On Thursday, January 23, 2003, at 09:28 AM, Wayne Wilson wrote:
Let's further say that an all electronic system requires more
physician time spent on data input/patient.
At the VA I think this is simply not true. The people who rave about
it are not geeks or especially workaholic.
Then, as a physician, the economic incentive is to see more patients
and that might mean spending less time/patient doing data input.
Data capture in the VistA system, in the case of raw text (and I
believe they have minimized that as much as possible) is keyboard. But
I believe that an option is dictation with transcription into the
system. The latter is the least common denominator for all physicians.
If this scenario is true (and if not at the VA, then perhaps in other
central payor systems where physicians are on salary, which I believe
exist in other parts of the world, Europe perhaps?) and the behavior
is as I describe for both systems and people, then one could conclude
that software developed in one incentive model will not work well in
the other incentive model.
If government said, "Adopt VistA. It works and we're sick of waiting
and watching people die," then differential uptake would not be an
issue. I'm all in favor of nurturing competition and reaping the
benefits of competition in a capitalist society, but one of the
underlying themes of this list is that when government steps aside what
results is not always in everyone's interest. Windows is a fine
operating system that resulted from a competitive environment. I hope
that will not be the model for medicine. I would also add that GSM is
an acceptable cell phone standard that permits a great deal of data
transfer options and has been a standard throughout Europe for awhile.
The US however uses a number of different standards none of which is as
good as GSM. But we have competition and are waiting gleefully to see
the benefits it will bring.
