Electronic decision support for US veterans

VA’s ‘Electronic Support for Patient Decisions’ initiative will use customised software called iMedConsent to provide patients with information about treatment options and standardise procedures among clinicians.

VA provides a broad spectrum of medical, surgical, and rehabilitative care to its customers – veterans of the US armed services.

“We owe it to our veterans to do all we can to ensure that they understand the care they receive and to make sure that the informed consent process is as patient-friendly as possible,” said Secretary of Veterans Affairs Anthony Principi. “This new program is a great complement to the success of VA’s electronic patient records systems."

The iMedConsent program takes physicians step by step through the informed consent process, displaying detailed educational materials about risks and benefits of proposed treatments. 

In addition the system generates and stores consent forms, incorporates electronic signatures into records and imports information from patient records. Although the program is designed primarily to assist family physicians, it also guides informed-consent discussions between doctors and patients.

According to the VA the goal of the informed consent process is to ensure that “patients are knowledgeable participants in decisions about their health care". This requires patients to understand their choices through discussions of proposed treatments, reasonable alternatives to proposed care, risks and benefits of each alternative.

The iMedConsent software was developed under the direction of VA’s National Centre for Ethics in Health Care by Atlanta-based software developer Dialog Medical. “By supporting patient decisions on a systems level, we are preventing problems before they arise. We like to call this ‘preventive ethics," said Dr. Ellen Fox, the director of the centre.

The electronic decision support initiative is VA’s latest step in the adoption of e-health technology to enhance patient care. For several decades, VA has led the US health care industry in use of electronic health records (EHRs) with its Veterans Health Information Systems and Technology (VistA), a widely-used open source system which allows health care providers to continuously update patient information, including lab tests and results and medications.

The VistA EHR provides clinicians throughout the VA healthcare system with instant access to a patient’s complete record, including diagnostic images, medications and lab results.  Patient records can be accessed inpatient, outpatient, long-term and home care environments or be accessed by authorised clinicians remotely.

In July 2004 VA announced plans to make VistA available, at a nominal cost, to private-sector health care providers.  Distribution of the software is expected to begin in late 2005.

VA has also partnered with the Centres for Medicare and Medicaid Services (CMS) to develop and promote developing VistA – Office EHR, a version of the EHR software optimised for community clinics and family physician offices. The first version of VistA – Office EHR is planned for late 2005 or early 2006.  VA and CMS hope to stimulate adoption of EHRs by providing a high-quality public-domain solution

A version of the open-source VistA is used at more than 1,300 VA facilities throughout the United States to maintain records on 5 million veterans who receive their health care from VA.  In addition to the VA, VistA is currently used by the Department of Health for the District of Columbia, together with healthcare systems in Finland, Germ