Electronic Records At The VA

ELECTRONIC RECORDS AT THE VA....What's the big deal about the VA's electronic medical record system? Almost uniquely, its original code was written by doctors for doctors, as part of an ad hoc, collaborative process. The story, which I chronicle in my book, Best Care Anywhere, is wonderful. It's one of an underground subculture of geeky doctors and other health care professionals, known as the Hard Hats, that emerged within the VA beginning the late 1970s. Hacking clandestinely on Tandy PCs and DEC mini-computers, they wrote some 18,000 different programs that eventually were integrated to become the VA's world class VistA system.

Because of this history, VA doctors have long had "buy in" to digitalized medicine that is still largely lacking in the rest of the health care system. And while there is no one definition of "open source," the VA's VistA system is essentially that. From this comes all sorts of advantages over proprietary software programs, including free distribution with no licensing fees, rapid detection and elimination of bugs, and the ability of end users to improve the code and adapt it to their own medical practices.

Finally, there's the huge networking effects that are unique to VistA. So your doctor carries a laptop around? Big deal. Electronic medical records have some value over paper files, but not much, if they cannot be widely shared among the many different specialists, labs, pharmacies and other players typically involved in a patient's care, either at one time or over an extended period. Also, the data contained in electronic medical records about which treatments work best is of little use to researchers if they can't aggregate that data across large populations. The potential for electronic medical records to drive the development of safer, more effective "evidence based" medicine is huge, but only if those records are part of a very large, integrated system like the VA's. It took me a long time to get my head around these realities, but once I did it was easy to see what a big deal the VistA system is.