health care worker with handheld computer

February 6, 2011 -- The conventional wisdom says that government-run = low quality and inefficiency... But is that true? Not so fast, says Mike Doyle of Medsphere, a promoter of the Veterans' Administration's electronic health record system, VistA. I had an opportunity to learn and use VistA on one of my clinical rotations and found it excellent. Furthermore, the VA itself is a success story. In his well-researched blog, Mike writes:

By all rights, after all, the VA should offer the worst care anywhere: it's a gigantic, unionized bureaucracy, micromanaged by Congress and political appointees, and beset by an uncertain budget, an aging infrastructure, and a legacy of scandal. That it nonetheless outperforms the rest of the U.S. health-care system, on metrics ranging from patient satisfaction to cost-effectiveness and the use of evidence-based medicine, suggests that much of what we think we know about health care simply isn't true.
The VA is not the only example. Medicare proceeds with 3.9% administrative overhead (acccording to the New England Journal of Medicine's "Cost of Health Care Administration..."), compared to private insurer's 15-35% overhead, depending on whose numbers you use. For example, the Physicians for a National Health Reform's peer-reviewed studies say 31% of our health care dollar is spent not on medical care but on the overhead and profit of the private insurers (Anthem, Blue Shield, Aetna, Humana, etc.) And while it's true that the plural of anecdote is not data, my family's experience with Medicare has been excellent.

VistA works well and I found it easy to learn and use. Furthermore, the source code is in the public domain (open source) and stands a good chance of setting the standard for the industry. It makes electronic health record software affordable. Even Fox News has gotten behind it. Nonetheless, Doyle cites research that says:

Astonishingly, 20 years after the digital revolution, only 1.5 percent of hospitals today have integrated IT systems like the VA uses, and those that do often find their commercial software programs to be buggy and inadequate.
It's time for an end to the myth of quality and efficiency in private sector health care!

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