How the Veterans Health Administration Opened a New VistA in Healthcare

It’s pretty remarkable how inpatient, outpatient, and pharmaceutical services have become integrated by new technologies. We often take for granted that doctors can now submit our prescriptions electronically to a pharmacy, which can match them to our online profiles to check for side effect complications, and then send them by express delivery to our front doors. Not long ago these steps had to be conducted manually, over the phone, or face to face.

In this post, we’ll take a look at VistA, a key technological milestone in the advancement of healthcare into the digital age. Developed and first implemented by the Veterans Health Administration, it is now the premier model for Electronic Health Record (EHR) systems across the country. What started as a program to improve healthcare for veterans unintentionally became the benchmark standard for all Americans.

A Brief History of the Veterans Health Administration

The Veterans Health Administration (VHA) gradually evolved over the last 150 years from the first government facility established for veterans. In March of 1865 – a month before the Civil War ended – President Abraham Lincoln established the National Home for Disabled Volunteer Soldiers specifically for honorably discharged volunteers of the Union Army.

By 1929, a federal system of “soldier’s homes” had grown to 11 institutions nationwide and accepted veterans of all American wars. In 1945 Paul Hawley, the Veterans Administration (VA) Director of Medicine, established a policy that affiliated all new VA hospitals with medical schools to promote resident and teaching fellowships and hospital-based research programs. Since the end of World War II, the VHA system has grown from less than 100 hospitals to more than 1,600 healthcare facilities, including medical centers, clinics, and community living centers.

Today, the VHA is the largest integrated health delivery network in the United States. More than 180,000 medical professionals provide care for 8 million Americans who have actively served in the armed forces. Because veterans comprise a special category of patients, the VHA has had to regularly review and update its medical policies and procedures to meet the unique needs of soldiers returning home from a variety of different military conflicts. Some of its more recent programs provide treatment for brain injuries, post-traumatic stress, and suicide prevention.

The Benefits of VistA

Perhaps the VHA’s most celebrated contribution to healthcare is the Veterans Information Systems and Technology Architecture, or VistA. Launched in 1978, VistA is an open-source EMR system of 180 applications for clinical, financial, and administrative functions all integrated within a single, authoritative database for veteran-related care and services.

The VistA Imaging system includes computerized order entry, bar code medication administration, electronic prescribing, and clinical guidelines. It can capture and manage:

• Clinical images (e.g., endoscopy, pathology, dermatology, and cardiology)
• Radiology and nuclear medicine images
• Scanned clinical and administrative documents
• EKG waveforms

These images can then be combined with text data into a patient’s EMR to make timely and accurate healthcare decisions. Hospitals, clinics, and pharmacies can all communicate with each other remotely by accessing a web interface using secure passwords. Doctors and nurses can call up patient records, order prescriptions, view X-rays, or graph a chart of risk factors. Patients also have their own homepage that records the details of every visit, test results, medications, and allergies.

Specific patient benefits Include:

• Improved continuity of care
• Fewer repeat procedures
• Decreased waiting times
• Better awareness of their condition
• Participation in treatment decisions

Specific clinician benefits Include:

• Simultaneous availability of patient images and data
• Less time spent locating information and more time spent treating patients
• Increased communication among departments
• Remote consultation with specialists
• Efficiencies in radiology from filmless operation

If any of these benefits sound familiar as part of your own EMR system, it’s one more reason to thank our veterans for their services to our country.

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