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OCR Page 1 of 14To: The First Lady
From: Paul A. London
January 6, 1999
Subject: Electronic Medical Records, the VHA System, E Commerce and Related Issues.
Per our conversation at Renaissance, the Veterans Health Administration probably has the best
system of computerized-patient medical records in the world. Better understanding of what VA
is doing in this area could save lives, reduce Medicare and healthcare costs, give the economy
and e commerce a significant boost, show our interest in veterans, and add humanity and texture
to the Administration's interest in technology.
The VA's Decentralized Hospital Computer Program (DHCP) links 160-70 hospitals. Forty to
60 of them already have modernized systems that allow the storage and transmission of records
with graphical images, e.g. X-rays, MRIs, images from a range of "scopes", mammograms,
sonagrams, etc. A few other hospitals, i.e. Women and Brigham/Beth Israel, Columbia
Presbyterian, Northwestern Memorial, the Salt Lake Medical Center, etc. have good systems, and
Kaiser-Permanente is investing about $1.5 billion in a system, but there is nothing like VA.
Healthcare as you know is a $1.1 trillion "industry" where 300,000 medical offices and over
6,000 hospitals are notorious for primitive records and their inability to communicate with each
other and with patients. Healthcare information systems for decades by and large have been
designed to bill Medicare and Medicaid, the insurance companies, and patients, but not to
improve care. It's an outrage.
The lack of modern medical information systems costs thousands of lives every year from
adverse drug interactions, failure to follow best practices, and similar causes. Old ladies walk
around with manila folders. X-rays and MRI's are lost. Everyone has a horror story. As much as
70 percent of the time, doctors don't have a full record when they treat you. Physicians are
grotesquely dependent on information gleened unsystematically from medical journals, meetings,
and drug salesmen, and most patients learn about as much from their mechanics as they do from
their doctors.
McKensie estimated in 1995 based on 1994 data that modern medical information systems could
save $230-270 billion a year. The head of the National Library of Medicine uses a $100 billion
figure. But medical researchers and NGOs do not think of healthcare as an "industry" and do
almost no studies of this incredible "market failure".
Where Could We Go from the VA Base?
- The President, you, the Vice President, Donna Shalala, and Secretary Daley (in his role as
lead in E Commerce) could take press, doctors' groups, business and payor groups, and others
to see these facilities in D.C. and in most other cities around the country. I have talked to
Relations
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