Continuity of Veteran Care

The following screenshots from the Veteran Workload Browser show the locations where care was given to a particular patient in November 2008. They show how “location” is more than a physical concept in VISTA and the VA - it represents a combination of place and the type of work performed and, in many cases, who is performing work. These combinations allow the VISTA system to capture hospital workload without forcing providers to explicitly code their work - a provider picks a location, not a code and the location sets to work code.

Specifically patient Frank Gilbert was seen at seven different “locations” in November 2008:

The Location List shows that Personal Locations make up 698 of the 1900 locations in the IOWA Hospital System.

Note: the Workload Data inside the Workload Service finished in March 2011. In the descriptions below, “Now” means March 2011.

IOW C&P AUDIO RODGERS (947)

Nancy Rodgers, an Audiologist, names this Personal Location. Work at this location is AUDIOLOGY, specifically C&P EXAMS

This is “where” Nancy Rogers performs C&P Audiology Exams. She picks this “location” for her work to tell VISTA what she is doing.

On November 2008, there were 18 piece of work (workload) performed there …

Work is spread throughout the month and it is all AUDIOLOGY, a value fixed in the location’s definition …

AUDIOLOGY is red, the color of Ancillary and General Support Services which is the DSS grouping it belongs to.

Patient Frank Gilbert was seen on the 25th. The workload is AUDIOLOGY/C&P EXAMS with a very generic CPT, DISABILITY EXAMINATION. This is a case of the DSS codes being more precise than CPT and if you examine other Workload in the same month, they share the same DSS/CPT combination …

What is NPCD in the property Sent to NPCD? That’s the VA’s National Patient Care Database in Austin Texas. Every VISTA sends Workload data to Austin .

ZZIOW C&P JENSEN (949)

Clyde Jensen, a Psychiatrist, names this Personal Location. Mr Jensen no longer works at the hospital. No doubt the room he used is now being used by someone else but for VISTA, the “location” named for him and his work is now inactive. The prefix “ZZ” is added to the name of such locations and they get an inactivate date.

Note that inactivate dates may happen long after a location is no longer in use - Mr Jensen’s workload timeline shows that December 2008 was his last month but it took over a year for a system administrator to inactivate his location.

Mr Jensen saw our patient near the end of his tenure at the hospital, on the 21st of November, and, as expected, the workload details reflects the type of work performed at this location …

The CPT Code, Disability Examination, is a lot less precise than the VA DSS code combination.

IOW OIF/OEF CASE MGT NURSE (1302)

This location isn’t personal - its “named for provider” property has no value. Instead it is named for the role NURSE, the discipline of the providers who use it …

On November 2008, six pieces of work, all Primary Care Medicine were performed there …

The location’s DSS is GENERAL INTERNAL MEDICINE, a DSS from the same DSS grouping. At some point between November 2008 and “now” (March 2011), the location’s DSS changed. A browse of its timeline shows the change happened in April 2009 …

Frank Gilbert was seen on the 25th and the Workload was given a Telephone CPT. This may be a mistake - CPTs used in other work for the month such as CASE MANAGEMENT (t1016) or OFFICE/OUTPATIENT VISIT EST (99211) seem more appropriate. Remember that CPTs for this type of Workload are manually chosen by the Provider making errors more likely …

Despite being named for a role (NURSE), all work performed at this location on this month is by one nurse, Edna Dawson. At least for this month, the location could have been named IOW OIF/OEF CASE MGT DAWSON.

IOW OPTOMETRY KNIGHT RETURN (855)

Jayden Knight, an Optometrist in the Iowa Hospital, names this location …

and this provider has performed steady work of this sort from late in 2001 until “now” …

There were six pieces of credited work in November 2008, all of type OPTOMETRY …

and all colored yellow, the color of OPTOMETRY’s DSS grouping, Surgical Services.

Frank Gilbert was seen on the 25th as part of a disability exam. Only the CPT code tells us that …

RADIOLOGY DIV 999 OOS ID 105 (193)

Like other work performed by Radiologist’s, XRAYs get their own “location” …

and perhaps XRAY DIV 999 OOS ID 105 would have been a better name.

The deep burgundy color of its timeline which stretches back to 1996 reflects large numbers of XRAYs taken in IOWA hospital over the years.

In November 2008 alone, there were 149 OUTPATIENT XRAYs and 27 INPATIENT …

which span the month …

Frank Gilbert had two on the 25th, each given a CPT. As they both occurred at the same time, they were gathered into one Workload record …

Notice that the work is described as ANCILLARY - this denotes that the workload was assembled automatically by VISTA.

ZZIOW C&P SALAZAR (932)

Genevieve Salazar is a Registered Nurse who names this location for General Medicine and specifically for C&P EXAMs …

The timeline for the location shows that March 2010 had the last work - though the official retirement date was months later. Hence ZZ in front of the name. This location is no longer in use as Ms Salazar has left the Iowa Hospital …

and Frank Gilbert was seen by her on the 25th of November 2008 for a Disability Exam. Here again, the CPT is less precise than the DSS combination …

IOW MH AGUILAR (1390)

Essie Aguilar is a social worker working in mental health (MH) who names this location …

She has a very large workload …

which starts in November 2008, the month we’re considering here.

Frank Gilbert was seen on the 26th …

Note that Ms Aguilar is not the only provider with a location for this type of work …