Excellent questions for the VA

I am listening live to a House of Representatives committee interviewing various VA officials. I have heard a couple of questions that are really excellent. My favorite one has to do with Information Technology. My second favorite one has to do with standardization.

Mr. Matkovsky, of the VA, was asked about the current state of Information Technology in the VA. As one Representative commented, the technology being used has been characterized as a 1985 technology. I would disagree, it is actually an early 1990’s technology. But, otherwise, the correct question was asked. After hundreds of millions of dollars have been voted by Congress for IT, we have an old and outmoded IT system. What do I mean?

When the people that I supervise in the Laboratory approve results, they approve the results on a blue screen with white letters. No, it is not DOS, it is Linux on a Windows GUI (note, I am not enough of a geek to say that this is completely correct). There is no modern truly Windowed (or Appled) interface that takes advantage of all the advancements of the last 20 years. Just the opposite is true.

In today’s modern healthcare setting, we have semi-robotic analyzers in the Laboratory that can automatically report normal results. They can not only do that, but, if a patient has been to the hospital before, it can compare the current results to the previous results to see if there is a discrepancy. (For you medical lab folks, this is called delta checking.) If the comparison is not favorable, the results will be held for further review. If the results are not normal, the software will hold the results for further review.

In this way, a Medical Laboratory Scientist can concentrate his/her time in reviewing only the abnormal or discrepant results. This not only provides faster patient results, but actually ensures that the Laboratory Scientist has time to look further into abnormal or discrepant results. Unfortunately, the VA IT system for the Laboratory is unable to allow that to happen. It is an outdated system that prevents rapid results and uses up much of a Laboratory Scientist’s time in “verifying” completely normal non-discrepant results. This type of setup would be totally unacceptable in a non-VA non-DOD healthcare setting.

Dr. Draper, of the VA, also admitted that there is a tremendous reluctance in the VA to standardize policies and procedures. That is a mild way of putting it. There is a saying that floats around the VA, that if you have seen one VA, you have seen one VA. As part of a nationwide e-mail lists of fellow VA Laboratory Managers, I see periodic questions about how to deal with certain technical and contractual subjects. Inevitably, the answers are that in “my” VA we do it this way. Then another will answer with a completely different solution that is allowed at “their” VA. Whether you get to accomplish what you need to accomplish all too often depends on whether you can convince your local folks to allow a certain solution. Appeals to the rules are non-starters as there is a great reluctance in the VA to admit that various national rules apply to a local VA.

Thus, it is not surprising that the VA has some of the problems that are currently on display. Outdated IT systems, insufficient infrastructure, shortage of qualified personnel. All these are true of the current VA.

The VA is not fully guilty. There are many dedicated practitioners, nurses, laboratory scientists, etc., etc., in the VA. I can remember speaking to one psychiatrist as she expressed her frustration that she had trouble fitting in the critical appointments because there are not enough psychiatrists. She is dedicated and will often put in extra time without complaint (and without extra pay, as she is salaried) simply out of concern for people.

I do not know what else to say, but I definitely feel the pain.