As often happens, when you look for one thing, something else pops up.
In doing research for this issue's cover story about the possible private-sector deployment of the Veterans Affairs Department's Vista information technology system, I ran across an organization called WorldVista, a group of Vista devotees called the Hardhats and a marvelous collaboration between the VA and the Defense Department called the Pacific Telehealth and Technology Hui (pronounced "hooey").
I also found an army of dedicated physicians, nurses and IT professionals who have helped build the Vista system and who are now eager to see the work of their hands spread to other healthcare providers. Unfortunately, I also heard from many of these same people that they are fearful and feel constrained from doing this.
Despite those fears, WorldVista, the Hardhats and the Hui have undertaken the mission of delivering the VA's terrific IT system to the outside world. Their efforts target not only hospitals but also outpatient settings, where the need for clinical IT is just as great but financial and technical resources are even more scarce.
But these Vista champions need more than just a good story written about them. They need the full support of our government at all levels, especially the physician leaders and programmers inside the VA, some of whom feel compelled to work clandestinely for the cause during their spare time so as not to jeopardize their employment.
Government employees in particular should be encouraged to engage in IT extension work to bring this taxpayer-funded asset to needy hospitals and small physician clinics in their communities. It is wrong to make people whose professional aim is to save patients' lives afraid for their jobs. The VA should take the Hui model for extension services and replicate it at VA medical facilities across the country.
If a law or policy needs to be changed to enable the VA to do that, then that law or policy should be changed, just as we are considering changing the federal antikickback laws with an eye toward the greater good of facilitating IT partnerships between hospitals and physician offices.
I've heard the argument for keeping the VA employees constrained: The government shouldn't compete with the private sector. I find the argument unpersuasive.
The facts are roughly 52% of physicians in office practice either work alone or with just one or two colleagues. Most private-sector IT vendors I've spoken with consider the small-practice market to be a vast desert in which the cost of selling and supporting IT installations runs up system prices beyond many doctors' reach.
What these office-based physicians need is a battle-tested electronic medical record like Vista, which has been installed in more than 800 outpatient facilities; they need it cheap and they need it now. The same could be said for rural hospitals and those hospitals in urban areas with high public-pay patient mixes and no margins.
The VA and the CMS have entered into an agreement to adapt Vista to the office environment, but the request for proposals for a vendor to contract for those modifications has yet to be issued. There is no plan in place on how these office systems will be sold and serviced. The target delivery date of the VistaOffice software is not until next summer.
Meanwhile, members of an army of knowledgeable Vista experts who could help implement these systems are being forced to sit on their hands, afraid they'll be reprimanded or fired, while patients die from preventable medical errors and a taxpayer asset is not being put to its best use.
The very existence of WorldVista and the Hardhats is a testament to the unwillingness of the VA to promote its system and the culture of fear that has been established to prevent that from happening. The VA should be doing all it can to install the system for those who want it, enabling the private sector to take on the servicing and maintenance.
When it comes to medical errors, this should be wartime. Five years ago, the Institute of Medicine reported that up to 98,000 inpatients die from preventable medical errors, while in 2003 the Center for Information Technology Leadership claimed 130,000 outpatients suffer life-threatening injuries due to lack of robust clinical IT systems.
Taxpayers own the Vista system. Unfortunately, its developers must be liberated to put it to full use.