There's an acronym for Defense, VA records project: SNAFU

Here's my take on the Defense Department's latest update on the proposed joint Pentagon/Veterans Affairs Department Electronic Health Record development project:

The goal of the project is to create a new electronic health-record system for use by the Military Health System and the Veterans Health Administration. Together, they operate about 110 hospitals and 1,100 clinics.

The 55-page report, "Department of Defense Enterprise Architecture to Guide the Transition of the DoD Electronic Health Record, and Related Matters," quickly turns into alphabet soup. By page 5, readers are already wading through paragraphs of brain-numbers: "The DoD/VA functional community leads the requirements development process through the FCPG, under the guidance of the ICIB. The FCPG identifies and defines proposed joint functional capabilities, then orients baseline architectural artifacts with the logical construct of the ECCF. A C-IPT—guided by the ECCF—re-engineers joint functional processes and supplements the descriptive content of architectural artifacts, as needed."

Two dangers loom for our boat of national affairs from this almost impenetrable fog.

One is the military's intention to use a "best-of-breed" approach that "includes a mix of SOA-compliant capabilities, commercial off-the-shelf, open-source and custom systems."

I know "best of breed" remains an oft-used strategy in healthcare IT. But what large healthcare system these days, given the opportunity and a Defense Department-sized budget, would go that route if it—as the Pentagon says—planned to adopt an entirely new system?

The other rocky outcrop is the dominance of the military in this project.

Its "Way Ahead" architecture is to be the "baseline" architecture for the new EHR, the report said.

Its Defense Information Systems Agency will run the system's common data centers.

Its Defense Manpower Data Center will become the single source for identity management.

A retired Army colonel heads the Interagency Program Office, the joint Defense/VA directorate coordinating the project.

You'd never know by all this that the VA operates the larger of the two healthcare systems or has developed what is, hands down, a far better EHR.

In fact, the Military Health System is still running a version of the VA's VistA EHR system called CHCS I that is based on the source code that a defense contractor obtained free of charge from the VA and then billed taxpayers more than $1 billion to clone.

The military has since spent a fortune trying to replace CHCS I, to no avail and to much unrest.

The Defense Department report also appears to undermine an innovative open-source development effort the VA had planned for VistA.

The scrapping of VistA before this open-source initiative is given even half a chance to develop, while open-source installations of VistA continue to achieve success in healthcare organizations outside of the VA and outside the U.S., would be a tragedy and a waste of taxpayers' money.

Sadly, for our military industrial complex, tragedy and waste are simply business as usual.

Follow Joseph Conn on Twitter: @MHJConn.



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