree that EHR supports effective communication among
team members.
 66.7% of the Physicians were not satisfied with the training they received on
CPRS
 66.7% of the Physicians feel that the EHR is not user friendly
 8 Physicians who were sound with computer skills felt that the EHR application is
not user friendly
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 RECOMMENDATIONS
 More change management efforts should be made so that the physicians develop a
positive attitude
 The templates for entering case history can be made simpler
 Free text option can be given for entering case history
 Before initiating the CPRS training an orientation process should be carried out
regarding the entire EHR process
MARSH
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CASE STUDY (2)
Comparative Study Of Paper
Medical Records & Electronic
Medical Records
MARSH
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 OBJECTIVE :
To do a comparative study of the Paper medical records and the Electronic
Medical Records
 METHODOLOGY:
 Observational & Discussion method
 The information is collected primarily by observation of the software and making
a comparison between paper medical records & electronic medical records.
 Focus points of discussion are:
• Disadvantages of PMR
• Advantages & EMR over PMR
• Disadvantages of EMR
• Also some information is collected using secondary data sources
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OBSERVATION: PMR VS EMR
PMR
EMR
• Patient is identified by name, medical • Patient can be identified by any identifier
i.e. Name, SSN, Date of birth, phone
record number & other identifier
number
• Progress notes might be produced by
dictation, free handwriting or form • Progress notes are produced as the visit is
produced
completion
• Consists of office or progress notes in • Stores progress notes and provides quick
access by date of visit, provider and the
chronological sequence. These are browsed
ability to browse by diagnosis and
by literally flipping through pages, until the
prescription
desired entry is located
• Prescription is written on paper. It is • Prescription is written in the system. It is
checked for interactions & allergies by the
manually checked for interactions &
system & then it is sent to the pharmacy by
allergies. It is then taken by the patient to
the system directly where it is verified &
the pharmacy .It takes time & can also
drug is dispensed. There are rare chances of
result in errors
errors.
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DISADVANTAGES OF PMR
1. Needs lot of space for storage
2. No centralization of records & collection of records is a tedious task
3. More chances of medical errors caused by poor legibility on paper forms
4. Less in efficiency as compared to EMR
5. Data cannot be easily exchanged or transferred
6. They are not eco-friendly
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ADVANTAGES OF EMR
1. Increasing storage capabilities for longer. periods of time
2. Is accessible from remote sites to many people at the same time
3. Retrieval of the information is almost immediate
4. The record is continuously updated and is available concurrently for use
everywhere
5. Information is immediately accessible at any unit workstation whenever it is
needed
6. Provides medical alerts and reminders
7. Supports accountable autonomy, collecting and disseminating information to
assist the medical professional in decision making
8. Allows for customized views of information relevant to the needs of various
specialties
9. Provide information to improve risk management and assessment outcomes
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DISADVANTAGES OF EMR
1.
Start-up cost is high
2.
Lack of Technical knowledge
3.
Inability of the provider to adapt
4.
Usability is a major issue
5.
Placement of hardware is an issue
6.
Crashing of computer & loss of data
7.
Change in workflow of the department after the implementation of an EMR
8.
Lack of standardized terminology, system architecture, and indexing
9.
Lack of flexibility and lack of capacity for the diverse requirements of the
different healthcare disciplines
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 RECOMMENDATIONS
• The robust back up methods, sophisticated protection mechanisms & advanced
data recovery methods should be developed
• Decisions regarding the portability of the equipment must also be considered
• Documentation forms must be revised in order to accommodate the changes in the
workflow
• Development of standard language is required
• A unique health identifier must also be developed
• Well planned training must be given to the end users
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