CPRS at CHVH
Louis V. Kaufman, MD, MS, CMD
Medical Director
Charlotte Hall Veterans Home
Charlotte Hall, Maryland
NASVH Conference
Burlington Vermont
July 2011
Who Are We?
Medical Director
Certified Network Engineer
Programming Staff
Why VISTA/CPRS?
Current Order Process
Interim
Physician
Order
Paper
People
Physician
Resident
Chart
Physician
Medication Treatment
Order
Order
Admin
Admin
Requisitions
Sheet
Record
Record
Courier
Bin
W
T
C
Nurse
C
F
T
R
R
T
O
D P
Pharmacy
T
C
H
M
Ancillary
Services
P
Print
T
F
Fax
C Copy
Transcribe
O
Courier
M
Mail
W
Write
H
Hand Carry
D
Data Entry
R
Proofread
Order Volume at CHVH
280,000 Orders Per Year….
Which is a lot of transcribing, writing, copying, faxing,…..
Current Order Process
Interim
Physician
Order
Paper
People
Physician
Resident
Chart
Physician
Medication Treatment
Order
Order
Admin
Admin
Requisitions
Sheet
Record
Record
Courier
Bin
W
T
C
Nurse
C
F
CPRS
O
D P
Pharmacy
T
T
R
R
T
C
H
M
Ancillary
Services
P
Print
T
F
Fax
C Copy
Transcribe
O
Courier
M
Mail
W
Write
H
Hand Carry
D
Data Entry
R
Proofread
Reengineered
Current Order Process
• Order Sheets
• Requisitions
• MARs
• TARs
Order
• Order Labels
• Prescriptions
CPRS/VISTA Advantages
Improves Quality of Care
Increased nurse-patient hands-on interaction
Reduced medication errors
Reduced transcription errors
Increased Quality Improvement process
Reduced nurse-clinical provider communication error
Increased Efficiency of Quality Improvement process
CPRS/VISTA Advantages
CPRS is 4 times less
expensive to install than
commercial electronic health
record systems
And costs 2/3 less to maintain
over the long term
Sharing Agreement Between Washington, DC VA
Medical Center and Charlotte Hall Veterans Home
Concept Initially Discussed at WVAMC in 2005
3-1/2 Years of Negotiation
Memorandum of Understanding
Signed In Late 2008 Between
Federal Veterans Administration
and the Maryland Department of
Veterans Affairs
Implementation “Nuts and Bolts”
Certified Network Engineer (CNE) Hired
Required by VA Information Technology and
Security Departments
Found existing CHVH computer network to be
inadequate for CPRS
Designed a new wired and wireless computer
network “from the ground up” to comply with
the VA’s computer hardware and IT security
specifications
Implementation “Nuts and Bolts”
Certified Network Engineer
Worked closely with WVAMC
telecommunications department to install
redundant high speed Point To Point data lines
between CHVH and WVAMC
Supervised the CPRS server move from
WVAMC to CHVH for programming
(Required by the VA Central Office legal team)
Implementation “Nuts and Bolts”
Certified Network Engineer
After programming completed, supervised the
physical move of the CPRS server from CHVH
back to the WVAMC
CPRS server will be physically located at the
WVAMC and managed by WVAMC personnel
with management and personnel fees paid by
the Maryland Department of Veterans Affairs
Implementation in the CHVH ALF
180 bed Assisted Living facility
Implementation began in April 2009
Adjustments required to use CPRS/VISTA in a
non Federal VA facility
Pharmacy
Laboratory
Implementation in the CHVH ALF
Laboratory Adjustments
LabCorp is the laboratory services provider
LabCorp has direct access to CPRS through a
national agreement with the Federal VA
This agreement allows bidirectional electronic
lab test ordering and reporting directly through
CPRS
CHVH lab tests are performed in both Virginia
and North Carolina
This led to miscommunication between the
LabCorp programmers in both states and at
CHVH
Hmmmm!
Implementation in the CHVH ALF
Pharmacy Adjustments
CHVH uses a commercial non-VA long-term care pharmacy
This means that the VA programmer pharmacist
needed to approve all medications and
treatments in 6 month time intervals
(“Real time” order checking is not currently
available in a non-VA facility)
Implementation in the CHVH ALF
Staff Training
Implementation in the CHVH ALF
Staff Training
Group training
Individual “hands on” training among staff members
Computer “Screen Shot” Tutorials
Lab Order Entry
Medication Order Entry
Implementation in the CHVH ALF
Staff Training Issues
Started too soon prior to implementation of CPRS
Staff forgot user names and passwords
Tutorials need further development
Training Database
Currently being implemented to separate “test”
patient files from the production database “real”
patient files
Future Implementations of CPRS at CHVH
278 bed Skilled Nursing Facility
Staff training to begin in September 2011
Imaging
VISTA/CPRS imaging being implemented
now to scan in documents, reports, EKGs,
etc., from outside providers
Future: scan actual x-ray images into the
patient chart
Future Implementations of CPRS at CHVH
Electronic Medication Administration Record (MAR)
Electronic Treatment Administration Record (TAR)
Bar Code Medication Administration (BCMA)
Conclusions
CPRS is 4 times less
expensive to install than
commercial electronic health
record systems
CPRS Costs 2/3 less to
maintain over the long term
CPRS Improves Quality of Care
Conclusions
CPRS is a great example of
Federal/State Partnership
Our Tax Dollars At Work!
and
Conclusions
The Best Care
Anywhere!