PwC pitches open-source electronic health records

One of the entrants in the military's $11 billion electronic health record procurement is proudly flying the open source flag. The group led by PricewaterhouseCoopers includes General Dynamics IT and two open source health record providers whose products are based on the open source Veterans Health Information Systems and Technology Architecture (VistA) -- DSS Inc. and MedSphere.

In a sense, their bid harks back to long-standing plans between DOD and VA to cooperate on an integrated electronic heath record.

In 2011, the presumption was that the open-source Veterans Health Information Systems and Technology Architecture (VistA) would be a key contributor to the joint system, which would be developed on an open source basis. Those plans were scuppered in May 2013 when DOD announced it would go its own way for a solution to replace the aging ALTA system with a commercial, off-the-shelf health record system that would be interoperable with the VA's product.

As far back as April of this year, the program executive officer leading the DOD Healthcare Management Systems Modernization (DHMSM) procurement told a Senate panel that he expected a VistA-based solution to be proposed by one or more bidders.

According to PWC's Dan Garrett, who heads the firm's Health IT practice, the VistA solution makes sense in the short term because of existing interoperability between DOD and VA, and in the long term because the open architecture of VistA gives DOD the ability to modernize at its own pace.

As VistA record providers, DSS and MedSphere are members of the Open Source Electronic Health Record Alliance (OSEHRA). They participate in a collaborative, open-source development environment that allows for health record applications or modules to run on a plug-and-play basis across member systems. Under the terms of PwC's proposed Defense Operational Readiness Health System product, Military Health System users would be able to select applications from across the OSEHRA ecosystem.

"You never get locked in," Garrett told FCW. "If they choose to get support or services from somebody other than us, they can go to any OSEHRA member and buy functionality and buy support. Like any competitive situation, it keeps everyone on their toes. It gives them an opportunity to take on any innovation that comes out from the industry. It basically gives [DOD] the right to control their own destiny that they didn't have when they evaluated whether they wanted to go right to the VA's version of VistA or not," Garrett said.

There is something of a dark cloud over VA technology lately, in part because of the way officials in Phoenix and elsewhere used under-the-table workarounds to beat requirements built into scheduling software. Garrett said the scheduling problems weren't about the software, and that improved functionality acquired by the VA will be adopted and built into the health record used by DSS and MedSphere.

'Levels of interoperability'

PwC's health practice has handled implementations for proprietary health records systems, including industry leaders Epic and Cerner -- both of which are participating in the DHMSM acquisition on teams led by IBM and Leidos, respectively.

But Garrett said the open-source solution makes sense for DOD.

"[VistA] was already funded and supported by U.S. tax dollars. It has the workflow that you need to support the federal sector side. It's not a system that was developed for billing and reverse engineered into an EHR system," Garrett said. He also touted the integrated dental and mental health components, which will be required for any winner of the DHMSM procurement.

In 2012, PwC acquired the Ray Group, a consultancy with a specialty in health IT integration, in advance of an expected procurement for an integrated EHR for both DOD and VA. That team, Garrett said, would play a big role in launching and supporting a VistA-based system.

DHMSM is not going to be a lowest price technically acceptable procurement, but Garrett said he expects his team's bid to effectively undersell rivals because of the emphasis on existing, open source software. And there are other economies that favor an open source approach, Garrett said.

"There's a lot of levels of interoperability other than just the technology and the medical record being the same. There's ease of use for physicians going back and forth between DOD and VA, and for service-members as they transition from DOD to VA," he said.

There have been a few short extensions of the DHMSM in recent weeks, over minor technical questions according to contracting documents. Final proposals from vendors are due Oct. 31.