Computerizing Large Integrated Health Networks: The VA Success / Edition 1

by Robert M. Kolodner

Overview

This book has been a long time in the making. The computerization activi­ ties described in these pages began in 1977 at the Department of Veterans Affairs (VA), but we devoted most of our focus and efforts to building and then implementing the extensive hospital information system known as the Decentralized Hospital Computer System (DHCP) throughout VA. Deliv­ ering the product has been our primary goal. We spent relatively little time documenting or describing our experiences or lessons learned. Except for some presentations at national meetings and a relatively few publications, almost none of which were in the standard trade journals read by Chief Information Officers (CIOs) and equivalent top managers in the private and nonprofit sectors, VA's accomplishments remained a well-kept secret. In 1988, Helly Orthner encouraged VA staff to consider writing a book, but the press of day-to-day activities always seemed to take precedence, and the book languished on the back burner.

Product Details

ISBN-13:	9780387948379
Publisher:	Springer New York
Publication date:	02/20/1997
Series:	Health Informatics
Edition description:	1997
Pages:	515
Product dimensions:	6.10(w) x 9.25(h) x 0.36(d)

About the Author

Kolodner, Robert M., MD (Veterans Health Administration)

The contributors represent the specialties of health information management and informatics. Most are from the Veterans Health Administration and regional veteran's medical centers.

Table of Contents

Section 1—Networking for Healthcare Delivery.- 1—Vision for Change: An Integrated Service Network.- 2—The Role of Systems at the Facility and Network Level.- 3—Teleinformatics: The Future of Healthcare Quality Management.- Section 2—System Design.- 4—Creating a Robust Multi-Facility Healthcare Information System.- 5—Infrastructure and Tools for Flexibility.- 6—Structuring Databases for Data Sharing.- 7—Collaborating for Integration.- 8—Supporting Systems After Installation.- 9—Privacy and Security Protections for Healthcare Information.- Section 3—Clinical Information Technology.- 10—Integrating a Clinical System.- 11—Capturing Data in Ambulatory-Care Settings.- 12—Moving to Clinical Workstations.- 13—Controlled Representation in Patient Records and Healthcare Delivery Systems.- 14—Clinical Decision Support in a Distributed Environment.- 15—The CARE Decision Support System.- Section 4—Clinical and Support Applications.- 16—Meeting Clinical Needs in Ambulatory Care.- 17—Surgical Systems.- 18—Nursing Use of Systems.- 19—Developing Clinical Computer Systems: Applications in Cardiology.- 20—Anesthesiology Systems.- 21—The Library Network: Contributions to the VA’s Integrated Information System.- 22—Using Data for Quality Assessment and Improvement.- 23—Developing and Implementing the Problem List.- Section 5—System Evolution.- 24—Conceptual Integrity and Information Systems: VA and DHCP.- 25—Hybrid Open Systems Technology.- 26—Using DHCP Technology in Another Public Environment.- 27—International Installations.- Section 6—Telemedicine and Telehealth.- 28—Telemedicine: Taking a Leadership Role.- 29—Telemedicine at the Veterans Health Administration.- 30—Telehealth for the Consumer.- 31—DigitalImaging Within and Among Medical Facilities.- Contributors.

Editorial Reviews

This multiauthored collection describes the historical development and current status of the Veterans Administration medical information system. Emphasis is placed on the development of standards that allow partial integration of the many locally maintained systems and on description of the file management and electronic mail systems. The book is intended to document the "quiet success" of the VA in implementing a practical working system in numerous disparate sites and to allow others to learn from their successes and failures. This is a worthwhile objective, for despite much hype, successful implementations of working hospital information systems (HIS) are still far from universal. Despite the inherent weakness of a multiauthored text, with some duplication and with chapters of varying depth, the book is worth owning and reading. The stated target audience is the hospital Chief Information Officer, but the book will be of broader interest. All clinicians and managers involved in designing or implementing HIS can benefit from the lessons of the VA. This is a bare-bones book, with adequate but not flashy illustrations. The references vary widely from chapter to chapter, but for the most part, they are relevant and current, with some dating from as recently as 1996. The book takes a shotgun approach, with 44 authors from a variety of disciplines covering everything from the philosophy of the system's original developers to specialty-specific applications. As such, there is some duplication between chapters, and tighter editing might have been useful. Despite this, the book is must reading for anyone involved in HIS design or implementation. Numerous pearls are found throughout thebook, describing what has and has not worked at the VA, and why. The success of the VA's pragmatic approach is supported by its widespread use and its adaptation in the U.S. (by the Indian Health Service) and in several foreign countries. I highly recommend this book.

Edward P. Hoffer

Reviewer: Edward P. Hoffer, MD(Harvard Medical School)
Description: This multiauthored collection describes the historical development and current status of the Veterans Administration medical information system. Emphasis is placed on the development of standards that allow partial integration of the many locally maintained systems and on description of the file management and electronic mail systems.
Purpose: The book is intended to document the "quiet success" of the VA in implementing a practical working system in numerous disparate sites and to allow others to learn from their successes and failures. This is a worthwhile objective, for despite much hype, successful implementations of working hospital information systems (HIS) are still far from universal. Despite the inherent weakness of a multiauthored text, with some duplication and with chapters of varying depth, the book is worth owning and reading.
Audience: The stated target audience is the hospital Chief Information Officer, but the book will be of broader interest. All clinicians and managers involved in designing or implementing HIS can benefit from the lessons of the VA.
Features: This is a bare-bones book, with adequate but not flashy illustrations. The references vary widely from chapter to chapter, but for the most part, they are relevant and current, with some dating from as recently as 1996.
Assessment: The book takes a shotgun approach, with 44 authors from a variety of disciplines covering everything from the philosophy of the system's original developers to specialty-specific applications. As such, there is someduplication between chapters, and tighter editing might have been useful. Despite this, the book is must reading for anyone involved in HIS design or implementation. Numerous pearls are found throughout the book, describing what has and has not worked at the VA, and why. The success of the VA's pragmatic approach is supported by its widespread use and its adaptation in the U.S. (by the Indian Health Service) and in several foreign countries. I highly recommend this book.