DB'S MEDICAL RANTS

Internal medicine, American health care, and especially medical education

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A love letter to the VA EMR

VA Takes the Lead in Paperless Care

I have used the VA EMR for over 5 years. It has major advantages over the paper record.

1. It is always accessible (expect for the rare computer shut down).

2. The correct data are easily found.

3. You have access to Xrays (including old films).

4. You can quickly see all the medications.

Although we type our notes in the VA system, it still saves time, and probably saves money.

This love letter is well deserved.

But this much is clear: Never again will a VA patient’s chart be an excuse for things not happening efficiently. Never again will information that is lost, hard to read or impossible to move from one place to another be a factor in the complicated calculus of what makes good medical care — and, on occasion, saves lives.

The electronic medical record is the most important single development helping to usher in the Era of No Excuses in modern medicine. It is an age in which clinical decision-making, physician performance and patient outcomes are increasingly transparent; patient safety is mechanized; and the once-secret medical chart is sometimes open to contributions from the patients themselves.

Electronic medical records make confusing and physically unwieldy masses of data instantly available, portable and searchable — altogether more useful than when the information was stored on paper. Computer-accessible records have the potential to save the cost-strangled American medical system billions of dollars in waste, repetition and error. They may also prove to be essential tools of research, allowing scientists to examine patterns of medical practice, drug use, complication rates and health outcomes.

Since 1999, the VA’s 155 hospitals, 881 clinics, 135 nursing homes and 45 rehabilitation centers have been linked by a universal medical records network. It allows any authorized person to look at 5.3 million patients’ records — everything from a nurse’s note written during a hospital stay, to the result of a blood test drawn at a clinic visit, to the moving-picture film of a coronary angiogram done in a cardiology lab.

Even though President Bush has set a goal of 2014 for when most Americans should have their medical information stored electronically, the Department of Veterans Affairs is today one of the few health systems — and by far the largest — that is virtually paperless.

So why does the rest of the country not adopt the VA EMR? Interestingly, this is the only EMR designed for patient care, rather than for billing. Hospital administrators want billing systems. The VA system was designed for health care professionals, not accountants.

I wish the entire country had a common EMR. We would clearly save money. Too often patients have expensive tests repeated because we cannot get the old results. Having complete medical information saves money and improves health care delivery.

A blogger can dream.

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