Thursday, May 22, 2014

A very short observation on EHRs and the Veterans Administration healthcare scandal

As has been in the news lately, it has been revealed that U.S. veterans' medical care was being delayed at a number of Veteran's Administration-run hospitals, perhaps many others as well not yet known.

A timeline for the Veterans Administration medical scandal is here:  http://www.usatoday.com/story/news/politics/2014/05/21/veterans-healthcare-scandal-shinseki-timeline/9373227/

The Obama administration is facing a serious scandal in which government officials are alleged to have falsified data to hide how long veterans were waiting to see doctors at VA hospitals. The controversy has led to calls for the resignation of Veterans Affairs Secretary Eric Shinseki, who has served for five years. Here is a timeline of events leading up to the current situation, which President Obama on Wednesday called "intolerable" and "disgraceful."

I will not comment on the issues per se.

I will only make this pithy observation:

The VA system possesses the best electronic medical records systems in the world, VistA CPRS, and is unhampered by EHR sellers' issues and agendas as the VA created it themselves over decades.  You can even download VistA CPRS and explore it with fictitious patients and medical data from test servers set up for that purpose, at http://www.ehealth.va.gov/EHEALTH/CPRS_demo.asp.

EHR's and other clinical IT, according to not-very-impartial organizations such as the industry trade group HIMSS, the sellers themselves, and a whole cadre of pundits highly invested in the technology and its implementation, are purportedly going to "revolutionize" medicine (rather than the somewhat less grandiose purpose of merely facilitating clinicians in providing better care).

The "revolution" includes reducing the need for human resources, increasing efficiency, saving gobs of money, and according to one billionaire, allowing a small group of doctors to remotely manage the care for an entire city's patients.  (See my Jan. 20, 2014 post "Computers + a few docs can manage 'an entire city', and other cybernetic miracles" at http://hcrenewal.blogspot.com/2014/01/computers-few-docs-can-manage-entire.html; I am not making that up.)

Yet here we have the VA, highly computerized - but instead of being the medical utopia promised by the information technology hyperenthusiasts, the VA is unable to even guarantee patients a two-week waiting period for care, with delays leading to possible patient injuries and deaths.

Thus, to those who promote the meme that spending hundreds of billions of dollars on this technology will 'revolutionize' medicine, increase "efficiency", reduce errors, reduce costs etc. and realize all the other fantastical claims made for the technology, I say, "sure, and I have a bridge for sale in Brooklyn."



This bridge at 40.7057° N, 73.9964° W is for sale to the highest-bidding hospital.  Its purchase, plus a few hundreds of millions of dollars of IT thrown into the bargain, will revolutionize healthcare at the lucky hospital with the winning bid.
 
-- SS

4 comments:

Anonymous said...

Indeed, the EHR VISTA of the VA did not function as the dreamers fantasized.

Worse, the efficiency of the doctors was likely reduced by one third, or more, by these devices.

Been there and done that with counterintuitive poorly usable EHRs.

gagz said...

great article as always dr(s),

but we need to work on making more catchy titles, the ones you guys have are too long (informative, albeit).

otherwise, GREAT JOB.

DocEpador said...

I have used many EMR, including VA system, multiple military systems, Practice Partner, EPIC, athenahealth, and more. The VA system is one of the worst. If your premise is that it is the best and since it doesn't work, none can, then your thesis fails from the get go.

Barbara Gartner said...

THE MONEY ALWAYS STARTS AT THE TOP AND RUNS DOWNHILLTO PUT IT SIMPLE IT'S THE ADMINISTATORS AND THE HIGHER UP DOCTORS WHO HAVE ROBBED THE VETERANS AND TAXPAYERS OF THEIR MONIES INTENDED FOR THE VETERANS! i KNOW FIRST HAND EVEN AFTER ALL I'VE BEEN THROUGH AT LOMA LINDA VA THE VA OR ANYONE ELSE CARES WHAT BONUSES WERE PAID THE YERAS OF MY BODIES DESTRUCTION FROM THE MEDICAL MALPRACTICE I RECIEVED!