From Day 1, VAMC is paperless

June 26, 1995, was a historic day for Veteran's Affairs Department hospitals. On that
day, the VA opened a medical center in West Palm Beach, Fla., that has never used paper

"I don't know of any other hospital in the world" without paper charts, said
Irfan Shaikh, health information manager at the Florida medical center.

The planning staff determined that up to 80 percent of its clinical data could be
stored online in the VA's own text-based Decentralized Hospital Computer Program. But DHCP
couldn't handle other information such as advanced directives, living wills,
administrative documents, outside-hospital information and flow sheets. So the planners
created an online document scanning and management system.

About 700 of the center's 1,300 employees-including nurses, administrative staff and
others-use the document system, Shaikh said.

The center can serve 1,000 outpatients per day and has 400 hospital beds and 120
nursing beds.

The online system "hasn't eliminated any [clerical support] staff, but you can't
put a price on having documents available 24 hours a day," Shaikh said.

Hospital information staff inputs documents into the online system at one of eight
scanner stations with 3000-series flatbed scanners from Fujitsu America Inc. of San Jose,

Document Storage Systems Inc. of Aurora, Colo., supplied the center with its DSS CNT
software for the paperless charts. "We have 110 clinical note templates [CNTs], which
are design templates in electronic form," said DSS president Mark Byers. "You
fill one out if you're examining a patient or performing dental work, surgery or other
medical procedures."

DSS CNT "primarily is for medical records, but you can store facilities
management, acquisitions and other data," he said.

The medical center also uses DSS' Forms Navigator software to manage different forms so
there aren't too many icons on the desktop. Each clinical note template is stored as a
tab, and each center user has no more than 24 tabs.

The center also uses the DSSearch terminal emulation query tool for text-based
information under Microsoft Windows 3.1.

The center bought the products through General Services Administration Schedule from
DSS and its partner, AmeriData Federal Systems of Gaithersburg, Md., for less than $1
million, Byers said.

Documents are stored on three 40G Hewlett-Packard Co. jukeboxes and a 1-terabyte D1050
jukebox from Document Imaging Systems Corp. of Sunnyvale, Calif., said Michael Cochran,
the network administrator. The center runs Disk Extender from Optical Technology Group
Inc. of Bethesda, Md., for file services on the Windows NT LAN and management of the

Though DSS' imaging software has worked well, "we're trying to make the system
more friendly to the scanning staff," Shaikh said.

The scanned document system is linked to DHCP so employees can highlight a patient's
Social Security number in a DHCP record and see the record in the document system.

Client platforms on the center's Novell NetWare 4.1 LAN are 66-MHz 486 PCs with 8M of
RAM and 800M hard drives, running the Microsoft Office suite. The hospital now makes
limited use of Windows NT 3.51 but, like the rest of VA, is migrating to Windows NT 4.0 as
its exclusive desktop and server operating system, Cochran said.

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