VA Portland Health Care System
Northwest Innovation Center (NWIC)
The Northwest Innovation Center (NWIC) was established in 2012 to improve efficiency and productivity. Our goals are to better meet the needs of Portland VA Medical Center (PVAMC) staff and leadership, and to disseminate products efficiently across Veterans Integrated Service Network (VISN) 20 and nationwide. We use mixed approaches to design informatics tools and processes including principles from human factors engineering and agile development. The NWIC formalized the consolidation of existing informatics services, including the Portland Center for the Evaluation of Clinical Services (PCECS), the web development team, Clinical Applications Coordinators (CAC), the Portland Informatics Center/Patient Safety Center of Inquiry (PIC/PSCI), Telehealth (TH), and My HealtheVet (MHV). We fall under the Chief of Staff (COS) service line, and it is our priority to develop and support initiatives for clinical users impacted by clinical care and quality improvement efforts.
Portland Informatics Center/Patient Safety Center of Inquiry - The PSCI/PIC is dedicated not only to support Veterans Health Information Systems and Technology Architecture (VistA) enterprise Medication Reconciliation (MR) efforts through development of novel tools and processes, but also to close the most important information gaps in our collective understanding of MR activities. We have framed our efforts in five domains: 1) product development, 2) operations and implementation, 3) research, quality, and evaluation, 4) service and citizenship, and 5) dissemination activities. Our portfolio is specifically designed to maintain a presence in each domain so that we can affect the greatest impact upon our colleagues and the Veterans Health Administration (VHA) healthcare system.
Clinical Business Intelligence – Identify clinical intervention approaches, facilitate development and implementation with stakeholders, particular focus on patient safety and multidisciplinary, complex issues. Identify clinical efficiencies for optimal resource utilization. Application of clinical guidelines in development of decision support tools at the point of care. Development of education and training materials. Publication and presentation of clinical projects and significant findings. Determine need for clinical improvement; data/literature review and program evaluation. Quantitative and qualitative analysis for complex, multi-divisional initiatives on patient safety and quality improvement; clinical chart reviews; automation of data extraction and processing.
Health Informatics - Provides for the management of the Computerized Patient Record System (CPRS) and associated Clinical Applications that are used on a facility wide basis and aren't supported by specific services. The Health Information Systems (HIS) staff serve as instructors for CPRS and other clinical applications programs, and project managers for a variety of clinical applications. They serve a variety of clinical committees advising services on how best to utilize CPRS and associated programs in their day-to-day work. The section can provide some limited data services based on the built-in reporting mechanisms that CPRS has.
Telehealth - TH has been at PVAMC for 3 years and was developed in a separate department in FY12 under Technology and Information Management Services (TIMS) to ensure the linkage between other virtual modalities of care, such as secure messaging and e-consults. TH consists of three main modalities: 1) Home Telehealth (HT), which is the care and monitoring of Veterans at home with regards to heart, blood pressure and diabetics issues in order to reduce hospital time, 2) Store and Forward (SF), which includes Teleretinal and other testing mechanisms that require reading to determine outcomes, and 3) Clinical V- Tel (CVT), which is any live real-time video with a patient involved. In FY 12 we have strengthened the TH program at PVAMC by developing an infrastructure that includes Telehealth Clinical Technicians (TCT), both Primary Care (PC) TH carts and Mobile carts, and processes that allowed PVAMC to increase the use of TH across a number of specialty areas including Mental Health (MH), Amputee/Prosthetics, Cardiology, Compensation and Pension, Dementia, Health Prevention and Disease Prevention (HPDP), Transplant and Spinal Cord Injury (SCI).
My HealtheVet - VHA was an early pioneer in utilizing an enterprise-wide electronic health record (EHR), with VistA. In 1999, a multidisciplinary steering committee identified strategies to further engage patients and families by leveraging technology. The committee envisioned the value of empowering Veterans with easy access to their EHR information, educational resources, and tools that enabled self-entered information, to include the ability to control access by others to the Veteran’s information through a delegation feature.
Based on this vision, the MHV Pilot Program was initiated in 2000 as a demonstration project to provide Veterans with secure access to their VA personal health information through a personal health record (PHR) prototype, and PVAMC was one of the pilot sites. The pilot represented an unprecedented opportunity to provide a cohort of VA patients with web-based access to information contained in their VA EHR. A registered pilot participant could obtain copies of 18 different data types from their VA EHR, from clinical notes and lab test results to tracking personal health metrics (e.g., blood pressure, blood sugar, etc.), accessing health education content, and granting access to others such as family members and health care providers.
Following the pilot’s success, the National MHV PHR Portal (www.myhealth.va.gov) was released in November 2003. It initially offered access to trusted health education resources and tools to enable Veterans to document and maintain their health information in a secure web-based environment. Since then, a variety of features have been added, including the expansion of available data types, which was added following the discontinuation of the pilot program in March 2011. Five of the 18 data types available to patients in the pilot program have now been added to the National MHV system, and much of the remainder will be added in 2013.
Secure Messaging, which allows VA patients to communicate securely with their VA healthcare teams, was initially available for a limited number of participants to support alignment with clinical practice workflows and enable participant feedback to inform refinement of the application. With the VA transformation to the Patient Aligned Care Team (PACT) model, which is based on the patient-centered medical home model, Secure Messaging has incrementally expanded until the service became available in primary care at all VA facilities in early 2011. Expansion to specialty and surgical care settings and nonclinical areas is currently underway.
Greater than 1.5 million Veterans are now registered for MHV. More than 968,000 of them have completed the In-Person Authentication process to gain premium-level access to their personal health information, and more than 525,000 have begun using Secure Messaging. Nationally, PVAMC continues to be a leader in rolling out this service to both patients and staff. Nearly 70% of PVAMC’s 78,000 patients are registered for MHV; 57% have premium-level access, and approximately 25% have started using Secure Messaging. Patients in PVAMC not only communicate electronically with their primary and specialty care providers, but also nonclinical teams such as the Billing Office, the Enrollment Office, the Patient Travel Office and the Patient Advocate’s Office.
PVAMC’s success in identifying and contacting patients who had not yet signed up for MHV was recognized by the National Program Office and adopted nationally. Utilizing the processes and procedures PVAMC built resulted in a significant increase in the rate at which Veterans around the country were signing up for the program. PVAMC also created a software application that dramatically improved the process by which users identify and make requests for improvements to the Secure Messaging system. PVAMC is currently completing the rollout of Secure Messaging, deploying self-service Internet Kiosks at VA facilities for Veterans who lack access to the MHV web portal, and ensuring unregistered MHV candidates are provided the information they need to make an informed decision.