Blog: Dear Jon Stewart

Dear Jon Stewart,

I'm a huge fan of your “Daily Show,” but last week, with your segment, “The Red Tape Diaries,” you and your staff waded into the swamps of health information technology, made more dense and impenetrable by the Defense and Veterans Affairs bureaucracies.

By the sound of it, your hearts were in the right place, but you made a hash of a couple of things.

One topic covered by your segment was the alleged lack of interoperability between the VistA and AHLTA electronic health-record systems at the VA and DoD.

The other was the backlog of disability benefits claims at the VA, currently in excess of 900,000 claims and growing. A backlog, I might point out, that's exacerbated by the time it takes the Defense Department to round up and deliver to the VA all the medical records needed to document a service-related injury. It's a broken element that you didn't mention.

You cut away to a clip of a Veterans Affairs activist saying 97% of the VA's disability claims are still on paper, and then ask, “Why haven't they modernized the system?”

You'd think these things—EHR interoperability and the backlog—would be related, and they could be, someday. But right now, not so much.

So that's why, when you cut to a video of Valerie Melvin of the Government Accountability Office, testifying about a recent report on how the VA and DoD efforts “to achieve fully interoperable health record capabilities” between their EHRs, you goofed.

And then, when you said, “Those two programs … I swear to you this is true … those two (EHR) programs are unable to communicate with each other” — well, Jon, that's not true, and it hasn't been true for a long time.

Is there complete interoperability between the VA and the DoD's healthcare systems' EHRs? No, not yet. Is there significant interoperability? Oh, yeah. Martin's own report cited multiple examples of the VA and DoD achieving levels of EHR interoperability that remain only stretch goals for most of the rest of the healthcare systems in the U.S.

Her report wasn't about the benefits backlog, either.

The backlog is a creature of the Veterans Benefits Administration, an entirely separate division from the VA's Veterans Health Administration, the division with the VistA EHR.

The VHA, not the VBA, was was the division Martin was testifying about, along with the Military Health System.

By the way, Martin's beef with VA and the DoD mainly was with the inadequacies in their IT project management systems in trying to reach even higher levels of interoperability.

Oops.

Finally, you spoke of an “insane” complication—this lack of complete interoperability. Well, welcome to healthcare IT!

At the end of your piece, you said President Barack Obama ought to do something about this, and you're right. He should.

The Institute of Medicine recently recommended “the completion of an interoperable or single combined electronic health record for all care that begins with entry into military service and continues throughout care in the Department of Veterans Affairs system after transition.”

That's not going to solve the benefits backlog at the DoD/VBA, but having both healthcare departments running on the same, or two completely interoperable systems, would only be a good start at a solution. I've weighed in on this issue already, but not having 2.2 million Americans cycling through two, three and four tours of combat duty in 10 years of war would be a good solution too. The latter might be a good subject for another segment.

Meanwhile, there is a petition on the White House website right now, calling for Obama to order the Defense Department to use the VA's VistA system. At 9:44 this morning, there were 80 signatures.

Maybe you should consider adding your signature to the list.