VA Medical Centers’ CART Program Improves Patient Care, Longitudinal Research

San Francisco, CA—The Veterans Affairs Health System is leveraging its massive size and scope with programs designed to both improve patient care and aid in longitudinal research. VA physicians discussed one such program Wednesday at TCT 2013.

The VA is “the largest integrated health care system in the United States,” said Mladen I. Vidovich, MD, of the Jesse Brown VA Medical Center in Chicago. It comprises 152 medical centers (which contain 78 cath labs), more than 53,000 medical professionals, and serves more than 8 million veterans. Importantly, it has a unique electronic medical record known as the Computerized Patient Record System (CPRS). “It is exactly the same in every single hospital in the country,” Vidovich said. “Other large systems can’t match this.”

Now, the VA has paired the CPRS with the Cardiovascular Assessment, Reporting, and Tracking (CART) program. This is essentially a national system for cath lab reporting and a data repository, said Andrew J. Klein, MD, of the St. Louis VA Healthcare System. Klein said that other quality programs are flawed in a number of ways: less centralized systems have potential for transcription errors; cost substantial amounts of both money and time to run; and the same information often needs to be retranscribed for billing or research purposes. CART is designed to simultaneously support patient care, knowledge generation, quality assurance, and quality improvement. In combination with the CPRS, Klein said it can provide insights into a patient’s overall continuum of care as well as long-term outcomes, “which is really what we care most about.”

CART allows clinicians to easily enter pre-procedure and procedural details into the system (see Figure), and in a number of ways allows quick adaptation for quality improvement. For example, all major adverse events are automatically reported, leading to a committee review within 72 hours. “This is a distinct advantage over the current system, which essentially fails to pick up any safety signals, for instance if you have a large amount of adverse events at one center,” Klein said. “That can’t happen with the CART [cath lab] system.”

The program’s standardization across the entire VA system also allows for smooth continued care in the cath lab. If a patient needs to come back for a second or third procedure, all data in the CART system will be pre-populated. Klein said the system is also flexible, so it can easily incorporate changes in technology like newly introduced stents. CART itself will soon have additional capabilities, including integration with ICD and pacemaker surveillance programs and a system for specifically tracking peripheral arterial interventions.

Though standardization to this extent may be difficult in other health care systems, it may provide a model for future initiatives. And its power for research is clear: in fiscal year 2012, the VA cath labs conducted 135,692 procedures in 40,657 patients. “We do need standardization, and we have achieved it with CART,” Klein concluded.


Klein and Vidovich report no relevant conflicts of interest.