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Ken Kizer is the miracle man of U.S. health care. Mr. Kizer brought in bold reform that transformed the vast and woeful Veterans Health Administration into an efficient, effective model institution with sky-high patient satisfaction. Starting in 1994, it took him five years to reduce costs and increase quality of care, while nearly doubling the number of patients.

The measurable results included a reduction in medication errors and patient deaths.

"What's wrong with expecting the government to do a good job?" he would ask those professing amazement at the change.

Key to the VHA's stunning improvement was the implementation of easily accessible electronic health records (EHRs).

What's so great about electronic health records?

It allows you to have all the information you need when you're actually face to face with the patient. It allows you to track and monitor performance and what should be done. Instead of sitting there and reciting a bunch of numbers to a patient, you can show them a single coloured graph that shows - for a diabetic, say - all their hemoglobin A1c readings for the last three years. And so much more. It changes the dialogue. It changes the way health care is provided.

What happened when you instituted them at VHA?

... It would be less than honest to say that it wasn't stressful and there wasn't some fallout. We lost between five to 10 per cent of our physicians.

Are there any downsides?

There are obviously risks of information leakage, although there are technical ways to prevent that happening. And you have to remember that EHR is just a tool. The real way it improves care is by making you focus on improving the process of care. If you automate a bunch of lousy processes, then you just get automated lousy processes.

How difficult was it to do this in a country where many people believe health care should be left to the private sector?

People said there was no way it could work, because it was government. But the number one lesson of the VHA is that governments can provide efficient, patient-centred, high-quality health care.

Where is the United States at now in terms of EHRs?

There's a lot of activity and a lot of money pouring in, but I'm not sure we're any better than you are in Canada.

You have headed a company that promoted "open-source" software for EHR, instead of a pricier proprietary system. Why do you think open source is better?

I believe the solution to health-care information technology lies in the open-source world that basically gives away the code. That is then adapted to local circumstances. With the proprietary model, you are always going back to the vendor for changes, and they decide whether to do them and how much they will cost. In Europe, open source EHR software is zooming. It's the most widely deployed EHR system in the world, but not here.

Why not?

... We have this very established and influential, private software industry that has done a good job of dissing the open-source system we put in at VHA. And people don't understand the conceptual difference between the two systems.