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

Loren Thompson | Forbes | March 3, 2015

...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.” ...

Open Health News' Take: 

This is one of the most insightful pieces that we have come across on the topic of the Pentagon's EHR procurement program and why it is guaranteed to fail. We have published two extensive articles in the past couple of months that outline why the open source bid to implement the open source VistA EHR is the only option that can succeed. This bid was led by PwC and Google and it was unexpectedly kicked out of the competition by the DoD bureaucracy.

The articles are:

US Defense Think Tank Calls for DoD to Adopt the Open Source VistA EHR and Avoid Closed and Proprietary EHRs.
Roger A. Maduro | Open Health News | February 13, 2015
One of the most prestigious U.S. defense think tanks, the Center for a New American Security (CNAS), issued a white paper Thursday calling on the Department of Defense (DoD) to replace their existing dysfunctional “vendor-lock” medical records system with an electronic health records system (EHR) that is "extensible, flexible and easy to safely modify and upgrade as technology improves and interoperability demands evolve." The white paper warns that a "closed and proprietary" commercial EHR - such as the ones offered by Epic, Cerner or Allscripts - will lead to "vendor-lock” and isolation of health data. 

Google Joins VistA Team Proposing Open Source EHR for the Department of Defense
Roger A. Maduro | Open Health News | January 28, 2015
Google has thrown its hat into the EHR ring by joining the team led by PwC which is proposing that the Department of Defense (DoD) upgrade their current EHR to Defense Operational Readiness Health System (DORHS), a customized application built for the DoD and based on VistA, the open source EHR developed by the U.S. Department of Veterans Affairs (VA)...Google’s participation has enormous implications for both the DoD’s EHR and to the healthcare industry as a whole. By choosing the open source EHR team, Google...has sent a clear message to the world that VistA is the best option for the DoD.

The Pentagon has spent 26 years under the yoke of lousy lock-in EHRs that has kept the military health system as a hostage to government contractors on anything related to health IT. This is the kind of "Stockholm Syndrome" path to EHR procurement as described by Paul Levy, former CEO of Beth Israel Deaconess Medical Center (BIDMC) in Massachusetts, in this article. Levy's explanation is the only one that fits the current behavior of the Department of Defense. Hopefully more writers like Thompson will expose this scandal and alert the rank-and-file military personnel and their families who will be the victims of this travesty.