I enjoyed Dr. James Roberts' article documenting the pros and cons of various ED charting systems. (EMN 2005;27: 17.) The VA charting system I used while working briefly in the ED at the VA Medical Center in Atlanta is actually a very good system, light years ahead of other systems in its level of integration.
Using the system, the physician can document at the bedside and call up laboratory information on any patient from years back, and the system can then turn the information into charts and graphs so the provider can evaluate trends. Past EKGs and current and past radiographs are available, and they can be magnified, flipped, and inverted for closer looks at problem areas. Nurses' notes are integrated, and pharmacy information is available as well. When the patient tells you he's on a little white pill for blood pressure, you can look up his pharmacy records, see what he is supposed to be taking, when he last filled his prescription, and check any recent changes made by his physician.
In addition, doctors can access clinic-visit notes. This last was the weakest part of the system because some clinics are better at completing their notes than others. Discharge instructions can be downloaded, printed, and given to the patient, and prescriptions can be sent directly to the VA pharmacy for filling.
The biggest drawback at the time I used the system about three years ago was that the user had to type everything. If you're not good at typing, it's frustrating. But having all that past history available anytime without waiting on medical records to find the chart was wonderful, and it made working in the VA ED slightly less of a challenge.
This is a hospital-wide system; the ED cannot run it alone, and it is only available at VA hospitals. The system, called computerized patient record system, or CPRS, was developed by the VA medical system. It began as an outpatient charting system called Vista, and after CPRS was developed for inpatient charting, the two were merged about five years ago.
Although it was deployed as a complete system that apparently was very slow at first, it has been revised, tweaked, and integrated to the point where a VA hospital in one area of the country can obtain records online from a VA hospital anywhere else. After Hurricane Katrina, for example, the VA in Atlanta was able to access the pharmacy database for veterans from New Orleans to refill their prescriptions. Paper records are scanned into the system. Unfortunately, the system is not available commercially, but it shows what is possible in charting.
Sussan K. Sutphen, MD