Lessons from the VA: what you can learn from someone else’s problems

For all their problems, Veterans Affairs medical centers across the country are at the vanguard of the implementation of electronic health records. As such, there is a lot to learn from the problems that the VA system has experienced in this area. According to an article in the March 4, 2009 Journal of the American Medical Association, the problems experienced by the VA include mixed-up patient names and missing medication orders. These types of problems are probably endemic in any EHR system.  (This very point was made by Drs. Jerome Groopman and Pamela Hartzband in their March 12, 2009 Wall Street Journal op-ed.) Given these built-in weaknesses, frequent auditing of records, with strong and persistent audit trails, are a vital component to any EHR system.  Also, communications between all levels of workers in the care setting are important, to provide similar feedback.  The VA has adopted these mechanisms as part of its EHR systems. VA health care workers are encouraged to report problems with the electronic medical record systems, and those reports are closely monitored. Ironically, this may be why we hear so much about the VA’s issues – they are finding problems that others have in their data systems, but do not yet know about.