Some of our work
The Veteran’s Health Administration (VHA) did not have dedicated work products for its Computerized Patient Record System (CPRS) to screen and treat Veterans during the COVID-19 pandemic. Existing clinical templates used to document patient symptoms and other related data were wholly inadequate to manage the patient care documentation, decision support, and data capture required to address COVID-19. Further, no plan was in place to address and resolve any COVID-19 clinical needs for Veterans Affairs (VA) providers.
The BAC team served an essential role in the VHA initiative to address the evolving demands of COVID-19. We supported the design, development and deployment of COVID-19 CPRS tools, drafted training materials, provided ongoing national support for all developments and materials, and provided best practice diffusion across all VA Medical Centers (VAMC) throughout the pandemic. We assisted government staff in the production of over thirty (30) original, critically needed, national COVID-19 clinical templates and an even higher number of updates, in order to provide guidance consistent with evolving CDC guidelines. We also developed metrics and reporting mechanisms to track adoption rates by clinical staff, the impact of our work upon Veterans, and a strategy for tracking, reporting and minimizing CDC vaccination documentation errors.
COVID-19 clinical templates have been utilized for screening, documenting, decision support and data tracking in over 34 million instances with over 6 million unique Veteran patients, with a minimum adoption rate of 98% across the VA. The BAC team is continuing to provide significant COVID-19 support, continually reassessing facility needs to enhance patient care delivery through the pandemic.
The Veteran’s Health Administration (VHA) asked BAC to investigate the problem of clinician fatigue and burnout related to View Alert Management within the Computerized Patient Record System (CPRS). View Alerts provide medical staff with important patient information. However, the large volume of alerts that are often generated in CPRS can result in a significant burden for clinicians. View Alerts contribute to clinician overload, fatigue and burnout, and they can increase the risk of important patient information being missed.
Over two years the BAC Team supported and then led the effort to mitigate the View Alerts burden on providers. Our team conducted significant environmental scanning for research and best practices, held focus groups and engaged in in-depth discussions with subject matter experts. Ultimately, the BAC team determined that a software enhancement to CPRS was needed. We led the effort to define software requirements and acquire the necessary resources, and then to develop, test, deploy and implement new national software for VA.
The software introduced new CPRS tools including an editor that allows parameters to be changed for entire groups of providers at the same time, for example for all physicians in a primary care setting. This feature enables optimal alerts settings to be standardized across patient care settings, for providers who have similar needs and requirements. The software includes reports that provided significant time-savings and ease of use, standardizing settings while also enabling individual preferences.
Provider Alert Redesign and Implementation ("View Alerts")
BAC was asked to assist the Veteran’s Health Administration (VHA) in addressing inadequacies with its colorectal cancer screening and surveillance (CRCS/S) program: across VHA facilities there was large variability in screening and surveillance rates along with low patient follow-up rates.
BAC contributed to the design, development, testing, training, national release and implementation of four (4) national clinical reminder templates to manage colorectal cancer screening and follow-up for eligible Veterans receiving care through the Veterans Affairs (VA) and the Community. The clinical reminder templates included an Average Risk Screening Reminder, Colonoscopy Follow-up Reminder, Waiting for Recommendations Reminder, and FIT/FOBT (+) Reminder, which appeared at different times and under different circumstances to promote cancer screening. Additionally, the BAC team participated in testing and national implementation of seven (7) new VHA Support Service Center (VSSC) Reports that were developed to identify key events in the CRCS/S workflow timeline and provide visibility when additional action may be indicated.
Colorectal Cancer Screening and Surveillance Clinical Reminders (CRCS/S CR) Design and Implementation
This project enhanced adherence to average risk screening guidelines, polyp surveillance, and the prevention of advanced stage colorectal cancer in Veterans. The result was elimination of variability in screening and surveillance across VHA facilities. All VA facilities now use a standardized approach for screening and monitoring colorectal cancer.
During Mann-Grandstaff VA Medical Center (Spokane) transition from Computerized Patient Record System (CPRS) to Cerner Millennium, users needed CPRS read and write access during and after transition to Cerner. BAC created an interim manual solution that enabled read access while limiting write access in CPRS. It was implemented by modifying and creating User Class, Business Rules and through VistA menu and security key management. The manual solution was effective but was not optimal due to the level of effort required to implement and maintain. Additionally, the manual solution inadvertently created the potential for impacts on downstream VistA and commercial applications and interfaces that relied on User Classes and Business Rules. For the remaining Cerner transition sites, a standard electronic solution was needed to manage ‘write’ capability in the CPRS graphical user interface (GUI).
BAC assisted with software requirements definition, development, testing, and implementation of CPRS Write-Access Restricted in VA facilities transitioning from CPRS to Cerner. BAC was integrated into the Office of Information and Technology (OI&T) development team which created new CPRS parameters at the Package, System, Division, and User level to manage write access for users for specified capabilities in each CPRS Tab (Coversheet, Problems, Meds, Orders, Notes, Consults, Surgery, and D/C Summ). BAC served an essential role in testing and validating the new CPRS Write-Access Restricted functionality by testing it in software development accounts and the test and production environments of multiple facilities transitioning from CPRS to Cerner.
Computerized Patient Record System (CPRS) Write-Access Restricted
CPRS GUI functionality is now available to manage write access for specific CPRS tab capabilities and specific users. These new capabilities will help bridge the gaps between Cerner and CPRS and will be available for all sites when they transition from CPRS to Cerner Millennium. The changes made to CPRS to manage write access only apply to CPRS and do not have any impact on downstream applications and interfaces. Efforts are underway to integrate the new capability into the nationally released versions of CPRS.