The VA Health Care System
An interesting but previously unknown fact was that the Veterans Health Information Systems and Technology Architecture, VistA , is actually a bundle of nearly 20,000 software programs originally written in the 70’s by physicians for physicians. Interestingly, the author reports that many of the big EMR vendors today benefitted from the Open Source VistA EMR software – such as Epic and Cerner.
VA Health Care can be looked upon as a standard for future medical successes. The author spoke to an analogy of comparing the VA System with Accountable Care Organizations.. He writes, “we don’t need, and don’t have time for, endless studies and pilot programs to show how it could be done. With only a few tweaks, the VA can provide us with a proven model because it was an ‘accountable care organization’ long before most health-care wonks had any such concept.”
As a former VHA Staff RN I can relate to the many examples of quality care given to veterans in Longman's book. How, as a nation, do we care for our military and their families? They put their lives on the line, the ultimate sacrifice, and deserve the best care possible. As a nurse, I witnessed care of an Army Veteran mother who gave birth to an 11 lb. baby without requiring a C-Section. Due to his size, was born with distocia in his shoulder but fortunately without damage to his upper brachial plexus nerves. Mother and baby were fine, Physical Therapy (PT) and time healed the wound. Another example is a veteran who experienced shoulder pain after dislocation and a compressed vertebral disk. Again, PT was provided with pain management and without surgical intervention; his pain was virtually gone in a short while. He now serves with the Army’s Airborne Elite.
As an RN educated in the style of western medicine and therapeutics, I would have thought an OB/Gyn provider would have quickly performed a Cesarean Section for a fetus that size. I also would have expected that the man with the shoulder and compressed disk problem would have undergone some type of orthopedic surgery.
These examples are shared with their possible alternatives because the private health system is incented to provide interventions for which they are paid (fee-for-service). In contrast, the VA is incented to keep veterans healthy over their lifetime, though preventative care, education, patient involvement, and at lower healthcare costs.
- Through use of VistA for the past 20+ years, the VHA has access to longitudinal records of veterans that can be used to study what works and what doesn’t work for patients with specific conditions, given certain treatments.
- These records provide excellent insight into evidence based medicine. In comparison to private health plans, VHA and clinical guidelines are developed using this data. that support the benefit of long term relationships between veterans and the VHA.
- Considering the aging population, the progression and high incidence of chronic diseases, coordinated and continuous care is required. Unfortunately, with the multitude of software systems for the healthcare market (clinics, CAHs, etc.), the ability for Clinicians to view longitudinal care received by patients is not available.
- In our current state of EMR adoption, lack of free-flowing data from provider-provider or hospital-provider, hinders accumulation of medical knowledge that educates and informs clinicians in the practice of medicine.
This brief commentary on the book and use of medical data by the VHA is an exemplar of how health data collected over a long period of time, when analyzed in the context of disease and health conditions has the potential to predict which evidence becomes medical best practices.
The VA Health Care System
An interesting but previously unknown fact was that the Veterans Health Information Systems and Technology Architecture, VistA , is actually a bundle of nearly 20,000 software programs originally written in the 70’s by physicians for physicians. Interestingly, the author reports that many of the big EMR vendors today benefitted from the Open Source VistA EMR software – such as Epic and Cerner.
VA Health Care can be looked upon as a standard for future medical successes. The author spoke to an analogy of comparing the VA System with Accountable Care Organizations.. He writes, “we don’t need, and don’t have time for, endless studies and pilot programs to show how it could be done. With only a few tweaks, the VA can provide us with a proven model because it was an ‘accountable care organization’ long before most health-care wonks had any such concept.”
As a former VHA Staff RN I can relate to the many examples of quality care given to veterans in Longman's book. How, as a nation, do we care for our military and their families? They put their lives on the line, the ultimate sacrifice, and deserve the best care possible. As a nurse, I witnessed care of an Army Veteran mother who gave birth to an 11 lb. baby without requiring a C-Section. Due to his size, was born with distocia in his shoulder but fortunately without damage to his upper brachial plexus nerves. Mother and baby were fine, Physical Therapy (PT) and time healed the wound. Another example is a veteran who experienced shoulder pain after dislocation and a compressed vertebral disk. Again, PT was provided with pain management and without surgical intervention; his pain was virtually gone in a short while. He now serves with the Army’s Airborne Elite.
As an RN educated in the style of western medicine and therapeutics, I would have thought an OB/Gyn provider would have quickly performed a Cesarean Section for a fetus that size. I also would have expected that the man with the shoulder and compressed disk problem would have undergone some type of orthopedic surgery.
These examples are shared with their possible alternatives because the private health system is incented to provide interventions for which they are paid (fee-for-service). In contrast, the VA is incented to keep veterans healthy over their lifetime, though preventative care, education, patient involvement, and at lower healthcare costs.
This brief commentary on the book and use of medical data by the VHA is an exemplar of how health data collected over a long period of time, when analyzed in the context of disease and health conditions has the potential to predict which evidence becomes medical best practices.