# Presentation: 922714

## VA EXPRESS CARD

**Dennis M. Lewis, FACHE**
**Director, Edward Hines, Jr., VA Hospital**
**Hines, Illinois 60141**
**Dennis.Lewis@med.va.gov**

- CardTech/SecurTech 2001

## Overview

**26 million veterans and 43 million dependents**
**Nearly one-third of the nation’s 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

**Nation’s 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**
**Nation’s largest cemetery system with 116 national cemeteries**

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## History

**Metal ID**
**1930’s-1970s**

**Paper ID**
**1940s-1970s**

**Plastic ID**
**(1st generation)**
**1970s-1990s**

**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 didn’t change**
**The veteran’s 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 it’s 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 VA’s business services and bring inherent value to VA’s mission and veterans**

- CardTech/SecurTech 2001

## 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 VA’s business services and bring inherent value to VA’s mission**
**It will work across government and contain a digital certificate to facilitate veteran’s participation in e-commence and e-government**

- CardTech/SecurTech 2001

## 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 America’s 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 Nation’s 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

- CardTech/SecurTech 2001

## 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**

- CardTech/SecurTech 2001

## 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 organization’s goals and objectives**
**Don’t expect immediate acceptance**

- CardTech/SecurTech 2001

## 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**

- CardTech/SecurTech 2001

## Further Information

**http://vaww.va.gov/proj/onevacard/**

- CardTech/SecurTech 2001