The Resident Assessment Instrument/Minimum Data Set (RAI/MDS) is a comprehensive assessment and care planning process used by the nursing home industry since 1990 as a requirement for nursing home participation in the Medicare and Medicaid programs. The RAI/MDS provides data for monitoring changes in resident status that are consistent and reliable over time. The VA commitment to quality propelled the implementation of the RAI/MDS in its nursing homes now known as VA Community Living Centers (CLC). In addition to providing consistent clinical information, the RAI/MDS can be used as a measure of both quality and resource utilization, thereby serving as a benchmark for quality and cost data within the VA as well as with community based nursing facilities. Workload based on RAI/MDS can be calculated electronically by the interactions of the elements of the MDS data and grouped into 53 categories referred to as Resource Utilization Groups (RUG-IV). Residents are assessed quarterly. The data is grouped for analysis at the Austin Information Technology Center (AITC). Conversion to electronic data entry and transmission to the AITC was completed system-wide by year-end 2000. In 2010, the Centeres for Medicare and Medicaide Services released a significantly upgraded version, MDS 3.0, to begin to be implemented on October 1, 2011 in VHA CLCs. Training is underway currently. The MDS 3.0 will generate a new set of Quality Indicators and Quality Monitors as well the RUGs will increase to 64 RUGs from the current 53 RUG groups.

The Performance and Operational Web-Enabled Reports (POWER) system is a state-of-the-art data warehouse containing data on Veterans Health Administration (VHA) performance metrics that are obtained daily from the individual Veterans Health Information Systems and Technology Architecture (VistA) systems.The POWER system was developed to measure the key performance indicators across VHA facilities and is helping to improve VHA's Medical Care Collections Fund (MCCF) revenue operational performance by providing accurate, reliable, and up-to-date performance measure information. POWER leverages a data warehouse to maintain data used in VHA performance measure calculations. The site provides Web-based analytical reporting capabilities, allowing users to view data by dimensions, such as, National, Consolidated Patient Account Center (CPAC), Veterans Integrated Service Network (VISN), or Station locations and by month. The data can also be displayed in tables, graphs and spreadsheets. It should be noted that POWER is not an accounting system; rather, it is a strategic and operational performance reporting system.The POWER system supports VHA's efforts to improve its revenue business operations by providing accurate and reliable performance information on the following metrics: Collections, Gross Days Revenue Outstanding (GDRO), Percentage of Accounts Receivable (AR) Greater than 90 Days, Days to Bill, Total Billings, Percentage of Collections to Billings, and Cost to Collect. POWER is VHA's revenue performance metric dashboard monitoring system that tracks MCCF performance by National, CPAC, VISN and Station.

The Patient Advocate Tracking System (PATS) is a centralized, web based application that records and tracks instances of patient compliments and complaints concerning their care at VA health care facilities. These instances of patient contacts may come from a variety of sources including the patient, family members, congressional members and/or Veterans service organizations on behalf of the Veterans receiving care at VA facilities. This database provides a menu of reports that can be used to track and trend data across Veterans Integrated Service Networks (VISNs). Reports of contact allow the Patient Advocate to trend compliments and complaints, and ensure that issues raised are resolved. The reports include data such as patient demographics, date of contact, method of contact, who made the contact, issues involved, what service was involved, resolution date and resolution status. Data is collected from Veterans Affairs Medical Centers and sent to the VHA Support Service Center (VSSC) where the data is maintained and reports created.

This database is part of the National Medical Information System (NMIS). The Patient Treatment File (PTF) contains a record for each inpatient care episode provided under VA auspices in VA and non-VA facilities nationwide. Each episode contains data on admission, diagnosis, procedures, surgical episodes, and disposition (discharge) information and Diagnostic Related Group (DRG). Each transfer is recorded to allocate days of care properly to the service(s) responsible for that care. Recurring and special purpose reports are used for studies on patient movement trends, diagnostic frequency, workload, budget preparation, Diagnostic Related Group (DRG) assignment and accreditation requirements. Reports are available for online access via Roger's Software Development's (RSD) Online Report Viewing. Several large data files are installed on-line at the Austin Information Technology Center for remote access. Selected data can be downloaded to perform end user processing, including report generation. Information is received from a variety of modules in Veterans Health Information Systems and Technology Architecture. This batch system is written in Common Business Oriented Language and ALC. Processing is done on a daily, weekly, and monthly basis.

The Patient Assessment File (PAF) database compiles the results of the Patient Assessment Instrument (PAI) questionnaire filled out for intermediate care Veterans Health Administration (VHA) patients. The PAI is filled out within two weeks of admission. It is also completed semi-annually on April 1st and October 1st for each patient by a registered nurse familiar with the patient. The PAI questions cover medical treatments, conditions, selected diagnoses, activities of daily living, behaviors, some rehabilitation therapies, and chronic respiratory support. The database is managed by the Geriatrics & Extended Care Strategic Health Care Group in the Office of Patient Care Services. It is currently running at the Austin Information Technology Center (AITC) and is stored in flat files. PAF's primary customer is the Allocation Resource Center (ARC) in Braintree MA. The ARC receives the data from AITC and combines it with data from the Patient Treatment File (PTF) which contains more detailed demographic and treatment information. The ARC builds ORACLE tables, assigning RUG II (Resource Utilization Group II) scores and weighted work units reflecting the level and type of care needed. The 16 different weighted work units, ranging from 479 to 1800, are a factor in the resource allocation and budget decisions on long-term care, and are used to measure efficiency. The data is also used in other reports to Central Office, the Veterans Integrated Service Networks, and the facilities. Several other units also use PAF information including the Decision Support System (DSS). Currently, PAF is in the process of being replaced by the Resident Assessment Instrument/Minimum Data Set (RAI/MDS). RAI/MDS uses a much more extensive questionnaire as its source of information. The RAI/MDS provides clinical data and care protocols in addition to the newer RUG III scores, and is required by the Centers for Medicare and Medicaid Service funded hospitals.

The Veterans Health Administration (VHA) pays for care provided to VA beneficiaries in non-VA hospitals through its contract hospitalization program as mandated by Congress in the late 1980s. The Non-VA Hospital System (NVH) software captures the patient's Demographics, Provider, Hospital Name and Location, Medicare Provider Number, Diagnoses and Procedures for which the patient received care during his/her inpatient stay. The data is received from either the patient or the medical center providing the care (normally on a UB-92 form). The billing office employee enters the information into Veterans Health Information Systems and Technology Architecture and sends information to the Austin Information Technology Center (AITC). The non-VA hospitals are reimbursed at Medicare rates based on the Prospective System (PPS). PPS uses the appropriate Diagnostic Related Groups (DRGs). Each DRG has a different rate-adjusted reimbursement based on the regional and urban/rural designation of the provider non-VA Hospitals. NVH is housed at the AITC and uses software developed by the AITC in conjunction with 3M and the Center for Medicare and Medicaid Services (CMS). It is a batch system written in Common Business Oriented Language, ALC, and Statistical Analysis Software. Processing occurs daily.

The Non-VA Care Medical and Pharmacy System (FEE) automates the Veterans Health Administration (VHA) Fee for Service program. It authorizes and pays private physicians, hospitals, and pharmacists for products and services provided to Veterans approved for the program. Veterans are reimbursed through VistA Fee for medically-related expenses including travel. Information is entered into the VistA Fee system through Veterans Health Information Systems and Technology Architecture (VistA) online menus. VistA Fee is run at the Austin Information Technology Center and interfaces with the Financial Management System (FMS), the Beneficiary Identification and Records Locator System (BIRLS), and the VHA Work Measurement database (VWM), to produce payments, accounting updates, and reports. VistA Fee facilitates money management, master record updating, and input error resolution. Daily reports indicating all payments processed and erroneous input transactions are transmitted to approximately 170 Veterans Affairs Medical Centers (VAMCs). Letters are sent to Veterans on a monthly basis detailing payments made on their behalf to Non-VA Care Service providers. Monthly, quarterly, semi-annual and annual reports are sent to the Veterans Affairs Central Office (VACO) and VAMCs. The Non-VA Care Fee Basis Medical System is commonly referred to as Central FEE.

The National Prosthetics Patient Database (NPPD) established a central database of Prosthetics data recorded at each Veterans Health Administration facility. Its objective was to enable clinical reviews to increase quality, reduce costs, and improve efficiency of the Prosthetics program. Increase the quality of the services to our Veterans by providing a means to develop consistency in services, review prescription and management practices, develop training, monitor Home Medical Equipment, and measure performance improvements. Reduce costs by comparing costs system-wide, identifying common items for consolidated contracting, identifying costs for Medical Cost Care Funds (MCCF) purposes and improving contracting cost benefit. Improve efficiency by validating the data, improving budget management, determining where coding errors occur, providing training, and comparing unique social security numbers for multiple site usage and item issue. The NPPD Menu provides patient information, patient eligibility, Prosthetic treatment, date of provision, cost, vendor, and purchasing agent information. This system tracks average cost data and its usage and provides on both a monthly and quarterly basis detailed and summary reports by station, Veterans Integrated Service Network (VISN) and agency. The NPPD Menu resides in Veterans Health Information Systems and Technology Architecture (VistA) at the medical center level. This data is updated quarterly. Data is rolled up at each facility and transmitted to Hines. The data is then loaded into the Corporate Data Warehouse (CDW) from which data extracts are done. The data is also put into a ProClarity cube and is available to VA local, regional, and national managers online. National managers have the ability to properly monitor, oversee and manage the national program and regional managers are able to effectively manage their respective areas using this tool. The primary purpose of this database is to provide financial and clinical oversight of the Prosthetics program and is used primarily by the Prosthetics and Sensory Aids (PSA) including VISN staff, VISN Prosthetics Representatives, Prosthetics Program Managers and other Prosthetics staff.

As of June 28, 2010, the Master Veteran Index (MVI) database based on the enhanced Master Patient Index (MPI) is the authoritative identity service within the VA, establishing, maintaining and synchronizing identities for VA clients, Veterans and beneficiaries. The MVI includes authoritative sources for health identity data and contains over 17 million patient entries populated from all VHA facilities nationwide. The MVI provides the access point mechanism for linking patient's information to enable an enterprise-wide view of patient information, uniquely identifies all active patients who have been admitted, treated, or registered in any VHA facility, and assigns a unique identifier to the patient. The MVI correlates a patient's identity across the enterprise, including all VistA systems and external systems, such as Department of Defense (DoD) and the Nationwide Health Information Network (NwHIN). The MVI facilitates the sharing of health information, resulting in coordinated and integrated health care for Veterans. New Information Technology systems must be interoperable with the MVI and legacy systems will establish integration by October 1, 2012. The Healthcare Identity Management (HC IdM) Team within VHA's Data Quality Program is the steward of patient identity data, performing maintenance and support activities.

The Post-Deployment Health Strategic Healthcare Group (PDHSHG) Registry System of Records is the information system encompassing the Ionizing Radiation Registry (IRR), the Agent Orange Registry (AOR), and the Gulf War Registry (GWR) which also includes related Depleted Uranium (DU) exams. The IRR area of the Environmental Health Program (EHP) database contains the results of questionnaires completed by Veterans who may have been exposed to ionizing radiation while on active military duty and have had an IRR examination at a VA medical facility.