A love letter to the VA EMR


Category : Medical Rants

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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Comments (10)

There is a conference called “Towards the electronic patient record” Key word is “Towards” It’s going to have its 23rd annual meeting soon.


I started to comment, but posted it instead.

Whatever EMR system(s) the rest of the healthcare system ultimately implements, it/they must be interoperable to insure maximum value. For a system like the VA’s, couldn’t there be a separate billing module that providers could buy if they need it?

Ah, but who will get the big contract ? It’s all about money and financial interests for vendors.
Who thinks that now, in the US, better care and patient’s best interest are the leading motivations for change ? Both patients and doctors lost their freedom to chose. It is rather the army of CEO’s and their political friends who lead the destiny of healthcare here.
We can talk a lot but until we resign “en masse” from contracting with insurance companies, we will remain slaves.

The VA EMR is great.
The amount of data available is great. And now that we can link to all the other VAs in the system continuity of care is much improved.
However, there are some downfalls.
Too much “cut and paste” of notes. The housestaff notes look nearly exactly the same from day to day and sometimes clinic to clinic visit. And some providers copy way too much garbage into a note. The use of boiler plate templates results in poor documentation and recording things that likely were not done. I wish the administration would audit notes to reduce this inappropriate (? fraudulent at times) behavior.
Overall though, it is a very nice system to use.

Hello Robert,

Resourceful blog…I have found very good information about health… there is helpful post about fitness and weight loss but it seems like you have stopped posting under that category … keep the updates… will be waiting for them..thank you for sharing…

Let me be the devil’s advocate…not all about the VA EMR is good. It is used against us (doctors) as well. The VA tries to cut corners in measuring what they call quality by using electronic searches of the EMR to document “quality”. For example, if I see a diabetic patient I am expected to do a foot exam for pulses, lesions and sensation. No arguments there. What I dont get credit for is documenting it in freetext in my note. The VA only looks for clinical reminders to be done- these are electronically generated reminders to check certain things or give immunizations. They are supposed to be just that- a reminder. INstead they are used to document “quality”. So if I do a foot exam and document it in the note I get no credit for it unless I fill out the reminder…the VA isnt measuring quality of care but quality of documentation. Other examples exist.

Why mention this here? Well EMRs can be exploited in a negative way and we must be aware of this. There is always a dark cloud for every silver lining.

I think that there are two views points to be considered when strongly advocating the use of EMR in practices. For a Doctor it needs to easy to use and save time so that more time can be spend on the patient. Currently we have many vendors with different types of EMR that are so hard to use that it simply puts them off. I think healthcare technology companies need to develop product after regular interaction with doctors to ensure that they provide just what is required. At binaryspectrum we have developed our healthcare solutions after spending countless number of hours with doctors to ensure that its work flow is kept simple and intuitive. This is then followed up with a period of Beta testing in real time environment before it is offered as a product in the market.

Do you think it would be possible to “enhance” the VA’s EMR by adding the parts necessary for billing?

Thanks for the information.

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