Secretary of Defense Chuck Hagel’s long-awaited (in health IT circles, anyway) decision on the Department of Defense’s core health IT system has been made. The VA’s VistA system is out as the preferred DoD. Unless it’s not.
In his May 21 memo, Hagel directed the DoD to initiate a competitive process for a commercially available electronic health record (EHR) solution. Understandably, the secretary has to create a level playing field, a competitive process, so he can tell Congress with certainty that due diligence was done. Hate it a lot or hate it a little, this is the nature of our political process.
Already, many are spinning Hagel’s decision as a huge win for proprietary solutions; popular blogger Mr. HIStalk has already established Epic as the frontrunner in the upcoming DoD derby.
But before we simply anoint Judy Faulkner the queen of American health IT, I want, as the Brits say, to throw a spanner in the works.
Commercial ≠ Proprietary
A careful review of the Hagel memo and other recent statements from his top lieutenants reveal a more progressive vision and clear requirements for an open architecture and service model.
From the Hagel memo:
I am convinced that a competitive process is the optimal way to ensure we select the best value solution for DoD … A competitive process will allow DoD to consider commercial alternatives that may offer reduced cost, reduced schedule and technical risk, and access to increased current capability and future growth in capability by leveraging ongoing advances in the commercial marketplace … Also, based on DoD’s market research, a VistA-based solution will likely be part of one or more competitive offerings that DoD receives.
To sum up, the secretary has directed the DoD to go commercial instead of developing and maintaining their own VistA-based solution, but commercialized VistA-based solutions will be included in the competitive process.
In these politically polarized times, Americans expect Republicans and Democrats to disagree on every detail right down to what day of the week it is. This is especially true in the posturing hurly-burly of the House, where members can appeal to the few select priorities of a gerrymandered district to win re-election.
So it’s remarkable and unexpected when any legislation exits a House committee with unanimous bipartisan support. It’s even more surprising when the legislation potentially threatens the status quo for established corporate interests—in this case information technology companies.
The Federal Information Technology Acquisition Reform Act (FITAR)—sponsored by California Republican Darrell Issa along with Virginia Democrat Gerry Connolly, and supported by every member of the House Oversight and Government Reform Committee—threatens to put open-source software on par with proprietary by labeling it a “commercial item” in federal procurement policies. The proposal wouldn’t give open source a privileged position, just an equal one.
After a decade of conflict in Iraq, our troops have come home, producing the largest increase in the number of American veterans since the 1970s. After Vietnam, an America tired of war and consumed with political angst neglected its veterans. Fortunately, the veterans of today are receiving the homecoming they deserve. To make that homecoming complete, America needs to ensure that our returning warriors have access to one of the most important benefits they have earned: health care provided by the Department of Veterans Affairs.
A Health Care Challenge: Fewer Battlefield Deaths, More Injuries
The United States military is the most technologically sophisticated fighting force in the world. This technological advantage means that our troops in Iraq and Afghanistan are subject to fewer casualties than in Vietnam. But those who do receive injuries are significantly more likely to survive because of body armor and the high quality of medical care. According to a study conducted by the University of Pennsylvania, only 13 percent of those injured in Iraq were likely to die compared to those injured in Vietnam, where the fatality rate was nearly 25 percent. But our ability to save lives also means that many more veterans are returning home after losing limbs or suffering from the after-effects of traumatic brain injuries (TBI) from blasts experienced in battle or as a result of improvised explosive devices.
A frightening aspect of TBI is that it can be quite difficult to diagnose. It is possible for someone exposed to an explosion to show no signs of injury until weeks or months later when symptoms—such as depression, anxiety or anger issues—become apparent. Untreated, these symptoms can lead to major depression, substance use problems, unemployment and ruined family relationships. In addition to TBI, other problems—from back injuries to exposure to toxins—may only become apparent after the veteran has been separated from service for months or even years.