Electronic Records

Phillip Longman sings the praises of electronic record keeping at VA hospitals. Tyler Cowen, meanwhile, praises Shannon Brownlee's new book on the grounds that:

The (favorable) discussion of VHA is more insightful and more subtle than the usual treatments. For instance we learn that the much-heralded computerization of VA records was created in direct violation of government law.

Ah, the dread "government law."

Comments

"government law"

As distinguished from natural law? Physical law? Mother-in-law?

Posted by Joel | September 16, 2007 1:10 PM

Of course the DoD uses a very similar system without the same level of success. Of course the DoD system is maintained by the same contractor. But the DoD system is nore complicanted, includes many specialties that are not offered by VA facilites, and include the entire family instead of just individuals.

Maybe the authors of the book on th eVA should take a look at the hodge podge of DoD systems that no not really work.

Posted by superdestroyer | September 16, 2007 1:27 PM

superdestroyer,

Interesting point about the DoD system (Tricare). You're correct it does cover specialties, such as pediatrics, not covered by the VA.

However, from what I remember, Tricare is a single payer system and not single provider. That is, its more like Medicare than the VA-- the doctors are independent and not government employees.

Posted by beowulf | September 16, 2007 1:55 PM

Beowulf,

I was actually writing about the electronic record keeping system that the DoD uses in its own facilities. Remember, the DoD has its own clinics and then uses Tricare in addition. Tricare is not single payer. It is more like a PPO or HMO.

However, the EMR at DoD has a long history of problems. It has several indepdent systems. It is much more complex that the medical record system used by the VA. On top of the that, the DoD computer system do not intergrate inventory control or billing into their system versus a private hospital.

An anecdotal story about the problems with the DoD system. When a physician orders a lab test that is not done at the facility, the DoD system required the request to be printed out, the lab people fill out forms by hand and mail the sample off. When the result comes back, the lab people have to key the results back in so that the care provider can see the results. I would guess that the VA system works the same way.

A private hospital EMR is much more complex that than the VA system that everyone keeps harping about.

Posted by superdestroyer | September 16, 2007 2:07 PM

Going to electronic records - misguided laws written generations ago or more modern HIPAA that might possibly have been breeched in the letter but not the spirit - did dramatically elevate care, lower costs, and lower the error rate of patients being accidentally killed to levels that the French and German systems that use modern IT have accomplished.
It is no longer the age of horse and buggies and the country doctor that has all the papers and records for patients they know. Now the person's medical history can be silo'd in many specialists offices, separate hospitals, different cities and MD's clueless of medical history and test results in the past.

Newt Gingrich and Hillary both want the US to come into the 20th Century from the 19th as far as medical record keeping and access goes - and match the progress, quality, and productivity gains Europe and Asia (and the VA) have realized from going to computerized, low-paper reliant systems.

Any laws in the way should be scrapped if possible, and ignored if the law kills people as new lifesaving systems come into existence, andit can be shown that enormous medical gains can be realized with a new modern IT. Eventually, we need a 21st Century national medical law that supercedes all current State and Fed law - but getting ourselves to a higher quality care system will require the freedom to experiment and see what parts of other nation's heathcare IT or our own new systems - work.

Posted by Chris Ford | September 16, 2007 8:06 PM