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Friday, March 29, 2013

Jon Stewart Don't Know Squat About Data

This past Wednesday (Mar 27, 2013), the Daily Show included a segment on the backlogs within the VA and found the cause to be
  • The reliance on paper to transfer medical records between the DoD and the VA
So far, so good.  Good investigative reporting.  If they had only left it at that and allowed viewers to form their own conclusions...

Instead, John Stewart made a joke about validating his preconceived ideas concerning Republican responsibility.  He played a clip of a Republican member of the Defense Appropriations committe comparing AHLTA (the DoD healthcare information system) and VistA (the VA's Healthcare Information umbrella) to Play Station and X-Box which, though both can use the same TV, cannot talk to one another.  AND THEN Mr.Stewart suggested that the parent of the household, if he/she wanted to minimize contention and confusion, could impose a single solution on the household.  A photo of President Obama was displayed during this, clearly indicating that all the blame could be laid at the President's feet.

Nothing could be further from the truth.  The VA has been assembling the components of VistA since 1987  and it was fully formed by the late 1990s.  AHLTA was introduced amidst much fanfare at the beginning of 2004.  The birthing process for AHLTA overlapped the adolescence and maturation of VistA, indicating a conscious decision (pre-2004) by the DoD to ignore the VA's efforts.

This entire mess is too complex in its origins and effects to discuss in a single blog entry so I'll content myself with one last piece of exculpatory evidence on behalf of anyone who has assumed elected office since 2004.  The only way to move information from AHLTA to VistA is
  1. Generate paper from AHLTA
  2. Send the paper to the VA
  3. Enter the information from the paper into VistA
This is also the reason why the DoD can't simply replace AHLTA with VistA. 

There is a lot more to be said on this subject but, among other things, it seems clear that this is but one (albeit very painful) example of the inability of our health care "system" to adopt anything approaching a standardized view of the enterprise.  Interoperability is something to be wished for but which cannot exist in an environment in which healthcare systems vendors are the X-Box, the Play Station, and Wii.


  1. Maybe I'm wrong here, but I searched google and found this

    It states very clearly that they both use the same records what's the problem? Couldn't they update them both to include a bulk import/export feature? I'm no software engineer, but this sure sounds like it can be done because:

    "AHLTA and VistA do share significant EHR information"

  2. The document you refer to is something of a marketing publications. You no doubt noticed that the business model of the two databases is different (first question and answer).

    The second answer is the one you point to and I will say only that this looks very similar to other marketing brochures you may have seen. Such documents never (NEVER) state a negative and like this one, usually "answer" a question without ever taking a stand. The actual text is pasted below.
    􀀗 Can AHLTA and VISTA “talk” to each other?
    Yes, AHLTA and VistA do share significant EHR information. The Bidirectional Health Information Exchange (BHIE) allows for information sharing of lab/radiology results, medications, allergies, procedures, problems, encounter notes, other clinical notes, vital signs, drug allergies and anatomic pathology/microbiology lab results.
    The types of information specifically called out as being part of the interface (BHIE) are, in fact, significant but are by no means complete and depending on the actual usage (for example of encounter notes) may or may not be common coin. Note particularly that AHLTA is used for dependents as well as active duty service members. VISTA deals only with the service member. AHLTA uses social security number internally to tag information but an internally generated identifier to make sense of a family's information. That AHLTA specific identifier is meaningless to VISTA and this alone could render the transfer of data extremely difficult if not impossible.