Obama military deference threatens health reform
That's because the U.S. military, along with its veterans, are the largest consumers of health care.
This puts the Veterans Administration especially in a position to set standards and a good example.
Right now they are not doing that.
Instead the VA seems to be going along with moves made under the Bush Administration to centralize all decisions and contract IT job out to private industry, under proprietary standards.
This results in closed systems rather than open ones. It is also leading to shoddy work.
Under Bush open source systems like VistA were starved of funds while proprietary systems like HealtheVet, a health records portal contracted to Aquilent last year, have seen deadlines slip by many years.
A recent report by the VA's Inspector General blames the 2006 decision to centralize IT decisionmaking for the growing problem. That structure now has 10 times the budget it did in 2006. thanks to the new President's priorities, but the money may now be wasted.
The good news is that Stephen Warren, a career government man who is now acting VA CIO and a principal deputy assistant secretary at the VA, said he agrees with the IG report and is working to implement its recommendations.
But a story by Nextgov indicates even Warren is making excuses for poor performance by contractors. He called reports the VA will miss targets "purely speculative" without noting it has yet to finish its documentation for fiscal 2010, which starts in November.
Critics of the original centralization plan, like Roger Maduro (above), say the proper reaction is to "fire all the nincompoop IT people and contractors, and revive the VistA collaborative approach."
In many areas of the government, this is the normal reaction of a new Administration. You can their guys and their methods and do things differently.
But when the subject turns to the military, the President has deferred repeatedly to the military system, with its bureaucracy and its slow pace of change. He is ignoring his own promises and keeping many of the old staffers in place to handle much larger budgets.
Even if a centralized, proprietary approach made sense in 2006, budgets are now rising 10-fold, along with a sense of urgency. The IG report shows the Bush-era system is a bottleneck toward getting the larger job done.
Someone needs to give an order to change, or the VA's efforts will fail, the military's efforts will fail, and the government will have only a model of failure to match against the closed standards and proprietary systems CCHIT and HIMSS are offering the general health IT market.
In other words there is a dead canary deep in the government coal mine and if the proper response does not come the whole health reform effort, which is based on improved IT and comparative effectiveness leading to savings, will come to nothing.