Several days ago, Rear Adm. Ronny Jackson confirmed he will drop out of the confirmation process for the Veterans Affairs secretary position after Donald Trump fired the then-Secretary David Shulkin last month.
Whoever ends up taking the lead in managing the American heroes’ healthcare bears quite a heavy burden, and careful selection, approval, and confirmation process is warranted.
More Than What Meets The Eye?
As a medical student and radiology resident, I rotated through VA medical centers and know its stereotypes. It should come as no surprise that reports of long wait times and delays in follow-up care, particularly for veterans who are older and in rural areas. The Veterans Affairs health system is also large and mired in heavy overhead costs. Recent reports have raised doubts that billions of taxpayer dollars invested in the VA health system have made little progress.
Looking Under the Hood
Our veterans do deserve better, but it is also important to put things in perspective.
Electronic Health Records
The VA was one of the first systems in the country to implement electronic health records (EHR), integrating VistA across all of its systems as early as 2001. Even a full 8 years later, in a 2009 New England Journal of Medicine article, researchers conducting a survey through 3000 hospitals found that only 12% of hospitals had instituted electronic physicians’ notes. The VA was well ahead of its time.
The VA administration recognized the benefits of EHR early a move that both improves the quality and reduces cost – EHR saves money over time, primarily through the elimination of having to repeatedly chart new patients (and obtaining blood work and radiology scans) as they move from one system to another. When a veteran moves from one state to another, VistA allows the new VA provider to access his/her records from the prior site.
The VA was also one of the first to implement a patient-centered web portal, called My HealtheVet, through its VistA backend. Today, when many public and private health systems are still debating whether it’s a good idea for patients to have instantaneous access to their own records, veterans already could review their imaging results, lab data, and order prescription refills and even share their health records with doctors outside of the VA health system. And they’ve been able to do this for years.
Because a significant portion of the veterans population lives in rural areas without ready access to a clinic, and because long wait times may have been the source of much criticism, the VA implemented telemedicine services and provided access to care through a variety of technologies such as text messaging, secure email, and telephone visits for its wide range of patient demographics from veterans of Operation Iraqi Freedom to Word War II survivors.
Emergent research data is showing that connected healthcare technologies such as a well-designed text messaging system can make a measurable impact on patient behavior.
Not All VAMCs Are Built the Same
The VA system is also heterogeneous in its quality. What I remember as a medical student and what ends up on CNN, MSNBC, or FoxNews are likely outliers. “Rather cost-effective, quite good quality” care doesn’t make it to our memory, and certainly doesn’t excite Anderson Cooper. The executive branch keeps an ongoing conscious effort to measure quality at the VA using a star system. Some VA systems are as good as any tertiary academic center, while some are in need of an overhaul. Before we make broad, sweeping statements about the VA health system, it is important to think about its internal variations.
With Rear Adm. Ronny Jackson dropping out of the confirmation process, a new candidate would be taking his place. The problems of VA health system is in part due to its sheer size and internal variations. The VA also has a long history of innovation – partly out of the necessity of its ever-increasing cost and partly due to its forward-thinking leadership – that deserves the best leader it can find.