Crises at the Veteran’s Administration

Last week, Congress passed a bill that will allow veterans who have been unable to get VA appointments and live more than 40 miles from a VA facility, to see civilian providers. While we don’t know precisely how many will be affected, they’ll number in the thousands. (The most recent VA Inspector General’s study reported that 57,000 veterans have been waiting more than 90 days to see a care provider.) This clearly is a giant step towards righting an unconscionable wrong.

Unfortunately, these vets along with the millions of other vets who see civilian providers, will still get short changed. VA and civilian providers can’t exchange records so they can’t coordinate care, and that’s why serious mistakes happen — mistakes that annually kill thousands of patients and make many more thousands sicker rather than better. And that’s what triggers unnecessary or redundant tests — all of which add $$billions to the cost of care without improving quality.

In short, as bad as the VA scheduling problem is, it is dwarfed by this inability of civilian and military providers to share records and coordinate their patients’ care.

Ten years ago we adopted a national strategy to solve this problem. It was to force every provider to adopt an electronic medical record (EMR) system, and then to link them together via electronic networks called health information exchanges. A reasonable-sounding strategy — but $24 billion in subsidies later, we’ve learned that it doesn’t work!

The first part, while incredibly costly, has been working. More than 60% of providers and 80% of hospitals are using EMR systems to some degree. That’s a huge accomplishment and a huge plus. But the second part — the part that was supposed to link them together so they can provide better, coordinated, lower-cost care — doesn’t work and many believe never will. Technical issues, patient identification, security and privacy problems are among the reasons why.

Yet we persist down this path, ignoring its terrible consequences for all of us as we struggle to make it work. Each year as we chase this illusory solution, thousands of veterans and civilians are dying, many thousands more are suffering and we are wasting hundreds of $$billions — enough to bankrupt the country!

Isn’t that one definition of insanity: doing the same thing over and over again and expecting a different result?

And isn’t it time to do what we’ve done in other industries, namely, think outside the box, come up with a very different solution and disrupt the status quo?

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