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."