Really Successful use of Health IT in the US Veteran’s Affairs Department.

Good news for the effectiveness of properly implemented health IT this week.

Report lauds VA's focus on quality care, health IT

By Mary Mosquera

Published on January 11, 2008

The Veterans Affairs Department has improved its quality of health care through management initiatives and use of health information technology, the Congressional Budget Office said in an interim report. VA's accomplishments come during a period of increased demand for its services from soldiers returning from Afghanistan and Iraq.

VA has restructured efforts to permit more shared decision-making among its central office, regional managers and facility directors; measure performance, process and outcomes; and use health IT system wide.

The department's integrated structure and appropriated funding may have helped it focus on providing the best quality care for a given amount of money compared with fee-for-service incentives toward billable services and procedures, CBO said in the Jan. 9 report.

The improvement in VA's health care quality has been documented in a number of independent studies, including by the Institute of Medicine. VA will provide care to more than 5.8 million veterans this year in its 153 hospitals and nearly 900 clinics.

VA tracks the quality of its care using indicators such as adherence to clinical guidelines and standards that have been shown to improve outcomes, waiting times for access to services and customer satisfaction. This year, VA plans to adopt more industry wide quality measures, such as those in the Healthcare Effectiveness Data and Information Set, to boost comparability with other providers, CBO said.

VA's structure as an integrated health care system makes it easier for the department to use two effective tools: incentives for managers and providers to meet quality of care and practice guideline targets, and health IT systems that provide reminders about tests and treatments recommended by the practice guidelines, CBO said. It also found that the low cost of care for veterans was an incentive for seeking care.

….

VA has an electronic health record for every patient, which provides up-to-date information about a patient at the point of care, including medical history, allergies and medications. It also contains relevant diagnoses and laboratory tests, which lets providers avoid duplicate tests and adverse drug interactions. Research indicates that computer reminders and prompts can significantly improve adherence to clinical guidelines, particularly for preventive care.

VA could serve as a model for improving other health care systems through sustained efforts to monitor indicators of quality, access and satisfaction. CBO’s final report, expected early this year, will consider how other health care systems can apply similar approaches and lessons from using health IT.

…..

Read the full article here:

http://www.govhealthit.com/online/news/350168-1.html

Read the full report here:

http://www.cbo.gov/ftpdocs/88xx/doc8892/12-21-VA_Healthcare.pdf

What is shown in this report – and what will be more fully developed report due later in 2008 – is that is a single payer environment like the VA Department there can be substantial quality and efficiency improvements through the use of appropriate Health IT.

Given the successes already seen in Scandinavia and at Kaiser Permanente it seems to me we have reached a tipping point in the strength of the evidence about the utility of Health IT. This all has a climate change style denial feeling about it to me.

The question is not anymore whether Health IT is a good thing or not – the question is how can it be most efficiently and effectively introduced to meet the needs of my health sector!

David.