Wednesday, May 21, 2008

VistA , A MODEL OF HEALTH CARE

Surgeon Michael DeBakey last month received the highest civilian award for his pioneering work in life-saving cardiac surgery. This 99-year-old inventor of open-heart surgery took the occasion to recommend to health-care policy makers and others, veterans’ health care ( VistA ), as the very best model available. A member of the selection committee, he presumably had studied all health-care systems.

VistA? Nowhere have we seen it discussed. It is not even mentioned once in the eight-paged VA Connecticut Information Packet. Fortunately, there’s an excellent new book: Best Care Anywhere, Why VA Health Care Is Better Than Yours, by journalist Phillip Longman (Sausalito , CA , PoliPointPress, 2007, 158pp). Longman came to the subject from months of exasperating experiences dealing with prestigious health-care providers for his wife, a breast-cancer patient.

Two unique factors distinguish VistA. One is the VA’s “spectacular” use of electronic medical records: its “integrated health information system, including its framework for using performance measures to improve quality, is considered one of the best in the nation,” according to the Institute of Medicine. The Journal of the American Medical Association praised it as “a bright start in the constellation of safety practice.”

No private-sector hospital can begin to match the VA’s use of electronic medical records, and only about 20 percent of the hospitals have tried. Private hospitals have been loath to computerize their medical records as too expensive and no way to recoup their investment.

Health Savings Accounts are the only model that introduces motivation by patients, a factor in keeping costs down; but it is the socialist VA that is setting the standard for best practices while controlling costs. The private sector lags in quality and cost-effectiveness. In 2004, the Bush Administration, looking for a case of high quality and lower-cost hospital, selected the Baltimore VA Medical Center. It could find no private hospital which was superior.

VistA ’s second uniqueness stems from its first. Patients stay on its records forever. No matter where they move to in the U.S., patients are always enrollees in the records of veterans’ hospitals. Their records remain for all their future doctors to see. In KATRINA lots of medical records were lost, but not VistA ’s. They could be retrieved by any veteran’s going to any VA hospital anywhere in the U.S. and announcing he is a Katrina evacuee who wants to know his records are retrievable.

Among VistA ’s numerous other advantages, there is no chance a doctor’s prescription cannot be read since it is not in his unrecognizable script. The system is wired to prevent errors. For example, a doctor enters a prescription on his laptop. The computer checks the patient’s record for an inappropriate combination of medicines or previous allergic reactions and sends up a red flag is there’s a problem. The system reminds doctors of patients who need to make appointments. The VA estimates that VistA has saved 6,000 lives by improving rates of pneumonia-vaccination among vets with emphysema, and has cut pneumonia hospitalizations in half, reducing costs by $40 million a year.

Through its record-keeping, VistA has been able to maintain a database of medical records to create the first national analysis of how patients fare, after undergoing different types of surgery in the many VA hospitals. The analysis shows decreases of nine percent in mortality and 30 percent in morbidity between 1994 and 1998. It also shows which outcomes are the best and the worst.

In the early ‘90s there was criticism of veterans’ hospitals and calls for them to be shut down. “The Worst Health care in the Nation,” blared a Washington Times headline. Young veterans sought medical help elsewhere. Meanwhile, VA dissidents known as “Hard Hats,” quietly pursued their own medical revolution and invented software for their own needs. Endocrine oncologist Andrew W. Schally, experimenting in his lab in the New Orleans VA hospital, was a Nobel Laureate as far back as 1977. The VA was the first facility to use nuclear powered pacemakers.

By 2003 and with the help of Dr. Kenneth Kizer who had been brought in to head the VA, things began to change. In places where there were too few veterans to support a hospital, Dr. Kizer contracted with private hospitals to take them. Only one percent of male patients had been screened for prostate cancer. The VA, with its “stable population of patients,” changed that and gave the VA an opportunity for improving quality. By 2003, the VA had become a leader in safe, high-quality, and innovative health care.

After all that, it is refreshing to learn that VistA ’s costs are lower than average hospital costs. In 2004, all hospitals’ average cost per-patient was $6,280, in VA hospitals $5,562 including prescription drug costs and long-term care benefits.

TIME magazine asked doctors what scares them the most about being a patient. The three most frequent answers were fear of medical errors, fear of unnecessary surgery, and fear of a contracting a staph infection in a teaching hospital.

The VA hospitals do not deal with vets’ families, but they should. Dozens of vets’ hospitals are scheduled to be closed because of insufficient patients. Only a few families are eligible, only for specific treatments and only when beds are available. A step toward comprehensive health reform would be to open them to veterans’ spouses and children.

By Natalie Sirkin
gnsirkin@aol.com
c2008
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