DoD EHR Contract: Open Source Vs. Commercial

Like a spurned but stubborn lover, the open source VistA electronic health records system will try once more to win the affection of the Department of Defense. Or, rather, a coalition of firms led by PwC have cast themselves in the role of matchmaker, trying to get the two together.

On Friday, PwC US formally submitted its bid as lead integrator in partnership with firms that have created commercial implementations of VistA -- DSS, Inc. and Medsphere Systems Corporation, Medicasoft -- with additional backing from General Dynamics Information Technology.

Even as military leaders are signaling their desire for a commercial EHR, PwC will argue that a commercial implementation of the government's own open source is the best answer. "It's designed for this market, and it's a better fit than anything else that's commercially available," Dan Garrett, leader of PwC’s health care IT practice, said in an interview.

VistA is the electronic health records system created by the Veterans Administration, which became open source because as the result of taxpayer funded work it was covered under the Freedom of Information Act and was obtained by outside companies seeking to leverage it for their own projects. The VA and the DoD flirted with using VistA as part of a common open source EHR that would cover members of the military from the first day of active duty into their lives as veterans. But whether because of organizational or technical reasons, that joint technical project broke down.

Now, the DoD is asking for bids from commercial EHR vendors and system integrators. Four teams are expected to bid, and there's always a chance of a last-minute surprise entry.

The first team to emerge consisted of IBM, EHR vendor Epic, and health IT systems integrator Impact Advisors. If the DoD wants to go commercial, then the IBM/Epic combination might seem to have the inside track. For large hospitals, Epic has almost the same "nobody ever got fired for buying ___" reputation that IBM once held -- and still does, to some extent.

CSC and HP have teamed with Allscripts, another commercial EHR vendor, while Leidos and Accenture are working with EHR vendor Cerner.

Leidos, formerly known as SAIC, is a well known government systems integrator and might have an advantage as the company that created and supports the two related systems that currently function as the military's EHR, known as AHLTA and CHCS. While the DoD has been clear that it wants to move onto a more standard EHR platform, by bringing Cerner into the mix Leidos fulfills that requirement while still offering its own intimate knowledge of the system currently in place.

Dean Maricka, senior vice president for federal programs at Allscripts, said one of the keys of this competition is not just supporting military hospitals but keeping track of the care military personnel get off base from private providers. "With 70% of the care coming from non military providers in commercial outpatient settings, we have to think about what will help them reduce costs and improve outcomes," he said.

PwC's bid might seem to face a challenge to the extent that the DoD has already considered and rejected VistA. However, what PwC is proposing is not the VA's VistA but a commercial implementation of it, following standards developed outside of government by the Open Source Electronic Health Record Alliance (OSEHRA) and incorporating the best features of several commercial versions.

This option "decouples VistA from the Veterans Administration," Garrett said. In other words, it becomes a solution the DoD can order built to its specifications rather than having to negotiate with another agency.

As PwC notes in its press release, VistA is also that rare EHR that physicians actually like. In WebMD’s Medscape EHR Report 2014, VistA scored highest overall and in key categories such as "Satisfaction" and "Usefulness as a Clinical Tool."

DoD has said it plans to make a decision by July 2015.