Patient records project stalled

A project to build a first-of-its-kind, governmentwide electronic patient record system has stalled because of funding uncertainties.

Contracting officers at the Defense Department, who are in charge of awarding a task order for the Government Computer-based Patient Record (G-CPR), had planned to make an award Oct. 1 to Litton/PRC Inc. to develop the system. Under the task order, which some industry sources estimate to be worth about $500 million, Litton/PRC would develop an electronic records framework and standards that should make it easier and quicker for DOD to share patient information with the Department of Veterans Affairs.

But the stalemate over the federal budget last month delayed the award. Even after Congress and the Clinton administration hammered out a budget deal, DOD officials are trying to figure out where in their budget they can tap money for the task order, according to Maureen Coyle, the VA employee who serves as project manager for the G-CPR framework.

The delay in awarding the task order has miffed G-CPR project leaders. "It's a shame that we've kept every single deadline that we've kept for ourselves," Coyle said.

Coyle said earlier this month that G-CPR leaders considered moving the contracting authority for the project from DOD to the VA, which already has money budgeted for its portion of the project.

G-CPR officials had planned to award the task order through one lot of a $4 billion DOD contract called the Defense Medical Information Management/Systems Integration, Design, Development, Operations and Maintenance Services (D/SIDDOMS) II.

Moving the contracting authority to the VA would be easier than shifting VA dollars to DOD for the task order, said Coyle, who added that the VA has budgeted less than $20 million this year for its portion of the project.

Coordinators of G-CPR envision the project as a way for DOD, the VA, the Department of Health and Human Services' Indian Health Service and perhaps other agencies to provide faster, better health care because doctors will have easy computer access to a patient's detailed medical history. The electronic records would tie together a patient's medical history that is stored in paper files at doctors' offices at different medical organizations.

What the G-CPR partnership is hoping to craft is a blueprint for a national computer-based patient record that will make it easier and faster for any health care provider to share a patient's medical record with any other health care provider who needs that information to treat that patient. G-CPR partner members expect that the electronic record format developed will use World Wide Web-based technology.

Health care experts said, in theory, the concept of sharing patient information would improve health care, but with the delay in the award for the task order, they wonder if DOD and the VA know what they want the project to accomplish and whether the project is viable.

"The idea of having the same information taken the same way everywhere is exactly where you want to go," said Lewis Lorton, executive director of the Healthcare Open Systems&Trials consortium, a group that promotes the development of information technology to improve health care. "But we've got to be able to show the benefits.... That's the problem. How do you measure benefits?"

Lorton said that if DOD and the VA cannot show Congress the benefits, they may not be able to justify the costs. "Every time [DOD and VA officials] talk, the focus is slightly different; the scope is shifted," Lorton said. "I just don't know what's happening with G-CPR, and I don't know what their plan is."

Coyle maintained that DOD and the VA are moving ahead with G-CPR. "It's not dead," she said. Moreover, agencies continue to prepare for the G-CPR format that should be developed once a task order is awarded.

"We're in the very, very beginning stages," said Dave Chipman, a deputy project manager with Electronic Data Systems Corp., which is consulting the VA on how to prepare its systems to work with the G-CPR standards and formats that are expected to be created by Litton/PRC. "We'll be looking at the activity going on to try to make sure the two efforts are in synch."

Coyle said DOD and the VA continue to work on the project although the task order has not been awarded. Their work includes building common information models and deciding on security roles among agencies. Coyle said that if G-CPR officials decide to move contracting authority to the VA, the move would not occur until January.