VA EXPRESS CARD

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VA EXPRESS CARD

• Dennis M. Lewis, FACHE
• Director, Edward Hines, Jr., VA Hospital
• Hines, Illinois 60141
• Dennis.Lewis_at_med.va.gov

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Overview

• 26 million veterans and 43 million dependents
• Nearly one-third of the nations population are
  potentially eligible for VA benefits
• Facilities in all 50 states, Washington, DC,
  Puerto Rico, Virgin Islands, Philippines, Guam
  and Samoa

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Overview

• Nations largest medical system with 173 medical
  centers, 129 nursing homes, 35 domiciliaries and
  400 community based clinics
• 58 regional veterans benefits offices providing
  monetary, disability, pension, education and
  vocational rehabilitation benefits
• 13 million home loans and the nations largest
  insurance program
• Nations largest cemetery system with 116
  national cemeteries

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History
Metal ID 1930s-1970s
Plastic ID (1st generation) 1970s-1990s
Paper ID 1940s-1970s
Veteran Identification Card (VIC) 1997
VAlor Card 2001
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Background

• In 1993, the VA approved testing of a 1st
  generation veteran identification card (VIC) at
  VA Hospitals. VIC was to
• Be a Universal VA Identification Card
• Prompt Health Card versus Hospital Care
• Improve services to veterans - seamlessly

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Background

• The national implementation of VIC was completed
  in April 1997
• The card is plastic, embossed, with a magnetic
  stripe and bar code
• The embossed information allows for paper
  transfer of information, while the magnetic strip
  and bar code are electronically readable

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Background

• VIC was to rapidly look-up medical and
  administrative information on the veteran
• It would allow for electronic registration
• Card were personalized at each facility with five
  data elements including name, date-of-birth,
  social security number and service connection

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Background

• VIC also contained a small black and white
  picture of the veteran
• Takes about a minute to produce
• To date over eight million cards have been issued

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Background

• The information on the card didnt change
• The veterans name and social security number
  were visible on the card

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Background

• After a complete program review of VIC in
  1998/1999 it was recommended that ...rather than
  make incremental improvements to the existing
  VIC, the VA should move to smart identification
  cards
• The recommendation was conceptionally approved in
  the Fall of 1999

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Background

• Additional recommendation addressed the need for
  significant culture/operational changes in the
  way VA conducts its clinical and administrative
  practices.

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Objectives

• There will be ONLY one card across the Department
  of Veterans Affairs
• The card may be presented by a veterans at any VA
  (VHA, VBA, NCA) facility and honored by all VA
  employees
• The card will be scaleable
• The card will enhance VAs business services and
  bring inherent value to VAs mission and veterans

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Objectives

• The card will be network-centric as opposed to
  card-centric
• The card will enhance veteran quality of care,
  safety and service
• Will enhance VAs business services and bring
  inherent value to VAs mission
• It will work across government and contain a
  digital certificate to facilitate veterans
  participation in e-commence and e-government

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Objectives

• For the first time, the card will contain
  clinical and administrative data that is subject
  to change
• Will contain data from all three principal VA
  organizational units
• As the VA Express Card matures it will provide
  additional applications
• Veterans will be able to interact with VA kiosks
  where appointment listings can be obtained

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Objectives

• Pharmacy refill requests
• Veterans can charge administrative information,
  mailing address, telephone numbers, etc.
• Obtain updated benefits information, disability
  rating, military service status and eventually,
  electronic purse functionally

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Initial Implementation Goals

• Determine adequacy of visual ID with introduction
  of larger, full color veteran picture
• Determine adequacy of data carrier for
  registration and emergency medical information
  demographics
• Determine portability of patient information,
  specifically between VA and non-VA facilities

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Initial Implementation Goals

• Realization of a paperless system and
  acceptance by veterans and staff of the VA
  Express Card
• Identify impact upon business processes - what
  can be streamlined, changed eliminated
• Identify technology requirements/barriers to the
  use of the VA Express Card
• Identify non-VA program needs/requirements, i.e.,
  DOD, G-8, etc.

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Business Case The fundamental inefficiency
of Americas health care system is the timely
matching of patient need to the most appropriate
level of service at the most appropriate costs
T.U. Gaboatie
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Business Case

• In 1998, more than 100 million citizens visited
  the Nations 5000 emergency rooms
• In FY00, 1.17 million veterans had over 2.17
  million emergency room encounters

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Business Case

• 80 or more of all patients presenting in
  emergency rooms are treated based on
  self-reported medical history, or no history at
  all
• In FY00, 37 of all veterans were treated at more
  than one VA facility

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Business Case

• In FY00, approximately 3.9 million veterans were
  treated at VA facilities
• Approximately 1.44 million were treated at
  multiple VA facilities

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Current Status

• A requirements analysis, business case and
  project plan was completed in July 2000
• An initial proof of concept is a lab setting was
  successfully completed in August of 2000
• Initial deployment of hardware software
  necessary to facilitate nationwide implementation
  began in January 2001 in Network 12

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Current Status

• Electronic embossing proof of concept demo
  completed and installed - March 2001
• Single and all form embossing demonstration
  completed - March 2001
• Site testing staff training on embossing
  replacement completed April 2001

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Current Status

• Installation of card issuance hardware/software
  completed April 2001
• Communication launch to veterans at Milwaukee and
  Iron Mountain started April 2001
• Approximately 11,000 smart cards mailed out April
  2001

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Summary

• Multiple rolls are seen for the VA Express Card
• Visual Identification (improving veteran privacy)
• Electronic identification (keys certificates)
• Portable data carriers pointer to additional
  data
• Significant reduction in potential patient
  treatment errors
• Physical Access
• Information System Security
• Electronic Payment/Digital Purse

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Final Thoughts

• Smart card technology is resource expensive
• In large organizations, must be developed in
  concert with overall organizational information
  technology strategy
• Business case must be strong, identifying closely
  with organizations goals and objectives
• Dont expect immediate acceptance

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Final Thoughts

• Patients and staff will use the smart card when
• Its adaptable
• Its integrated with other functions
• It leverages the strengths of your other
  systems
• Its personal and customizable
• It provides greater service

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Further Information

• http//vaww.va.gov/proj/onevacard/