Last month I wrote a post highlighting a truly boneheaded development in the Department of Defense (DoD): the introduction of AHLTA, a new system of electronic medical records for the military. Usually I’m a big fan of electronic medical records (EMRs), but not in this case  AHLTA is an entirely new system built by military contractors and funded by taxpayer dollars. Its mere existence is wasteful, because the military has long had a high-quality health care IT system in place called VistA, the Veteran Administration’s (VA) EMR system. And VistA  could have served as a very efficient foundation for modernize military health records. 

As I’ve mentioned in the past, VistA has quite a lot going for it: the VA has improved productivity by 6 percent a year since it was implemented in VA hospitals nation-wide; VistA has helped the VA cut its health care costs by 32 percent since 1996; and the VistA computerized prescription system is incredibly accurate, correctly matching patients and medication 99.997 percent of the time. It makes little sense to ignore this homegrown asset when setting out to build a broader DoD EMR system. Worse still, AHLTA can’t even communicate with VistA, adding a new layer of dysfunction to the military’s IT development.

This is all incredibly foolish, but maybe the real kicker is that AHLTA is proving a total failure. Not only is it a waste from an IT development stand-point, but it’s also proven to be a hindrance to the very military clinicians whom it’s supposed to be helping.

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Over at Kevin M.D.’s excellent website, The Happy Hospitalist recently posted a “Reader’s Take” on Medicare that sparked  a fierce debate.

The Happy Hospitalist began by pointing out, rightly, that Medicare is approaching a financial crisis:  “On March 25, 2008 the Boards of Trustees released their Annual Report of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. In this 43rd edition, the Trustees note [Medicare is] a government program covering just over 44 million people at an expense of $425 billion dollars during 2007. That equates to approximately $10,000 per beneficiary.

“Ten thousand bucks. A cost accelerating at an unsustainable rate”

This is entirely true.  If we continue in our profligate ways, Medicare will break the bank. But then Happy Hospitalist explained his solution:

“The appropriate course of action should be a radically new approach to the Medicare entitlement program…A restructuring of the program towards a transparent means based qualification system is necessary. Having Uncle Sam pay for an elective cataract surgery so grandma can go on an African safari is inexcusable in a time of financial collapse.”

Often I agree with The Happy Hospitalist. But on this point, I cannot.

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