Internal watchdog blasts DoD's health IT efforts

Monday - 4/22/2013, 8:02pm EDT

The Defense Department's current approach to achieving health record interoperability with the Veterans Affairs Department is "manifestly inconsistent" with White House directives to adopt and use open data standards, according to a memo from the Pentagon's top systems evaluator.

A memo sent March 28 by J. Michael Gilmore, DoD's director of operational test and evaluation, to Deputy Secretary of Defense Ashton Carter argued the multi-year effort is destined to produce a costly system that "may or may not succeed."

Federal News Radio obtained a copy of the memo.

Michael Gilmore

J. Michael Gilmore

Gilmore wrote DoD should stop all solicitations to industry for procuring a new health record system until DoD significantly revises its approach to the iEHR project and proceeds with "a much reduced budget focused on pursuing what the President has actually directed — defining and testing an architecture using open standards that enables rapid near-term progress on improving data sharing between the department and the VA."

Gilmore's stern, four-page memo comes at a time when DoD is assessing a new path forward with respect to its share of the work involved in integrating the medical records systems of the government's two largest departments, which the White House wants completed by 2017.

Revised approach

In February, DoD and VA decided to revise their approach to the project. Rather than building a new joint system from the ground up, each department would choose a separate core-technology starting point and focus on rapidly increasing the amount of data they are able to share between the two systems.

VA decided to stick with VistA, the legacy EHR system it is currently working to modernize. DoD wants to retire its current EHR, AHLTA, but has yet to decide what will replace it. The department issued a request for information in February to gather ideas.

But Gilmore suggested the decision's already been made.

"Unfortunately, the department's preference is to purchase proprietary software for so-called 'core' health management functions. This will be an expensive, complete replacement that may or may not succeed and that may or may not result in a system that adheres to open standards," he wrote. "To adhere to the President's agenda, the iEHR program should be reorganized and the effort to define and purchase 'core' functions in the near term be abandoned."

But a senior Defense official, who has been deeply involved in the health record integration effort, said the memo was off the mark and insisted no decision had been made about whether DoD would choose a commercial product, simply adopt VistA or select still another alternative.

"I'm not really sure where these statements come from," said the official, who requested anonymity in order to discuss pending DoD decisions. "I'm not sure why the memo accuses of the department of not adhering to standards or going counter to what the administration has asked for. We have been in lock-step with them. I and others have been sitting in these sessions for at least the last two, probably three, years. We intend to continue the proliferation of the data standards irrespective of the IT solution that helps move the data."

One of many views circulating

The official stressed that Gilmore's view was just one of many circulating through the Pentagon at the moment and that the final decision on DoD's way ahead for the EHR will be made at the very top of the department by Secretary Chuck Hagel.

Hagel disclosed in Congressional testimony last week that he had blocked three EHR-related requests for proposals that the Pentagon expected to release in late March while he evaluates the best approach. He said he expected to make a decision within the next month.

"I didn't think we knew what the hell we were doing," he told the House Appropriations Committee. "Until I get some understanding of this and get some control over it, we're not going to spend any more money on it."

VA would strongly prefer DoD adopt VistA, which the department is modernizing as a collaborative effort with the open source software community.

The senior DoD official said that option remains under consideration, but contrary to Gilmore's assertion, added that choosing a commercial product would not necessarily impede the directive to share patient data between DoD and VA.

"At the end of the day, it's all about the data," the official said. "If the prize here is to get the data to the clinical community and the military members and vets, then the architecture needs to be designed to ensure that we can achieve information flow and data interoperability. I'm not aware of anything in our current thought process that says that we aren't aligned to open standards to the maximum extent we can be. We're trying to ensure that it's a seamless exchange of information wherever we can possibly make it."

Data dictionary under construction

Under the revised iEHR plan VA Secretary Eric Shinseki and then-Defense Secretary Leon Panetta agreed to in February, VA and DoD would undertake separate modernization efforts of their legacy health IT systems, and in a separate but closely-related effort, take steps to make sure the data generated by each system was understandable by the other.

Under the current timeline, DoD and VA plan to begin using a shared health data dictionary by the end of the year.

Among other near-term objectives, the departments want to achieve a single sign-on capability through an identity management system hosted by DoD's Defense Manpower Data Center and begin using a common graphical user interface in several clinics that the two departments operate jointly.

The new approach, officials said, would produce "quick wins" on data interoperability, while the two departments modernize their underlying software systems.

But Gilmore opined that for DoD to procure a large new software system before a standards-based, sharing-friendly architecture was fully in place was to put the cart before the horse.

"In order to meet the president's open standards goal, the DoD should first define and test the overall architecture for implementing iEHR and then purchase or build a software 'layer' consistent with that architecture enabling the DoD's healthcare system, which is currently AHLTA, to interact with the outside world via open standards while remaining itself unchanged," he wrote. "The architecture for iEHR necessary to ensure data sharing and adherence to open standards needs to be defined first, before any action is taken to purchase existing software."

But the Pentagon official said that whatever system DoD settles on, the department will take care not to "break" the interoperability functionality it's already developed with VA, and there is no inherent reason that a proprietary IT product can't be made interoperable.

"There are hospitals all over the United States and abroad that use commercial capabilities, and there's all kinds of sharing within those systems," the official said. "So I think what the secretary wants to do is to make sure he's got all the facts, has heard from everybody who has something to say within the department, and then chart a way forward that we can collectively stand behind and then implement."

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