In a previous diary which certainly engendered some serious discussion and for reasons unknown to rational man seemed to drive User Ticket Punch to madness, but at any rate, I discussed how the VA became the Best Medical System in the US
and how the lessons learned by VA would pay off for regular americans.
And for Bonus Points:
When a Republican says "Who could be interested in VA after Walter Reed" they are FOS because?
- VA saves 20% over the national average because VA is able to invest into it's patient pool
- VA has the Information tools to extract information on treatment, outcome, drug interactions and
continuity of care, because all doctors and clinics use a commone Patient Electronic Medical Record
(EMR) called Vista.
- VA has automated Prescription dispensing so there is no human error.
- When a Mistake is made the VA has the doctor Apologize.
he centerpiece of that culture is VistA, the VA's much praised electronic medical-records system. Every office visit, prescription, and medical procedure is recorded in its database, allowing doctors and nurses to update themselves on a patient's status with just a few keystrokes. In 1995, patient records at VA hospitals were available at the time of a clinical encounter only 60% of the time. Today they are 100% available. Some 96% of all prescriptions and medical orders, such as lab tests, are now entered electronically. The national comparison is more like 8%. "One out of five tests in a civilian hospital have to be repeated because the paper results are lost," says Veterans Affairs Secretary R. James Nicholson. "That's not happening in our hospitals." VistA is a big reason why the VA has held its costs per patient steady over the past 10 years despite double-digit inflation in health-care prices.
VistA has also turned out be a powerful force for quality control. The VA uses the data gathered in its computers to pinpoint problem areas, such as medication errors. The network also allows it to track how closely the medical staff is following evidence-based treatment and monitor deficiencies. Such tracking pays off. When Rand did an extensive study comparing quality of care at the VA with private-sector hospitals, it found that performance measurement played an important role in helping the VA score higher in every category except acute care, where it came in about even
At the hospital pharmacy, prescriptions are doled out by robotic devices -- one reason the organization is able to hold co-pays at $8. Each bottle of medicine carries a bar code that is scanned by the computer. If a patient is allergic or takes a conflicting drug, the system will sound an alarm. Similar bar codes are affixed to patient ID bracelets to protect against the wrong patient getting a procedure, a common mixup in hospitals. The bar code idea was thought up by a VA nurse in Topeka, Kan., who noticed that rental cars were checked in with portable bar code scanners and figured the same technology could be used in hospitals.
Right Now, The HHS could pay to provide VISTA to every clinic and Hospital and doctor taking Medicare
and require that all Medicare and Medicaid patient be coded through VISTA.
this would improve quality, save money and create a national standard for records.
Then the US could pay for all pharmacies accepting Medicare Part D and Medicaid to put in
Robotic dispensers hooked to VISTA.
Then let medicare negotiate prices for drugs.
now this will probably annoy Ticket Punch but there was a great comment from alhoo
Well, it isn't the perfect system but (3+ / 0-)
It is getting better and it is certainly better than many civilian hospitals.
Disclaimer: I am a vet who uses the system as well as a health care provider who works at a VA hospital. My comments are only from my point of view from my little corner of the world/system and not to be considered an official VA statement etc.
The big advantage of the VA as a large system (the military is trying to get there but not everyone is on the same sheet of music yet) with a great (one of the best I have worked with) electronic medical record is the cost savings in terms of repeat labs and ability to look up previous records. You can look up an x-ray taken anywhere in the country (at other VA's, obviously) and also read other nursing, pharmacy, physician notes. In the past, the patient would show up in the clinic with a large thick chart (maybe Volume 6 or 8 or who knows how many) and I guarantee that most folks would maybe thumb through it at best or ignore it. That means each visit you had to figure out what the patient was there for and almost start from scratch. Now, I at least, will actually look through past notes to see what other providers are doing/thinking and can tailor my visit to the problem at hand. Everything (almost) is there in the EMR. The only time really spent calling other places is to occasionally get a test result from an outside hospital faxed to us (then it gets scanned and it in the record.)
What are the complaits about the VA...
Access - yes it has been tough in the past for the average veteran to get into the system - there just weren't enough primary care providers/clinics to accomadate every vet. So there is a priority system - financial as well as service (ie Purple Heart vets are higher than just non Purple Hearts, no money higher than have money or insurance vets etc) That is improving with funding and time but not everyone can get in even now. Good news now is that if you are an OIF/OEF veteran, you get in regardless of financial ability for 5 years of free medical care (no co-pays). Once you are in the system you are in and the care is good. The problem was getting into the system.
Care - I agree that the prior reputation of the VA was very poor care. I think that the diarist has done a nice job outlining the changes and I would argue that the care provided at the VA on the whole is as good as you can get outside. Are there certain facilities and hopsitals that are subpar? Sure, but that is the advantage of the large database - we can see where they are and work on fixing it.
The VA is considered underserved population so for a foreign doctor is is one of those jobs that gets a Green Card so there are a fair number of foreign doctors serving in the VA. Many times, people perceive that as substandard but they are trained and licensed in the United States so I would hope that arguement is nullified, but the perception is there, I guess.
Distance - this is the real downside in my mind of the VA. In order to keep costs down and keep fols in the system, the VA makes a vet travel to get his or her care. Sometimes that can mean a 3 hour trip (or more) for a single appointment. Now they do reimburse mileage, but that single 15 minuite appointment might cost a whole day of time. You can't get care in your hometown. Now for some folks, that is the same as if they were in the private system - the service they need just isn't there. But for others, it can be tough. If you live in Charlottesville next door to a major medical center you have to drive 1.5 hours to Richmond to get surgery at the VA there. The VA is trying, opening up primary care clinics closer to home, but they can't have full medical centers in every town.
waiting time - yep, can be an issue. Things just don't move at the speed of light when the services are limited (in number, not scope) The VA does send folks out into the community, but they try not to in order to save money, so sometimes a vet has to wait longer then they should for some services.
Most complaints seme to me to be about access and waiting time, not actual care. Not to say that care is perfect, but there is no place in the country that provides perfect care without mistakes or missed diagnoses.
Well, that is enough for me now. I do think care at the VA stacks up with care received at most private hospitals but there are other issues that make it not the sole answer to the nation's health care debate. I mean, the VA is basically the system that they have in England and unless the gov't was going to run every hospital and clinic in the US, then we won't get to a VA system in the United States. Do not equate "single payer" with the VA. We used to have a more robust Public Health Service (with hospitals) that would/could be similarly run to the VA and may be part of the answer to covering the uninsured, but I don't think it is the final be all end all answer to our problems.
EMR stands for the generic term "Electronic Medical Record." Many hospitals and clincs are trying to go to these and certainly that is a big push for the Obama administration to reduce health care costs and improve care given.
VISTA is the VA's version of the EMR. It is windows based, fairly user friendly and allows the user the ability to pull up labs, xrays (both results and the actual digital images) and previous outpatient, inpatient notes, discharge summaries, operative notes, medications, vital signs etc. Obviously, as with all EMR's you only get out what is inputted in (garbage in = garbage out) but it is very extensive. Older records are in the system, but not all of them (originally due to storage bytes, I think, but also due to the millions of manhours that would be required to scan all that stuff). The system also has an internet based component that allows you to pull up all the records noted above from all other VA facilities. That can take a while in the case of some x-rays (for example) but not unusable.
The nice thing about it is that they built it on previous systems and continue to add to it. Some places I have been (the Army, my residency) also have EMRs but rather than build on the older system they keep getting new systems. For example, my last duty station I had to use one system for outpatient notes, a separate one for inpatient notes, a third one to pull up x-rays, a fourth one to schedule surgeries. They sort of partially talked to each other but not really so complete data was not readily available. You had to check all the systems to make sure you had all the data – obviously not efficient.
I, at one time, heard that since the software was developed at gov’t expense that anyone could buy it essentially for the cost of the hardware needed to set it up (in other words, the software was essentially free). I will not swear that is or was true but if it is, I wish everyone would buy it.
Finally, one major concern about EMR is the safety of personal data. The VA is especially tight since they lost that laptop a few years ago but it is a major concern for all health care providers who are bound by HIPAA laws to protect patient data. Especially for famous folks. Obviously, paper records can be stolen, but EMR can be hacked or accessed by folks who shouldn’t be looking at the record (a little harder in the case of a paper record). This is a problem, not just for EMR but for everything we do these days on the internet.
I'd like to second Alhoo's comments. VA isn't perfect, i'm sure 10 % of the patients feel screwed
or get screwed, but for the Median patient, VA provides Excellent service.