Another Walter Reed-Type Scandal

[Gimpy]

Well, it looks like the Bush administrations "leadership" abilities and propensity to allow "cronism" and half-baked dingbats "run the ship" has once again reared it's UGLY HEAD!

###START###

Soldiers at the military hospital languished in part due to incompatible databases and dismal record keeping. Welcome to the Pentagon's $20 billion medical-records boondoggle.

By Niko Karvounis ...... September 15, 2008



In February 2007, William Winkenwerder Jr. announced he was stepping down from his post as assistant secretary of defense for health affairs following a press conference in which he downplayed the Walter Reed scandal as a mere "quality-of-life experience."

In the months that followed, it seemed clear that Winkenwerder's negligence may have been partly to blame for the deplorable conditions at the military hospital. Now, more than a year and half after his departure, Winkenwerder's legacy lives on in a multibillion-dollar Defense Department medical-records management system that many military doctors believe is fatally flawed. One military physician, speaking anonymously, calls it "another Walter Reed-type scandal."

The story of the Armed Forces Health Longitudinal Technology Application, or AHLTA, begins years ago, when the Pentagon began to develop an updated version of the Composite Health Care System, a bare-bones electronic medical records (EMR) management program it had been working on for a decade to help military hospitals keep track of their patients. In 2000, the DOD signed a $60.6 million contract with an IT firm called Integic for the initial design and installation of an improved "CHCS II" system

The Defense Department approved CHCS II in 2002. It introduced the system into military facilities in January 2004, under Winkenwerder's oversight. By spring of that year, clinicians were already complaining that CHCS II processed data too slowly to be useful. Dissatisfaction grew vocal enough to raise rumors that the Pentagon was going to suspend use of the new system until it could be brought up to par.

The military stuck with the system until November 2005, when Winkenwerder, who oversaw all DOD health care, held a press conference rechristening the system "AHLTA." "We have put a new name on what we are doing because it is not a 'version two' of anything, but an entirely new system," he said. But AHLTA was CHCS II, warts and all—and a new name couldn't hide the program's problems.

Over the course of AHLTA's implementation period, which has continued through this year, military doctors have grown increasingly disgruntled with the system. They complain that AHLTA is difficult to use, error prone, and slow, and that it has too many nonsensical tics such as an inability to capture patient data unless the patient stays in a hospital overnight.

According to AHLTA's critics, one of its biggest failings is its inability to share patient data with VistA, the records-management system that Veterans Affairs has used for the past 25 years. When patient databases can't communicate with each other, soldiers suffer: this was at least part of the reason why patients languished at Walter Reed was a lack of coordination between Army personnel and medical records.


Unlike AHLTA, VistA has been a huge success. Research from the University of Washington and the VA shows that it has enhanced VA productivity, reduced costs, and improved prescription accuracy to a remarkable 99.997 percent. Given its stellar performance, VistA is considered a model from which the military could expand its use of EMRs to include active soldiers as well as veterans.


But Winkenwerder championed the private-sector solution. Like many Bush administration appointees, Winkenwerder was plucked from industry. An MD/MBA, he never served in the military and was a vice president of Blue Cross Blue Shield, New England's largest private health insurer, before arriving at the DOD. Winkenwerder was proud of his corporate pedigree: During his nomination process, he told the Senate that "coming from the private sector, I am…confident in the ability of private health care contractors to [provide]…high quality services." (Winkenwerder did not respond to an interview request.) (can you blame him?-----------Gimp)

Despite a growing consensus among military doctors that Integic's product was a bust, Winkenwerder and the Pentagon kept pushing forward on AHLTA. Winkenwerder even took the unusual step of hiring the PR firm Edelman to drum up media attention for the system and brushed off complaints from clinicians. In 2006, even Stars and Stripes—a military newspaper subsidized by the Defense Department—noted that Winkenwerder had "ignored a rising chorus of critics" and "volunteered only praise" for AHLTA.

This stubbornness has shaken military medical staff, many of whom view AHLTA as an impediment to providing quality care. According to the military physician, internal polls cite AHLTA as "the biggest issue of concern for military clinicians," and "while Walter Reed is a more visible scandal, this failure actually impacts [soldiers'] health more," since doctors across the military are using an unreliable system to manage patient records.


The AHLTA debacle hasn't come cheap. So far the Pentagon has invested an estimated $5 billion of taxpayer money in the project. This figure includes the original Integic contract and other corporate handouts such as a $67.7 million follow-up contract for "monitoring" and "management" with Northrop Grumman—which bought out Integic shortly before AHLTA was announced—and another $12.3 million to Northrop and Booz Allen Hamilton for aid in assessing how AHLTA and VistA can share data.

Meanwhile, it would have probably been easy—and vastly cheaper—if the Pentagon had simply used VistA in the first place. In April, Phillip Longman, a senior fellow at the New America Foundation and author of Best Care Anywhere: Why VA Health Care Is Better Than Yours, told the tech website ZDNet that the government "could wire Walter Reed or Bethesda (the two biggest military hospitals) for VistA in an afternoon. Technically, there's no big problem." In fact, VistA's code is so flexible that it's even been adapted for use in other countries. "Yet," said Longman, "there are DOD people who have built their careers on AHLTA and want people to switch to their system."


Winkenwerder was one of those people, going so far as to reject criticism from members of Congress who expressed frustration at the Defense Department's tunnel vision. In 2006, then-chairman of the Senate Veterans' Affairs committee Sen. Larry Craig (R-Idaho) noted "that [since the] VA has an award-winning, highly-touted [EMR system]…I have to wonder whether DOD is just trying to justify the agency building its own system." In response to pressure from legislators, Winkenwerder had one of his deputies send a letter to Congress insisting that adoption of VistA would be too expensive and time-consuming.

The Pentagon has often relied on this excuse when defending AHLTA. Last year, Government Executive magazine reported that, in order to promote use of AHLTA, the Defense Department was blocking military doctors from accessing a new patient-tracking system that operated through the Internet. Like VistA, this system was embraced by the VA and has been touted by doctors as being more efficient than AHLTA. It cost just $320,000 to develop and an additional $2 million a year to maintain, and because it's accessible through standard Web browsers instead of complex software, it's more useful on the battlefield.


When Lt. Colonel Mike Fravell, who developed the alternate system while serving as the chief information officer of the military's Landstuhl Medical Center in Germany, spoke out against the Pentagon's obstructionism, he was first transferred to South Korea and then to a post just outside of Washington, DC—or, as one congressional source put it to Government Executive, "bureaucratic Siberia." When Congress confronted the Defense Department about its attempt to quash use of Fravell's system, the military claimed that AHLTA couldn't integrate with the tracking system without more time and money—in this case, $30 million more. Battlefield medics were livid: "It is time to say, 'the emperor has no clothes'" when it comes to AHLTA, one combat surgeon told Government Executive last year.


In June, military doctors got their chance to do just that when Winkenwerder's successor, S. Ward Casscells, held an online town hall for clinicians to weigh in on AHLTA. The forum received almost 200 comments, the vast majority of them negative.

One colonel declared, "I remain completely disappointed. AHLTA…[is] slow, inefficient, unreliable, and in every respect an inferior product." Another colonel blasted the DOD for being too concerned with "rice bowls"—military slang for pet projects—and a captain urged the Defense Department to "save money and incorporate the VA system." Another military clinician agreed, saying that it's "time to cut our losses and switch to the VA EMR."

In July Casscells called the town-hall outpouring "shocking" and "galvanizing," and announced that it was time "to find an alternative…to AHLTA." Even so, that alternative won't be the VA's program, but rather a so-called "converged evolution" of AHLTA and VistA. In other words, the two systems will be gradually tweaked so that they can work together. Still, Casscells admits that VistA is "much more popular with the doctors," which suggests that AHLTA will become more like the VA's system, rather than vice versa.

But making these systems interoperable will come at enormous taxpayer expense: Casscells says the price tag for convergence will be another $15 billion over the next several years, putting the total cost of AHLTA somewhere in the realm of $20 billion—four times what the government had originally budgeted for the entire AHLTA process. "There's been plenty of blame to go around," Casscells said at a forum on military health care last month. "Nobody's gonna like it."


Nobody except perhaps the Pentagon contractors, including Northrop Grumman, who stand to make additional billions off the project.


For his part, Winkenwerder, who boasted that the system "works" and "is improving care" in an October 2007 interview, is still touting the success of AHLTA. His profile at Deloitte Consulting, where he serves as a senior adviser, proudly claims that he oversaw "the world's…most sophisticated electronic health record system."


###END###


Par for the course for this DoD management team. One more example of incompetence and cronism from this republican Bush administration. And some folks STILL want to vote "republican"???????? For Gods sake......WHY?


Gimp

[Gimpy]

where all the "support the troops" right-wingers are?

Just one more example of "sticking their heads in the sand" when it comes to the Bush administrations awful record of doing the right thing for our troops.

Surprised?.............NOT!

Gimp

[Advisor]

If these clowns did this in their companies, they'd be fired. Oooops..sorry. They'd be let go with a golden parachute & the rank and file would be fired. Maybe it would be better to appoint people who have actually done something and ignore these "businessmen" who have done nothing but make policy & count on the 'grunts' to make it happen. And, funny thing about these dolts. If the policy is successful they take the credit. If it is not, the heads of the underlings will roll.

[Gimpy]

You hit the nail right on the head!

Hell, Nicholson and former VA Secretary Principi went on to work for major companies providing services and/or equipment to the VA and are responsible for getting them MILLIONS in Government contracts while IN office. And, then went on to either WORK for them, or "lobby" for them afterward!

Talk about "reaping what you sew"..............these Rethugs are MASTERS at it!

Gimp

PS----------Still no voices of "outrage" nor "condemnation" from those "Holier Than Thou" right-wingers though..............Hmmmmmmmmmm. Guess they're just to embarrased to say anything, ya s'pose?

[MORTARDUDE]

Thanks for posting this !!!

Larry

[Packo]

me talking about this whole screwed up mess when I worked at the Naval Hospital? The VA's electornic record keeping system is second to NONE in the world. Friends of mine at the VA have stated how well the system works, and were very skeptical at the beginning. When DOD was going to a new system the VA offerred theirs so the systems could interact. This would have been so special, especially after discharge, the VA would have instant access to the service members records....but NOOOOOOO. DOD had to have their own system. We were a kindof test market for one system called M2K. Our hosptital spent millions on this system. It was a total piece of crap....to put it mildly. We had to scrap the whole system. My question was...."what about all my electronic mental health records on M2K????" Response...."well, I guess they are in there somewhere but there is no way to retrieve them now". Hmmmm.....so along comes CHCS II and AHLTA. I was lobbying for the VA system....big time, but nobody was listening to me. This system, compared to the VA's is another piece of crap. I asked about what would happen when a veteran files a claim and needs a copy of his treatment, like from my clinic. Oh, well, when we get the request, we'll go into the system and get them, I was told. I asked, who's doing this now? Do we have somebody authorized to get into the electronic system to retrieve these records? Ahhh, no. Are we hiring someone???? Ahhh, no. Well, then....it would seem there will be lots of people filing claims, and being told..."No record of treatment." Ahh, yes.

Idiots...

Another reason I'm glad I'm retired and out of there.

Pack

[reconeil]

Sorry for You & US ALL.
But, that's what LONGTIME bloated and basically uncontrollable government gets you,...
and EVEN MUCH MORE as lately quite despicably surfacing.

Still, and as to overall ineptness of VA & all other multitude of overly large bureaucracies
common to America,...can't understand why solely: "Bush & Administration" are ONLY ONES
perpetually; "Bashed & Trashed" for such?

If one were to believe Majority Controlling Democrats (for about 2 Years) ALONE,...it would
then have to be believed that there are no longer U.S. Congressional Oversight Committees
for every imaginable Governmental Program (actually U.S. TAXPAYER Funded Program) possible?
Have all such Oversight & Regulatory Committees & Commissions been disbanded?

Orrrrrrrrrrr,...that continual lunacy of: "Bashing & Trashing Bush (now also McCain & Palin) will
solve most everything INSTEAD of Honesty, Integrity,Forthrightness & Working to rectify
matters as OATH TAKEN done initially,...for-a-change?

Whatever, Pack. Don't hold your breath waiting for things to be soon rectified sensibly.
Longtime intenched Ruling Elite, Bureaucrats, Politicians & Devout Hacks just won't let it happen.
Such being especially so for: "Recapture The White House AT ANY COST to America" types.

Neil

[Packo]

and Secs. of Defense, don't get involved in stuff like this. It's so far down the beauracratic pay scale. Entrenched beaurocrats decide this kind of stuff. I wouldn't blame any president, be they Dem or Rebub for this kind of stuff. It's been going on in government since the begininng. I use the M-16 as a good example. No president would be involved in this procurement. Stuff like this is entrusted to military and career civil service people to make the decisions. That all said, it's this kind of crap that continues to bother me because as always, the little people suffer. There will never be an end to it no matter who gets in office.

Pack