Ebook: Computerizing Large Integrated Health Networks: The VA Success

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.

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Creating a Robust Multi-Facility System.- The Value of Information in a Multi-Facility System.- Information and the Integration of Services.- The Role of Systems at the Facility and Network Level.- Moving to a Network Focus.- Designing Delivery Systems for Quality Care.- The Organizational Impact Informatics.- Conceptual Integrity in System Design.- Infrastructure and Tools for Flexibility.- Supporting Systems After Installation.- Open Structures for Multiple Sites.- Security and Confidentiality.- Integrating Clinical Systems.- Decision Support.- Meeting Clinical Needs.- Nursing Use of Systems.- Systems in Medicine.- Surgical Systems.- Developing the Problem List.- Using Data for Quality Assurance.- Anesthesiology Systems.- Using Clinical Systems in Another Public.- Environment.- International Installations Using the VA System.- Structuring Databases for Data Sharing.- Relating Data Structure to Clinical Needs.- Capturing Data in Ambulatory Care Settings.- UMLS and Linkages to Medical Knowledge.- Collaborating for Integration.- Hybrid Open Systems Technology (HOST).- Telemedicine Initiatives at the VA.- Telemedicine Systems.- Teleimaging and PACS.- Telehealth for the Consumer.