A Salute to the VA on Memorial Day—Part 1

In 2007, a book by Phillip Longman sent lasting ripples through the U.S. health care establishment. The title was audacious: Best Care Anywhere. But it was the subtitle that shocked: Why VA Healthcare is Better than Yours.

Was Longman suggesting that the Veterans’ Health Administration provides better care than the treatment that millions of well-insured Americans typically receive in the private sector?  Yes.

Longman had uncovered what one reviewer called “the biggest untold story of the past decade,” the quality revolution that Dr. Ken Kizer launched when he took over the VA health system in 1994. And Longman had eye-popping evidence to back up his claims: overwhelming hard-core data from the most prestigious peer-reviewed medical journals. The research revealed that when it comes to everything from outcomes to patient satisfaction, and patient safety, the VA outperforms.

Most people don’t associate the VA with innovation. But the majority of its doctors have faculty appointments at academic institutions, one reason that the VA is on the cutting edge of evidence-based, patient-centered medicine. And over the years, Longman reports, the VA has been responsible for developing the CT scanner, the first artificial kidney, the cardiac pacemaker, the first successful liver transplant, and the nicotine patch.

When I saw Longman’s first story about the VA’s turn-around in a January /February 2005 Washington Monthly article, I was finishing my book, Money-Driven Medicine. I pored over the studies Longman cited, comparing care at the VA to care elsewhere, and realized that everything he said was true. After visiting a VA hospital and interviewing Kizer, I wrote about the VA in MDM and went on to describe its successes on The Health Care Bloghere and here, where I explained that the Army, not the VA, runs Walter Reed, and that the VA had nothing to do with the scandal about care at the Army hospital.

The 2010 Edition of Best Care Anywhere

Today, Longman, who is a fellow at both the New America Foundation, and The Washington Monthly, has revised The Best Care Anywhere. In this second edition, the author doesn’t just update the stats: he offers news, and new ideas.

First, Longman reveals how the VistA software program which is the centerpiece of the VA’s electronic medical record system is now being used outside the VA.  Ken Kizer, the doctor who transformed the VA, is now CEO of Medsphere Systems, a company that is adapting the VA’s software (VisTa) for other doctors and hospitals. The software itself is free–anyone can download it online. But a hospital still needs to install VisTa, adapt it, and learn how to use it. Medsphere offers those services to customers like Midland Memorial Hospital, a 371-bed, three-campus community hospital in Southern Texas.

In 2007 Midland installed VistA, and since then, Longman reveals, the new system has had “dramatic effects” on quality and patient safety. For example, “the system prompts doctors to follow guidelines when dressing wounds or inserting IVs, which in turn, caused infection rates to fall by 88 percent.”

Over the Memorial Day weekend, I spoke to Longman, and he told me that today “Some thirty hospitals and clinics are now using VistA. In terms of applying the software to the private sector,” he said “it’s a proven concept.”

The advantage of using VistA is that it’s “open source” software which means that it’s available at no or minimal cost, and allows different IT systems to operate compatibly. Because anyone can download it, the software is not controlled by Medsphere or any single company. Instead, a community of users can work to improve the code simultaneously, sharing ideas, and speeding development. Finally, unlike the proprietary software that most vendors sell, VistA is “software written by doctors for doctors.” 

A New Context: Health Care Reform Is Now a Reality

In January of 2007, when the Best Care Anywhere first appeared, the idea of universal coverage could best be described as a gleam in presidential candidate Hillary Clinton’s eye. (Both Edwards and Obama would back reform, but Clinton’s efforts in the early 1990s made her the Mother of all health care reform.)

When Longman revised his book, he was writing at a very different time: reform was about to become a reality. He tells me that his deadline for the 2nd edition forced him to turn in his manuscript shortly before the final vote on reform. This must have been enormously frustrating. But, wisely, Longman bet on passage—and this optimism animates the 2010 edition.

Longman updated Best Care Anywhere with an eye to what the VA can tell us about health care reform. As he explains in his new introduction, the VA has done virtually everything that we want to do nationwide: “Health care quality experts hail it for its exceptional safety record, its use of evidence-based medicine, its heath promotion and wellness programs, and its unparalleled adoption of electronic medical records and other information technologies. Finally, and most astoundingly, it is the only health care provider in the United States whose cost per patient has been holding steady in recent years, even as its quality performance is making it the benchmark of the entire health care sector.”

As Dr. Donald Berwick, President Obama’s candidate to head the Centers for Medicare and Medicaid observes on the back cover of the new edition: “The improvement of the VA healthcare system in the past decade is one of the most impressive stories of large-scale change . . . in modern times. Students of quality improvement will find lesson after lesson in this important case study.” The VA can show us how to turn a very large ship.

But the VA will serve as a model for national reform only if more reformers understand how the VA has changed the practice of medicine. Most journalists under the age of 50 who write for national publications don’t know any vets, which helps to explain why so few fully understand how the VA has used information technology, both in treatment and in research, to effectively manage chronic diseases. “Comparatively few Americans, especially among coastal elites, have any contact with the VA these days,” Longman observes. Yet despite the VA’s low profile in the media, Longman realizes that the veterans’ health care system is an “example that shows that it is possible to make vast improvements in the quality, safety and effectiveness of the healthcare that all Americans receive, and to do it for but a fraction of what an unreformed health care system would cost.” This isn’t a theory; at the VA, it’s a reality.

In other words, reformers don’t have to start from scratch. The VA already has laid out a roadmap and it would be happy to share the comparative effectiveness research that it has gathered with the rest of the nation. We don’t have to look to Europe to find examples of systems that work. I believe that studying care in Europe can be extraordinarily useful, but on the phone, Longman confided that, as a young journalist, he was told, “Never start a sentence, ‘In Sweden, they . . .’”  Americans are more likely to be persuaded by home-grown solutions.

The VA under Bush vs. Obama

In the 2010 edition of Best Care Anywhere Longman also recounts how the Bush administration attempted to dismantle the open-source VistA software culture that Kizer had built, “doing its best to recreate the dysfunctional VA of the 1970s.”  Meanwhile, as more vets turned to the VA for care (in part because the care was so much better than it had been in earlier years), the Bush administration failed to provide enough funding, leading to long lines and not a few complaints. Nevertheless, Longman told me, “although the VA “took a lickin,’ it kept on tickin'.”

Now, he poses the pivotal question: Will the Obama administration re-commit to VistA? Or will it cave to the “heavy-weight” vendors who hope to reap billions selling hugely expensive proprietary “closed-source” software supporting electronic medical records that won’t be able to talk to each other.(I’ve posted about that danger here.)

Longman hasn’t given up hope. “The Obama administration is sending mixed signals,” he told me.  But he
is encouraged by the legislation that Senator Jay Rockefeller introduced in April, a bill that would subsidize a roll-out of VistA and other open-source software “as a public utility,” that could save taxpayers billions.

Growing the VA

In his new book Longman also describes how the VA might expand. First, he suggests that the VA begin offering care, not just to Vets but to their spouses and children. If a family chooses the VA, family practitioners could treat the problems that vets and their spouses share.

In our conversation, Longman acknowledged that, in many regions, the VA doesn’t currently have the capacity to take on more patients:  “In Florida, Arizona, Nevada, they are strained to the seams. But in Boston, they have more VA hospitals than they need.” And because the VA already knows how to offer better care for less, over time, it would make sense for Washington to use funding already available in the reform legislation to help the VA expand.

Going a step further, Longman suggests that the VA might serve as the “blueprint” for a separate, “civilian VA” that could provide care for a vastly expanded pool of newly insured patients. He envisions an integrated health delivery system that he calls the “VistA Health Care Network.”  This national network would use VistA software. “The VA would help individual doctors, public hospitals and charity care hospitals install the free VistA software,” Longman suggests, “ as long as they would agree to adhere to the VA’s guidelines for evidence-based ‘best practice’ care.”

In Part 2 of this post, I will lay out Longman’s vision for a “civilian VA.” I also will explain what Longman has to say about  the importance of the decision that the VA should treat all  Vietnam vets exposed to Agent Orange—many of whom are now developing Parkinson’s Disease—and the implications for expanding the VA. Finally, I’ll explain why The Best Care Anywhere is being translated into Chinese.  (Hint: China, which owns a huge share of this nation’s debt, has a vested interest in whether we begin to figure out how to rein in runaway health care inflation.)

22 thoughts on “A Salute to the VA on Memorial Day—Part 1

  1. Thanks for sharing! I’m so excited that there are plans to use this fabulous software outside of the VA. I used it as a medical student, and though it’s not perfect it’s a great EMR & far better than the one our hospital has started using. What people don’t seem to understand about EMRs is that, first of all, they are primarily designed for billing, to ensure that the right things are checked off and placed in the right order to ensure the highest level of reimbursement possible. As a result they do not tend to be provider friendly; our EMR adds at least an hour to my day because it’s so poorly designed for the kind of care that I provide as a primary care provider (it’s probably better for specialists who do exactly the same thing with every patient all day). There are a few things that are better (ie no more lost charts, easy ability to access information from off-site, easy to write notes about phone conversations), but the disadvantages outweigh the advantages in my opinion.
    The other problem with EMRs is that we are throwing money at all of these private companies when in fact we have already spent taxpayer money developing VistA. The many EMRs do not talk to each other (in fact, the inpatient EMR and outpatient EMR at my hospital are made by the same COMPANY and don’t talk to each other!) and thus are not suited to the amazing kind of in-depth clinical research the VA has been able to do due to the integration of inpatient, outpatient, and pharmacy data. If we could do the research they do on a nationwide level we could learn an amazing amount; the VA studies tend to be limited by the population that the VA represents.
    Maggie, I hope this gets some attention; I’ve been thinking about this ever since Obama allotted stimulus money for EMR adoption.

  2. V.A. is doing well in many ares, but in the management of type II diabetes they still push the use of the old,ineffedtive sulfonoureas and bolus+insulin regimens that are cheap but do not acheive the control (hgbA1c<6.0 that can be easily obtained using TZds,gliptins, metformin and 24 hour acting insulins. What they save in cost of drugs is increasing costs many fold in increased vascular complications, dialysis and increased hoslpitalization.

  3. Sharon M.D.–
    Yes, yes, yes.
    Everything you say is true.
    You really should write a letter to someone like Jay Rockefeller, or Rosa De Laura (Rep, CT) or try to publish an Op-ed somewhere just saying what you say in this post.
    The vendors have huge clout but the Obamam administration seems willing to hear about VistA, and if docs who have use both VistA and proprietary soft-ware speak out, they could be heard.
    Docs who have used both areally are the people who really are in a position to compare the software.
    Finally, as you say VistA is far from perfect, but it can be improved, and we might better refine it than start from scratch with an overpriced product developed by people who aren’t doctors and really aren’t in a position to understand the realty of using EMRs in a hosptial,an emergency room, a PCP practice.
    Finally, if EMRS can’t talk to each other, we’re wasting a huge amount of money.

  4. b.a. Kottke–
    Thanks for your reply
    I’m really not in a postiion to comment on specific treatments for diabetes.
    But the VA does use the database generated by its electronic medical records to tell it which drugs and treatmens work best for which patients.
    Perhaps the VA hasn’t yet recognized the greater effectiveness of the treatment you mention–or perhaps that treatment work for only a few patients.
    If that’s the case, a VA doctor is always free to go outside the formulary to prescribe something that he belives will work better for a particular patient. He just has to record that he’s going outside the formulary on the chart, so that other docs can see his decision.
    If they disagree, they’ll let him know, and in a collegial way, explain their concerns about the newer treatment.
    He’ll then explain his decisoin. This give and take can be very useful for everyone.

  5. We shall see if vista expands, one only needs to follow the money to see the odds are stacked against it happening. Google, IBM, GE were some of the largest donors to the Obama campaign and all have EMR system and stand to make out very well, Microsoft as well.

  6. Jenga–
    Yes, you’re entirely right.
    That’s why I’m intersted in seeing whether putting some pressure on the Obama adminsitration could tip the scales.
    Longman isn’t naive; he understands the clout that these large player have
    On the other hand, the extraodinary cost of the Health IT they are selling, combined with our very real need for interoperable, affordable medical records is likely to give some (many??) in the administration pause.
    The problem is that the Bush administraiton got the ball rolling in the wrong direction. Already “sunk” investments will be lost if we reverse course.
    Nevertheless, it’s the only sensible thing to do.
    We’ll just have to wait adn see
    Btw, I don’t take a rosy view becuase I wera rose-colored glasses. By tempermament, experience adn training, I’m a skeptic.
    But I’ve learned that when there is a cause to support (and often there isn’t), the most useful thing I can do is to try to make persuasive arguments (and find good evidence) to argue that we can and will do the right thing.
    Too many smart progressives are cynics. It doesn’t really do us any good.

  7. The quality of VA medical care has been praised by the Iraq and Afghanistan Veterans of America (IAVA), an advocacy group, but it has also criticized its claims process. “Some veterans wait up to six months to get their initial VA medical appointment,” reports David Zucchino in a front page story in today’s (6/1) L. A. Times (“Battlefield of red tape”). “The typical veteran of the Iraq or Afghanistan wars waits 110 days for a disability claim to be processed,” he continues, “with a few waiting up to a year. For all veterans, the average wait is 161 days.”
    A ruling on an appeal of a disability rating takes more than 600 days on average. IAVA says the average is 776.
    According to the Times story, the VÅ is “deluged with 90,000 new claims a month,” and the backlog has reached 175,000. One reason: the VA is still using a paper system for claims, but plans to switch to an electronic system by 2012.
    There’s much more at http://www.latimes.com and scroll down to Print Edition.

  8. Tom–
    Good to hear from you And thanks for the link.
    As I mentioned in the post, the Bush adminsitration underfunded the VA for 8 years. (They raised funding during that time, but the number of Vets needing care was rising much faster–Vets returning from Iraq and Afghanisatn as well as aging Vietnam vets. . .
    Also, becaue the VA developed a much better rep in the 1990s, many vets on Medicare who would have gone to Medicare in the 1980s began coming to the VA. This is good– it can give them better care than fee-for-service Medicare, for less. But the Bush adminsitration funding didn’t meet increased demand.
    The result, as I noted in the post above, was long waiting lines.
    The Obama administration has greatly increased fudning, but it will still take time to catch up with the backlog.
    Also, Longman told me that a younger generation of vets are much more open to the idea of getting help with mental health problems-and soldiers coming out of Iraq & Afghanistan suffering from trauma often need this help.
    But the VA just wasn’t staffed to meet the new demand.
    I’m hoping that over the next year we will see shorter waits. (I’m also hoping that we’ll see an end to the wars.)

  9. Thanks for the great post Maggie! I work at a VA medical center in patient safety and I appreciate your praise for the VA system.
    In the post I noticed there was a lot of focus on the VistA system and I can attest to its power;
    this week we began analyzing a year’s worth of medication error data to identify patterns of medication error at our facility. I’m excited for this analysis because it will help illustrate the mechanisms behind our medication errors and will help us design targeted improvements.
    In addition to the VistA system, my medical center also employs Root Cause Analysis (RCA) which is an inter-disciplinary process for investigating all types of errors at our facility. The key aspect of the RCA process is its non-punitive nature. Leading medical error experts like Lucian Leape have identified that the majority of medical errors are not a result of individual negligence but rather, most error is caused by a variety of systemic factors aligning to create a situation where a person will err. In his first book, Complications, Atul Gawande brilliantly illustrates this concept by telling the story of one of his own errors (Part 1 pgs.47-55). The RCA is a powerful process because it transcends individual blame to identify and address the systemic causes of failure at our facility and it is trough the RCA process that we learn and improve. I’m not sure what methods are used in the private sector to address medical error but I can tell you that the private health network I previously worked at (one that is held in high esteem within the local community) had no structured process for learning from error.
    If anyone is interested, here are a few links to VA resources:
    VA National Center for Patient Safety
    http://www.patientsafety.gov/
    VA Health Research and Development Service
    http://www.hsrd.research.va.gov/research/

  10. May I suggest that the accomplishments of the VA are only mildly related to their software. VistA is old software and has the same difficulty as everybody else in communicating with other EHRs. The VA knows that and is planning a complete overhaul and a new version named Aviva http://bit.ly/dy5TlV
    I am familiar with VistA and other large EHRs and when all is said and done they are all pretty clunky. I can see how one can get used to a product after many years of use and consider it superior to a different one. The VA had the advantage of being able to mandate that its physicians use the software. Kaiser, with the same type of arrangement has also achieved pretty much the same with a different piece of software (probably the same one Sharon is using too). Civilian hospitals with non salaried docs are not so lucky.
    I’m not sure what people expect President Obama to do, but I would object to a government effort to force civilian health care organizations to use VistA, Aviva or anything else. Being “open source” does not equate to being free. The major cost associated with an EHR is not the software per se, but the installation, maintenance, support and upgrades. This would amount to many millions of dollars for any given hospital, and there are companies that offer VistA services in this manner.
    The holy grail is interoperability, not open source. ONC is feverishly working to promote and standardize such interoperability and arguably this is the main goal of the stimulus funds for HIT.
    BTW, neither Google nor IBM have any EMR to offer, so whatever their reasons to support the Democratic ticket, selling EMRs wasn’t one of them.

  11. Jenga & Margalilt
    Jenga –Thank you.
    Margalit–
    I read the article you linked to. In it, VA CTO Peter Levin says “VistA’s user interface is arguably the best in any electronic medical record.”
    He also said the “VistA will remain the key component of Aviva.”
    VistA was the centerpiece of the VA’s successful
    overhaul in the 1990s.
    Of course, the VA will continue to improve on it, and Aviva is part of that process.
    But it’s worth noting that VisTA has teamed up with Kaiser Permanente and found a way for VistA to “talk to” Kaisesr’s EMRs. (I’ll be writing about this in part 2.)
    So VistA can be made interoperable.
    VistA is not a “failure”–see comments from readers working with it– though the Bush administration wanted people to think it was: “The Bush Administration starved VistA of development funds, preferring a system of contracts and [for-profit]contractors” –much as they used private contractors in Iraq, over-paying them and wasting billions.
    “Then the reformers and the Obama administration came in. . . They reversed the trend, and proclaimed themselves fans of VisTa and its open-source approach.” Above is from
    http://www.smartplanet.com/technology/blog/rethinking-healthcare/why-open-source-may-win-the-electronic-health-record-market/684/
    Open Source is key.The fact that “AViVA creates an open source platform” means that the “software to be shared with entities outside of VA, creating opportunities for further innovation and development beyond the agency.” See http://ahier.blogspot.com/2010/04/health-it-in-veterans-affairs-open.html
    VistA is far less expensive to install than
    Epic and because its open-source users can refine it and improve it.
    (In the case of “proprietary” software, only the company that owns it can refine it. And that company usually knows very little about healthcare, the needs of clinicians, ERs, etc. VistA was created by Doctors for Doctors.
    For an very readable indepth discussion of the battle between open-source software and proprietary, see this article http://www.washingtonmonthly.com/features/2009/0907.longman.html
    By the way, IBM is now making its product open-source; the Mayo Clinic which has what is probably the best system uses open-source.
    As for the govt forcing civilian hospitals to use VistA (or a new, improved VistA) only 1.5% of US hospitals now have interoperable HIT
    98.5% need something, and it’s looking more and more likely that open source will win the war.
    Finally, IBM etc contributed to the Democrats because it was becoming apparent that they would win. McCain was a very weak candidate. Corporations want to be friends with the people in power, whoever they are.

  12. Maggie,
    That Longman article is so wrong on so many things and uses incorrect terminology and basically the guy doesn’t really know anything about software, so I’m not even try to argue with his content.
    As to VistA, of course it’s not a failure. It is doing a great job for the VA as I’m sure Aviva will do in a few years when it is ready for prime time. I am very happy to see that the VA CTO thinks his product is the best out there. I’m sure every CEO of every software company can sympathize with that feeling.
    Open source software has been around for decades and some very good products have emerged as open source. Most software, however, is not open source. The source code is the only intellectual property a software company has and very few would be willing to part with it. Believe me IBM is not doing any such thing. IBM has always been known to donate bits and pieces to the open source community and then reincorporate the improved product back into their commercial offerings. Nothing has changed there.
    You don’t need to have open source products in order to have interoperability. You only need to let other software vendors know how to communicate with you (APIs or web services specifications). VistA is no more, and no less, capable of communications than Epic or Eclipsys who just recently opened its platform to folks that want to write extensions and add ons for Eclypsis. This is not open source. This is only a published interface and that is all you really need to foster interoperability. EHRs of all sizes communicate all day every day with Labs, Pharmacies, insurers, hospitals, devices, etc. We’re not completely in the dark ages. We just need more doctors on board.
    A more integrated approach is the salesforce.com model. It is not open source, but folks can write little modules to work with the main program. Same for the iPhone – very, very proprietary stuff. Very, very proprietary.
    I love open source. Software developers can get all sorts of good stuff for free and use it to build nice products for half the investment of buying or writing. However, open source does nothing for lay users. They can’t just go in there and make changes just like that, and if they do they will be in dire straits when the open source project releases a new version. It’s not all simple and it’s not all black and white and all hospitals that wrote their own software can make the same changes as the VA can, open source or not. I am also sure that Kaiser has an entire team of Epic developers at their disposal, probably 24×7.
    BTW, about every EMR vendor states that their software was built by doctors for doctors. It’s part of the sales pitch and most times there is a doctor or two amongst the founders and all large vendors employ a multitude of physicians in product design and all have customer advisory boards. “By doctors for doctors” means absolutely nothing. It’s like saying that stents were built by cardiac patients for cardiac patients.

  13. Margalit–
    You write: To say taht VistA was written “By doctors for doctors” means absolutely nothing. It’s like saying that stents were built by cardiac patients for cardiac patients.”
    The analogy doesn’t track. Patients don’t use stents, doctors do. So we need stents designed by doctors who have used stents.
    Similarly, we need EHR designed by docs who deal with health records.
    You suggest that Longman has absolutely no idea what he’s talking about. I really don’t know what to say. His book was very well received. He has written numerous articles about this for Washnington Monthly.
    If he is clueless, one would think that, by now, someone would have pointed
    that out.
    I can well imagine that some people disagree with him on some points, but to say “and basically the guy doesn’t really know anything about software” seems unlikely.

  14. I didn’t want to do this, but here is just a sample:
    “The trend is so powerful that IBM has abandoned its propriety software business model entirely, and now gives its programs away for free while offering support, maintenance, and customization of open-source programs, increasingly including many with health care applications. Apple now shares enough of its code that we see an explosion of homemade “applets” for the iPhone”
    IBM sells lots of software – Websphere, Rational, Cognos, Lotus, Tivoli, DB2, etc. None of these enterprise tools are free and none of them are open source. In fact each and single one is probably the most expensive in its class to the tune of tens of thousands of dollars per CPU. Service and support is extra. Call IBM, Maggie.
    “Applets” are a Java technology. Java used to be open source (not sure what Oracle will do now that they acquired Sun). Apple (which has nothing to do with “applets”) is specifically forbidding iPhone developers to use Java toolkits.
    “Similarly, the IT system at the Mayo Clinic (an open-source one, incidentally)”
    Not at all. Mayo uses Cerner (http://bit.ly/dcw1Jk), the same Cerner that is quoted earlier in the article as the antithesis to efficiency of open source.
    Yes, Mayo and IBM teamed up in an effort to analyze data and placed the code in the public domain (http://bit.ly/ci431x), but that’s all there is to it and it is a far cry from Mayo and IBM opening their source code to anybody. And I could go on, but I think this is a good start.
    Again, Maggie, I am all for open source, but facts are facts and should not be misrepresented, even for a good cause.

  15. Margalit–
    What you quote all comes from Phillip Longman’s “Code Red” piece in Washington Monthly.
    I don’t know him personaly, but Longman is a seasoned, excellent journalist. Washington Monthly is pretty careful about faqcts.
    This doesn’t mean that Longman couldn’t make a msitake, but I would be surprised that no one has poimted ouu so many mistakes in that story. .
    Neverthelest I’m e-mailing Longman to as him to respond to your comments. My guess (and I could be wrong) is that you and he are talking past each toher. In other words, you’re both right but talking about different things.
    In any case, I’m pretty hopeful that Longman will clear this up.
    Finallly– I hate to ask this, and don’t mean it as a hostile question, but just for the sake of full dislcousre, are you in any way involved with, consult for, own stocks or options in the proprietary HIT software that you recnetly wrote about on The Health Care Blog?
    In that post on The Health Care Blog, you also put down the VA’s VistA open-srouce free software.
    Let me stress: I have no reason to think that you are involved with the companies. selling proprietary softare.
    But I think it always helps to clear the air to state any potential conflict of interest.
    Thanks for your comment and taking this issue so seriously.

  16. Margalit–
    What you quote all comes from Phillip Longman’s “Code Red” piece in Washington Monthly.
    I don’t know him personaly, but Longman is a seasoned, excellent journalist. Washington Monthly is pretty careful about faqcts.
    This doesn’t mean that Longman couldn’t make a msitake, but I would be surprised that no one has poimted ouu so many mistakes in that story. .
    Neverthelest I’m e-mailing Longman to as him to respond to your comments. My guess (and I could be wrong) is that you and he are talking past each toher. In other words, you’re both right but talking about different things.
    In any case, I’m pretty hopeful that Longman will clear this up.
    Finallly– I hate to ask this, and don’t mean it as a hostile question, but just for the sake of full dislcousre, are you in any way involved with, consult for, own stocks or options in the proprietary HIT software that you recnetly wrote about on The Health Care Blog?
    In that post on The Health Care Blog, you also put down the VA’s VistA open-srouce free software.
    Let me stress: I have no reason to think that you are involved with the companies. selling proprietary softare.
    But I think it always helps to clear the air to state any potential conflict of interest.
    Thanks for your comment and taking this issue so seriously.

  17. Maggie,
    I have no financial interest, or any other interest, in any proprietary, or non proprietary software or company of any kind.
    I don’t recall putting down VistA. It is just one EMR amongst others. I don’t think it is inherently better or worse, but I do applaud the VA’s plans for a major upgrade (Aviva).
    If we end up with a gem of an open source EHR as a result of the VA effort, I will be very happy.
    I hope Mr. Longman can clarify what could very well be a misprint or misunderstanding.

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>