On March 25, the program executive overseeing a proposed modernization of the military healthcare records system testified before the Senate’s defense appropriations subcommittee. Christopher A. Miller urged committee members to support a costly upgrade to the way in which the healthcare records of military personnel and their dependents are stored and shared — which at a projected price-tag of $11 billion will be the biggest investment in an electronic health record system ever undertaken. If past experience with such IT projects is any indication it will end up costing a lot more, but that’s not the real problem. The real problem, as Miller unwittingly revealed in his testimony, is an acquisition strategy that can’t deliver what the department needs.
Comprehensible, accessible healthcare records are crucial to the well-being of America’s warfighters. If a battlefield surgeon or overseas caregiver can’t get detailed information about a wounded warrior’s medical background quickly, fatal mistakes can be made. These kinds of mistakes happen everyday in the civilian healthcare system because doctors don’t have ready access to information about the medical status of patients. The wrong drug is prescribed, or preexisting conditions are overlooked, or unnecessary tests are performed as precious minutes tick away. The result is flawed healthcare that can hurt patients rather than help them. In a combat environment, where life-threatening wounds are commonplace, lack of access to healthcare records can kill.
Thus it isn’t hard to see why the Department of Defense wants to replace its widely criticized healthcare records system with a more modern approach. The goal of the Defense Healthcare Management Systems Modernization Program, as it is called, is to deploy an electronic health record system that is fully interoperable with similar systems for veterans and civilians, so that vital information is available in timely fashion to caregivers regardless of what a patient’s circumstances may be. The program office favors the word “seamless” to describe how it hopes to integrate medical records across the various care-giving communities.
But there’s a disconnect between the laudable goals of the modernization effort and the acquisition strategy being used to pursue those goals. As Mr. Miller states in his prepared remarks, the defense department proposes to buy an “off-the-shelf” commercial product already in use by the healthcare profession and adapt it to military needs. Only two pages later, though, he concedes that, “Today, in almost every sector besides health, electronic information exchange is a common way to do business.” In other words, the department wants to modernize by tapping technology in what may be the most backward sector of the economy when it comes to information sharing.
You don’t need to take my word for that. Remember the last time you visited a new doctor for a procedure — the forms you had to fill out, the tests they charged you for, the precautions they took — all because the doctor knew nothing about your previous medical history? Medical offices and hospitals are pretty much the only places left in the U.S. economy where you still encounter clipboards and fax machines, because the healthcare profession relies on pre-internet technology to manage its records. The standard model in the health records business today is the so-called enterprise software system that severely impedes sharing of information between organizations. Physicians complain bitterly about how costly and difficult it is to share medical information using the most common enterprise software solutions.
This is the “state-of-the-market” commercial technology that Mr. Miller’s organization proposes to make the foundation for the electronic health record system on which America’s warfighters and their families will depend. The respected RAND Corporation think tank describes such technology as “proprietary designs and terminologies not well-suited for interface” that provide “poorly integrated information exchange.” Relying on technology that predates the internet to “modernize” health records is a contradiction in terms. The Pentagon needs to slow down the award of its upgrade program and rethink what it is buying before America’s warfighters suffer for lack of adequate support to caregivers.
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