Pentagon's $11 Billion Healthcare Record System Will Be Obsolete Before It's Even Built

...In order to understand why the modernization initiative is doomed to failure, you need only grasp the significance of two key phrases the program office uses in its approach to industry for proposals.  First, it says it is seeking a “state-of-the-market” electronic health record system.  Second, it says whatever it selects will be an “off-the-shelf” product.  In other words, it is seeking to acquire an electronic health record system that already exists in an industry noted for its antiquated approach to the movement of information.  Furthermore, despite the program office’s insistence that it will avoid getting locked into reliance on a single monopolistic vendor, the project manager told Politico he envisions the contract as “an extensive prenup and no divorce.”

Sounds like vendor lock to me.  The business model the program is pursuing resembles a proprietary enterprise software system of the sort that many major hospitals have installed.  If you don’t know what an enterprise software system is, the first sentence in Wikipedia’s entry on the subject gets to the point: “Enterprise software…is purpose-designed computer software used to satisfy the needs of an organization rather than individual users.”  Got that — rather than individual users?  This approach to information system design is a throwback to the pre-internet days of mainframe computers.  In fact, the dominant version currently in use by private healthcare providers relies on upgrades to software developed nearly half a century ago at the Massachusetts General Hospital.

These enterprise systems have proliferated in healthcare during the Obama years due to an imposing structure of federal incentives and penalties put in place to encourage the transition from paper to electronic health records.  That transition was intended to facilitate communication and collaboration across the healthcare community, but the information service companies that have leveraged federal rules to sell their record systems profit more from limiting access to paying customers.  Some major medical complexes have paid over a billion dollars to install their enterprise systems, and yet still have to pay high fees to move information beyond the boundaries of their in-house information systems.  Thus, the Obama-era incentives have promoted digitization in healthcare without promoting integration.  In some ways, the system is more balkanized now than it used to be, because the cost and complexity of the installed technology deters sharing.

A RAND Corporation report issued last year compared the implementation of information technology in the healthcare field very unfavorably with other parts of the information economy, describing the current state of healthcare IT as “proprietary designs and terminologies not well-suited for interface” typified by “minimal user feedback” and “high cost of failure.” ...