Authors & Collaborators
Optimizing Informatics Support for
Collaborative Care: VA Smoking and
Depression Treatment Examples
• Edmund Chaney PhD, Laura Bonner PhD,
•
•
•
Academy Health
Boston
June 28, 2005
Collaborative Care
Clinical Information
System Challenges
• VA CPRS is a state of the art HR system,
evolving toward HealtheVet VistA
• What is missing to support chronic care?
• If more is necessary, how to add it?
–Development & programming process
–Dissemination and backup plans
•
Susan Vivell PhD, Colletta Austin MA,
Scott Sherman MD and Colleagues
VA HSR&D Mental Health QUERI
VA VISNs 10, 16, 21, 22, 23 Clinicians,
Informatics Specialists & Administrators
VA HSR&D Centers of Excellence at Seattle,
Sepulveda and Little Rock
VA MIRECCS in VISNs 22, 20 & 16
What needs further
development in CPRS?
• Integrated Mental Health assessment tools
• Panel management
• Team communication tools
• Patient self-management support
• Decision support for evidence-based
•
treatment
Program evaluation tools
How to Provide Missing Functions
as CPRS Evolves?
• Balance development time, cost,
feasibility, extensibility & transportability
• Options:
– Local VistA extensions
– Local external applications
– Web-based, internet or VA intranet access
– Combinations
Scott Sherman MD, VA VISNs 21 & 22
Clinicians & HSR&D Researchers
California Smoker’s Helpline
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Telephone Care Coordination to
Improve Smoking Cessation
Counseling
Menu options on VA VistA for TeleQuit
• Provider referral
• Research randomization
• Assessments
• Medication orders
• TeleQuit Care Coordinator Panel
•
Management
Quality and research reports
Local VistA Augmentation
TeleQuit Consult
– Providers may send a patient referral by entering a consult in CPRS
• Counselors enter clinical and scheduling data
into a VistA file
• Patient data objects created for selected fields
• Data automatically uploads into CPRS progress
note templates
• Reports based on the VistA file facilitate crosscoverage and track clinical outcome,
administrative and cost data
Information Transferred to Helpline
• A summary of responses can be provided to the Helpline
during a 3-way call
Request for Smoking Cessation
Guides
•TQCC can enter a request to send the “Take Control” or “Decide” guide for selfhelp patients
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Medication Request Consult
Patient Progress Note
•TQCC can upload information from VISTA into CPRS to provide information
• TQCC can send request for medication to the TeleQuit Nurse
regarding patient’s smoking history to the TeleQuit Nurse Practitioner
Practitioner and indicate contraindication(s)
VA SUD QUERI Demonstration
Project Results
Augmented Functions:
• Streamlined Clinical Process: providers and the
TeleQuit staff receive up-to-date information
regarding:
– Referrals to TeleQuit
– Baseline information on patient’s smoking history
• Summary of patients responses
– Requests for smoking cessation guides
– Patient requests for medication
– Clinical progress notes
• Quality Control:
produces administrative reports
to ensure that patients are contacted on a timely
manner and quality care is provided
•
•
2,900 referrals for smoking cessation in
10 months
45% of patients starting treatment were
abstinent six months later
–equal to or better than smoking cessation
clinics
• Substantial savings per quitter compared
to provider and clinic-based programs
TIDES Primary Care Clinic Sites
Translating Initiatives for Depression into
Effective Solutions (TIDES)
TWIN PORTS
SEATTLE
• Helps interested VA VISNs to locally adapt
BLACK HILLS
PORTLAND
AKRON
HOT SPRINGS
evidence-based collaborative depression
care models
–Formed partnerships with 4 VISNs
–Conducted Expert Panels
–Designed tools and providing training
–Assisting with ongoing evaluation
–Sustaining clinician-researcher partnerships
SIOUX FALLS
VISN 23
CANTON
NEW YORK
YOUNGSTOWN
CINCINATTI
LONG
BEACH
WEST LA
LUFKIN
PENSACOLA
BEAUMONT
Tentative Sites
SHREVEPORT
Prospective Sites
HOUSTON
Participating Sites
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TIDES Informatics Projects
• Depression Care Manager training aid
–PsyOpSys
• Internet information site
• User-configurable CPRS consult and note
templates
–Similar to TeleQuit
• Depression Performance Measure tracking
TIDES Website Statistics
(First 6 months of 2005)
Patient Self-Management,
Provider & Organization Education
• http://www.va.gov/tides_waves
• Three Goals:
–Support depression self-management
–Depression treatment information for primary
care clinicians
–Up-to-date depression collaborative care
information for Practice or Healthcare
Organizations
Top Pages by Visit (2005)
• 9,180 visits (daily average of 52)
• 52,117 hits (daily average of 299)
• 4,581 total visitors
• 44% of visitors came from a referring site
or search engine.
• Average of 3.9 pages viewed per visit.
Popular Pages
1. Homepage
2. Depression Info for Clinicians
–Information on depression burden and
treatability
3. The Cycle of Depression
4. Depression Info for Veterans
–Basic information and links to other pages on
symptoms, causes, and treatment
5. Description of Tides Projects
–Goals and methods
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Conclusions
• It is feasible and productive to augment VA
•
CPRS to assist in the collaborative care of
chronic conditions such as smoking and
depression.
Such augmentations help inform the
continuing development of HealtheVet
VistA and My HealtheVet.
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