Defense and VA will make commercial software a top priority for joint electronic health record, memo says

The Defense and Veterans Affairs departments will make the purchase of commercial software their first choice for development of a joint electronic health record, according to a March 25 internal memo signed by top officials in both departments.

The memo recaps a meeting between Defense Secretary Robert Gates and VA Secretary Eric Shinseki and said the two departments agreed on joint development and acquisition of a number of functional capabilities and applications for an integrated electronic health record. The departments have scheduled a follow-up meeting on May. 2.

The memo, signed by Lynn Simpson, performing the duties of the principal deputy undersecretary of Defense for personnel and readiness, and Dr. Raul Perea-Henze, assistant secretary for policy and planning at VA, said the joint record will be developed based on three business rules:

-- Purchase commercial software for joint use.

-- Adopt a department-developed application if a modular commercial solution is not available and one department has a solution.

-- Approve joint application development on a case-by-case basis if neither a commercial application nor department-developed software is available.

Elizabeth McGrath, deputy chief management officer at Defense, described the approach at a hearing of the House Armed Services Committee's panel on emerging threats and capabilities on April 8.

This emphasis on commercial software for the joint record appears to conflict with the open-source software approach backed by Shinseki and VA Chief Information Officer Roger Baker. On April 1, Shinseki said he backed an open-source approach to modernization of the Veterans Integrated System Technology Architecture, the department's current electronic health record.

Baker declined to say if there was a conflict between the open-source software approach backed by VA and the emphasis on commercial software in the March 25 memo, and referred questions to Defense.

A Defense official, who declined to be identified, said in an email to Nextgov that the purchase of commercially available solutions for joint use refers to the acquisition of functional capabilities and substitutable applications that best satisfy the requirements of the departments.

She added, "There is nothing implied with regards to the number of vendors that may provide solutions at any given time, or whether particular capabilities will be acquired individually or in bundles. Capabilities will be modular and interoperable, facilitated by adherence to interface specifications maintained by an open source community."

In February, five Wisconsin lawmakers urged Defense and VA to consider using software from one commercial vendor for the joint record. Epic Systems Corp., based in Verona, Wis, is one of the largest vendors of electronic health record software in the country.

Tom Munnecke, who helped develop VistA at VA and then served as chief scientist for Science Applications International Corp., where he worked on developing the Defense electronic health record, said that Defense and VA together employ some of the finest medical minds in the world, resources that should be tapped in development of the next-generation record to serve both departments.

Munnecke said Defense has a 30-year track record of failure in health information technology, while Veterans Affairs has an equally long track record of success. "After three decades of watching DoD flounder and VA thrive, it's time for DoD to reconsider how it manages it's health IT, and above all, not infect the VA with its failed model of software management," he said.