healthy4u: Veterans Administration medical scandal

Sham Peer Review Issue Goes Mainstream. WaPo: VA Physicians Fear Sham Peer Review

The paper's words this time, not mine: From the Washington Post, "VA docs concerned about retaliation", June 12, 2014, <a href="http://www.washingtonpost.com/blogs/federal-eye/wp/2014/06/12/va-docs-concerned-about-retaliation/">http://www.washingtonpost.com/blogs/federal-eye/wp/2014/06/12/va-docs-concerned-about-retaliation/</a>: <blockquote class="tr_bq">Retaliation from management is a real concern among <a href="http://www.va.gov/">Department of Veteran Affairs </a>(VA)  employees ...  James Martin, a physician and a representative of the American Federation of Government Employees National VA Council, told the gathering  that sham peer reviews are a problem in the department. In a later interview, he elaborated, saying, “orchestration of facts” related to issues involving contact with patients [in other words, fabricating stories about substandard patient treatment by physicians, cherry-picking minor incidents and exaggerating them, etc. - ed.] is an issue at some facilities.” Sham reviews, he explained, can be used when management wants to replace or punish a doctor. Retaliation against employee whistleblowers was again the subject of discussion during Thursday’s <a href="http://veterans.house.gov/hearing/an-examination-of-bureaucratic-barriers-to-care-for-veterans">hearing</a> of the House Veterans Affairs Committee.</blockquote> Further amplifying the point: <blockquote class="tr_bq"> ... During the hearing, Republicans Jeff Miller (Fla.) and Dan Benishek (Mich.), both of whom spoke to the NAVAPD conference, asked Robert L. Jesse, the department’s acting under secretary for health, about reports that VA employees were instructed not to talk with members of Congress. Benishek, a physician and former VA employee, said agency doctors have told him they are “reprimanded and have this retribution if they try to change the system.” </blockquote> Read the whole article at the link above. Then, read more on sham peer review at the American Association of Physicians and Surgeons (AAPS) resource site at <a href="http://www.aapsonline.org/index.php/article/sham_peer_review_resources_physicians/">http://www.aapsonline.org/index.php/article/sham_peer_review_resources_physicians/</a>. A typical scenario is described like this: A conscientious doctor reports a quality care problem or patient safety problem to the hospital administration. This might be anything from an anesthesiologist falling asleep during surgery to a malfunctioning piece of equipment which places patients at risk for harm. <blockquote class="tr_bq">Instead of fixing the problem, some hospitals misuse the peer review process to attack and silence the physician whistleblower. The hospital administration and unethical physician collaborators then search for some pretext upon which to attack the physician whistleblower. This might involve the hospital bringing trumped up charges against the physician or it might involve bringing totally false and/or fabricated charges against the physician. The truth and the facts do not matter in a sham peer review in the hospital since the hospital controls the entire process. The hospital then goes through the motions of providing a hearing to the accused physician, which they call “fair,” yet the outcome of the hearing is predetermined. The physician’s due process rights are often utterly trampled. At the conclusion of the process, the physician’s privileges to practice at the hospital are terminated. The physician is reported to the National Practitioner Data Bank, and the physician’s career is essentially over. Once a physician receives a negative report in the National Practitioner Data Bank, it is unlikely that physician will ever work in any hospital again anywhere in the nation. </blockquote> Sham peer view affects all physicians, not just public-sector ones. It does not help patients when physicians, their supposed advocates, are cowering in fear over destruction of their careers for being "whistleblowers" (for which a better term might be "corporate integrity agents"). Finally, I think this fear helps explain the relatively low levels of complaints about bad health IT, on which hospital executives invest billions of dollars and their reputations. -- SS

Sham Peer Review Issue Goes Mainstream. WaPo: VA Physicians Fear Sham Peer Review

The paper's words this time, not mine:From the Washington Post, "VA docs concerned about retaliation", June 12, 2014, http://www.washingtonpost.com/blogs/federal-eye/wp/2014/06/12/va-docs-concerned-ab…

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13 Jun 2014

EHR Exceptionalism Debunked: Care Quality Variances Among VA Hospitals, Perhaps The Most Wired Hospitals in the World, Suggest the True Value of Information Technology in Healthcare Has Been Grossly Exaggerated

The Wall Street Journal somehow managed to get access to internal VA patient care quality data and published the following article: <blockquote class="tr_bq"> <a href="http://online.wsj.com/articles/veterans-affairs-hospitals-vary-widely-in-patient-care-1401753437">http://online.wsj.com/articles/veterans-affairs-hospitals-vary-widely-in-patient-care-1401753437</a></blockquote><blockquote>Veterans Affairs Hospitals Vary Widely in Patient Care Internal Records Show Facilities Such as Phoenix Have Far Higher Death Rates Than Peers Thomas M. Burton and Damian Paletta June 3, 2014 The Phoenix facility at the heart of the crisis at the Department of Veterans Affairs is among a number of VA hospitals that show significantly higher rates of mortality and dangerous infections than the agency's top-tier hospitals, internal records show. The criticism that precipitated last week's resignation of VA Secretary Eric Shinseki has focused largely on excessive wait times for appointments across the VA's 150-hospital medical system. But a detailed tabulation of outcomes at a dozen VA hospitals made available to The Wall Street Journal illustrates a deeper challenge: vastly disparate treatment results and what some VA doctors contend is the slippage of quality in recent years at some VA facilities. Some of the discrepancies are stark, especially for an agency known for offering high-quality care in 50 states.</blockquote> Yet, these are highly wired hospitals, perhaps the most highly wired in the world, with one EHR, VistA CPRS, allegedly among the best EHRs in the world developed over decades, and allegedly used by 100% of the clinicians. How can this be?  <blockquote class="tr_bq">... Scott McRoberts, spokesman for the Phoenix VA Health Care System, said on Monday the database "is an internal measurement system to benchmark our improvement, and is not for public consumption." The rate of potentially lethal bloodstream infections from central-intravenous lines was more than 11 times as high among patients at the Phoenix facility than it was at top VA hospitals, data from the year ended March 31, 2014, show. ... The findings come from a nonpublic VA database called Strategic Analytics for Improvement and Learning, known as SAIL. SAIL tracks procedure outcomes and ranks VA hospitals on a scale of five stars, the best, to one star, the lowest. ... In other examples of variations in care, the Atlanta VA Medical Center, a two-star hospital for quality, has more than three times the rate of central-IV infections than the average of five-star VA hospitals. Houston's VA hospital, ranked as a two-star hospital, had a 47% higher acute-care mortality rate than the five-star hospital rate.</blockquote> A 47% higher acute-care mortality rate? Hospitals are willing to go into tens of millions of dollars of debt and knowingly endanger patients (see e.g. "In Fixing Those 9,553 EHR "Issues", Southern Arizona’s Largest Health Network is $28.5 Million In The Red" at <a href="http://hcrenewal.blogspot.com/2014/06/in-fixing-those-9553-ehr-issues.html">http://hcrenewal.blogspot.com/2014/06/in-fixing-those-9553-ehr-issues.html</a>), and even attempt to stifle clinician conversation on drawbacks (e.g. see "Words that Work" at <a href="http://hcrenewal.blogspot.com/2013/10/words-that-work-singing-only-positive.html">http://hcrenewal.blogspot.com/2013/10/words-that-work-singing-only-positive.html</a>), to attain this technology on the stated reason of "improving patient safety" and "saving money." Former ONC Chair Blumenthal stated explicitly in the NEJM article "The 'Meaningful Use' Regulation for Electronic Health Records", Blumenthal and Tavenner (10.1056/NEJMp1006114, July 13, 2010): <div class="PlainText" style="font-family: arial;"> </div><blockquote dir="ltr" style="font-family: arial; margin-right: 0px;"><div class="PlainText">... EHRs will improve caregivers’ decisions and patients’ outcomes. Once patients experience the benefits of this technology, they will demand nothing less from their providers. </div></blockquote> There is no doubt expressed there. The industry itself has convinced the Federal Government to spend tens of billions of taxpayer dollars on this technology via HITECH incentives, and to start penalizing non-adopters via Medicare cuts.  The Government has bought into the hyper-enthusiasm hook, line and sinker, when the same money might have been spent elsewhere such as on care of the underserved...or on our Veterans. Yet the data from a highly-computerized organization like the VA show that these systems cannot be all they are made out to be.  They do not automatically "improve caregivers' decisions and patients' outcomes." This is an on its face observation. They are simply a tool, and in absence of appropriate human staffing, expertise, and conducive work environment, they mean significantly "less than advertised" in terms of improving care quality and outcomes.  Finally, as the VA has gotten busier due to factors such as the return of veterans from recent wars, one must also ask if the loss of productivity, cognitive burden, and other factors caused by needing to interact with a computer rather than paper has made the computer systems more of an impediment to good care rather than a facilitating tool. I think it's time the Government start to reform the industry hype surrounding this technology with far more sober predictions that would facilitate far more cautious implementations. No "revolutions" are happening soon, at least not due to information technology in healthcare. Finally, note that EHR oversell and exceptionalism has been going on for decades.   Donald A. B. Lindberg M.D. (<a href="http://www.nlm.nih.gov/od/roster/lindberg.html">http://www.nlm.nih.gov/od/roster/lindberg.html</a>), Medical Informatics pioneer and Director of the U.S. National Library of Medicine at NIH, observed in 1969 that: <blockquote class="tr_bq"> "The [second] reason for the dearth of significant success of computers in medicine has been the flagrant and consistent "over sell" of capability on the part of manufacturers and computer enthusiasts."  </blockquote> Read his full quote by clicking on the page below, from Morris Collen's book "<a href="http://www.amazon.com/History-Medical-Informatics-United-States/dp/0964774305">A History of Medical Informatics in the United States: 1950 to 1990</a>." <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrRIuVMu4XQOTRYpbyXb2-IXrnM019VAdbzcR3D8wVVCDQtXDkhG6UlZTWtBpmUKH7s4QnIHjxuyp65kccko4iKwx6nGV3Cxu8kZ75Fss742dcTMln77zZw4tJOu25MXPfH9Oq1F-i5egc/s1600/collen168.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrRIuVMu4XQOTRYpbyXb2-IXrnM019VAdbzcR3D8wVVCDQtXDkhG6UlZTWtBpmUKH7s4QnIHjxuyp65kccko4iKwx6nGV3Cxu8kZ75Fss742dcTMln77zZw4tJOu25MXPfH9Oq1F-i5egc/s1600/collen168.jpg" width="263" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Informatics pioneer Dr. Donald Lindberg's 1969 observations on health IT oversell.  Click to enlarge.</td></tr></tbody></table> Sadly, nothing has changed in health IT, at least since the year we landed on the Moon. -- SS

EHR Exceptionalism Debunked: Care Quality Variances Among VA Hospitals, Perhaps The Most Wired Hospitals in the World, Suggest the True Value of Information Technology in Healthcare Has Been Grossly Exaggerated

The Wall Street Journal somehow managed to get access to internal VA patient care quality data and published the following article:http://online.wsj.com/articles/veterans-affairs-hospitals-vary-widely…

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05 Jun 2014

"Texas VA Run Like a ‘Crime Syndicate,’ Whistleblower Says" - Can Reports About the Benefits of EHRs at the VA Healthcare System Be Trusted?

More and more is leaking out about alleged executive malfeasance at the Veteran's Administration healthcare system in the U.S. This article just appeared: <blockquote class="tr_bq">Texas VA Run Like a ‘Crime Syndicate,’ Whistleblower Says May 27, 2014 <a href="http://www.thedailybeast.com/articles/2014/05/27/exclusive-texas-va-run-like-a-crime-syndicate-whistleblower-says.html">http://www.thedailybeast.com/articles/2014/05/27/exclusive-texas-va-run-like-a-crime-syndicate-whistleblower-says.html</a> For years, employees at a Texas VA complained that their bosses were cooking the books. For years, the VA insisted there was no widespread wrongdoing. New whistleblower testimony and internal documents implicate an award-winning VA hospital in Texas in widespread wrongdoing—and what appears to be systemic fraud. Emails and VA memos obtained exclusively by The Daily Beast provide what is among the most comprehensive accounts yet of how high-level VA hospital employees conspired to game the system. It shows not only how they manipulated hospital wait lists but why—to cover up the weeks and months veterans spent waiting for needed medical care. If those lag times had been revealed, it would have threatened the executives’ bonus pay. What’s worse, the documents show the wrongdoing going unpunished for years, even after it was repeatedly reported to local and national VA authorities. That indicates a new troubling angle to the VA scandal: that the much touted investigations may be incapable of finding violations that are hiding in plain sight.  “For lack of a better term, you’ve got an organized crime syndicate,” a whistleblower who works in the Texas VA told The Daily Beast. “People up on top are suddenly afraid they may actually be prosecuted and they’re pressuring the little guys down below to cover it all up.”</blockquote> Read the linked article in its entirety.  It contains document images of altered electronic orders, the EHR system apparently being used for "creative storytelling" to allow for "good metrics", and an employee "performance plan" evaluation submitted by a whistleblower containing perverse incentives: <blockquote class="tr_bq"><a href="https://www.documentcloud.org/documents/1174555-4-performanceobjs.html" target="_blank">... The VA’s 2012 performance plan</a>, provided to The Daily Beast by the whistleblower, contains five critical elements to evaluate success, each one containing multiple sub-criteria. But critical element No. 5, the “Results Driven” component that contains the “wait time” criteria, is worth 50% of the overall score. That’s as much as all the other elements combined.</blockquote> I won't delve into the gory details of the article further...read it yourself...but I do raise the following issues: 1.  The VA EHR system VistA CPRS has been touted as among the best EHR's in the world, based on reports that come out of the VA. <ul><li>Can these reports on the benefits and safety of VistA CPRS be trusted, considering what may be going on systemically regarding altered data related to "making the numbers" and getting bonuses? </li></ul><ul><li>It is well known that EHRs slow clinicians down, through annoying alerts and reminders and other decision support, cryptic and complex order-entry processes, and the general need to navigate multiples screens and templates to perform what used to take seconds on pen and paper.   Is it also possible that the inability of the VA system to meet its care obligations in a timely manner is related to adverse effects on productivity of the EHR system itself?</li></ul> 2.  EHR audit trails are an automatically-generated log of user activities, such as viewing, printing, altering or deleting an electronic document or other data.  They are the only way to authenticate an electronic record as complete and unaltered, since all paper/handwriting cues are gone in the computer world. <ul><li>It may be of interest to investigate the electronic audit trails generated by the VA electronic health records (EHRs)... or the lack thereof, for as I understand it those audit trails are often only active for VIPs ("very important persons") in the VA VistA CPRS EHR system. </li></ul><ul><li>Even worse, in the commercial sector hospitals admit they can alter or delete the EHR system audit trails - see my post at <a href="http://hcrenewal.blogspot.com/2013/12/44-of-hospitals-reported-to-oig-that.html">http://hcrenewal.blogspot.com/2013/12/44-of-hospitals-reported-to-oig-that.html</a>.  It's likely the same applies in the VA, and it would be of concern that any audit trails of test and visit scheduling or other activities could be undergoing a "disappearing act" in the wake of this scandal, in addition to the actual test/scheduling data itself.</li></ul> It is unfortunate that this scandal sheds doubt on claims made about activities, including EHR use, at the VA hospitals.  I myself have taught my students that the VA model has been a model for others to emulate, at least as far as EHRs are concerned. ------------- As an important aside: I am personally familiar with very odd events at the VA, namely in 1995.  At <a href="http://hcrenewal.blogspot.com/2009/06/computer-and-other-mysteries-at.html">http://hcrenewal.blogspot.com/2009/06/computer-and-other-mysteries-at.html</a> regarding the computer-related radiation brachytherapy debacle at the Philadelphia VA Hospital I wrote [and I am adding some additional comments now in brackets]: <blockquote class="tr_bq">... I have some familiarity with odd events at the Philadelphia VA Hospital. (Not including the fact that I spent a few months there as a medical intern in the early 1980's). In the mid 1990's I took my father there for evaluation for increased service-related disability. He had been treated for skin lesions in the Army in WW2 and after by the VA with <a href="http://en.wikipedia.org/wiki/Fowler%27s_solution">Fowler's solution</a> (an arsenical) and as a consequence of this (even then-outdated and dangerous) treatment, had developed widespread basal cell carcinomatosis over a major portion of his body, with chronic bleeding and discomfort. I accompanied my father to the exam but did not identify myself as an MD, only as his son. [I was on vacation and was rather casually dressed.  I looked like any other schlep bringing his elderly veteran father in for care.] My father was seen in an evaluation by several physicians and students (arsenic-caused basal cell carcinomatosis is quite rare now) in my presence, and he was then handed his (paper) chart to take with him back to the main desk.  [As we were walking] I told my dad I wanted to look at the note. The note by a physician who'd seen him stated (paraphrasing): <blockquote class="tr_bq">"Mr. Silverstein said he'd taken more than the prescribed dose of arsenic for years, and even shared it with his wife."</blockquote> My father and I were shocked and dumbfounded. He'd said no such thing, and being a retired pharmacist of 40+ years, thought anyone making such a statement would have had to have been insane. (My mother had even harsher words when she heard about this.) [Along the lines of, "ARE THEY CRAZY???"] Needless to say, I was upset. I [identified myself and] confronted the physician who wrote the note, but that physician [a relatively young woman] would not change it, bizarrely claiming that they "remembered my father telling that story in a visit several years prior." Needless to say, such a claim violated all the precepts of medical information integrity of which I was familiar.  [I wondered to myself, "what type of utter imbecile would even say such a thing to a Yale physician/medical informatics faculty member?"] In an initial attempt to counteract this disability exam sabotage, I actually crossed out the statement in the chart, writing "this is untrue" or words to that effect and signed my own name. The head of the Philadelphia VA Hospital would not return my calls on this matter. That is, until <a href="http://en.wikipedia.org/wiki/Jesse_Brown">Jesse Brown, then Secretary of the Department of Veterans' Affairs</a>, inquired directly a few days later. Unknown to the VA examiners, my father had been sent for the disability exam after reporting problems to Sen. Jay Rockefeller's office about prolonged delays in having his case heard.  Sen. Rockefeller's staff [specifically, Ms. Charlotte Moreland, <a href="http://votesmart.org/public-statement/25153/retirement-of-charlotte-moreland">http://votesmart.org/public-statement/25153/retirement-of-charlotte-moreland</a>, who my mother had befriended through many telephone conversations] had set up the exam! Sen. Rockefeller's staff was rather upset at the story I reported upon my return to New Haven about the bizarre chart fabrication at my father's VA disability exam, and apparently relayed the story up the chain of command, as it were. After that, the head of the Philadelphia VA Hospital really, really wanted to speak to me and called me at Yale several times. He wanted to set up a phone conference between me, himself, and the doctors who'd seen my father. I told his administrative assistant that there was "nothing to talk about", and that the false statement in my father's chart would be removed. Period. I think it was. My father's increased disability was granted in the end, but what was going on here with disability exams was never fully investigated to my knowledge (having done disability exams myself years prior for the regional transit authority, police, fire etc. in Philadelphia, I suspected an "incentive" program to deny vets a disability determination). If I had not examined my father's chart, we might have never known a reason for his being turned down. A culture of honesty and accountability seemed lacking then, and seems lacking now.</blockquote> In retrospect, it seems there may indeed have been an "incentive program" for, in essence, limiting positive disability determinations by sabotage, thus causing negative determinations on benefits. Ironically, among other experiences, it was the impoverished experiences at the Phila. VA as an intern in 1981, with a decade of computer experience under my belt at that time, that led me to pursue a career in Medical Informatics. With inadequate staff and resources, especially at night when a medical student and I and a minimum of nurses covered something like 50 patients - and at that early stage of my career I am honestly admitting that I did not know what I was doing, really - and large amounts of time wasted on paperwork, I thought there had to be a better way via computing. I never expected that computers in medicine could become a tool for "creative data alteration" for executive enrichment, an impediment to good care, and a risk in and of itself, as was outed by a whistleblower recently in Athens, Georgia as at <a href="http://hcrenewal.blogspot.com/2014/05/i-could-not-make-this-up-if-i-tried.html">http://hcrenewal.blogspot.com/2014/05/i-could-not-make-this-up-if-i-tried.html</a>. -- SS May 28, 2014 Addendum:   Also see "How VA Clinics Falsified Appointment Records" at <a href="http://www.huffingtonpost.com/2014/05/28/va-clinics-falsified-records_n_5402547.html">http://www.huffingtonpost.com/2014/05/28/va-clinics-falsified-records_n_5402547.html</a> -- SS

"Texas VA Run Like a ‘Crime Syndicate,’ Whistleblower Says" - Can Reports About the Benefits of EHRs at the VA Healthcare System Be Trusted?

More and more is leaking out about alleged executive malfeasance at the Veteran's Administration healthcare system in the U.S.This article just appeared:Texas VA Run Like a ‘Crime Syndicate,’ Whistleb…

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28 May 2014

A very short observation on EHRs and the Veterans Administration healthcare scandal

As has been in the news lately, it has been revealed that U.S. veterans' medical care was being delayed at a number of Veteran's Administration-run hospitals, perhaps many others as well not yet known. A timeline for the Veterans Administration medical scandal is here:  <a href="http://www.usatoday.com/story/news/politics/2014/05/21/veterans-healthcare-scandal-shinseki-timeline/9373227/">http://www.usatoday.com/story/news/politics/2014/05/21/veterans-healthcare-scandal-shinseki-timeline/9373227/</a> <blockquote class="tr_bq">The Obama administration is facing a serious scandal in which government officials are alleged to have falsified data to hide how long veterans were waiting to see doctors at VA hospitals. The controversy has led to calls for the resignation of Veterans Affairs Secretary Eric Shinseki, who has served for five years. Here is a timeline of events leading up to the current situation, which President Obama on Wednesday called "intolerable" and "disgraceful."</blockquote> I will not comment on the issues per se. I will only make this pithy observation: The VA system possesses the best electronic medical records systems in the world, VistA CPRS, and is unhampered by EHR sellers' issues and agendas as the VA created it themselves over decades.  You can even download VistA CPRS and explore it with fictitious patients and medical data from test servers set up for that purpose, at <a href="http://www.ehealth.va.gov/EHEALTH/CPRS_demo.asp">http://www.ehealth.va.gov/EHEALTH/CPRS_demo.asp</a>. EHR's and other clinical IT, according to not-very-impartial organizations such as the industry trade group HIMSS, the sellers themselves, and a whole cadre of pundits highly invested in the technology and its implementation, are purportedly going to "revolutionize" medicine (rather than the somewhat less grandiose purpose of merely facilitating clinicians in providing better care). The "revolution" includes reducing the need for human resources, increasing efficiency, saving gobs of money, and according to one billionaire, allowing a small group of doctors to remotely manage the care for an entire city's patients.  (See my Jan. 20, 2014 post "Computers + a few docs can manage 'an entire city', and other cybernetic miracles" at <a href="http://hcrenewal.blogspot.com/2014/01/computers-few-docs-can-manage-entire.html">http://hcrenewal.blogspot.com/2014/01/computers-few-docs-can-manage-entire.html</a>; I am not making that up.) Yet here we have the VA, highly computerized - but instead of being the medical utopia promised by the information technology hyperenthusiasts, the VA is unable to even guarantee patients a two-week waiting period for care, with delays leading to possible patient injuries and deaths. Thus, to those who promote the meme that spending hundreds of billions of dollars on this technology will 'revolutionize' medicine, increase "efficiency", reduce errors, reduce costs etc. and realize all the other fantastical claims made for the technology, I say, "sure, and I have a bridge for sale in Brooklyn." <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhA3XNDg0DloxZAjRbNKM7INHWPOgAkdnazZOqRu1PYqgvv-QgjncHQDCyIeejK7jIGyQsOoDh3TpeQ_Ql6ezFNIzIRgUrTKTdWiX2D2Mz6CQ4ha5K74uE8Ww7Cxk3WU6zaY3gLwkbB-kH2/s1600/Brooklyn_Bridge_Postdlf.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="161" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhA3XNDg0DloxZAjRbNKM7INHWPOgAkdnazZOqRu1PYqgvv-QgjncHQDCyIeejK7jIGyQsOoDh3TpeQ_Ql6ezFNIzIRgUrTKTdWiX2D2Mz6CQ4ha5K74uE8Ww7Cxk3WU6zaY3gLwkbB-kH2/s1600/Brooklyn_Bridge_Postdlf.jpg" width="200" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">This bridge at <a href="https://www.google.com/search?q=40.7057%C2%B0+N%2C+73.9964%C2%B0+W">40.7057° N, 73.9964° W</a> is for sale to the highest-bidding hospital.  Its purchase, plus a few hundreds of millions of dollars of IT thrown into the bargain, will revolutionize healthcare at the lucky hospital with the winning bid.</td></tr></tbody></table>  -- SS

A very short observation on EHRs and the Veterans Administration healthcare scandal

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22 May 2014

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