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October 2005

Practice Perfect: Information Technology
Electronic Health Records, Part 2: Interoperability in Practice
By Chris McDonagh, Associate Editor

When it comes to clinical care, President Bush is proud that U.S. physicians have access to the latest technologies and pharmaceuticals. Yet he notes that many providers are still in the era of the "horse and buggy" when it comes to the paper-based way in which they track patient data. "It is almost like information technology hasn't shown up in health care yet," said President Bush. "But it has in one place, and that's the Veterans Department."¹

The VA's Electronic Health Record (EHR) system ensures that all a patient's clinical information" such as progress notes, test results, images and medications" are easily accessible at the point of care. The president hopes that his administration's 10-year plan for health care information technology will spread EHR systems such as this throughout the private sector. (See "Feds' 10-Year Plan: How the EHR of Tomorrow May Affect You Today" in last month's Practice Perfect.)

The VA Leads the Way
The VA began computerizing its hospital information system in the 1980s. Twenty years later, the Veterans Health Information Systems and Technology Architecture" more commonly known as VistA" has evolved into a robust electronic health record system that is used to keep 1,300 different sites of care connected.

"VistA Jr." for the small practice. Last year, the VA and CMS announced that they were retooling VistA to create a system that is more suitable for the small private practice" the VistA-Office EHR. Enhancements include features for patient registration and reporting of clinical quality measures. Although much of the software will be in the public domain, it is expected that practices will have to pay a license for use of VistA-Office's database software. They also would have to budget for the cost of implementation and training, together with a billing or practice management system with an interface that can connect to VistA-Office. It was scheduled to be released on Aug. 1, but this was postponed and a new launch date had not been announced at time of press.

Is the VA going head-to-head with the EHR industry? No. The goal of the VistA-Office project is to make the VA's software available to private industry. The government has contracted with WorldVistA to provide training to private vendors. Training will start after VistA-Office has been launched. You will then be able to visit for a list of private companies that have been trained to help practices with implementation and support.

Get Connected in Chicago
A physician at any of the VA's 1,300 sites of care can access a patient's entire health record, including any laboratory and imaging data. And at this year's Annual Meeting in Chicago, staff from the VA will help the Academy to demonstrate some of the advantages of this interconnectivity.

Integrating the Healthcare Enterprise (IHE) initiative. IHE is an initiative by health care professionals and industry to promote the coordinated use of standards such as DICOM (for medical images), SNOMED CT (for clinical content) and HL7 (for data management). The project aims to improve the way that health care information systems share data so that, for instance, you would no longer have to worry about proprietary devices not being able to communicate with one another. You would be able to pull up somebody's EHR and see all the data that has been gathered on that patient.

Build your own patient record at the IHE showcase. When you're at the Annual Meeting, visit the IHE Eye Care Multivendor Interoperability Showcase exhibit (Booth #2381, which is next to the Technology Pavilion and the Wi-Fi Hot Spot). VA staff will be on hand to help you register at a VistA workstation. Eight leading device vendors² will also have staff at the exhibit. They will take images of your eyes and then transfer those images to your VistA record. When you return to the VistA workstation, you can pull up your record and see the images displayed. You will also be able to put your record onto a CD to take home with you. Modalities that those vendors will be demonstrating include digital photo slit-lamp biomicroscopy, nonmydriatic retinal imaging, OCT and high frequency ultrasound.

1 Speech at a VA Medical Center in Baltimore, April 27, 2004.
2 Canon Medical Systems, Carl Zeiss Meditec, Digital Healthcare, Kowa Optimed Inc., Nidek Inc., Ophthalmic Imaging Systems, Ophthalmic Technologies Inc. and Topcon Medical Systems will be present. RADinfo Systems and Sorna Corp. will provide CD services.

Presentations in Chicago

Want to find out more about EHRs and interoperability? In addition to the IHE Eye Care Multivendor Interoperability Showcase, there are several presentations that you can attend.

Some of these are ticketed events, and you will be able to purchase tickets at the Course Ticket Sales desks in Hall A. Others are free Technology Theater presentations, which will take place at the Technology Pavilion exhibit (Booth #2979).

For further information, visit or check the Final Program when you get to Chicago.

Saturday, Oct. 15
EMRs: Roundtable Discussion.
J.C. Noreika, MD, MBA, Jim Messier (NextGen) and John Dalton (Penn Medical Informatics)" Technology Theater session; no ticket required" 12:30 to 2 p.m.

Sunday, Oct. 16
Implementation of EMR Systems Into Clinical Practice.
Ramana S. Moorthy, MD" Instruction Course 257" 3:15 to 5:30 p.m.

Health Information Interoperability Realized" the VA Perspective. Peter Kuzmak (DVA), Andrew Casertano (DVA), Linda Wedemeyer, MD, and Mary Lawrence, MD" Technology Theater session; no ticket required" 4 to 5 p.m.

Monday, Oct. 17
Understanding the EMR: An Overview of Modern EMR Applications From Evaluation and Purchase to Implementation and Scalability. Victor Chin, MD" Instruction Course 348" 9 to 10 a.m.

IHE (Integrating the Healthcare Enterprise)" Interoperability in the Real World, Progress Around the Enterprise. Joyce Sensmeier, MS, RN (HIMSS), Chris Carr (Radiological Society of North America), and Lloyd Hildebrand, MD" Technology Theater session; no ticket required" 11 a.m. to noon.|

Tuesday, Oct. 18
Selecting and Managing Your Ophthalmology Practice Management Computer System. Ron Rosenberg, MPH, PA-C" Instruction Course 571" 9 to 11:15 a.m.

Value of Community Wide Interoperability for Clinical Data Sharing; and Integration of Digital Imaging in EHRs. Mark Horton, MD, Lloyd Hildebrand, MD, Michael Schmidt (Carl Zeiss), James Jarmusch (Topcon) and Chad Steward (Ophthalmic Imaging Systems)" Technology Theater session; no ticket required" 9:30 to 10:30 a.m.

EMR Panel Discussion: Should You Implement EMR Now, and How Do You Make the Transition Successful? Moderator: Susan E. Jones" Instruction Course 610" 11:30 a.m. to 12:30 p.m.