Home » Time Capsule » Currently Reading:

Time Capsule: The VA Outperforms Private Hospitals in IT Vision and Resolve

September 23, 2011 Time Capsule 1 Comment

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in September 2006.

The VA Outperforms Private Hospitals in IT Vision and Resolve
By Mr. HIStalk


If you work in a non-government hospital, here’s what your patients are reading in this week’s Time magazine: Veterans Affairs (VA) hospitals are better than yours in satisfaction, quality, and technology. Their costs are going down while yours are skyrocketing. Elderly males treated in the VA system have a 40% less risk of death. You can only hope your ED patients don’t run out screaming to enlist in the military.

The article credits the VA’s advanced and fully-deployed information technologies, but commercial software vendors can’t gloat or take credit. The VA built the VistA system itself. It isn’t slick or technically impressive, but it works.

Like a tailor-made suit, VistA was developed to meet the VA’s needs, not those of a vendor’s “average” hospital customer. Just as hospitals talked themselves into buying instead of building (helped along by vendors and risk-averse CIOs,) the industry’s darling turns out to be a homebrew job.

The article pointed out the obvious: every hospital should match the VA in enterprise-wide longitudinal patient records and bedside bar-coding. Beyond that, though, is the implicit message that technology is a change enabler that requires significant process redesign to accomplish anything meaningful. Everybody hates to hear that because it moves the argument from “expensive” to “impossible in our culture.”

The VA didn’t go out and say, “Hey, let’s replace a couple of old systems with these we saw at HIMSS.” It didn’t hire a superstar CIO loaded with prejudices (positive or negative) formed by time spent elsewhere. It didn’t pander to making the “Most Wired” list. Earlier versions of VistA had been around for years before the VA mandated its full utilization. It took a strong, non-IT leader to drive home the mission to 200,000 employees. Information systems were involved, but it wasn’t an IT department project — not by a long sight.

Patients don’t care what tools you use. They care only about results. If your hospital is a good one, you’re probably already delivering fine care using whatever systems you have.

The bad news is for not-so-great hospitals — your IT checkbook can’t bail you out. Bad chefs don’t get better just by spending more on knives. Obvious, yes, but we seem to keep re-learning those lessons with big IT purchases that turn out to be a giant leap –sideways.

Technology’s failure to deliver isn’t usually a vendor or CIO problem, although it’s easy to make them targets. Once the software is up and running, it’s an organizational challenge, one often unfortunately dumped into the wrong laps. You can buy software as good or better than the VA’s, but your mileage will definitely vary.

Let’s give the VA its due. Against improbable odds, it managed to turn an underperforming government agency into an industry-beater, using a little bit of technology and a lot of vision and resolve. Miraculously, the VA did it while making both its patients and government bureaucrats happy. The VA has definitely raised the now-public bar for the rest of us.

View/Print Text Only View/Print Text Only

HIStalk Featured Sponsors


Currently there is "1 comment" on this Article:

  1. Hmm…. I find this very surprising. I would think that government run programs would be as cheaply run as possible to save itself money. Very interesting article nonetheless.

Subscribe to Updates



Text Ads

Report News and Rumors

No title

Anonymous online form
Rumor line: 801.HIT.NEWS



Vince Ciotti’s HIS-tory of Healthcare IT

Founding Sponsors


Platinum Sponsors






















































Gold Sponsors
















Reader Comments

  • Math: Dittoing on how awesome Zenni is, I've been using them for a couple of years. Most people don't realize how much of an ...
  • Code Jockey: Gotta love it when the kids show up..... After a number of years of almost constant travel and well over 700+ flights...
  • Kermit: My family's been happily using Zenni for years. Never a problem with the quality of their products. My last order was fo...
  • Cosmos: During an inpatient stay at a Boston area teaching hospital, my wife was approached by a research assistant about enroll...
  • AlphaCodeJockey: Finally, CodeJockey has a incentive to play up issues with developing custom solutions for Epic's platform as improvemen...
  • DeltaCodeJockey: I'd also point out that Epic insiders are probably right to be touchy about this topic as they get flack publicly and li...
  • Gamma Code Jockey: Code Jockey's example of an IT form that ties into Epic's system is wrong though - you are allowed to do that and you ar...
  • Bravo Code Jockey: Code Jockey - thanks a tonne for persisting and for your rational and informed responses to a lot of name calling and mi...
  • Bill O'Toole: Confirming first hand that Cape Cod Hospital was MEDITECH's first customer. My father, the Chief of Pathology, saw the i...
  • FormerCIO: Re JAMA article. How will access to my EHR data help me 'shop for high value health care services' and 'avoid the need t...

Sponsor Quick Links