Quick, if your life depended on it, which health care information system would you rather your hospital used:
- A proprietary system developed by software engineers based on marketing input, bug reports and customer requests?
- An open source system developed by thousands of health care practitioners including doctors, nurses, pharmacists, techs and developers, tested and refined in hundred of hospitals?
A Vista that works. Known as VistA (Veterans health Information Systems and Technology Architecture), it consists of over 20,000 programs that share an Electronic Health Record (EHR). While it was initially developed at the Veterans Administration Hospitals - America's single largest health care system - the open source product is freely available.
What does the VA know? The government can't do anything right - except for the finest military in the world, the National Labs, the very popular Medicare program, DARPA, aviation safety, GPS, the original Internet and hundreds of other excellent agencies and programs - so how good can VA care be? Is "best" good enough?
According to a
Fox News BusinessWeek magazine article:
The 154 hospitals and 875 clinics run by the Veterans Affairs Dept. have been ranked best-in-class by a number of independent groups on a broad range of measures, from chronic care to heart disease treatment to percentage of members who receive flu shots. It offers all the same services, and sometimes more, than private sector providers.
According to a Rand Corp. study, the VA system provides two-thirds of the care recommended by such standards bodies as the Agency for Healthcare Research & Quality. Far from perfect, granted -- but the nation's private-sector hospitals provide only 50%.
And while studies show that 3% to 8% of the nation's prescriptions are filled erroneously, the VA's prescription accuracy rate is greater than 99.997%, a level most hospitals only dream about. That's largely because the VA has by far the most advanced computerized medical-records system in the U.S.
And for the past six years the VA has outranked private-sector hospitals on patient satisfaction in an annual consumer survey conducted by the National Quality Research Center at the University of Michigan. This keeps happening despite the fact that the VA spends an average of $5,000 per patient, vs. the national average of $6,300.
One more kicker: vets are older and sicker than the general population, making this performance even more impressive. It wasn't always so - my late father, a WWII vet and a doctor, wasn't impressed in the '80s - but during the Clinton administration the VA launched a successful effort to improve care using technology and common sense.
Spend less? Get more? No wonder health reform is controversial!
Errors can be hazardous to your health Almost 200,000 people a year die of preventable hospital mistakes according to a recent report. That's 4x the deaths of traffic accidents - too bad hospitals don't have seat belts.
We don't know the exact number because the American Medical Association and American Hospital Association spent $81 million lobbying against a national medical error reporting system. They said the system would drive medical errors underground: doctors "burying" their mistakes?
Shocking. I so-o-o trust the medical establishment.
The bigger picture With the complexity of diagnosis and treatment, the many drug interactions, and the scarcity of good information on what works and what doesn't, it is obvious that information technology can - and in the VA and some other countries has - lowered costs and improved care as the President says.
But in today's system, the insurance companies make more money when they don't pay for care. And it is the sickest among us who suffer the payment denials, since they need the most care.
Today insurance companies make their money cherry-picking the healthiest and denying the sickest. So centralized electronic health records are a weapon that can be turned against us at any time as proof of a "pre-existing condition" to deny reimbursement.
Requiring that insurance companies offer insurance to everyone who applies and eliminating the "pre-existing condition" excuse are crucial reforms. After all, "life" is a pre-existing condition that inevitably leads to death.
Given the results the VA has shown, a "public option" is a great way to push the insurance companies and for-profit hospital chains to improve care, reduce errors AND drive down costs.
The Storage Bits take In a field as complex and fast-changing as health care a proprietary system would be hard-pressed to keep up with the needs of thousands of hospitals. Open source won't be perfect either, but putting the resources close to the people using them just makes more sense.
We are rapidly approaching a day when there is enough storage capacity for each of us to store detailed health-related records. Not just doctor's visits, but exercise details, diet, drinking and more.
When all Americans have access to non-emergency health care and aren't penalized for pre-existing conditions that information will help all who care to live stronger, longer and healthier lives. At lower cost to society.
Comments welcome, of course. I wrote more about my father's WWII experiences here. And I look forward to the day when American doctors and nurses can go back to doing what they signed up for: taking care of people in need.