"In the last four years, we have seen the beginnings of an unprecedented transformation of the VA health care system", stated Dr. Thomas L. Garthwaite, VA's Acting Under Secretary for Health. Veterans Affairs operates the largest health care system in the United States with over 1200 places where health care is offered. This includes 172 medical centres, 650 clinics, 206 counselling centres, 134 nursing homes and other facilities. Veterans Affairs has been in the forefront of adapting new technology to the needs of today's patients.
In their local VA health care facilities, veterans have witnessed the birth of computerised records. These days, it is not uncommon for a patient to see different health care professionals in a variety of locations. Usually, the full medical records of a patient are not transferred from hospital to clinic to the doctor's office. As medical care becomes increasingly sophisticated however, quick access by doctors to comprehensive patient records is important. VA is a national leader in the use of computerised systems for patient records. The VA computerised patient record system software gives medical providers a complete view of what has been done for a patient and a way to place orders for care and treatment. The latest upgrades in this CPRS software equally streamline the ordering of medications.
Clinicians use CPRS to record all their diagnostic procedures and to receive reminders of the latest guidelines for treating particular conditions. When patients move from one clinic or doctor's office to another, they can be sure that their medical treatments and meetings with health care workers are documented. It is a significant technological achievement, especially in large medical centres offering complicated procedures. For example, when the Manhattan unit of the VA New York Harbor Healthcare System implemented CPRS, it had a patient database of 31.000 patients per year.
Another innovation are the bar codes for medication. The familiar scanner codes on the bottom of food items have a place outside of the grocery store. Veterans Affairs is harnessing a similar system for medication which will be in all VA medical facilities by the end of the year. By helping ensure that the right medication is being given to the right patient at the right time, it can reduce potential medication errors by two thirds.
A third breakthrough is the use of telemedicine. VA health care professionals in 31 major specialities are using video cameras and computers to transmit images to physicians and researchers who are not in the same place as the patient or the patient's records. Called "telemedicine", it is now widely used within the VA system. Over 250.000 telemedicine consultations occur every year. Last year, the Orlando VA Health care Center, located in Florida, began to send vital signs and video pictures to medical professionals from the homes of patients who need close monitoring.
The Orlando and Tampa VA Medical Centers are among those that share x-rays with each other via telemedicine. It allows doctors in Orlando to treat patients 80 miles away in Tampa in specialities like neurosurgery. A planned expansion will make the Orlando radiology department filmless, with images available on high-resolution screens for radiologists as well as other medical professionals. In California, Nevada and Hawaii, VA medical centres have created clinical teams to support, via telemedicine, patients of the regional spinal cord injury centre at Palo Alto in California. Team members care for patients who have completed rehabilitation at the Palo Alto centre by video conferencing among their local VA facilities and patients in their homes. It is cost effective for the large geographic area.
In Nashville, Tennessee, "telepharmacy" allows medications to be dispensed 40 miles away at VA's Clarksville facility. A Clarksville physician enters the prescription in VA's computerised patient records system, CPRS. This technology notifies a pharmacist at the Nashville VA Medical Center that a prescription should be filled. The Nashville pharmacist electronically transmits the prescription information to Clarksville. Here, a special vending machine dispenses it, while a medical professional affixes the prescription label to the package. Patients get their medications quickly. The VA Medical Center in Loma Linda, California, created an Internet Web site which allows patients to request refills of prescriptions which are mailed to the veteran.
A fourth new VA application constitutes "virtual" medicine. Using computer technology to simulate stressful combat conditions as therapy for Vietnam veterans with post-traumatic stress, the Atlanta VA Medical Center soon will adapt the approach to help manage physical pain in other veterans. Dr. Garthwaite explained that Veterans Affairs has borrowed both methods and people from safety-conscious settings such as aviation and space travel, and from under-utilised disciplines like human-factors engineering. All these efforts have already produced significant improvements in VA health care and Dr. Garthwaite is convinced that they will do the same in all health care settings.