Way back in the day, in the 1990s, one of the best health medical record system belonged to the Veterans Administration. That once creaky, decrepit institution where veterans feared they'd exit a hospital stay missing one or more limbs, had miraculously re-invented itself as a leader of comprehensive health care with the best medical record system around. More than 60% of US physicians trained at least partially at a VA and uniformly boasted about the VISTA computer record system for patients. Sitting at a terminal, any nurse, respiratory tech, lab tech, or physician could see all the notes, x-rays, EKGs, lab results and put in new orders.
Flash forward to the 2010s and we see now an incredibly complex system of electronic medical records (EMRs) available to all private and public hospitals - and even to the VA. Since I don't currently work at a VA hospital, a google search of the current EMRs in use at the VA and throughout the Military Health System (MHS) reveals the following programs: AHLTA, Clinicomp/Essentris, along with the original VISTA. And then there's the failed $150 million VA patient scheduling system along with the possibility that ALTHA, implemented in 2004, could also be soon declared a failure.
WTF? How did we get from the early successes to these failures? And does this portend doom for the Obamacare website, which completely failed its premier? Yes - if the current development models continue to be used. Hiring different companies and using off-the-shelf tools will lead to failure. One of the reasons the VA health system worked is because there was no top-down model. Individual pharmacists, nurses and doctors took it upon themselves to write open-source code in guerrila style:
VistA was not developed as an “approved” project. It was developed as a kind of rebellion against the backward software that was available at the time and a rebellion against the backward ideas held by VA bureaucracy. This rebellion was called the “underground railroad” among VistA insiders.
In fact, when it finally did become top-down, it started to rot and gave us the hot mess we have now:
Once the VA approved the project and started managing the software development using top-down practices, everything slowed to a crawl.
So going back to its guerrilla-like roots and to open-source should drastically improve the overall function of the VA EMRs. In the same vein, 'guerrilla-like' websites like thehealthsherpa.com give a way forward to the Obamacare people. Give out parcels of the project, make it open-source code and give the crowd a way to make it work. Working in a top-down or closed environment, with off-the-shelf products will lead to further failure. Doing the opposite will give the website a glimmer of hope.