VA again

[Boatswain2PA]

PA co-worker applies for ED job at local VA hospital. Almost a year goes by when suddenly evaluation forms come to office asking her docs to rate her. Few months later she gets notified she's hired. Few months later she starts her first day on a Monday.

 

She is so frustrated by the computer system, and what she calls "hurdles" to patient care, that she can't even go back for a second day and quits.

 

This is a mature, experienced PA. Also a veteran.

 

One day on the job and she sees how big of a disaster it is. In a 12 hour shift she only saw FOUR patients.....

[EMEDPA]

I have heard that the govt EMR is completely nonfunctional. some of their sites pay very well, however those who I have spoken with say it's only worthwhile as a part-time gig because working there full time would lead to madness.

[cc56]

Wife works at the VA as a scrub tech.  She is also a veteran and has 10+ years in the OR.  Level 1 trauma (Afghan and civilian) to local hospital.  She works at the VA and every day has to talk herself off a ledge.  If it was not for her going back to school she would be out of the VA system.  We both say we would NEVER EVER get surgery at the VA!!!  People keep their job even when they get a DUI on their way into work and can't take call like the job requires!  

[EMEDPA]

recently discovered a scary VA coverage loophole. if a retied active duty vet needs to be transported to a va medical ctr for something major(say an emergent cardiac cath), the VA will pay for all services at their facility but not transport to their facility. if the vet is over 65 it is a non-issue because medicare pays, but if they are under 65 they are hit with the bill like a 63 yr old I had with unstable angina at my rural job who had to get a friend to loan him money for the drive 3 hrs to the nearest VA because he couldn't afford the ambulance ride himself.

[jcwinegardner]

I did my IM rotation at a VA hospital two months ago. It was a huge wast of time. Most of the providers I met were top quality, but we only averaged seeing four patients per day. What you have heard about the government EMR is true, I did all my notes using a blank provider note then switched the ownership to my preceptor in order to avoid wasting my time with it. The system is completely out-dated, and is the main reason so few patients get seen. It takes HOURS to document on a single patient. We would round on our patients in about an hour, and then my preceptor would spend the next 6-7 hours "charting." It completely turned me off to ever working in the VA system in any capacity.

[GetMeOuttaThisMess]

I haven't had this same experience with the EMR. One can free text an entire note if one so desires. I've written my own templates for common visits just over the past week. I have found it MUCH easier to use than Greenway PrimeSuite. The main problem I've found is the VA formulary which limits access to functional meds (Talwin NX not on formulary).

[cc56]

Active duty in 2006 the Army was using CHCS.  That was a Navy program from 1989.  No mouse only key board commands.  We also used a dot matrix printer that was barely working.  They were trying to impliment CHCS II but I got out before I saw that come to life.   

 

For one of my VA rotations the computer system with templates was not bad.  I did my rotation in the ED and the attending gave me some of his templates which made things easier. 

[Guest Paula]

IHS EHR is similar to the VA ehr and was a nightmare.  The doc I work with and his RN spent months during work time building templates  and we had two days of training. after less than two months we scrapped it and bought another system Intergy and it is much better.  

 

You get what you pay for and when it's free from the government it makes you a slave. 

[Gordon, PA-C]

I've worked at the VA before and I completely disagree with all of you regarding the EMR.  In my experience it is one of the best out there.  What other EMR system automatically connects to a hospital 1000 miles away and has their complete discharge summary available with a few keystrokes?

 

I think the USA would do very well to make VISTA/CPRS mandatory at all hospitals and all clinics.  

 

Are there problems at the VA?  Of course.  Too many fat cat managers.  Too many incompetent folks who never get fired.  But the EMR is an absolute gem.  The VA's got 99 problems but the EMR aint one.  

[GetMeOuttaThisMess]

As a new hire I didn't realize until Friday that follow up orders that my nurse asked me to order at the request of residents wouldn't be followed through on unless they were tied to an upcoming, scheduled appointment.  Oops.  I guess that's something else to file away for future reference.  As I had previously noted, I find the software to be quite user friendly after only one week.

[ventana]

even better yet

 

 

hiring for a local RN in the CBOC - salary range is about 45k--100k

 

hiring for an PS in the same VISN - not the local office - max salary of 94k.....

 

 

So we manage the patients and the nurse taking out orders gets paid more.... no wonder they can't fill slots....

[SoCalPA]

even better yet

 

 

hiring for a local RN in the CBOC - salary range is about 45k--100k

 

hiring for an PS in the same VISN - not the local office - max salary of 94k.....

 

 

So we manage the patients and the nurse taking out orders gets paid more.... no wonder they can't fill slots....

I agree! it's not rocket science. Pay more and get a wider range of clinician applicants.  Even the physician pay is low.

[PACProvider]

I work at the VA as well and have to say that there is truth on both sides of the argument. Overall, I like the EMR (CPRS). I crank out notes in ten to fifteen minutes which is a long time. The ability to see records from every other VA site and frequently from DOD sites helps when meeting a new patient. I find the automatic warnings about prescribing interactions or adverse effects to be superior to what I saw in Cerner Powerchart where I worked previously. There are three ways to actually produce a note. One is typing with templates. This method is slow, methodical and annoying since every field must be completed. The second is to use Dragon Speaking software which works very well. Good for long notes or when you've typed a lot and your hands are tired. Third, they still have old fashioned dictation over the telephone. One major nuisance is "Reminders" which force you to do things you have already done and documented (Audit C, PHQ9, AIMS, Cholesterol panel orders, etc). The reminders are driven by what was prescribed or the diagnoses. Another nice feature is that the billing is integrated into the CPRS so when you finish your note, you do your billing in a matter of a few keystrokes and you're done. Again, in my old job, with Cerner, I had to bill on paper and do notes by typing. 

[GetMeOuttaThisMess]

No one has mentioned actual dictation to me as being as option.  Heck, it's been a month now and I still don't have a key to my office/exam room (others have to let me in in the morning) nor a printed name plate for my door (didn't even get a response to the IM I sent to the responsible party).

[DissentingVoice]

People who don't understand the VA look down on it, but it's actually pretty awesome.  It's also the largest healthcare provider in the use.

 

Here are a few reasons why the VA is awesome:

 

The VA is frugal with equipment.

Instead of that useless, fancy fountain the new private hospital builds, the VA uses and fixes old equipment.  While the hallways may look like they're from the 50s, that new muti-million dollar operating room and Da Vinci rivals the local academic center.

 

VA providers are usually very happy

They VA often pays less, but the work environment is far less stressful.  PCP providers get 30 minute visits instead of 10.  The days end earlier and start later.  The VA outsources residents and highly skilled attendings from academic centers.  (So they can deliver the same procedures at less cost).  Residents get great training at the VAs.  VA providers are immune to tort lawsuits as well.  The VA also removes money as a concern for providers.

 

The VA built the first computerized EHR

VistA was the first EHR.  CPRS was the first practical GUI.  If you're not familiar with it, it may seem clunky.  It's actually pretty decent when you get used to it.  It's also open source, so anyone can create their own EHR.  (You can download it if you want and set one up on your computer.)  They also have a web client.  Most importantly, I can call up health records from ANY VA across the country.  Patients no longer need a million dollar workup at each hospital they can visit.  I can simply call up labs, reports, and progress notes from hospitals thousands of miles away instantly.

 

VA is rapidly advancing technology

They're leading on the telemedicine front, and it shows promise.  They've also recently invested into data warehouses so they can instantly run data mining on their massive collection of information.  Think of it this way.  Want to see if NPs or PAs provider better diabetes care?  You can spend thousands of dollars and many hours the current way.  OR...the VA can create a few SQL commands and mine the data in 4 minutes across all VA medical centers for free.  Instant answers.

 

VA has high satisfaction

Turns out, patients like 30 minute PCP visits more than 10 minute ones.  Some people might say:  'why would you ever go to a PA when you can go to an MD?"  Well, some might say "why would you go to the VA when you can go to an academic center?"  The answer is simple - patients just like they care they're receiving.  It's not inferior care.  

 

 

I love the VA.  Sure, it's quirky, but they're really leading the country on a lot of fronts.  Anyone who work there disagree?

[G. Davenport]

I've worked at the VA before and I completely disagree with all of you regarding the EMR.  In my experience it is one of the best out there. 

 

I agree.  The ONE thing I liked about my time with the VA was the EMR.  Sure it was bulky but everything you needed on that patient was there.  Once it was entered (you had to see more than four patients to see this benefit), it was easy to keep up to date.  Using established dot templates made it even easier.  And in the primary care field where you often worked an 8 hour day, your average patient load was around 13.  You had plenty of time to enter data (my experience).  

 

As for pay discrepancies.  Several years back, the nurses worked on a report defending (establishing) pay rates for their profession.  The PA has not done the same and this WAS the issue in pay discrepancies where i worked.  HR had no choice but to pay what was set by the VA (based on the well documented and accepted research the VA nurses had submitted).  If the PA wants to show equality in pay, they will need to submit statistical data with strong support on what the pay structure should be.  Just complaining does nothing.  In this area, we can learn much from the nursing profession.  

 

Finally, I worked for the VA twice - at two different sites - and my experience was the same at both.  My reason for leaving had nothing to do with the EMR, pay, or benefits.  In fact, I loved going to work at 7:30 AM and leaving at 4:30 PM.  I loved having 13 sick days (never used) and tons of vacation.  I loved no nights, week-ends, or holiday work.  I loved the autonomy.     

 

G

[PACProvider]

Although this is not specifically an EMR topic, I do like that leadership has purchased the complete works of Access Medicine (all books and references) and UpToDate. The UpToDate was purchased with the CME option which permits every individual to setup his or her own "no personal cost" account for CME credit for articles read. NCCPA accepts the CME. Viewing Access Medicine reference books and UpToDate is done through the GUI interface that presents in the CPRS EMR system so you can chart, order, review and lookup at the same time. 

[GetMeOuttaThisMess]

Wasn't aware of Access Medicine. Guess I'll have to look for it. Haven't spent any time in UTD either, though I did create an account. Been getting my money's worth out of Primary Care Med Abstracts (on my own dime).