Military Setting the Bar for EMRs: Part I of II

The origins of the VA’s EMR system (VistA) emerged back in the late 1970s, when a group of physicians began writing its original code.

For years now, the Department of Veterans Affairs (VA), operating the largest integrated healthcare system in the US, has been the frontrunner in developing and using EMRs, setting the example for the rest for the US healthcare system. The “VA is a national leader in the development and use of computerized patient records,” said former — Secretary of Veterans Affairs Anthony J. Principi in 2003. “I am proud that the health information technology and standards developed by the VA to improve health care for veterans will benefit all Americans, from newborn babies to senior citizens.”

The origins of the VA’s EMR system (VistA) emerged back in the late 1970s, when a group of physicians—that’s right, physicians, not computer geeks who know little-to-nothing about medicine—began writing its original code. They came up with nearly 18,000 programs that became integrated into the VistA system. Thanks to their efforts, VA physicians have “long had ‘buy in’ to digitalized medicine that is still largely lacking in the rest of the health care system,” according to CBS reporter Phillip Longman, who added that, “while there is no one definition of ‘open source,’ the VA's VistA system is essentially that. From this come 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.”

The VistA system allows providers at more than 1,400 medical centers, clinics, nursing homes, and other sites of care to have 24/7 access to the electronic records of more than 1 million patients, 100% of the time. With the old paper system, these records were only available 60% of the time. Wouldn’t it be nice to be connected with 1,400 other offices, clinics, and hospitals, allowing you immediate access to new patients’ records or the updated records of patients who’ve been in and out of the hospital (where that same record was updated), or providing other healthcare professionals access to your patients’ records when they end up in the hospital or are moved to a nursing home? Maybe it’s shooting for the stars, but couldn’t VistA be used as a model for a nationwide EMR system? Let’s take a further look at what it’s accomplished—and e-mail me your thoughts on why my pie-in-the-sky viewpoint would or wouldn’t work.

VistA Successes

“Today VA is on the razor’s edge of health care efficiency and quality, delivering its services with commitment, competence and compassion,” said Secretary of Veterans Affairs Jim Nicholson. “What cured us? Well, it was a large and concentrated dose of technology.” A big part of that dose of technology is VistA. More than 7.6 million patients are enrolled, improving quality of care, saving lives, and conserving healthcare dollars. He added that VistA and other VA computerized systems have allowed the VA to nearly eliminate prescription errors—one in five of which in the typical “private-sector” hospital and skilled nursing home settings is given in error—and the need for duplicate lab tests—17-49% of which in the private sector are needlessly performed due to missing paperwork, according to Nicholson.

Hmm…no prescription errors, no duplicate late tests; sounds pretty good, huh? Can you site such stats to your patients?

But wait, there’s more. VistA isn’t the only electronic medical record system being utilized by the military, nor is it the only one that will certainly be well-noticed, if not copied completely or partially, by the private sector—that’s you and your colleagues, and the vendors who create your EMR systems.

More on that in Part 2 of this article, coming your way on June 18. Stay tuned...

In related news today, the Department of Defense announced that all 9.2 million members of the Military Health System will be equipped with a PHR as early as next year.