April 9, 2013
I’m picking up strong signals that the Military Health System abruptly scrapped plans to upgrade its electronic health record -- the Armed Forces Health Longitudinal Technology Application, or AHLTA -- as senior Defense Department officials lean toward adopting the Veterans Affairs Department’s EHR -- the Veterans Health Information Systems and Technology Architecture, known as VistA.
Multiple sources have told me that Defense officials had planned to issue a bunch of requests for proposals from contractors over the last week to beef up AHLTA with commercial software after scrapping a grand plan in February to develop a joint electronic health record to serve both departments.
Those planned buys have now been put on hold, a sure sign, I’m told, that VistA has powerful backers in the Pentagon, including Defense Secretary Chuck Hagel. Hagel backed VistA in 1982 when he served as deputy director of the Veterans Administration (the Veterans Administration became the cabinet-level Veterans Affairs Department in 1989).
VA formally pitched VistA to the Military Health System on Feb. 27 as a viable system to meet the needs of the Pentagon and its 9.7 million health care beneficiaries. The proposal received a tepid response from top Defense officials at a House Veterans Affairs Committee hearing the same day.
Elizabeth McGrath, deputy chief management officer for Defense, told the hearing that the Pentagon would conduct an analysis of VistA against commercial alternatives. Military Health Service officials then started planning procurements that precluded the use of the free, open source VA software.
I’m told that mid-level MHS folks made the truly silly argument that they cannot figure out how to acquire free software. I think some of the smart folks at the Pentagon, which is reeling from budget cuts, probably should be able to figure this out.
VistA, sources tell me, stands an excellent chance of becoming the electronic health record for both Defense and VA if top management does its job and overrules the MHS bureaucrats and contractors who have a stake in AHLTA, which is as hard to kill as a vampire.
Dr. S. Ward Casscells, assistant secretary of Defense for health affairs in 2008, told me in an interview that many users found AHLTA "intolerable," making it incumbent on him to seek an alternative, including VistA.
Here we are five years later and Military Health Service clinicians are still saddled with an intolerable EHR -- and AHLTA might continue to reign supreme, except for what one source called the “Jon Stewart effect.”
The comedian lampooned the incompatible EHRs for Defense and VA on his “Daily Show” on March 27. His satire had more effect than any Congressional hearing or news article on the absurdity of the situation and helped cement the case for VistA, this source said.
April 9, 2013