Kudos for My HealtheVet
When you get it right, enjoy the applause! The Department of Veterans Affairs is on the award tour, reaping kudos for its My Healthevet initiative. They are being applauded for their 2009 "Towards an Electronic Patient Record (TEPR)" award as well as being a national finalist for the "Best Practices" award from the Utilization Review Accreditation Commission (URAC), an independent healthcare accreditation commission.
Why all the attention? Well because the VA has evolved from a medical miracle laggard to a leader in the development of electronic health record (EHR) and personal health record (PHR) technology.
My HealtheVet Offers a Tool for Managing Health
Now boasting 700,000 users, MyHealtheVet.com is an important instrument in the daily lives of veterans. The Web-based system is an online management tool that allows users to store and update personal health information, track their health information such as cholesterol levels and allergies, order pharmaceuticals, and view some test results--to name a few applications. My HealtheVet also links users to federal and veteran benefits, is accessible to patients at any computer via a login, and it is free. The platform is also an attempt to upgrade aspects of the existing electronic health information system developed by the VA known as VistA.
Lead technology architects at the VA worked in conjunction with physicians to create the Veterans Health Information Systems and Technology Architecture (VistA) in the 1970s, resulting in a more efficient health information system. While it succeeded in streamlining much of the health information for veterans, it is criticized as highly complex. Additionally, it faces challenges relative to the affordability and interoperability of newer technologies. That being said, VA Secretary Eric Shinseki appears to support to continuation of VistA while modernizing aspects of the system, making it more accessible and transparent to users.
"And I'm told that the medical record that's used in the Veterans Administration is very highly regarded, both in Veterans Affairs but also in the military departments, VA Secretary Shinseki said during a recent Congressional hearing. "And so I went and sampled with a couple of doctors here locally at -- the military doctors at Walter Reed -- a small sample of three. Everyone said VistA is the way to go. VistA happens to be the VA's version."
Hold the Applause!
But wait-there may be glitch. (Isn't there always?) According to the Associated Press, the electronic health information maintained by My Healthevet is not fool proof. In the fall of 2008, there were several cases where VistA provided incorrect and confusing alerts to physicians about their patients. Records flashed across the screen with more than one name, and many patients were treated with incorrect drug doses, most notably, heparin, a blood-thinner that is equally life threatening as life saving.
These incidents were kept from the public until January of 2009, although they occurred as early as October of 2008. Critics contend that there is too much reliance on PHRs and electronic health records (EHRs) as an end-all solution to healthcare efficiency. One physician note: "There's a lot of hype out there about electronic health records, that there is some unfettered good. It's a big piece of the puzzle, but they're not magic. There is also a potential for unintended consequences."
Additional concerns about the My HealtheVet initiative are swirling through the VA. Some fear that the older VistA will be completely replaced by the younger, more nimble My HealtheVet and commercial software packages that will centralize IT management. At its onset, VistA was created as a collaborative open source initiative between programmers and physicians. Today, some VA staff worry that the centralization of health technology at the VA would abandon a culture of cooperation between physicians and programmers that produce efficient, useful solutions.
Take for example the testimony to Congress of the Director of Informatics at a Northern California veteran's hospital. He argued that an eight-hour power shortage suffered in 2007 proved a grave threat to patient safety and in the process, blamed the VA's health information reorganization and centralization of IT management for the increased risk to patient safety.
Go Ahead, Take the Plunge...
Alas, do we abandon the accelerated shift to electronic health record information from paper files? Of course not. While constructive criticism for My HealtheVet project and others persists, it fails to make the case for eliminating an aggressive transition from papers to pixels. Clearly, the case of My HealtheVet is an important reminder that electronic healthcare technology is not simply a capital investment, but rather an ongoing piece of the healthcare system that requires oversight and physician scrutiny. Let the stimulus package and successes of EHRs and PHRs continue to motivate physician practices and hospital systems to make the leap to electronic record technologies; doing so will enhance the quality and continuity of care VA patients require and deserve.
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