What works, he thinks is VistA, and the Veterans Administration system that computer code supports. In shining the light of his small newsletter on recent attempts to harm both, he has become a hero in some eyes.
Mine for starters.
In the January-February issue of VistA & Open Healthcare News (PDF), Maduro details an ongoing crisis at the agency and how the VA was moved to eventually buy proprietary software from Cerner to run its labs.
It started in 2005 with a huge budget increase, to $1.2 billion, aimed at centralizing the agency's IT operations. Maduro writes the Republican Congress pushed the reorganization through over the agency's opposition.
Maduro calls the VA the most cost-effective health care network in the country, based partly on the dedication of its staff and partly on VistA, a decentralized IT infrastructure whose software was made public domain.
Under orders from Congress what worked was ripped out in favor of a proprietary replacement, Maduro writes, by people with no VistA experience.
In his article Maduro quotes Scott Shreeve, who co-founded Medsphere based on VistA code, as saying VistA is being replaced by a "best of breed approach" favoring proprietary software companies.
I did some Web searches to find out why. The answer appears to be politics.
Rep. Stephen Buyer, who chaired the Veterans Affairs Committee when the reorganization was pushed through, counts many medical lobbies among his biggest contributors. He has called VA centralization a model for other agencies.
Some veterans' groups see a plan to completely privatize the VA, criticizing Democrats as well as Republicans.
I contacted Maduro about this story. He wrote that over the last few weeks the VA has begun circling the wagons:
Over the past couple of weeks the VA has issued orders that no one is to speak to the press. In addition, from this point on no one from the VA can give any presentation at any meeting of any kind without first clearing it through the office of communication. All presentation materials will also have to be vetted by said office.
Maduro admits he's a big backer of the VA. "The VA has been not only providing the best medical care in the country, it has been doing it for about 1/3 of the cost of Medicaid/Medicare."
As to how to fix the present problems, he writes, a Federated computing model, as proposed by Undersecretary Jonathan Perlin, can work.
"There would have been no crisis if Congress had allowed the VA to continue with their Federated Model plan, which they were carrying out."
Now, however, the VA's IT infrastructure is going down for hours at a time, and without any paper back-up care is hampered whenever that happens, Maduro says. (This actually happened at Atlanta last year, when I visited Tommy following a cancer operation.)
It may already be too late to turn back, Maduro concludes.
The problem I see is that the personnel re-organization has been so massive and so many good people have been purged, that I don't know if the VA has retained enough key personnel that understands how this all works to reverse course.