In the Spotlight

Picis Helps Pioneer Development and Use of National Standards Content  

Operating the largest integrated healthcare delivery network (IDN) in the United States, the Department of Veterans Affairs (VA) provides services at 130 hospitals serving more than 6 million patients annually. In an effort to better support evidence-based care delivery in this massive network, an initiative to examine existing clinical information systems (CIS) was launched in 2007 by members of the VA. Clinical information systems were evaluated at two Veterans Integrated Services Networks (VISNs) to determine best practices regarding system implementation, configuration and utilization in order to document consistent data between areas and hospitals and to make this data readily available for clinical analytics. Physicians at these VISNs ascertained that establishing standardized medical data and terminology for intensive care unit (ICU) CIS and anesthesia record keeping (ARK) systems across the entire VA network would undoubtedly help clinicians improve patient care as well as help the VA streamline care delivery.

Paving the way
The VA, a noted healthcare IT pioneer, paved the way for advanced IT initiatives such as medication barcoding and computerized physician order entry (CPOE) and rolled out the first electronic medical record across its medical centers in the 1980’s. Now, the VA is once again attempting to lead the healthcare industry on the analytics front by standardizing medical terminology and data nationwide.

Picis, a market leader in perioperative, anesthesia, and critical care information systems, is right in step with them, as the first vendor to adopt and demonstrate the VA’s national clinical standards for ARK and ICU CIS in its software. Picis participated in multiple onsite meetings with the national committee comprised of analytics advisors and clinical representatives to help develop these standards.

As a VA partner for more than a decade, Picis has a long-standing history of success with ARK and ICU solutions installed or planned to be installed in 48 VA Medical Centers across 11 VISNs. This experience in accessing and reporting data led Picis to quick success in adapting its solutions to meet the standards and work effectively within the VA environment. Picis has integrated with VistA/CPRS and other VA systems both through direct proprietary interfaces as well as open, third-party standards. With 600 surgical management, 300 anesthesia/PACU, and 130 critical care customers, Picis has unprecedented experience in the perioperative environment.

Partnering for success
Vendor requirements and standard data fields and terminology were established including mandatory Document Storage Systems (DSS) interfaces and certification, comprehensive analytics capabilities and a vendor starter set for ICU CIS and ARK systems. The VA’s vision was to ensure that data and terminology standards were shared by each vendor across the nation. Picis is the only vendor with live installations helping to drive this initiative forward.

Standardizing terminology
The VA teamed up with Picis to create a standard content library for vendors with standardized terminology and processes for analytics extraction. Data fields were refined to be vendor neutral, ensuring seamless patient and record handoff between VISNs and hospitals. Currently, 23,000 terms are standardized between ARK and ICU CIS, which helps to track the treatment of patients in these areas where they are most vulnerable. In the next one to two years, more than 100 million patients will be cared for by leveraging standardized outcomes data.

By leveraging standardized clinical data during the most important and data intensive portions of a patient's hospital stay, the goals of helping clinicians improve patient care, conserving heath care resources, and supporting outcomes research are achievable.

The benefit to patients: Advanced clinical decision support
The benefits of standard content to patients are multifold. By utilizing standard content, clinicians can use powerful analytics to understand which treatment plans have been most successful for a similar patient group. Therefore, managing clinical pathways becomes easier. Clinicians are able to use an extensive library of data for advanced decision support, ultimately helping clinicians to improve patient care because data elements are measurable, free text is not.

In addition, standardized documentation provides seamless care continuity as patients move from one hospital to another, especially for Picis VISNs that have a single, central Picis database for all of their VA facilities.

Standardized content also provides the opportunity for longitudinal patient care assessments. For example, VA medical centers treat many patients with traumatic brain injuries. Capturing standard terms and consistent test scores between hospitals and patients enables clinicians to better track the progress of individual patients over time, and compare these to other veterans being treated across the VA health system to identify the best clinical care process. Members of the VA recognize that not every patient is alike, but many care elements become common. By standardizing terminology, clinicians can track and improve treatment as time progresses.

Enhanced analytics and reporting
By mandating standardized terminology and data across the network, patient information is consistently captured to support advanced analytics and reporting.

Data standardization creates a framework for healthcare data analysis that is currently lacking. Because of the size of the VA, putting ICU and OR data together helps to facilitate clinical decision making on a broad scale. Standardized content also creates a foundation for boundless clinical research and reporting capabilities.

Predictable implementations
Standardized content helps to make implementations faster, easier and more predictable for both hospitals and CIS vendors because the need for customization is often limited. This means that VA hospitals can potentially delve into testing and training on Picis systems more quickly than they otherwise could have. Standard content often means that end user acceptance is higher and there is less focus on individual user customizations and more focus on efficient system utilization.

As the only vendor to spearhead this initiative with the VA to date, Picis is well positioned to roll out information systems with standard content throughout the remaining VA facilitates.

Toward the future
VA leadership understands the value of advanced decision support tools and is very focused on standardization.

Looking ahead, standards within the VA could become highly applicable for the Department of Defense (DoD), as well as other entities. The VA, in fact, is working with the DoD to cross reference existing standards with the DoD’s electronic medical record. This will ensure the Veteran’s Lifetime Electronic Record (VLER) will reflect national standards regardless of where care is provided, ultimately helping clinicians promote quality care.