Dr. Kaboli has also become well versed on the advantages of the VA’s EHR in the area of patient discharge. The greatest benefit to hospitalists of having a fully integrated medical record with CPOE and all inpatient and outpatient notes available in all the VA facilities across the country, he says, “is the almost seamless transition of these records both from the clinic side to the hospital and from the hospital back to the clinic.”
One “great luxury” of having that integrated system, Dr. Kaboli adds, is that a hospitalist can hand patients their discharge summaries and advise them to pass the information on in the next doctor’s visit. “Even though you’re going to send it via e-mail, [in a] fax, or by mail, you have that as another option to translate that information to other docs,” he explains. Hospitalists can also “alert other providers by making them co-signers to notes so that when it comes into their inbox, they know that a patient was discharged, and they get the discharge summary immediately.”
There is no connection electronically with non-VA providers, however, which is the same situation that exists in any other non-VA healthcare system. “We know [that] a fairly large percentage of veterans receive care, both within and outside the VA, who are what we call co-managed,” says Dr. Kaboli. “If a patient doesn’t live near a VA hospital or clinic, he may have to travel an hour or two, so that person might as well have a local doctor. Without that [EHR system], if [the patient is] speaking to a primary care physician in a local community, [that physician is] up against the same challenges as [someone who works] outside the VA.”
Get on the EHR Bandwagon
“The federal government has a crucial leadership role in promoting a national health information infrastructure,” said Dr. Kizer in his June 17, 2004 testimony to Congress. When asked about that statement, Dr. Saint (who is also director of the VA/University of Michigan Patient Safety Enhancement Program) has one piece of advice for his hospitalist colleagues. “You don’t want perfect to become the enemy of the very good,” he says. “Rather than waiting until there is a national technology information infrastructure, which may be years—if not decades—away, you can at least advocate for change in your own hospital.”
Use the VA as a model, he says. “You don’t have to use the exact same system, but at least you can point to some of the quality advantages that electronic medical records and CPOE can provide. You can also point out some of the advantages that investment in quality improvement and health services research can bring to an organization and say, ‘We can adapt—not necessarily adopt—what the VA has done.’ ”
How can hospitalists best do that? Many publications in the peer-reviewed literature address the quality improvement focus of the VA. There is also a VA Web site that discusses the focus on HSR and development (www1. va.gov/health). A VA-sponsored national health services research and development (HSR&D) meeting, at which investigators from all over the country present their latest findings, is held annually in Washington, D.C., usually in February.
For the young hospitalist who wants to pursue additional training, Dr. Saint says, there are VA-funded fellowships, HSR&D, a quality scholars program, and other career development opportunities within the VA that promote leadership roles both in and outside the VA.
Dr. Kaboli suggests identifying networks of hospitalists within and outside of your own healthcare system that you can work with and learn from. Hospitalists can also collaborate in developing protocols that incorporate local modifications. Also, he suggests, “there are a lot of questions that come up in the day-to-day care of patients. If you have colleagues as interested as you are, as hospitalists, in the quality of care for hospitalized medical patients, you can tap into that passion. The SHM listservs are a great way to connect; one for VA hospitalists has just been organized.