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VA CART and Real-Time Locator System (RTLS) Technology:
Automated Capture and Integration of structured device data
Paul D. Varosy, MD, FACC, FAHA, FHRSDirector of Cardiac Electrophysiology
VA Eastern Colorado Health Care SystemAssociate Professor of MedicineUniversity of Colorado Denver
Overview
• Beyond Meaningful Use• The CART Concept• CART Device Surveillance• VA Real-Time Locator System (RTLS) Technology
VA and Device Data:Beyond “Meaningful Use”
VA: Multiple IT applications capture device data– GIP/IFCAP – VA Logistics/Supply IT system– Cath/EP recording system– CART Program– Prosthetics system (funding for implantables)– CPRS (VA EHR)– National Cardiac Device Surveillance Program
Challenges of Device Identifier Capture in a “Pre-UDI” World
• Device-Specific Identifiers:– Manufacturer– Model Name/Number– Serial/Lot Number– Date of Manufacture– Date of Expiration– Size(s)
• Difficult to capture manually
• Non-intuitive• Non-standardized• Prone to data entry
error
VHA Cardiovascular Assessment, Reporting and Tracking (CART) Program
Integration of structured data collection into the process of care
documentation
CART SITESAll VA Cath Labs (N=76)
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Current Non-VA Post-Market FDA Device Surveillance
• Underreporting• Voluntary = Passive• Numerators, not denominators
http://www.fda.gov/cdrh/postsurv/medsunappendixa.htmlwww.fda.gov/cdrh/postsurv/medsun.pdf
J Gen Intern Med. 2006;21(9):942-948. Arch Intern Med. 2008;168(1):40-46.
BURDENSOMETIME-CONSUMING
NOT AT POINT OF CAREDIFFICULT PROCESS
CART-FDA Post-Market Device Surveillance
• Challenges pre-RTLS:– Lack of granular information on device identifiers makes
FDA reporting difficult– Difficult to capture identifiers even with CART in place
• New model:– Seamless capture of device identifiers by RTLS– Closer collaboration with FDA via MedSun program
Real-Time Locator Systems (RTLS)
• Technology to locate and track assets in real time• Many possible technologies
– Radiofrequency ID (RFID) – active vs. passive tags– Infrared– Ultrasound– Many others
• Examples:
VHA RTLS
• $543M National Contract – Total cost ~$1.6B (remainder funded by individual
VISNs/sites)
• Part of VA’s “Transformational Initiatives”• T-15: Health Care Efficiency Initiative
– Facility Automation• RTLS – 4 use cases
– Asset Tracking– Cath/EP Supply Chain– Critical Temperature Monitoring– Sterile Processing Workflow
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RTLS in VHA Cath/EP Labs
• Implementation VHA wide for inventory management in Cath/EP labs
• Rationale– Expensive tools (catheters, stents, pacemakers,
defibrillators)– Recall management/device surveillance– CART presents a unique integrative data solution
RTLS Implementation:
Smart cabinet technology with data integration solution
Single point of data entry integrated into the process of care
VA RTLS Implementation: Ann Arbor VAMC
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VA RTLS Implementation: Ann Arbor VAMC
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VA RTLS Implementation: Ann Arbor VAMC
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VA RTLS Implementation: Ann Arbor VAMC
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RTLS for Cath/EP Lab Inventory Management
RTLS for InventoryManagement
CART
GIP
PIP NCDSP
CPRS/VistA
Hemo/EP Recording System
RTLS Implementation
• Planning – (began 2010)• National RTLS Contract (2012)• Nationwide implementation (2012 – 2016)
– VISNs 10, 11 (2012)– VISN 23 (early 2014)– VISN 19 (including Denver), 20, 21, 22 (late 2014)– Remainder of VA (2015-2016)
Vision
• Collect data ONCE and multiply leverage the data for multiple purposes.
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Vision
Data Collection
Nursing Documentation Billing
and Coding
Supply Chain Management
Registries Device Surveillance Research
QI/QMPhysician Documentation
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Vision
Moving beyond Meaningful Use of HIT
to
Meaningful Integration of HIT
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Vision
Requires Meaningful Resources
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