Pentagon Resists Administration’s Mandate for an Open Source Health Records System

President Obama has backed open standards for an integrated electronic health record system to serve the Defense and Veterans Affairs departments since his first term, but Pentagon plans to acquire commercial software to replace the department’s current EHR are “manifestly inconsistent” with that approach, J. Michael Gilmore, the Pentagon’s director of operational test and evaluation wrote in a blistering memo. Gilmore noted that Defense has resisted open standards and software for years.

Gilmore, in a March 28 memo to Deputy Secretary of Defense Ashton Carter obtained by Nextgov, said, “The White House has repeatedly recommended that the Department take an inexpensive and direct approach to implementing the President’s open standards.”

The White House, Defense and VA reached an agreement for an integrated electronic health record based on open standards last Dec. 6, Nextgov reported today.

“Unfortunately, [the Pentagon] 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,” Gilmore told Carter.

Gilmore said the iEHR project, whittled down by Defense and VA in February, “should be reconstituted with a much reduced budget focused on what the President actually directed” -- an open standard system based on a universal health exchange language for all health care providers in the country, an idea backed by the President’s Council of Advisors on Science and Technology in a 2010 report on health information technology.

Gilmore sent his memo as Defense readied requests for proposals to buy commercial laboratory, pharmacy and immunization systems for the integrated systems, which, if acquired, would be detrimental to the open standards approach. Last Tuesday, Defense Secretary Chuck Hagel told a hearing of the House Appropriations subcommittee on defense that he “deferred” issuance of those RFPS because “I didn’t think we knew what the hell we were doing.”

In order to meet the open standards goal, Gilmore said the Pentagon should first define and test the overall iEHR architecture and then purchase a software “layer” to connect the current Defense health record, the Armed Forces Health Longitudinal Technology Application, or AHLTA, to the outside world via open standards.

The Defense-VA Interagency Program Office did acquire such a software layer called an Enterprise Service Bus, about which Gilmore wrote, “The [interagency program office] will say that it has implemented an ESB, however this may or may not be true. The ESB has been purchased, but it has not been connected to anything real.”

Gilmore added that a presidential science advisor expressed doubts that the IBM WebSphere ESB acquired by the interagency program office met the open standards mandate as it has “hundreds of proprietary interfaces.”

Gilmore reported two software packages purchased by the program office were intended to allow clinicians to sign onto a patient record in one application and then automatically switch to another application -- called single sign-on/context management -- failed in recent operational assessments. “Planning for the operational assessment was halted when it was observed that these products could not be made to work at three facilities and were of limited to no use at the other two.”

Barclay Butler, the interagency program office director, told attendees at a Defense healthcare conference that the single sign-on/context management software from Harris Corp. had been tapped for use in the iEHR.  Harris also has a contract to supply the ESB for the integrated health record.

Gilmore said that the Pentagon’s resistance to open standards stems from an incorrect assumption that modernizations based on open systems, as opposed to proprietary commercial systems, will take too long. He noted that “the lack of immediate progress will inevitably cause the department to be forced to adopt the VistA [Veterans Health Information Systems and Technology Architecture] used by the VA.”

On Feb. 27, VA formally pitched VistA to Defense for use as its heath record. Gilmore told Carter, “The President’s open standards agenda has nothing whatsoever to do with the Department using VistA.”

Army Lt. Col.  Elizabeth Robbins, a Pentagon spokeswoman, said Hagel is consulting with many members of his leadership team on how to move ahead with the iEHR. Robbins said the Gilmore evaluation “represents just one opinion that the Secretary is considering as he ensures that DoD has exercised due diligence prior to committing to implement a particular core technology solution in accordance with the two Departments' revised strategy.”