VA managers use special software to make health, budget decisions

The Department of Veterans Affairs last month ratcheted up training at its medical centers on how to use a special software program to assess the costs and benefits of providing health care - findings from which the agency will use to make management and budget decisions.

The software is the heart of the Decision Support System (DSS) which combines financial clinical and patient utilization information so that health care administrators for the Veterans Health Administration can allocate its budget better and veterans can find the best care.

The DSS "captures financial and clinical information as well as patient utilization of services and combines and consolidates that information on two levels " said Colin MacKenzie director of operations for VA projects at Transition Systems Inc. (TSI) the Boston-based vendor that is installing the software in the DSS. One level is organized for VA managers who can monitor the patterns of how medical services are used and then make budget decisions based on those findings. The other level is organized for patients who can check the performance of medical service providers.

TSI under a $24 million nine-year contract has been installing the DSS since 1994. About 60 out of 154 sites are outfitted with the software said Daniel L. Marsh director of the DSS project for the VHA.

High-Level Training

The higher level of training that VHA officials started last month will teach VHA health care decision-makers to do more than simple evaluations the training will focus on tactical uses of the DSS MacKenzie said. VHA managers will learn how to use the software to determine how adding something such as a catheterization laboratory will affect demand for radiological services at a medical center.

GAO: Electronic Data Needed

The beginning of heightened training coincides with a General Accounting Office report released last month. In a portion of the report GAO concluded the VA could make better use of the DSS which can help health administrators pinpoint which doctors are having greater success in treating patients determine which services are most costly to provide and determine which age groups consume which resources the most.How well VHA uses its DSS depends on the quality of its data and GAO is pushing for better data-gathering by agency officials.

"VA's automated performance measurement and resource allocation systems lack complete and accurate data " GAO reported. "While DSS can provide data on patterns of care and patient outcomes as well as their resource and cost implications the ultimate usefulness of the system will depend not on the software but on the completeness and accuracy of the data going into the system."

To make the data as complete as possible VHA officials hope to make more patient records electronically available for the DSS. "Certainly we would like a much more aggressive approach in the field in capturing data electronically " said Daniel L. Marsh director of the DSS project at VHA.

Even if the data is not all there the VA should be able to squeeze a good deal of value out of DSS use. "[The VA has] such a diverse layer of information that [without a DSS] it's impossible to get a clear picture of what the costs are for managing patients " said Larry Gunsberg regional sales manager for Computer Sciences Corp. Healthcare's Decision Technology Market and who is familiar with DSS.

But some of the findings in the GAO report are based on two 1995 GAO reports. "We are much further along than [we were] when" those 1995 reports were written Marsh said.