Mark Byers is president and CEO of DSS, Inc. He is a Service Disabled Veteran, with more than 33 years working in the data processing industry, of which more than 20 years have involved the development of VistA-integrated solutions. He has also been actively involved in the development of electronic health record software, specifically the VistA-based platform, for more than 16 years. @DSSHealthIT

As healthcare becomes more interconnected, it is essential for Department of Veterans Affairs facilities to be able to share information both within their networks and with commercial healthcare providers. Interoperability is especially important in high-risk clinical settings such as operating rooms and intensive care units, since providers in these two areas must have access to the most current patient information to make life-saving decisions.

Moreover, the exchange of patient data across the surgical care continuum must start well before the day of surgery. A range of data — including pre-op test results, labs and physician sign-offs — needs to follow the patient through admission, surgical scheduling, post-acute care, discharge and follow-up. All of this information must arrive at the correct point in the care delivery process in a timely fashion.

Within the VA system today, however, much of this information is transferred by paper. This creates potentially negative impacts on both access to care and critical transitions of care. Without the ability to send data through a secure firewall, for example, the VA historically has followed a time consuming process of submitting information by secure fax. Yet a VA patient's access to surgical care is partly determined by whether the information required for OR admission is available. Any missing or incomplete patient information can result in delayed care.

Here lies one reason why manual, paper-based systems are being replaced with electronic solutions for managing, documenting, analyzing and improving each step of the perioperative process.

Enhancing intraoperative care

Today's technology can provide tools such as dashboard views that align relevant details about a patient and proce­dure with each phase of the surgical process. Thus, technology can connect the right data to the right point in the care delivery process to improve access to care. In addition, the ability to integrate real-time patient data with workflow automation helps to efficiently coordinate and manage care.

Here is one best practice example: Integrating patient data from a VistA/CPRS Anesthesia Information System and monitoring devices with automated surgical workflow and patient safety processes can enhance intraoperative care. If a patient is moved to an ICU from surgery, for instance, real-time data can be sent to the ICU staff so they don't have to wait for paper charts, which improves preparation and informs post-operative care.

Managing all patient data electronically — from pre-operative patient assessments through surgery and discharge — creates highly efficient workflows and improves communication and patient safety. Furthermore, with more veterans seeking care outside the VA, connectivity between the two sectors is becoming just as important as communication within the VA.

Tips to implement commercial integration

Moving patient data between VA and commercial systems also can be enabled through technology. Solutions based on middleware can filter information from VistA/CPRS to a commercial Clinical Information System or an Anesthesia Record Keeper, integrating the systems using various communication tools. Technical and clinical leaders within the VA who want to begin leveraging such solutions should start with a technology and process review.

From a technology perspective, the key aspects to evaluate are the data elements typically found in a VA patient's chart. One consideration includes mapping the fields between the VA and non-VA systems. Managers will need to determine if there is alignment of the fields within both systems. They should also understand where data will be stored in both systems in the context of data transfer.

Another part of a good technology evaluation is seeing how the two systems support and manage patient identification. A successful implementation requires knowing the differences.

From a people and process standpoint, it's critical to identify multiple clinical champions within the VA and at commercial hospitals to help define and drive integration efforts. Clinical champions play a key role in moving a project forward, and can help define the workflows, procedures and required resources for the Veterans Integrated Service Network. Additionally, they are often effective trainers for clinical staff because they are familiar with the workflows.

Data exchange strengthens surgical care

Whether within the VA or as a bridge to commercial providers, VA facilities can leverage technology to coordinate patient information across the surgical care spectrum. As such, it is becoming increasingly important to evaluate interface technology capable of exchanging data with VistA/CPRS and commercial CIS and ARKs. As clinical and business drivers align around the need for data sharing with commercial systems, VA facilities can support best practices that ensure the highest quality surgical care transitions for veterans.

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