Military Environmental Exposure Non-Registry Template
Last updated
Share PrintThe Promise to Address Comprehensive Toxins (PACT) Act requires all enrolled Veterans to complete a Toxic Exposure Screening (TES). Almost 30% of screened Veterans request a referral to Environmental Health for a toxic exposure assessment and approximately 1 out of 4 endorse a non-registry toxic exposure and do not meet eligibility criteria for a formal registry. While Environmental Health staff have a standard template to capture toxic exposure assessments for the Airborne Hazard and Open Burn Pit registry, there was no standardized method to capture non-registry toxic exposure referrals such as Camp Lejeune, asbestos, lead, and all other in-garrison exposures. Establishing a non-registry template provides a standardized tool to address the many different types of military-related non-registry exposures that millions of Veterans have experienced.
Origin:
March 2023, Dayton VA Medical Center
Adoptions:
4 successful
Partners:
Academic Affiliations
Recent Updates
Overview
The problem
Almost 25% of Veterans completing a Toxic Exposure Screening (TES) endorsed exposure to toxins during military service (such as Camp Lejeune contaminated water, asbestos, "other", etc.) but did not qualify for formal documentation within a VA Registry. National TES data shows that of the 4 million Veterans that have been screened, 43% report a toxic exposur
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Almost 25% of Veterans completing a Toxic Exposure Screening (TES) endorsed exposure to toxins during military service (such as Camp Lejeune contaminated water, asbestos, "other", etc.) but did not qualify for formal documentation within a VA Registry. National TES data shows that of the 4 million Veterans that have been screened, 43% report a toxic exposure - of those, 7%, or 166,381, endorse Camp Lejeune contaminated water exposure, and 15%, or 354,594, endorse "other" exposure for which there is no VA Registry.
A standard process was needed to address the thousands of new consults entered nation to address those non-registry toxic exposures.
The goal of establishing a Military Environmental Exposure Non-Registry template is to provide a standard evaluation tool to document and address the many different types of military-related toxic exposures (and concerns) that don’t qualify for a VA Registry. See more
A standard process was needed to address the thousands of new consults entered nation to address those non-registry toxic exposures.
The goal of establishing a Military Environmental Exposure Non-Registry template is to provide a standard evaluation tool to document and address the many different types of military-related toxic exposures (and concerns) that don’t qualify for a VA Registry. See more
Images
Above:
Endorsed Exposures from National Toxic Exposure Screening Report
The solution
VISN 10 established a standard process to document, track, and address all non–registry toxic exposure assessments by developing a CPRS progress note template and standardized clinic coding. This effort originated in Dayton and was developed, approved, and implemented at 10 VAMCs within VISN 10 (excluding 1 VAMC using Cerner) and allows facilities to consist
...
VISN 10 established a standard process to document, track, and address all non–registry toxic exposure assessments by developing a CPRS progress note template and standardized clinic coding. This effort originated in Dayton and was developed, approved, and implemented at 10 VAMCs within VISN 10 (excluding 1 VAMC using Cerner) and allows facilities to consistently capture all non-registry toxic exposure assessments for Veterans that do not meet eligibility criteria for a formal Registry.
See
more
Files
- CPT Coding for Registry vs Non-Registry Assessments Registry vs Non-Registry Exams
- Toxic Exposure Non-Registry TEMPLATE Toxic Exposure Non-Registry TEMPLATE
- Non-Registry Toxic Exposure Assessment Clinic Coding Guidance Non-Registry Toxic Exposure Assessment Clinic Coding
The results
Implementing the new Non-registry template allowed clinicians to document and address Veterans exposure concerns for those that did not qualify for formal, standardized documentation within a VA Registry. Clinicians were able to also document a toxic exposure assessment and education provided to the Veteran. These non-registry templates increased productiv
...
Implementing the new Non-registry template allowed clinicians to document and address Veterans exposure concerns for those that did not qualify for formal, standardized documentation within a VA Registry. Clinicians were able to also document a toxic exposure assessment and education provided to the Veteran. These non-registry templates increased productivity and telehealth utilization since the assessments were completed in 20-30 minutes (each) via phone and video modalities; while VA Registry assessments typically require 60-90 minutes. Providing this service also improved Veterans experiences and met the full intent of the “Promise to Address Comprehensive Toxins (PACT) Act”.
See
more
Images
Above:
Completed Non-Registry Toxic Exposure Assessments, March - August 2023
Metrics
- The Non-Registry toxic exposure template has been actively utilized in 4 stations across VISN10 for the past 6 months. From March to August, the 4 facilities completed 1,470 non-registry toxic exposure assessments and documented Veterans concerns. Without this template, those 1,470 Veterans would not have had an assessment and had their concerns captured in a manner that may also be used by other stakeholders as VACO, WRIISC, and DoD. Veterans were able to be educated on their exposures, thus improving the Veteran experience while supporting VA’s core “I CARE” values.
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
-
1-2 weeks
Installation of template/note by local Clinical Application Coordinator (CAC) -
1-2 weeks
Set up of non-registry clinic profile/grids -
2-4 weeks
Environmental Health clinician/coordinator training
Departments
- Administration
- Telehealth
- Patient services
- Information management
- Primary care
- Registry exams
Core Resources
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PROCESSES |
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Support Resources
| Resource type | Resource description |
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PEOPLE |
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PROCESSES |
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Risks and mitigations
| Risk | Mitigation |
|---|---|
| Not enough local resources available (environmental health clinicians) to address toxic exposure concerns/assessments | Cross training clinicians, utilizing CRH, hiring additional Environmental Health/toxic exposure staff, OT clinics, |
Contact
Comment
Comments and replies are disabled for retired innovations and non-VA users.
Email Marc.Rohner@va.gov with questions about this innovation.
About
Origin story
The PACT Act was approved in August 2022, part of which required that all enrolled Veterans receive a Toxic Exposure Screening (TES) and be referred to other local resources for any toxic exposure questions and concerns. These referrals results in a surge in demand for Environmental Health services across the country, and VA facilities across the country be
...
The PACT Act was approved in August 2022, part of which required that all enrolled Veterans receive a Toxic Exposure Screening (TES) and be referred to other local resources for any toxic exposure questions and concerns. These referrals results in a surge in demand for Environmental Health services across the country, and VA facilities across the country became inundated with Registry and “non-registry’ military toxic exposure concerns. These “non-registry” referrals were the exposure concerns that did not meet the eligibility criteria for a formal VA mandated registry program (such as Agent Orange registry Airborne Hazards/Open Burn Pit Registry), but were still part of the PACT Act Law. The largest example of the non–registry referrals is Camp Lejeune contaminated water exposure concerns. We realized we had to develop a way to efficiently evaluate and address this type of “non–registry” referral. We developed a CPRS template tailored to evaluate these non–registry toxic exposure referrals, which standardizes the non-registry evaluation. This template, along with clinic coding guidelines, were approved by our VISN leadership, and the template installed at our 10 VAMCs across the VISN; the 11th VAMC is using Cerner.
Original team
Marc Rohner
Supervisory Program Specialist (IDES Manager)
Forrest Fornash
Physician Assistant/ Dayton VA Lead Environmental Health Clinician
Lana Davila
Program Management Officer, VISN10/CRH
Hello - I am currently leading an evaluation of the impact of legislation related to toxins and how it affects Veterans seeking health care and disability. We are focused on two groups 1) camp Lejeune, and 2) PACT Act eligible Veterans. would be interested in learning more about what you are doing, where the data is going, etc. One of the biggest compliants I hear is that there is no registry for Camp Lejeune.