Health IT Archives

I can't do this job without the help of a lot of people, and this is the time of the year to thank them -- and they deserve it, because sometimes I can get cranky.

So, kudos to the following folks who exhibit true grace when dealing with me:

• Katie Roberts, Veterans Affairs Department press secretary
• Roger Baker, VA CIO
• Art Wu, Republican Deputy Staff Director, Oversight and Investigations Subcommittee, House VA Committee
• Laura Williams, public affairs officer, Defense Information Systems Agency
• Air Force Lt. Col. April Cunningham, Pentagon press desk
• Lt. Col. Lee Packnett and Lt. Col. Steve Warren, Army Pentagon media relations
• Paul Mehney and Dave Hampton, Army public affairs officers who help me my trips to Ft. Bliss/White Sands Missile Range
• Lt. Myers Vasquez, Navy public affairs, Pentagon
• Warren Suss, Suss Consulting
• John Garing, DISA/Suss Consulting
• Bernie Skoch, Consultant and fellow radio geek
• Army Brig. Gen. Loree Sutton, former director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, and Dr. Greg Reger, Army psychologist with the National Center for Telehealth and Technology, for their insights into PTS/TBI at the Government Executive Leadership Breakfast in April

Ahh, an acknowledgement from inside the Military Health System that the AHLTA electronic health record system has so many problems it needs junking.

Lt. Col. Dan Davis, chief of EHR clinical requirements at MHS, not only called the military EHR antiquated and incomplete, but also said it lacks the reliability, usability and functionality to adequately to manage care of military personnel and their families, according to the slide set of a talk he gave in July that a reader sent my way.

MHS has all kinds of tiger teams working on a new EHR, and based on Davis's slides, it looks like a decision on a new system may happen by this December.

And oh yeah, of course it will play well with the VA EHR system -- but how often have we heard that?

I'm not talking about the disease -- although some folks treat it as such -- but the software that is the heart of the Veterans Health Information Systems and Technology Architecture, the electronic health record system at the Veterans Affairs Department.

The big obstacle for MUMPS is the perception that no one except VA uses it, a simplistic view reinforced by Sen. Richard Burr, R-N.C., during a hearing on the future of VA information technology systems on Tuesday.

At about the same time Burr was bashing MUMPS, the Coast Guard awarded a $14 million contract to Epic Systems Corp. for an electronic health record system based on MUMPS. That should be no surprise because Judy Faulkner, Epic's chief executive officer, founded the company in 1979 after working on MUMPS for VA.

Faulkner has grown Epic into a giant in the heath care IT field, including a megabillion dollar contract with Kaiser Permanente, which has 8.6 million patients and 15,000 doctors. The company competes with Genera Electric Healthcare, which also based its software on MUMPS. The last I checked, GE was no mom and pop oufit.

So, why, of why, do VA and its chief information officer, Roger Baker, want to move off a MUMPS-based VistA, and why is the Defense Department considering Epic when they can tap into the stable and free system Faulkner based her company on?

If everything goes to plan, by the end of September the Coast Guard will award a contract for a spanking new commercial electronic health record system that will replace a network based on an ancient version of the Defense Department's electronic medical system.

The Coast Guard emphasized in its requirements for the new system it wanted a commercial product, and if such a product did not meet all its needs, then the system needed to be enhanced to meet the requirements before delivery.

Such an approach saves the humongous costs that result when federal customers ask vendors to bolt stuff on after they win a contract.

The Coast Guard's strategy might be a good one for the Military Health System to follow as it seeks a commercial replacement for its AHLTA electronic health record system.

But at the glacial pace MHS operates, the Coast Guard will have deployed its new system to its 500 medical personnel while MHS is still buffing and polishing requirements.

They're busy rearranging the executive deck chairs at the Military Health System while the nomination of Dr. Jonathan Woodson to be the next assistant secretary of Defense for health affairs molders away in the Senate due to a hold by Sen. Roger Wicker, R-Miss.

MHS put out a press release on Tuesday that in the absence of Woodson, Dr. Clifford L. Stanley, the Defense Department's undersecretary for personnel and readiness, named Dr. George Peach Taylor Jr., who served as Air Force surgeon general from 2002-2006, as the head guy at MHS, with the rather awkward title of "performing the duties of the Assistant Secretary of Defense for Health Affairs."

Taylor, I'm told, has been hanging around MHS as an SESer for the past couple of months, and before that was managing director of Federal Government Practice at PricewaterhouseCoopers and then did a stint as health care IT veep at Northrop Grumman, which until recently had the biggest chunk of the MHS IT portfolio. Taylor replaces Dr. Charles Rice, who will return to his position as president of the Uniformed Services University of the Health Sciences.

There's a lot more action, insiders told me.

Another MHS newcomer, George Chambers, has been named special assistant to the secretary of health affairs and head of EHR Way Ahead Planning Office (EWAPO), which among other things is supposed to come up with a new commercial electronic health record to replace the loathed AHLTA record system.

Chambers, and his key job, mystifies a lot of folks who track MHS, including those on the Hill. Chambers' LinkedIn bio says he serves in both the MHS job and as vice president of CPS International, which bills itself as the "preeminent provider of Information Systems Solutions and Consulting Services for the Health care community." The CPS website does not say where the company hangs its hat.

Hmmm . . . does this mean an outside "adviser" will now drive development of the next generation military electronic health record? Or, does Chambers have his SES pips, as some folks speculate?

Whatever his status, Chambers has a vast portfolio within MHS. This October, I'm told, he will run the Defense Health Information Management System -- a job currently held by Army Col. Claude Hines -- portal development, critical fixes, distributed development and everything else but raising and lowering the flag at MHS headquarters.

There's other key personnel changes afoot at MHS that I can't write about at the moment, but purpose of the exercise, I'm told, is to burrow in before a new boss is confirmed.

In the almost forgotten era before the Internet, if you were sick enough to go to a hospital, all you had do was lie in bed, have doctors and nurses care for you, and you eventually got better.

Now, thanks to technology, the Veterans Affairs Department wants to develop an Interactive Patient Bedside Care Tool, or an e-patient terminal. The idea is to encourage patients to "be more actively involved in the care process."

VA wants a contractor to turn the bedside TV into an interactive terminal so patients can access the MyHealheVet website, stream educational videos, view a list of scheduled appointments for the day and, who knows, maybe a surgery webcam.

I reported on Monday the Military Health System decided to consider commercial software for its loathed AHLTA electronic health record system. The folks over at MHS told me the planning process started in December 2009, with establishment of an EHR Way Ahead Planning Office this February.

For those into wiring diagrams and org charts, the EHR Way Ahead Planning Office (EWAPO, right?) resides within the MHS Joint Medical Information Systems Program Executive Office under the Office of the Chief Information Officer.

Mary Ann Rockey, acting MHS CIO (she's acting because Chuck Campbell, the CIO, has been dispatched to the "in limbo" ASD/NII, an organization slated for whatever lies beyond limbo) told me in an e-mail EWAPO was stood up "to look into the options available for the future of the military's electronic health record."

The Military Health System may have finally decided to get rid of its electronic health record system called AHLTA, which military clinicians loath and what S. Ward Casscells, who served as the Defense Department top doc from 2007-2009, described as being "hard to learn and use, slow and often down". Officials are looking to replace the system with some (hopefully) easier to use commercial software.

In a Special Notice tucked away inside the FedBizOps digital closet on Aug. 12, MHS Tricare Management Activity said it wants to find commercial outfits capable of modernizing AHLTA.

The notice said MHS wants an "interoperable set of EHR capabilities automating health care in a continuum of care settings including: inpatient acute care, ambulatory care, intensive care, emergency department, expeditionary (wartime, peacekeeping, disaster relief, and humanitarian) and ambulatory surgery."

The agency also wants a system that will provide patient identity management, e-mail between patients and their clinicians, and share data with the Veterans Affairs Department and health care systems connected to the National Health Information Network.

Since the Defense Department operates 59 hospitals and 364 outpatient clinics worldwide, and has more than 9 million health care beneficiaries, this is the kind of announcement that should attract attention from a slew of commercial contractors, including Epic Systems (the EHR supplier to Kaiser Permanente, the largest private health care organization in the country), GE Healthcare, Siemens as well as Google and Microsoft.

If MHS goes for a pure commercial play, it might be able to modernize its EHR system for a price tag measured in the hundreds of millions of dollars.

But, and I fear this will happen, if MHS taps an inside-the-Beltway contractor to adapt commercial software to its needs, it could end up paying billions of dollars for software delivered late. Does this make me a cynic or a realist?

Bob Brewin is on vacation and will return to writing What's Brewin' later this month.

Counselors have begun to use apps to treat patients online. Physicians are developing iPhone apps to treat conditions like vertigo. So, it shouldn't be surprising that the Defense Department, which is embracing everything app, has an iPhone program to help treat stress, maybe even post traumatic stress syndrome.

The National Center for Telehealth and Technology, which is part of the Defense Centers for Excellence, has created iBreathe, an app that walks soldiers through what is called a diaphragmatic breathing stress management technique - a.k.a. "belly breathing."

From the Defense Centers for Excellence's blog post:

iBreathe will provide video-based instruction that explains the body's reaction to stressors and how belly breathing can reduce stress. The application includes illustrative examples, narrator-guided exercises, practice sessions, pre/post stress ratings, graphically-charted progress, a journal, a visual stress tracker, customization and a feature that allows users to tag data points with personal notes.

According to [telehealth and technology center's Dr. Jennifer] Alford, the application can be used as a standalone stress management tool or as a supplementary resource during actual treatment rendered by a health care professional.

Hat tip: Danger Room

The Senate Armed Services Committee wants to make it easier to transfer medical information from the Defense Department to the Veterans Affairs Department without the need for prior authorization from a service member.

The committee said in its version of the fiscal 2011 Defense authorization bill that it plans to accomplish this by aligning Defense regulations with the Health Insurance Portability and Accountability Act to permit the interdepartmental release of such information without going through a lot of hoops to get the OK from everyone who leaves the service.

I can (sort of) understand the need for the change to ensure a continuum of care. But how hard would it be to have someone check a box when being discharged authorizing that release?

My health care information belongs to me - and only I should have the right to authorize its release.