The VA National Clozapine Registry tracks the health and demographics of patients who have been prescribed clozapine by the VA. Clozapine, or the brand name Clozaril, is a drug used to treat the most serious cases of schizophrenia. Unfortunately, clozapine may also affect portions of the blood, lowering the body's resistance to infection and sometimes creating life-threatening circumstances. Realizing the severity of the problem, the Food and Drug Administration (FDA) established guidelines for analysis of White Blood Cells and Neutrophils and set strict minimum limits. The FDA also mandated that any manufacturer of clozapine must maintain a Clozapine Registry. These registries are to track the location and the health of clozapine patients and to ensure 'weekly White Blood Cell testing prior to delivery of the next week's supply of medication'. To date, the clozapine manufacturer registries have been unable to develop sufficient controls to meet these requirements, especially the ability to prevent dispensing clozapine when blood results are abnormal. However, because of the unique structure of Veterans Health Information Systems and Technology Architecture, the Veterans Health Administration obtained permission from the FDA and clozapine manufacturers to use its in-place computer network to gather and evaluate weekly patient information, then export this data to manufacturer clozapine registries. The VA assigned functional administration of this effort to the National Clozapine Coordinating Center (NCCC) located in Dallas, Texas. Weekly data on each VA clozapine patient is processed at two locations. Facility Level --When a clozapine prescription is written, a computer program in each facility's internal computer system retrieves white blood cell count, neutrophil count, and clozapine dose and evaluates the information according to FDA guidelines. If an adverse blood condition is found, the computer may warn to trigger a physician reevaluation, or lock out entirely to prevent dispensing, depending on the severity. Weekly, this information, along with certain patient demographic information, is gathered locally and transmitted to Hines Office of Information & Technology Field Office for centralized storage. This data can only be accessed by the NCCC. Raw data is downloaded from the Hines OI Field Office database on a weekly basis. An ancillary computer program reformats the data and evaluates the information for inconsistencies and data gathering errors. The computer-corrected data is manually compared with hand-written facsimile information sent to the NCCC by each site. This manually corrected data is again reformatted for data storage in MS Access format at the NCCC. The corrected data is also reformatted into American Standard Code for Information Interchange fixed-length fields and transmitted via modem to the manufacturers' Clozapine Registry and, in turn, to the FDA.

As the number of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Traumatic Brain Injury (TBI) patients has grown, so has the need to track and monitor care to meet the lifelong needs of these veterans. In March 2007, a Computerized Patient Record System (CPRS) OIF/OEF TBI Screening Reminder was released. This is a first-line screening tool to identify potential TBI patients. Additional information about veterans who have been identified as possible TBI patients by the initial Screening Reminder is collected through a Comprehensive TBI evaluation. Reminder results, in the form of Health Factors, Comprehensive TBI evaluation data, and Comprehensive TBI Follow-up results of individual Veterans will be sent to a national database. This data will be aggregated in order to provide relevant responses to key stakeholders, such as members of Congress, to monitor the quality of care and to implement system improvements. In addition, tracking applications will be used to collect data on TBI patient appointments.

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.

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 Environmental Agent Service (EAS) Registries 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. These registries were originally developed using paper code sheets that were sent to the VA Austin Information Technology Center where typists converted to data files on the mainframe. The Registries have undergone a modernization and simplification effort that allows the entry of data via a web interface at https://vaww.registries.aac.va.gov/eas/ by staff at the VA medical centers. In compliance with the Federal Information Systems Management Act (FISMA) this is considered a single system of records with the three registry components i.e. IRR, AOR, GWR with DU that have been integrated into a single Oracle database. Please see individual Monograph entries for specific details on: Ionizing Radiation Registry (IRR), Agent Orange Registry (AOR), and the Gulf War Registry (GWR).

In 2009, the Department of Defense estimated that approximately 40,000 service members who served in OEF/OIF may have embedded fragment wounds as the result of small arms fire or a blast or explosion caused by an Improvised Explosive Device (IED), rocket propelled grenade (RPG), landmine, grenade, or enemy or friendly fire. Studies have shown that embedded fragments are not inert in the body, but may breakdown slowly over time and potentially affect an individual�s health. The recognition of potential short and long-term health effects of embedded fragments and the large number of soldiers with injuries resulting in embedded fragments led the Presidential Task Force on Returning Global War on Terror Heroes to recommend that the VHA establish a registry and medical surveillance program for Veterans with retained fragments. The Toxic Embedded Fragment Surveillance Center (TEFSC) has been established at the Baltimore VA Medical Center to coordinate this charge. A critical component of the TEFSC medical surveillance program is the development of an Embedded Fragment Registry. This registry provides a mechanism to identify Veterans with embedded fragments, manage clinical data related to embedded fragments, and develop medical and surgical guidelines that will enable the TEFSC staff and VA clinicians to deliver appropriate medical care to these Veterans.

The VA's Veteran Health Administration, in support of PL 112 260 established an Airborne Hazards and Open Burn Pit Registry to study the potential exposure of concern that may result in long-term health impacts to Veterans.

The Breast Care Registry is an Office of Women's Health sponsored intranet based registry providing data for the longitudinal tracking of breast care.

The Converged Registries Solution (CRS) has been replaced by the Veterans Integrated Registries Platform (VIRP). The information contained in this entry discusses the CRS prior to its replacement. The Converged Registries platform was a hardware and software architecture designed to host individual patient registries and eliminate duplicative development effort while maximizing VAs ability to create new patient registries. The common platform included a relational database, software classes, security modules, extraction services and other components. The Converged Registries obtained data from the Corporate Data Warehouse (CDW), directly from the Veterans Health Information Systems and Technology Architecture (VistA) as well as by direct user input. Registries Projects - Embedded Fragment Registry (EFR), Eye Injury Data Store, Traumatic Brain Injury (TBI) Registry and Veterans Implant Tracking and Alert System (VITAS).

The Clinical Case Registries (CCR) replaced the former Immunology Case Registry and the Hepatitis C Case Registry with local and national databases. The CCR:HIV and CCR:HCV are administrative and clinical databases designed to provide population-based data on VA patients infected with Human Immunodeficiency Virus (HIV) and/or Hepatitis C virus (HCV). Each Veterans Health Information Systems and Technology Architecture (VistA) system contains a local CCR where patients who are potentially HIV or HCV infected are identified based on International Classification of Diseases (ICD-9) codes and/or positive antibody test results. The local HIV or HCV coordinator must review these cases to determine which patients are truly infected and should be added to the local registry. The local CCR provides extensive reporting capabilities to the local HIV and HCV clinicians to monitor their patient population. The local CCR software also extracts data elements from multiple VistA packages and transmits Health Level Seven (HL7) messages to the national database at VA Austin Information Technology Center. The national database is used for monitoring clinical outcomes, assessing resource utilization and quality assurance.