The Department of Defense has traditionally bought its IT systems, under contract. Its system, called the Armed Forces Health Longitudinal Technology Application (AHLTA), has been heavily criticized for being ineffective and over budget.
The VA's VistA system is open source, but aged. Late in the Bush years moves were made to replace it with a contracted system. In the new budget those moves are expected to bear fruit, just as open source VistA implementations are making waves in the private Electronic Health Record (EHR) marketplace.
For 2011 DoD is asking for $1.5 billion in health IT money, up $100 million. The VA is asking for $1.3 billion, down about $100 million.
For 2011, a lot of the VA's health IT money is going into HealtheVet, a Personal Health Record application built by Aquilent, which says it uses Java, J2EE, BEA Weblogic and open source frameworks like Spring in its design. Early implementations won awards, for both the portal and the contractor. The Aquilent system shows how make-or-buy questions can be sidestepped, even when open source components are used.CORRECTION: A Personal Health Record (PHR) system called MyHealtheVet was produced by Aquilent last year, and won high praise. The VA now says it wants a new Electronic Health Record (EHR) system dubbed HealtheVet that will interface with MyHealtheVet and replace VistA. It wants $346 million for the effort this year. Aquilent is not working on the EHR system, which is led by a consortium of vendors including EDS, which is now part of HP.
Why replace a good transaction-oriented architecture like MUMPs with Java? Why does the back-end have to run on the same basis as the front end?
And is this money all going to Aquilent?
Explanations are needed. One might be that HealtheVet will be taking over from a proprietary scheduling system that was deemed a failure last year. That would be a success for open source, and bringing contractors in on salary, as is done in private industry, might result in significant savings.
Underlying all this, according to the budget, will be an Oracle database. Defense is being charged with creating a program called EHR Way Ahead, a records system that can in time let the Defense and VA systems be combined.
But is that going to be another proprietary, contractor-developed system like AHLTA, or will open source components be used that might let both agencies take control of their own IT?
A 2009 HIMSS presentation on the vision is unclear. (The illustration is from the presentation.) Integration with the open source NHIN is promised. A Service Oriented Architecture separating applications from the underlying business layer is heralded. Buzzwords like robust standards and open architecture abound.
But who will do it, and specifically what they will do, is still unanswered.
If EHR Way Ahead is using open source components and delivering something DoD and VA employees can manage and extend, it's a good thing. If this is going to be another Windows-Oracle set of promises, created and managed by outside contractors, that's something else entirely.
The question matters to the whole industry because, between them, DoD and the VA serve 15 million patients. It's one of the biggest chunks of the whole health IT market. The direction these public agencies choose is going to be a big driver in what the private sector uses.
The answers chosen by the DoD and VA may hold the key to the whole health IT market.