Federated VistA

Interfacility Consults (IFCs) Anchorage [463]

The following describes Consults, specifically Interfacility Consults (IFC), for the most recent year of Anchorage VistA cut on 2021-01-06.

Local consults - those ordered and fulfilled within this VistA - represent fully 132,553 (98.8%) of the consults created in this VistA during the last full year for which data is available. Of the IFCs, there are more Placer consults (“placed” elsewhere) 1,483 (1.11%) than Filler consults (fulfilled by this VistA for another) 129 (0.1%). In terms of IFCs, this is a Placer VistA

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VistA Consults are ordered using consult types called services. Local consults use 362 (67.79%) of the services used in this system, less than their proportion of consults. In other words, more services are employed for ordering IFCs than their numbers would suggest. Notice also that some services used for local consults - 0 - are also used for IFC fulfillment. While services used for placement are exclusively for IFCs, the same is not true for fulfillment.

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As seen below, most patients with consults only have local consults and the majority of the balance have both local consults and IFCs (“mixed”).

A small minority of patients have only fulfilled consults. With fulfilled consults, a patient’s home record is typically elsewhere so you would expect to see more such patients and less mixed patients. The lower number of such “remote-only patients” should be examined further.

As for users, a smaller proportion are only involved in local consults. While no users only fulfill consults submitted from elsewhere, a relatively large set only place consults elsewhere. This set of “placer only users” needs further examination.

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Placer

There are 170 Placer Services - services that route/place consults to 76 other facilities. In VistA, a Placer Service identifies a specific remote (routing) facility which is always the main, default facility of a remote VistA. In this VistA, 92.0% of the IFC Consults are “Placed” and the vast majority go to other facilities in the same VISN, facilities highlighted in bold in the tables below. Placer consults can be broken into four broad classes …

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6 of the Placer Services are for TeleReading to 3 facilities …

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Service by Service …

# Placer Service To Facility # Status’
1 TELEDERMATOLOGY IFC (PUGET SOUND) SEATTLE VA MEDICAL CENTER [663] 177 COMPLETE [163], DISCONTINUED [14]
2 TELE-EYE IMAGING IFC (BOISE FROM ANC) BOISE VA MEDICAL CENTER [531] 67 COMPLETE [57], DISCONTINUED [10]
3 DIABETIC TELERETINAL IMAGING IFC (PORTLAND) PORTLAND VA MEDICAL CENTER [648] 48 COMPLETE [43], DISCONTINUED [5]
4 TELE-EYE IMAGING IFC (BOISE FROM JUNEAU) BOISE VA MEDICAL CENTER [531] 7 DISCONTINUED [4], COMPLETE [3]
5 TELE-EYE IMAGING IFC (PORTLAND FROM MAT-SU) PORTLAND VA MEDICAL CENTER [648] 3 COMPLETE
6 TELE-EYE IMAGING IFC (PORTLAND FROM ANC) PORTLAND VA MEDICAL CENTER [648] 1 COMPLETE

80 of the Placer Services denote travel to remote facilities and represent 33.72% of placed consults. These prove to be the exception to the rule that a VistA places most IFCs within its own VISN.

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By Facility …

# Facility Consults Services
1 PHOENIX VAMC [644] 52 (10.4%) TRAVELING VETERAN UNIVERSAL IFC CONSULT (PHOENIX)
2 SOUTHERN NEVADA HCS [758] 32 (6.4%) TRAVELING VETERAN COORDINATOR IFC (LAS VEGAS)
3 SEATTLE VA MEDICAL CENTER [663] 30 (6.0%) TRAVELING VETERAN CONSULT IFC (PUGET SOUND)
4 BILOXI VAMC [520] 27 (5.4%) TRAVELING VETERAN COORDINATOR IFC (BILOXI)
5 SOUTHERN ARIZONA VA HCS [678] 24 (4.8%) TRAVELING VETERAN COORDINATOR IFC (TUCSON)
6 PORTLAND VA MEDICAL CENTER [648] 23 (4.6%) TRAVELING VETERAN COORDINATOR IFC (PORTLAND)
7 NORTHERN ARIZONA HCS [649] 16 (3.2%) TRAVELING VETERAN COORDINATOR IFC (PRESCOTT) [12], TRAVELING VETERAN COORDINATOR IFC (NORTHERN, AZ) [4]
8 LOMA LINDA HCS [605] 15 (3.0%) TRAVELING VETERAN COORDINATOR IFC (LOMA LINDA)
9 RAYMOND G. MURPHY VAMC [501] 13 (2.6%) TRAVELING VETERAN COORDINATOR IFC (ALBUQERQUE) [11], TRAVELING VETERAN COORDINATOR IFC (NEW MEXICO) [2]
10 HOUSTON VAMC [580] 12 (2.4%) TRAVELING VETERAN COORDINATION IFC (HOUSTON)
11 GEORGE E. WAHLEN VAMC [660] 12 (2.4%) TRAVELING VETERAN COORDINATOR IFC (SALT LAKE CITY)
12 ATLANTA VAMC [508] 11 (2.2%) TRAVELING VETERAN CONSULT IFC (ATLANTA GA)
13 SPARK M. MATSUNAGA VAMC [359] 10 (2.0%) TRAVELING VETERAN COORDINATOR IFC (HONOLULU)
14 MANN-GRANDSTAFF VAMC [668] 10 (2.0%) TRAVELING VETERAN COORDINATOR IFC (SPOKANE)
15 FARGO VA HCS [437] 9 (1.8%) TRAVELING VETERAN CONSULT IFC (FARGO)
16 N. FLORIDA/S. GEORGIA HCS [573] 8 (1.6%) TRAVELING VETERAN COORDINATOR IFC (NORTH FL)
17 ROCKY MOUNTAIN REGIONAL VAMC [554] 8 (1.6%) TRAVELING VETERAN CONSULT IFC (DENVER)
18 VA NWIHS, OMAHA DIVISION [636] 8 (1.6%) TRAVELING VETERAN COORDINATOR IFC (IOWA CITY, IOWA) [6], TRAVELING VETERAN COORDINATION IFC (OMAHA, NE) [2]
19 OKLAHOMA CITY VAMC [635] 8 (1.6%) TRAVELING VETERAN COORDINATOR IFC (OKLAHOMA)
20 TAMPA FL VAMC [673] 8 (1.6%) TRAVELING VETERAN COORDINATOR IFC (TAMPA FL)
21 C.W. BILL YOUNG DEPT OF VAMC [516] 7 (1.4%) TRAVELING VETERAN CONSULT IFC (BAY PINES FL)
22 ORLANDO VAMC [11003] 6 (1.2%) TRAVELING VETERAN CONSULT IFC (ORLANDO FL)
23 DALLAS VA MEDICAL CENTER [549] 6 (1.2%) TRAVELING VETERAN CONSULT IFC (DALLAS TX)
24 TENNESSEE VALLEY HCS [626] 6 (1.2%) TRAVELING VETERAN COORDINATOR IFC (TENNESSEE VALLEY)
25 WEST LA VAMC [691] 6 (1.2%) TRAVELING VETERAN COORDINATION IFC (GREATER, LOS ANGELES)
26 MINNEAPOLIS VA HCS [618] 6 (1.2%) TRAVELING VETERAN CONSULT IFC (MINNEAPOLIS MN)
27 BOISE VA MEDICAL CENTER [531] 5 (1.0%) TRAVELING VETERAN COORDINATOR IFC (BOI)
28 OLIN E. TEAGUE VET CENTER [674] 5 (1.0%) TRAVELING VETERAN COORDINATION IFC (TEMPLE TX)
29 WASHINGTON VA MEDICAL CENTER [688] 5 (1.0%) TRAVELING VETERAN COORDINATION IFC (WASHINGTON, DC)
30 JONATHAN M. WAINWRIGHT VAMC [687] 5 (1.0%) TRAVELING VETERAN COORDINATION IFC (WALLA WALLA)
31 MILWAUKEE VAMC [695] 5 (1.0%) TRAVELING VETERAN COORDINATOR IFC (MILWAUKEE)
32 VA HEARTLAND - WEST, VISN 15 [589] 5 (1.0%) TRAVELING VETERAN COORDINATOR IFC (KANSAS CITY) [3], TRAVELING VETERAN COORDINATION IFC (COLUMBIA, MO) [2]
33 NORTHERN CALIFORNIA HCS [612] 5 (1.0%) TRAVELING VETERAN COORDINATION IFC (NORTHERN CALIFORNIA)
34 SAN DIEGO HCS [664] 4 (0.8%) TRAVELING VETERAN CONSULT IFC (SAN DIEGO)
35 RICHARD L. ROUDEBUSH VAMC [583] 4 (0.8%) TRAVELING VETERAN COORDINATION IFC (INDIANANPOLIS)
36 FAYETTEVILLE NC VAMC [565] 4 (0.8%) TRAVELING VETERAN COORDINATOR IFC (FAYETTEVILLE NC)
37 IOANNIS A. LOUGARIS VAMC [654] 4 (0.8%) TRAVELING VETERAN COORDINATOR IFC (RENO)
38 BLACK HILLS HCS [568] 4 (0.8%) TRAVELING VETERAN COORDINATION IFC (BLACK HILLS, SD)
39 AUDIE L. MURPHY MEMORIAL HOSP [671] 4 (0.8%) TRAVELING VETERAN CONSULT IFC (SAN ANTONIO)
40 HARLINGEN VA CLINIC [11436] 4 (0.8%) TRAVELING VETERAN COORDINATOR IFC (TEXAS VALLEY COASTAL)
41 SAN FRANCISCO VAMC [662] 3 (0.6%) TRAVELING VETERAN CONSULT IFC (SAN FRANCISCO)
42 DUBLIN VAMC [557] 3 (0.6%) TRAVELING VETERAN COORDINATION IFC (DUBLIN GA)
43 DAYTON [552] 3 (0.6%) TRAVELING VETERAN COORDINATION IFC (DAYTON OH)
44 MIAMI VAMC [546] 3 (0.6%) TRAVELING VETERAN CONSULT IFC (MIAMI)
45 LONG BEACH VAMC [600] 3 (0.6%) TRAVELING VETERAN COORDINATION IFC (LONG BEACH CA)
46 PALO ALTO VA MEDICAL CENTER [640] 3 (0.6%) TRAVELING VETERAN COORDINATOR IFC (PALO ALTO)
47 WHITE CITY VA MEDICAL CENTER [692] 3 (0.6%) TRAVELING VETERAN COORDINATOR IFC (WHITE CITY OR)
48 BIRMINGHAM VAMC [521] 2 (0.4%) TRAVELING VETERAN COORDINATION IFC (BIRMINGHAM, AL)
49 W.G. HEFNER SALISBURY VAMC [659] 2 (0.4%) TRAVELING VETERAN COORDINATOR IFC (SALISBURY NC)
50 ROSEBURG VA MEDICAL CENTER [653] 2 (0.4%) TRAVELING VETERAN COORDINATOR IFC (ROSEBURG)
51 CHARLESTON VAMC [534] 2 (0.4%) TRAVELING VETERAN COORDINATOR IFC (CHARLESTON SC)
52 EL PASO VA HCS [756] 2 (0.4%) TRAVELING VETERAN COORDINATOR IFC (EL PASO)
53 FORT HARRISON MEDICAL CENTER [436] 2 (0.4%) TRAVELING VETERAN COORDINATOR IFC (MONTANA)
54 VA MARYLAND HEALTH CARE SYS [512] 2 (0.4%) TRAVELING VETERAN COORDINATOR IFC (BALTIMORE)
55 DURHAM VA MEDICAL CENTER [558] 2 (0.4%) TRAVELING VETERAN CONSULT IFC (DURHAM)
56 MARTINSBURG VA MEDICAL CENTER [613] 2 (0.4%) TRAVELING VETERAN COORDINATOR IFC (MARTINSBURG, WV)
57 HAMPTON VA MEDICAL CENTER [590] 2 (0.4%) TRAVELING VETERAN COORDINATOR IFC (HAMPTON)
58 CHARLES GEORGE VAMC [637] 2 (0.4%) TRAVELING VETERAN COORDINATOR IFC (ASHEVILLE NC)
59 CHEYENNE VA MEDICAL [442] 2 (0.4%) TRAVELING VETERAN COORDINATION IFC (CHEYENNE, WY)
60 CLEVELAND VAMC [541] 2 (0.4%) TRAVELING VETERAN COORDINATION IFC (CLEVELAND, OH)
61 JACK C. MONTGOMERY VAMC [623] 2 (0.4%) TRAVELING VETERAN COORDINATION IFC (JACK C MONTGOMERY)
62 SIOUX FALLS VA HCS [438] 1 (0.2%) TRAVELING VETERAN COORDINATION IFC (SIOUX FALLS)
63 HUNTINGTON VAMC [581] 1 (0.2%) TRAVELING VETERAN COORDINATOR IFC (HUNTINGTON)
64 UPSTATE NEW YORK HCS [528] 1 (0.2%) TRAVELING VETERAN COORDINATION IFC (SYRACUSE, NY)
65 PROVIDENCE VAMC [650] 1 (0.2%) TRAVELING VETERAN COORDINATION IFC (PROVIDENCE, RI)
66 IRON MOUNTAIN VAMC [585] 1 (0.2%) TRAVELING VETERAN COORDINATOR IFC (IRON MOUNTAIN MI)
67 WEST PALM BEACH VAMC [6054] 1 (0.2%) TRAVELING VETERAN CONSULT IFC (WEST PALM BEACH FL)
68 DETROIT, MI VAMC [553] 1 (0.2%) TRAVELING VETERAN COORDINATOR IFC (DETROIT, MI)
69 ALEXANDRIA VA MEDICAL CENTER [502] 1 (0.2%) TRAVELING VETERAN COORDINATION IFC (ALEXANDRIA)
70 HINES, IL VAMC [578] 1 (0.2%) TRAVELING VETERAN COORDINATOR IFC (HINES)
71 EDITH NOURSE ROGERS VAMC [518] 1 (0.2%) TRAVELING VETERAN COORDINATION IFC (BEDFORD MA)
72 WILKES-BARRE VAMC [693] 1 (0.2%) TRAVELING VETERAN COORDINATOR IFC (WILKES BARRE, PA)
73 ANN ARBOR VA MEDICAL CENTER [506] 1 (0.2%) TRAVELING VETERAN COORDINATOR IFC (ANN ARBOR)
74 SALEM VA MEDICAL CENTER [658] 1 (0.2%) TRAVELING VETERAN COORDINATION IFC (SALEM, VA)
75 MANCHESTER VAMC [608] 1 (0.2%) TRAVELING VETERAN COORDINATION IFC (MANCHESTER, NH)
76 HUNTER HOLMES MCGUIRE HOSPITAL [652] 1 (0.2%) TRAVELING VETERAN COORDINATOR IFC (HUNTER HOLMES MCGUIRE)

10 are “Common” Placer Services sent between both filler and placer VistAs. They represent a range of typical administrative (“VIRS”, Lodging, Domiciliary) and care requests to remote facilities (Follow ups). In this VistA, such requests represent 4.25% of placed consults.

Note that equivalent services are filled by this VistA. Those are detailed in the Filler Section below.

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By Facility …

# Facility Consults Services
1 SEATTLE VA MEDICAL CENTER [663] 42 (66.67%) LODGING IFC (SEA) [31], DOMICILIARY ADMISSION REFERRAL IFC (PUGET SOUND) [6], VIRS COORDINATOR IFC (PUGET SOUND) [5]
2 PORTLAND VA MEDICAL CENTER [648] 6 (9.52%) LODGING IFC PORTLAND [4], DOMICILIARY ADMISSION REFERRAL IFC (PORTLAND) [2]
3 WHITE CITY VA MEDICAL CENTER [692] 5 (7.94%) DOMICILIARY ADMISSION REFERRAL IFC (WHITE CITY)
4 ROSEBURG VA MEDICAL CENTER [653] 4 (6.35%) DOMICILIARY ADMISSION REFERRAL IFC (ROSEBURG)
5 BOISE VA MEDICAL CENTER [531] 3 (4.76%) DOMICILIARY ADMISSION REFERRAL IFC (BOISE) [2], VIRS COORDINATOR IFC (BOISE) [1]
6 JONATHAN M. WAINWRIGHT VAMC [687] 3 (4.76%) DOMICILIARY ADMISSION REFERRAL IFC (WALLA WALLA)

The balance, 74, of the Placer Services to 7 facilities, are mainly for specialized clinical services and represent 41.6% of placed consults. Once again, the vast majority go to other facilities in the same VISN but the flow is mainly from smaller facilities to larger with the small placing with the large.

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By Facility …

# Facility Consults Services
1 SEATTLE VA MEDICAL CENTER [663] 344 (55.75%) PAIN IFC E-CONSULT (SEA) [67], ENDOCRINOLOGYIFC E-CONSULT (SEA) [27], HEMATOLOGY IFC E-CONSULT (SEA) [27], CARDIOLOGY IFC E-CONSULT (SEA) [16], NEUROLOGY IFC E-CONSULT (SEA) [14], UROLOGY IFC E-CONSULT (SEA) [13], INFECTIOUS DISEASE IFC E-CONSULT (SEA) [13], ONCOLOGY IFC E-CONSULT (SEA) [12], VASCULAR SURGERY IFC E-CONSULT (SEA) [11], RHEUMATOLOGY IFC E-CONSULT (SEA) [11], OPHTHALMOLOGY IFC (SEA) [10], VISN 20 TELEPAIN IFC (PUGET SOUND) [10], MENTAL HEALTH IFC E-CONSULT (SEA) [9], PAIN IFC (SEA) [8], ANC TELEDERMATOLOGY PATHOLOGY IFC [7], NEUROSURGERY IFC E-CONSULT (SEA) [7], OTOLARYNGOLOGY IFC (SEA) [6], NEUROLOGY IFC (SEA) [6], GASTROENTEROLOGY IFC E-CONSULT (SEA) [6], RENAL IFC E-CONSULT (SEA) [6], CARDIOLOGY IFC (SEA) [4], OTOLARYNGOLOGY IFC E-CONSULT (SEA) [4], RHEUMATOLOGY IFC (SEA) [4], ORTHOPEDICS IFC (SEA) [3], GENERAL SURGERY IFC E-CONSULT (SEA) [3], REGIONAL AMPUTEE CENTER IFC (SEA) [3], REHAB IFC E-CONSULT (SEA) [3], ALLERGY E-CONSULT IFC (SEA) [3], ORTHOPEDICS IFC NON-VISIT (SEA) [3], SPINAL CORD INJURY IFC (SEA) [2], DERMATOLOGY IFC E-CONSULT (SEA) [2], MENTAL HEALTH ECT IFC (SEA) [2], GENERAL SURGERY IFC (SEA) [2], HEMATOLOGY IFC (SEA) [2], PLASTIC SURGERY IFC E-CONSULT (SEA) [2], SPINAL CORD INJURY TELEHEALTH IFC (SEA) [1], RENAL IFC (SEA) [1], PODIATRY IFC (SEA) [1], CARDIAC SURGERY IFC E-CONSULT (SEA) [1], DERMATOLOGY IFC (SEA) [1], UROLOGY IFC (SEA) [1], PULMONARY IFC E-CONSULT (SEA) [1], TBI IFC E-CONSULT (SEA) [1], DIABETES IFC E-CONSULT (SEA) [1], NEUROSURGERY IFC (SEA) [1], GYNECOLOGY IFC (SEA) [1], DENTAL IFC (SEA) [1], REHAB IFC (SEA) [1], OPIOID SAFETY REVIEW BOARD IFC (SEA) [1], SPINAL CORD INJURY IFC E-CONSULT (SEA) [1], GYNECOLOGY IFC E-CONSULT (SEA) [1]
2 PORTLAND VA MEDICAL CENTER [648] 206 (33.39%) WESTERN TELEMENTAL HEALTH NETWORK IFC [109], ENDOCRINOLOGY IFC E-CONSULT (POR) [54], LIVER CLINIC IFC E-CONSULT (POR) [25], INFECTIOUS DISEASE IFC E-CONSULT (POR) [4], PULMONARY-E-CONSULT IFC (PORTLAND) [4], RHEUMATOLOGY IFC (POR) [3], TELE-EYE IMAGING IFC (PORTLAND FROM JUNEAU) [1], NEUROLOGY - MULTIPLE SCLEROSIS IFC E-CONSULT (POR) [1], NEUROLOGY IFC E-CONSULT (POR) [1], CARDIOLOGY IFC E-CONSULT (PORTLAND) [1], CIPC PAIN IFC (PORTLAND) [1], VASCULAR SURGERY IFC E-CONSULT (POR) [1], RHEUMATOLOGY IFC E-CONSULT (POR) [1]
3 GEORGE E. WAHLEN VAMC [660] 32 (5.19%) TH GENETICS IFC (SALT LAKE)
4 BOISE VA MEDICAL CENTER [531] 24 (3.89%) TELEHEALTH ADMINISTRATIVE REQUEST IFC (BOI) [13], PHARMACY TELEHEALTH IFC (BOI) [9], NEUROPSYCH TELEHEALTH IFC (BOI) [2]
5 PALO ALTO VA MEDICAL CENTER [640] 7 (1.13%) NEUROLOGY CLINIC IFC (PALO ALTO) [3], WAR RELATED ILLNESS AND INJURY STUDY CENTER IFC (PALO ALT0) [3], PTSD RESIDENTIAL REHAB PROGRAM/TRAUMA RECOVERY PROGRAM (PA) IFC [1]
6 SOUTHERN ARIZONA VA HCS [678] 2 (0.32%) TRANSGENDER IFC E-CONSULT (SOUTHERN ARIZONA VA HCS)
7 C.W. BILL YOUNG DEPT OF VAMC [516] 2 (0.32%) MST RESIDENTIAL PROGRAM IFC (BAY PINES) [1], PTSD RESIDENTIAL ADMISSIONS IFC (BAY PINES) [1]

Filler

There are 2 Filler Services - services that accept/fill consults from other facilities. In VistA, a single Filler Service may be employed by more than one remote facility and may also be used for purely local consults. In this VistA, 8.0% of the IFC consults are “filled”, mostly from VistAs in the same VISN …

# Filler Service From Facilities # Status’
1 VIRS COORDINATOR IFC ANCHORAGE SEATTLE VA MEDICAL CENTER [97], PORTLAND VA MEDICAL CENTER [21], WHITE CITY VA MEDICAL CENTER [1] 119 (92.25%) COMPLETE [107], CANCELLED [6], DISCONTINUED [5], ACTIVE [1]
2 DISCHARGE FOLLOW-UP IFC (ANCHORAGE) SEATTLE VA MEDICAL CENTER [3], PORTLAND VA MEDICAL CENTER [7] 10 (7.75%) COMPLETE [9], ACTIVE [1]