Lead the Change
Modern medicine … certainly as it should be practiced by hospitalists, is the most information-intensive activity that human beings ever engaged in,” says Kenneth W. Kizer, MD, MPH, CEO and chairman of the board of Medsphere Systems Corporation in Aliso Viejo, Calif.
He should know. From his first healthcare-related position in 1969 as a hospital orderly at Stanford University Hospital, he rose to become the Under Secretary for Health in the Department of Veterans Affairs (VA)—the CEO of the largest healthcare system in the nation. He is widely credited as being the chief architect and driving force behind the successful transformation of VA healthcare in the 1990s.
The VA’s 154 hospitals and 875 clinics, which serve 5.4 million patients, have been rated “best in class” by a number of independent groups since it implemented the changes in the 1990s.1 In a study conducted by the Rand Corporation, the VA scored higher compared with the U.S. private sector hospitals in every category except acute care, in which “the numbers ran neck and neck,” says Dr. Kizer. “Where the VA has done much better [than private sector hospitals] is in managing chronic disease and integrating prevention and health maintenance into the acute care program.”
Differences between a VA facility and one in the private sector are mostly “cosmetic and in the financing,” says Dr. Kizer. “The VA takes care of a particular patient population—veterans of military service—but it is a civilian practice that happens to be run by the federal government.”
According to a July 17, 2006, article in BusinessWeek, “The Best Medical Care in the U.S.,” the VA system provides about two-thirds of the care protocols recommended by organizations such as the Agency for Healthcare Research and Quality, compared with 50% provided in private sector hospitals.1 Also, as many as 8% of the prescriptions filled in private sector hospitals contain errors, but the VA’s prescription-related accuracy is greater than 99.997%. In addition, the VA spends an average of $5,000 per patient compared with the national average of $6,300.
Dr. Kizer’s focus on quality improvement at the VA should not be surprising in view of his long-time focus on improving the quality of healthcare. In his mind, an essential element in improving the quality of American healthcare is the widespread adoption of electronic health records (EHR).
When he arrived at his post at the VA in 1994, Dr. Kizer was pleasantly surprised to find advanced automated information management in place. The VA had been working on developing an EHR since 1978. As part Kizer’s transformation of the VA, all of the VA’s information systems were integrated, and VistA (an acronym for Veterans Health Information Systems and Technology Architecture) was launched in 1997. VistA is often the first thing that VA-affiliated hospitalists mention when they are asked what distinguishes VA hospitals from non-VA hospitals.
Key Features and Benefits of the VA
Sanjay Saint, MD, knows a great deal about academically affiliated VAs. He was a resident (July 1993-June 1995) and then chief medical resident at the San Francisco VA (June 1995-June 1996), an affiliate of the University of California at San Francisco. He was also a fellow at the University of Washington-affiliated Seattle VA (July 1996-June 1998), and for more than eight years he has been on the faculty at the University of Michigan as a professor of internal medicine (1998-2006). Dr. Saint is currently a hospitalist at the University of Michigan-affiliated Ann Arbor VA Hospital. He was also recently the acting chief of medicine there for six months (Dec. 2005-May 2006) while the permanent chief was on sabbatical.
