Rick Antonucci


How to spot opportunities in VA's health record quest

The story of federal electronic health records (EHRs) has taken another turn, with solicitations released by of the Defense and Veterans Affairs departments..

The VA thinks its Veterans Health Information Systems and Technology Architecture (VistA) Evolution Program could be the standardized EHR format across VA and the DOD – and they aim to prove it by pursuing DOD’s Department Healthcare Management Systems Modernization (DHMSM) contract, now in its third revision. (This version much more specifically lays out the requirements for the contract and removes the veterinary record requirement.)

The VA’s approach for developing the latest iteration of VistA – a contest among contractors with a cash prize for the best solutions – is a less than ideal approach. At the same time, though, it could be an excellent opportunity for the products community to have its solutions baked into the project early.

The Trouble with Contests

Contests are not new to government problem-solving. Under the America COMPETES Act, the government can hold a contest to solicit ideas from contractors that the government would then own and implement itself.

The VA has released a sources sought notice for a new iteration of VistA, offering cash prizes to the contractors submitting the selected solutions. This solicitation (and VA’s stated intent to put VistA forward as a replacement for the DOD EHR) comes on the heels of the DOD releasing the new $11 billion DHMSM contract, which the department hopes to make a single-prime award  by the end of 2014.

In this case, a contest does not seem a sufficient incentive to obtain the best solutions for the VA. Contractors will not want to surrender their intellectual property on the chance that they might get a cash prize. Having the VA own any solutions provided by contractors could stunt the number and quality of solutions provided (although there may be opportunities to sell into the VA once they decide on a solution).

Regardless of the outcome, the VA’s attempt to tie the VA and DOD together again using contractor innovation in conjunction with its own systems development has merit. It will, however, take strategic collaboration between industry and government to succeed.

Vendor Opportunity and Strategies

A common EHR standard across the DOD and VA was conceived with the iEHR initiative, and shelved after escalating cost estimates ran out of control. However, with the DOD’s draft RFP for the DHMSM as a replacement for AHLTA (Armed Forces Health Longitudinal Technology Application), the VA’s pursuit of the DHMSM contract could lead to a single health care record standard.

The DHMSM will be utilizing COTS solutions, so manufacturers will be able to work with the prime contractor to sell solutions centered around health care management/delivery, as well as analytical capabilities for the massive amounts of unstructured data embedded in health records.

In moving forward with this opportunity, remember that the government does not have the best track record of managing projects or creating their own systems. Healthcare.gov is a great example of a major IT initiative becoming a huge source of controversy due to poor agency project management.

Therefore, good communication will be key throughout this process with VA. Help your government customer understand your capabilities, be responsive to their needs and tell them when their requirements need to be adjusted to arrive at the best solutions.

Make sure you keep your eyes peeled for updates, and come to the table with a thorough understanding of government needs as well as a way to accomplish them.

Part of this is including sales engineers in the customer meetings so that they can provide a clear picture of the technical benefits of your product in an easy to understand way, explain how your tool or solution will allow the government to do something better and cheaper while still being (largely at least) off the shelf.

Whatever happens, whether there is a common health record or two separate ones, government and industry will need to work together to ensure that the new health record system(s) are held up as an example of IT done right.

About the Author

Rick Antonucci is an analyst with immixGroup, which helps technology companies do business with government. He can be reached at Rick_Antonucci@immixgroup.com

Reader Comments

Wed, Jul 30, 2014 Fondella LaMoore No. Virginia

Greg Macksh: hey, this game is not cage fighting in groups for prizes and entertainment. The contracting is for important government missions and with our money. You want to ignore Past Performance? "Heck, any company can have a bad project," you say. Well each of the big companies who do this kind of work have mainly troubled projects, evident in overruns, schedule busts, and delivery of systems that don't work right. And they get paid for their mistakes. Do you really want VA (and DoD) to ignore crappy work? Accept the same bunglers on the next contract award? The odd thing about govcon is that disaster after disaster in IT systems competitions and contract performances Does Not Result In Better Contractor Selections in the next program. Rather, it results in less competition, even with the fig leaf of more bidders in some cases, because the miscreant firms are never penalized for their lousy work. No one loses their job, firms get their money, government clients continue undisturbed with their careers. It is like dog owners who walk away from their pets' steaming production on the sidewalk on a hot summer day. Someone else will step in it.

Mon, Jul 28, 2014 Greg Makshonowicz

In order to ensure enough competition, we must ensure that any company that wants to can bid on this work. It does not matter if they were/are associated with past EHR failures. Heck, any company can have a troubled project. We need to instead focus on LPTA and resumes.

Mon, Jul 21, 2014 Norm

Rick, Well done. Thoughtful and informative. Keep up the good work.

Thu, Jul 17, 2014 James Keuning United States

Excellent question by Mel Ostrow. Take a look not only at past VA and DoD contracts but what these bidding companies are doing with their own systems. DoD has stressed that interoperability is going to be a priority, but no one has figured that out yet! EHR providers have to-date kept their data siloed in their system; no one has a proven interoperable system.

Thu, Jul 17, 2014 Mel Ostrow

Mr. Antonucci: what do you think about the chances of companies that have "been there" in prior VA and DoD EHR contracts? Many household names in govcon have been involved (implicated) in failed contracts for design, SW engineering, and IV&V. Others have had contracts to "strengthen" the departmental organizations involved and to perform BPR. All have a hand in the massive failure and waste of taxpayer funds to date. Should these companies--a long list--even both bidding? Or will their prior experience be ignored in the competition for the new contract?

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