Who Will Cut The Gordian Knot of Healthcare Billing?

In a story about open source medical records systems, I couldn’t help but be struck by the irony in the following statement:

Referred to by health care quality guru Philip Longman as an “unrecognized national resource,” VistA’s open source code is constantly being improved and updated by its users. However, John Halamka MD, Chief Information Officer at the Beth Israel Deaconess Medical Center in Boston, is quick to note that VistA is not designed for complex billing scenarios that challenge large hospital systems because the VA is a single payer system unlike the health system for the general public.

It’s true that VistA is designed for hospital management and patient care rather than billing, but isn’t it a sign of something wrong when the billing tail wags the dog of care?

For so many problems in our society, solutions are dismissed as impossible because they would require changes that people don’t want to make. That’s why change so often comes from outside. Perhaps the simplicity of VistA is a feature, not a bug. In its early days, the internet was cited as inadequate — too lightweight for serious networking — by proponents of complex, over-built systems. Where’s Alexander when we need him? Gordian Knots are everywhere.