Thursday, September 16, 2010

Book Review: Best Care Anywhere

Philip Longman’s second edition of Best Care Anywhere is a valuable, high level summary of the history of the Department of Veterans Affairs, the story of the VistA EHR system, and how incentives can be aligned within this huge health care system to achieve some of the highest scores on quality metrics, including HAI rates.

Of particular interest to me was the story of how the VistA EHR system was originally created. VistA was the brainchild of a community of computer-savvy VA physicians, and was developed in occasional opposition to the wishes of senior leadership. A virtual “Underground Railroad” emerged to enable the continued development of the system through the 1970’s and 1980’s. VistA has become legitimate during that time, with support from several presidential administrations, and adoption beyond the VA. It's interesting that earlier this week, an RFI has been released seeking assistance in maintaining the open source nature of VistA to continue this legacy.

Longman proposes a controversial strategy of extending the VA’s model of health care delivery beyond the VA, asserting that such an approach would improve care quality and reduce health care costs. He proposes not only extending VA's reach by opening access to non-veteran beneficiaries, but also implementations of VistA well beyond the VA into community and rural hospitals.

I'm very curious to see the response of policy makers, providers, and patients towards this controversial new strategy of health care quality transformation.

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