DoD chooses interoperability over integration for new e-health record system

Frank Kendall says many different factors played into the Pentagon's decision to go with a competitive bidding process to develop its integrated electronic heal...

The Defense Department still is a long way from picking a successor to its aging electronic health record system. But the Pentagon said Wednesday that whatever it settles on, it’s committed to open data standards, and proprietary solutions are off limits.

And it’s also leaving its door cracked to adopting a system akin to that used by the Department of Veterans Affairs.

A month ago, Defense secretary Chuck Hagel ordered a pause in DoD’s health care record modernization plan, telling Congress at the time that he didn’t think the department “knew what the hell it was doing.” That pause is now over.

In a memo Tuesday, he told the department to move forward with a full and open competition to select a new health record system. He also made Frank Kendall, the department’s top acquisition official, personally in charge of the effort.

Kendall told reporters Wednesday that the Pentagon went that route so it could evaluate a broader range of options rather than simply adopting VistA, the government-owned, open-source health record system VA uses. He said, however, the decision leaves open the possibility DoD still will settle on VistA, even if it’s a custom variant marketed by a commercial company.

“We did market research on this and we had about 20 responses from industry. Three of them were from VistA-based approaches and the rest were from other approaches. So we think we have a rich field to pick from and we can make a best value determination for DoD,” he said. “So, on the one hand, we’re going to continue the existing program for seamless integrated data records for our people with VA, and we’re going to move into a competitive approach for the longer-term modernization of our healthcare management software.”

Seamless data sharing is the goal

DoD now is treating its plans to upgrade its own EHR as a distinct and separate effort from the shorter-term goal of being able to seamlessly share patient data with VA and private health care providers. The department said DoD and VA will continue to work together to develop common data standards so that VistA and DoD’s current system, AHLTA, can exchange more health information in the short-term.

VA argues the entire enterprise of building an integrated health record that follows a military member from enlistment to veteran status would be a lot easier if both departments just used VistA. But Kendall said the back-end technology doesn’t matter much, as long as both systems can be configured to speak to each other in the same language.

“Once we have the common data standards, we’ll be able to interact with VistA or commercial products,” he said. “Remember that our people get healthcare not just in DoD and VA hospitals. We also have to ship health records to hospitals out in the civilian market, just as seamlessly as we do to a VA hospital and between two DoD hospitals. So the whole initiative that the President started was designed to allow that to happen. And that’s the first step for that reason. It’ll allow us to do this with whoever we have to work with or wherever our people have to go to get healthcare.”

Not interested in proprietary answers

In a report to Pentagon leaders two months ago, DoD’s chief of operational test and evaluation blasted what he said, at the time, was the department’s insistence on pursuing a commercial replacement for AHLTA rather than focusing on the longstanding White House mandate for record interoperability with VA. The memo predicted that DoD would wind up buying a proprietary product that may or may not work, and may or may not be interoperable with VA systems.

But Kendall said DoD will make clear in its upcoming solicitation that it’s not interested in proprietary answers.

“One of the things we have to consider in a best-value equation is the degree to which we’re locked into a specific vendor because of proprietary content and his products,” he said. “We’re very aware of that and there are a couple of ways to get at that problem. And as we go out and we ask people to bid to us, that’s one of the things we’re going to assess. We do not want to be locked into a specific vendor for the long-distance future.”

At least one lawmaker wasn’t happy with DoD’s decision. Rep. Mike Michaud (D- Maine) said he’s disappointed in DoD’s decision because it backs an interoperable approach and not an integrated one.

“An integrated electronic health record is something that Congress mandated years ago and has already spent hundreds of millions of dollars on. Delaying the delivery of a seamless information sharing system runs directly against congressional intent and, ultimately, hurts our veterans,” said Michaud in a release.

Michaud and 19 other Democrats and Republicans sent a letter to President Barack Obama Wednesday asking for him to step in and fix the DoD-VA health records impasse and the claims backlog at VA.

“The time has come for a decision to be made and for the permanent merging of electronic health care records of the DoD and VA,” the lawmakers wrote. “Select a system, pick a path and move forward. We can no longer waste time or money that will result from endless bureaucratic inaction.”

Acquisition strategy TBD

Kendall said DoD hasn’t yet mapped out an acquisition strategy for its EHR project, but whatever comes next probably will not be an all-at-once, drop-in replacement for AHLTA.

“Modernization is probably going to take place to some degree in an incremental fashion. The idea is to have a core set of capabilities and then later add on other modules of capability as you move down the modernization path,” he said. “The speed with which we go down that path is probably going to be driven by how much money we can afford to put into this area of the defense budget. And the future budgets for the Defense Department are pretty up in the air right now.”

DoD and VA have mutually agreed to start from their own respective “core” technologies as they aim toward the goal of full health record interoperability. Kendall agreed it made perfect sense for VA to start with VistA, since versions of the system are already installed across the entire network of Veterans Health Administration facilities and clinicians are already trained to use it.

“We are not going to try to modernize based on AHLTA though,” he said. “That’s a system that has not been maintained and it is not in a position where we can build on it. We want to look at a broader range of options, and what we’ll do is we will evaluate cost, schedule, performance, growth capability, and risk as part of a best value source selection. And then based on that, we’ll pick the best modernization path for us for the core.”

But Kendall said, in the end, DoD decided it would be far too difficult for both departments to try to build one single record system, whether it’s based on VistA or anything else.

“We’re both very large organizations with a lot of cultural differences, and we have to make sure that our people are brought on board and are comfortable with the product that we’re going to acquire here, and so does VA,” he said. “We have not had good success in the department, even internally, trying to do very large- scale software systems or business systems across the military services. So I think this path, frankly, has a higher chance of success than if we tried to force ourselves together into a single solution and negotiate every single detail of that. I think that’s a very difficult path to tread.”


Hagel orders DoD to ‘restructure’ path toward integrated health record

DoD, VA accelerate schedule for integrated health record

VA pushes DoD to adopt VistA as starting point for electronic health record

Internal watchdog blasts DoD’s health IT efforts

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