Records

DOD looking for new health records system

army medical records

Spc. Jose Gonzalez and Sgt. Jeffrey Cook had to take inventory of thousands of paper medical records at the Army Health Clinic in Mannheim, Germany to prepare for the base's closure in 2011. Electronic health records take much less time and expense to tally and transfer. (U.S. Army photo by Dijon Rolle.)

After a month-long review to determine the way forward in a joint electronic health records program with the Veterans Affairs Department, Defense Department officials now say they will open their end of the system to competition.

The announcement cements DOD's decision to not use the VA's core health records system, known as VistA, and instead select a commercially provided solution to modernize the department's healthcare management software.

"Our objective is to provide the best possible health care for our service members with continuous quality care," Defense Secretary Chuck Hagel said in a statement released on May 22. "Our service members and veterans, and their families, expect and deserve a seamless system to administer the benefits they have earned. [VA Secretary Eric Shinseki] and I will continue to work closely together to deliver on that promise."

In February Hagel and Shinseki announced the agencies would shift the program's focus to near-term efforts, such as coordinating to enhance interoperability, something to which Hagel reiterated his commitment in the May 22 announcement.

Now the long-term plans will begin coming together with the decision to seek software capabilities from the private sector. Frank Kendall, under secretary of defense for acquisition, technology and logistics, has been designated to lead the efforts going forward.

"After the work we've done, the conclusion we've come to is [to seek an] approach that taps into the market and brings in some modernized commercial systems as candidates, along with VistA-based systems as well," Kendall said at a May 22 Pentagon press conference. "We did the market research and had about 20 responses from industry. Three were from VistA-based approaches; the rest were [other] approaches. We think we have a rich field to pick from and we can make a best-value determination for DOD."

Central to the issue are the 1980s-era systems currently in use – VistA at the VA, AHLTA at DOD. The VA has pledged that it will move forward with VistA – which will present challenges in working with today's standards, insiders say – but DOD officials are opting for new software instead.

"We have strong cooperation with VA on the interoperability of the integrated records; we are not as much in agreement on the best way to modernize," Kendall said. "We are not going try to modernize based on our legacy systems...we want to look at a broader range of options."

When asked, Kendall could not put a price tag on the plans, and alluded to fiscal uncertainty as part of the reason. He noted "quite a bit of investment" in the architecture thus far, and that "going further downstream toward modernization, we're going to have to assess that." He added that modernization will likely involve an incremental approach that incorporates different modules of capability over time. He also pointed to the historical difficulties in implementing wide-scale IT and businesses systems, noting that a separate approach may be a better option.

"We have not had good success at the department, even internally, when trying to do very large-scale software systems and business system across multiple agencies or multiple departments," Kendall said. "I think this may have, frankly, a higher chance of success than if we force everything together into a single solution and try to negotiate every single detail. That's very difficult."

The next step will be to prepare for upcoming contract action, a process in which Kendall said he will be mindful of "not being locked into a specific vendor" or proprietary system and in which DOD will seek a better position to incorporate new technologies into the program. He also said it is possible DOD could end up with a VistA-based approach, but that it is not necessary to carry out the mission – a mission to which DOD remains committed.

"In an ideal world I think they'd prefer we simply go along with them, and we may end up there. In source selection, we may end up with VistA," Kendall said. "We will continue to coordinate closely with the VA as we go down this path. ... We need to modernize our system, VA needs to modernize their system and there's no requirement we use the same software to do that."

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