Graham Nixon arrived on US shores 30 years ago from Britain as a newly minted RN. Now, Nixon is a clinical informatics specialist, playing an instrumental role in the development and implementation of virtual lifetime electronic records.
From Nursing to Computers
Nixon’s nursing career began at VA Palo Alto Health Care System in the mental health field. He became interested in computers and business, and left VA in 1985 to pursue an MBA and to teach himself about computers. He worked in HMO’s after earning his MBA as a medical economics analyst.
During this time, Nixon developed an interest in quality management, specifically in the philosophy of W Edwards Deming, who revolutionized the Japanese car industry in the 1950s. He wanted to implement Deming’s philosophy, which focused on quality over costs, in healthcare. VA began hiring people to work in quality management in 1994, presenting Nixon with his opportunity to put Deming’s ideas into practice.
Nixon rejoined VA, working in quality management at the San Francisco VA Medical Center. He found that creating a Deming-based environment in VA’s top-down bureaucratic organization was frustrating.
Discouraged, Nixon became a data analyst and programmer. His programs, still in use today, include one that reported bed situation and patient flow, and one that produces reports on patient incidents. In 1999, he began work on a Masters degree in medical informatics from the University of California, Davis. With his new degree, he applied for and was granted the position of associate chief of information technology at the VA San Diego Medical Center in 2003.
Creating a Virtual Lifetime Electronic Record
In San Diego, Nixon helped form a team of developers working on software to improve the patient care environment. Nixon moved out of IT when VA centralized all of its IT offices establishing a San Diego VAMC office of clinical informatics, which reports to VHA.
The office is responsible for a number of local applications, including scheduling programs and a peer review database, as well as a patient event reporting system based on the one Nixon designed while at San Francisco. His team rewrote that system, and it is being rolled out nationally.
In 2009, San Diego became the site of a pilot program under VA’s National Health Information Network (NHIN), designed to share electronic health records between the VA and Kaiser Permanente in real-time, as part of an effort to create a virtual lifetime electronic record (VLER).
Nixon’s office deployed the software, which was developed at the national level, to local sites. He was personally responsible for overseeing all of the details that make implementation successful, from both the VA and Kaiser Permanente side. Every day brought new challenges, from defining a shared patient population to deciding who would pay postage on all the letters recruiting patients.
In September 2009, the system was tested and it went live that November with a pilot population of some 1,000 patients. Two months later, DoD joined the initiative and identified 4,000 common patients to add to the mix. Since then, NHIN communities have launched in Utah, Virginia, Spokane, and Indianapolis. Each of those programs includes a community coordinator to help shepherd the process along—a role that originated with Nixon.
Now, Nixon is looking to help expand the sharing community to include the entire city of San Diego. The University of California San Diego Health System has received a $15 million federal Beacon grant aimed at improving patient care city-wide, one component of which is to expand the VLER program to all providers in San Diego within the next three years.
“The goal is that from the moment that young lady or young man walks into a recruiting office to the day that they die, their healthcare record is available to a clinician at any given time,” Nixon said. “And that’s a very exciting proposition.”
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