Close the gaps on VA healthcare services

By Bernie Monegain
11:21 AM

 "The true number of military personnel injured in Iraq is in the hundreds of thousands  -  maybe even more than half a million  -  if you just go a bit beyond the Pentagon's narrowly-tailored definition of 'wounded in action," writes Dan Froomkin, deputy editor of in a December 2011 piece on the site.

The number of veterans returning home from the two wars wounded and maimed  -  broken  -  is staggering.

Here's an area where health IT has proven to be a force for good, yet not forceful enough. The childhood sing-song rhyme that ends, "All the kings horses and all the king's men couldn't put Humpty Dumpty together again" may not be quite on point, but it keeps playing in the background, a reminder that we humans are fragile. 

The Department of Veterans Affairs (VA), charged with providing patient care and federal benefits to veterans and their families, has been in the forefront of innovation and the use of  healthcare information technology to make a difference in patient care. There's the VA's highly touted VistA open-source EHR, multiple telemedicine programs, and a massive effort towards interoperability.

In his cover story this month, Mike Miliard provides example after example of what VA is doing to make a difference, how the agency is bringing its resources, brains and health information technology to bear on this daunting consequence of war. 

The casualties continue at home. Veterans deal with missing limbs, fractured skulls, traumatic brain injury, post-traumatic stress disorder (PTSD) and the pain takes its toll not only on the veterans who will never be truly themselves again, but also on their families and friends. 

Consider one veteran  -  perhaps not one of those recorded among the "wounded"  -  lying in the snow after having shot four people at a New Year's Eve party, killing a park ranger who got in his way.

Or, take Army Reservist Douglas Barber, 35, who in 2006 told a reporter he spent two years fighting the military to get counseling for what he believed was PTSD. Just days before he shot himself, he wrote: "We cannot stand the memories and [we] decide death is better. We kill ourselves because we are haunted by seeing children killed and families wiped out." 

What about Wolfgang Ward? Ward, a young, wounded former Marine Corps squad leader, told Miliard he wished there was something like Skype he could use to talk with his doctor  -  apparently unaware, like so many others  -  of the VA's widespread telehealth services. 

This is not about the failure of health IT to help. These accounts are of people who had trouble navigating the system, or who came head to head with human error  -  the family member, the intake worker, the doctor, the nurse, who failed to help make the connection to the right treatment, the right care, the right care-giver, the one that might have proven to be life-saving. There's no telling, of course. 

But I have been struck time and time again by a common assertion from IT professionals: "It's not about the technology." CIOs and others repeat this time and time again  -  almost as a chant or mantra.

They are right. It's not about the technology. It's about how the technology helps us to be more human. How it helps us to care for the returning wounded, to move them closer to being whole again  -  with each encounter. The problem  -  at least some of the problem  -  lies in the gaps.

If those who need the help don't know it's available, then it's as if it were not there at all. What a waste of state-of-the-art technology. No number of grants, new outpatient clinics or telehealth programs will matter unless they reach those who need them. Let's close those gaps, boost information on what services are available  -  and where and how  -  and do everything possible to get the word out to the right people at the right time, everywhere they live.