I've written about plans to scrap the Veterans Affairs Department's VistA electronic health-record system and replace I've written before about plans to scrap the Veterans Affairs Department's VistA electronic health-record system and replace it with a whole new EHR system built from scratch, jointly, with the military, but it bears repeating—that idea, building a whole new EHR system, was worse than nutty.
Taxpayers have invested billions of dollars in VistA. The development effort, started in 1977, produced one of the best EHRs ever, maybe the best.
I was personally introduced to VistA in 2003 by Dr. Louis Coulson, who graciously gave me a demonstration at the Jesse Brown VA Medical Center in Chicago.
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Trade and professional organizations are warning the feds not to even think about acting on a new set of recommendations for Stage 3 of the electronic health records incentive payment program under the American Recovery and Reinvestment Act of 2009 until they take a good look at Stages 1 and 2 and fix what needs fixing.
The American Hospital Association, in a recent letter to acting CMS Administrator Marilyn Tavenner (PDF), alluded to problems with testing and certification of EHRs for reporting of clinical quality measures at the start Stage 1 of the program back in 2009 and 2010. Page 3 of the letter has a time table of five recent additions or changes in specifications and testing criteria to be used to certify EHRs for Stage 2 reporting of clinical quality measures since the Stage 2 final rule was published back in early September 2011.
Last month, the Electronic Health Record Association, an affiliate of the Healthcare Information and Management Systems Society, warned the feds that problems in its own development of EHR testing software was creating a bottleneck in the testing and certification of systems for Stage 2.
Presented with these examples of government fallibility, what should the response of the governed be?
Put yourself in their shoes. Be as patient with our brothers and sisters in government as you would have them be patient with you.
I've reported on the affairs of government and the private sector for 33 years. During that time, I've seen my share of knaves and incompetents mucking up the works in both spheres.
That's generally not the case, here. The people I've met and spoken with at the federal level and in the private sector who work in the health IT field are some of the brightest and most dedicated folks around.
It's just that this stuff is hard.
I was at the IHE Connectathon last week and saw more than 500 software engineers laboring away in the basement of a hotel in Chicago for the better part of a week. If this were easy, that much talent would have achieved total interoperability after the first Connectathon back in the 2000.
The U.S. healthcare industry didn't sink into its current IT deficit—compared with other industries—overnight, and so it won't dig its way out of this hole by morning.
In general, industry responses to the government's multiple requests for information and public comment have been forthright, but tempered, reflecting the needs and problems of their constituents, while wisely refraining from polemics. Keep it up. Feedback is vital, vitriol is not.
I also was impressed that Carol Bean, director of the EHR testing and certification efforts at the Office of the National Coordinator for Health Information Technology at HHS, made herself available and spoke candidly about the government's own problems developing testing tools. Keep that up, you federales. Transparency is what's needed to best get everyone through the many long days of trial and error to the ultimate success that lies ahead.
This is a marathon, not a sprint race. But no one sector, public or private, will be a winner without the other.
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I spoke with Dr. David Brailer last week and have been mulling over something he said ever since.
“The fight over the control of data will be an epic struggle,” he said. “I think it's going to be the reining battle of this decade.”
Brailer rephrased his statement to “a very large struggle” so as not to imply the fight will be between Judy Faulkner’s Epic Systems and everyone else, although the EHR wars are shaping up that way.
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