Part one of a two-part series:
The Defense and Veterans Affairs departments have received recommendations from consultants that it is at least feasible that their two massive healthcare organizations could jointly develop a common electronic health-record system.
If such a plan is approved, and a decision could come in the next couple of months, it would mean the VA and Defense would develop, install and maintain an inpatient EHR system for nearly 200 hospitals, becoming the largest and, most likely, the most expensive healthcare information technology project in U.S. history.
The feasibility recommendation comes as the VA still has a long way
to go, according to the Government Accountability Office, to develop HealtheVet-VistA, a clinical IT system to replace its vaunted Veterans Health Information Systems and Technology Architecture, or VistA, system. The VA has committed seven years and $600 million to an estimated $11 billion program to develop HealtheVet-VistA.
It also comes as the Defense healthcare leaders are under increasing pressure
from an erupting host of Military Health System clinicians calling on the brass to either fix or scrap what one called an “embarrassment,” the chronically balky AHLTA clinical IT system developed primarily by Northrop Grumman Corp. ALHTA is the 9-year-old, designated replacement for Defense’s first-generation system called the Composite Health Care System, or CHCS I. In the late 1980s and 1990s, outside contractors headed by Science Applications International Corp. were paid more than $1 billion to convert the VA's public domain Decentralized Hospital Computer Program (later renamed VistA) to create CHCS I, which became a proprietary system for military use, but could no longer “talk” to its parent system at the VA. Since then, according to the GAO, which, along with Congress, has repeatedly harangued the VA and Defense about the lack of communication
between their two clinical IT systems, the VA and Defense have spent more than $149 million trying to make the two systems talk to one another on top of the $1.3 billion the two departments have spent on HealtheVet-VistA and AHLTA. The Military Health System operates 65 hospitals and 412 medical clinics. The VA operates 135 hospitals and 731 clinics.
One oft-stated reason for both of the IT system upgrades has been to improve data exchange and IT system interoperability for the two healthcare organizations. The quest for interoperability at the VA and the Defense dates back at least to 1997 and an executive order by President Clinton. To date, that goal has been only partially achieved.
“It was a two-phase study,” said Paul Tibbits, deputy chief information officer for enterprise development at the VA, of the work by consultants Booz Allen Hamilton and Gartner. In phase one, he said, they were asked to look at the feasibility for the joint development of the inpatient portion of the EHR. Tibbits said Defense’s inpatient IT system, CHCS I, “does not provide them the full spectrum of functionality” while the VA is working on a replacement of VistA, so it made sense to see if a joint system was possible. The first phase of the study, which has been presented to both department secretaries, “concluded it was certainly feasible,” he said. This next phase is incomplete, but Tibbits said he expects to be finished “in the next few weeks or so,” and would recommend “the best way to do it.”
No matter how good the new HealtheVet-VistA can become—whether or not the joint development option is chosen and HealtheVet VistA survives as a system—it probably won’t match in one key respect its predecessor, VistA, which is now 25 years old but is still in wide use within the VA. As the VA administration contracts out future IT development work or buys commercial, off-the-shelf elements of the VA's proposed EHR, copies of at least several key elements of HealtheVet-VistA are unlikely to be made available free for the downloading under the Freedom of Information Act as most of the VistA system is today, according to Tibbits.
The ability of anyone under FOIA to obtain copies of the same, 25-year-old VistA system that powers the VA—with a minimum of licensing fees—has prompted the adoption of VistA by hospitals in multiple foreign countries. It also has spawned the development of a fully open-source version of the VistA software with little or no licensing fees and led a half dozen or more companies to develop business plans around installing and supporting VistA at public and private sector hospitals and clinics in the United States and abroad.
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