Defense Archives

First came word that major health insurers were getting into the health IT business. Now some of the world's largest defense contractors are entering the health IT ring as a means of hedging their bets against declining defense budgets.

In the past month both General Dynamics and Lockheed Martin Corp. announced health IT acquisitions. General Dynamics is paying about $960 million to acquire Vangent Inc., which provides health IT and business systems to federal agencies, including health informatics and information exchange, electronic health records and data analytics. The deal is expected to be final by Oct. 1, with Vangent becoming part of General Dynamics Information Technology.

Lockheed Martin is acquiring QTC Holdings Inc., described as the largest provider of outsourced medical evaluation services, including IT-enabled case management, to the U.S. government and the Department of Veterans Affairs. The deal, terms of which were not announced, should be complete by the end of the year, Lockheed Martin says in a news release. QTC will become part of Lockheed's Information Systems & Global Solutions business.

Industry analysts told the Washington Post that defense contractors are looking to reposition themselves into a growth industry as budget cuts eat away at defense spending. Government contractors across the board are increasing their health IT holdings, George A. Price Jr., senior equity research analyst for information technology services at BB&T Capital Markets, told the paper.

Army field medics soon could be using touch-technology tablet computers for everything from accessing patient records to recording vital signs and documenting care in combat zones.

The handheld devices that Army medics have used for four years can't fully support the Pentagon's electronic medical record system, Federal Times reports. In addition, iPads, iPhones and Android-based devices don't have keypads that can be damaged by sand. Tablets also are able to run "more robust" versions of soldiers' inpatient and outpatient medical records, including medication history, the newspaper says.

The Army plans to have tablets approved for use by December, having successfully run military EMR applications on Apple and Android operating systems in tests last year, according to the article. Federal Times says the tablets will provide advantages including:

• A larger screen allowing medics to zoom in on information using the tap-and-stretch feature.


• Access to basic laboratory, radiology and pharmacy applications.


• The ability to scan a patient's Common Access Card to record patient information.

Medics will still have laptops for downloading field treatment information into patients' permanent records, according to the report, but those are too heavy and bulky to carry onto the battlefield.

As Nextgov's Bob Brewin has reported, the Pentagon and the Department of Veterans Affairs will create a common platform for their electronic health records. A plan for implementing the joint venture is due in early May.

Lt. Gen. Eric Schoomaker, the Army surgeon general, said last week that a single EHR would make it easier to transfer patient data and increase the amount of patient information shared between the two departments. As Brewin noted in a blog post last week, Defense Secretary Robert Gates and VA Secretary Eric Shinseki agreed to the common platform in a March 17 meeting.

A General Accounting Office report dated Feb. 2 sharply criticized the VA and Defense departments for failing to articulate explicit plans, goals and timeframes for common health IT requirements. GAO said each organization was too narrowly focused on their own EHR modernization, among other issues, to join in planning for their common requirements together.

The departments have separate EHRs. DoD uses the Armed Forces Health Longitudinal Technology Application, commonly known as AHLTA. It is transitioning to the Electronic Health Record Way Ahead system. The VA's system is called VistA, for Veterans Health Information Systems and Technology Architecture.

DoD and VA agreed in April 2009 to create something called the Joint Virtual Lifetime Electronic Record to facilitate sharing of medical records between them. Testing is under way in five pilot programs, according an article Tuesday by the American Forces Press Service.

"No two health organizations in the nation share more nonbillable health information than the DoD and the VA," Schoomaker said in testimony before the Military Personnel Subcommittee of the House Armed Services Committee. "The departments continue to standardize this sharing activity under delivering information technology solutions that will significantly improve the sharing of appropriate electronic health information."

The Departments of Defense and Veterans Affairs need a unified battle plan when it comes to health IT investments, the General Accounting Office says.

In a report issued last week, the GAO blames barriers in IT strategic planning, enterprise architecture and investment management. The two departments are establishing the Virtual Lifetime Electronic Record (VLER) and shared health IT capabilities for the first joint DoD-VA hospital, the James A. Lovell Federal Health Care Center, in North Chicago.

The report noted a number of failures, including:

• Not having explicit plans, goals and timeframes for common health IT requirements for the DoD and VA electronic health record systems.


• Not establishing a clear path for transitioning to future IT architecture.


• Not creating a joint process for approving IT investments based on cost, benefit, schedule and risk for each department.


• Not knowing whether IT capabilities developed for the Lovell hospital are transferrable to other DoD and VA medical facilities.

DoD and the VA, which operate two of the largest health care systems in the country, are too focused on the nuts and bolts of their own EHR modernization to plan for their common requirements, the report says.

GAO recommends revising the departments' joint strategic plan to specifically address common business needs as both EHR systems are modernized; defining future joint health IT architecture and a detailed plan for transition; and developing a robust plan for identifying and selecting joint health IT investments.

This item was posted by Nextgov Editor at Large Bob Brewin.

The Veterans Affairs Department has added its Richard L. Roudebush Medical Center in Indianapolis to a list to test medical data exchange through the Nationwide Health Information Network in partnership with the Indiana Health Information Exchange, the largest health information exchange organization in the United States.

VA already is testing NHIN for data exchange with private health care providers in San Diego and the Tidewater area of Virginia. The department has invited veterans in the Indianapolis area to sign up for the pilot.

VA said veterans who participate in the pilot will not have their medical information shared without their authorization. Participants will be asked to allow their public and private sector health care providers and doctors to share -- safely, securely and privately -- specific health information electronically.

VA Secretary Eric Shinseki described the pilot, which will run through 2012, as another step in the development of a Virtual Lifetime Electronic Record for veterans.

Standards that facilitate the sharing of electronic medical records between health care providers still aren't perfect, according to members of the federal advisory Health IT Standards Committee.

Government Health IT reports that while the new certification and standards final rule from the Office of the National Coordinator for Health IT do allow some additional flexibility for how patient information is entered and used, the guidelines may not be specific enough.

For example, the Veterans Affairs and Defense departments use C32, a standard format recommended by the ONC. C32 includes information about a patient's medical status but can be tailored based on an organization's needs. That flexibility may work for sharing data on some levels but not on others, the article states, which has left the agencies unable to pass records back and forth.

With the first stage of meaningful use, "we pushed the ball a little further down field. But I don't think we have sufficient specificity to guarantee interoperability," [said Dr. Doug Fridsma, acting director of ONC's standards and interoperability office]. At the same time, too much specificity can preclude innovation. "We're still trying to get this right," he said.

A pilot project underway in California is testing the use of wireless technologies to treat veterans with mental health issues.

The Veterans Transition to Community project leverages patients' cell phones and PDAs to collect their mental health data and increase their contact with health care providers, said Lincoln Smith, the president and CEO of the Altarum Institute. Smith testified before the House Veterans Affairs Committee on Thursday.

The nonprofit health systems consultancy developed the protocol to treat veterans suffering from post-traumatic stress disorder, substance use disorders, major depressive disorders and mild traumatic brain injury. Several times a day, over a period of months, the system prompts veterans under care to answer questions designed to document emotional states such as stress, rejection, fear, craving, pain and coping. By amassing a rich data set, Altarum hopes to improve assessment of behavioral health disorders and improve treatment options.

"Reminders, supportive messages, pictures of pleasurable memories, inspirational music, and an interactive pain-scale support the service members and veterans to avert crises that may affect them in their transition from the therapeutic environment to work and community life," Smith told lawmakers. "In a time of increasingly tight budget, the incremental cost of maintaining a service member in this program is negligible."

Altarum has tested the system at a residential veterans treatment center in Napa Valley. Combining data collected from multiple patients will afford a means to assess treatment options and outcomes of cohorts defined by theater of conflict, service, gender, age and other factors.

Up to 20 percent of soldiers serving in Iraq and Afghanistan have been in proximity to explosions that resulted in positive screenings for mild traumatic brain injury, which is associated with a 90 percent increase in the occurrence of post-traumatic stress disorder, reports Altarum.

I'm reminded of what the late, great George Carlin had to say on the subject way back in the 1980s, long before cell phones and the war in Afghanistan, which this month became the longest in our nation's history:

There's a condition in combat. Most people know about it. It's when a fighting person's nervous system has been stressed to its absolute peak and maximum. Can't take anymore input. The nervous system has either snapped or is about to snap. In the first world war, that condition was called shell shock. Simple, honest, direct language. Two syllables, shell shock. Almost sounds like the guns themselves. That was seventy years ago. Then a whole generation went by and the second world war came along and the very same combat condition was called battle fatigue. Four syllables now. Takes a little longer to say. Doesn't seem to hurt as much. Fatigue is a nicer word than shock. Shell shock! Battle fatigue. Then we had the war in Korea, 1950. Madison Avenue was riding high by that time, and the very same combat condition was called operational exhaustion. Hey, we're up to eight syllables now! And the humanity has been squeezed completely out of the phrase. It's totally sterile now. Operational exhaustion. Sounds like something that might happen to your car. Then of course, came the war in Vietnam, which has only been over for about sixteen or seventeen years, and thanks to the lies and deceits surrounding that war, I guess it's no surprise that the very same condition was called post-traumatic stress disorder. Still eight syllables, but we've added a hyphen! And the pain is completely buried under jargon. Post-traumatic stress disorder. I'll bet you if we'd of still been calling it shell shock, some of those Viet Nam veterans might have gotten the attention they needed at the time. I'll betcha. I'll betcha.

Today, veterans receiving some type of treatment from the Veterans Affairs Department attempt 950 suicide each month, according to Army Times. Suicide is a bigger risk factor for death than is suicide bombers. Thank god we now have an app for that.

I wonder what George would say?

Nextgov Editor at Large Bob Brewin reported on Thursday that the Defense Advanced Research Projects Agency is holding a conference on Friday to talk to contractors about a new $9 million program that will rely on social media, virtual worlds and other online apps to help soldiers cope with post-traumatic stress disorder and traumatic brain injuries. The agency is doing this despite the Senate and the House Armed Services committees saying they don;t like the idea -- so much so that they aren't funding it, at all. They say DARPA doesn't have the expertise in health privacy law to properly protect soldiers' medical information.

But could there possibly be more behind the decision to zero out the program? Could the Senate, not known for its techno-prowess, be more than a tad skeptical about this social media fad? From the Senate's report on the fiscal 2011 Defense authorization bill (emphasis added):

The budget request included $90.1 million in PE 62304E for cognitive computing, including $9.0 million for the development of a social networking site for veterans. The committee recommends a reduction of $9.0 million to terminate this specific project since its activities do not appear to align themselves with the Defense Advanced Research Projects Agency's vision of addressing challenging problems. Furthermore, such activities, if truly deemed necessary, should be undertaken by either a service or an appropriate agency that has the necessary policy and legal expertise to ensure personal privacy and the confidentiality of health data on such a site.

That's the kind of snarky disclaimer someone writes when they think an idea isn't truly necessary. It's like saying, "Well, if you really must, then . . . ."

I think it would be helpful to remember that these severely wounded soldiers are very young, meaning they never knew life without the Web, virtual worlds and gaming; they text; they download music from the Internet; they are more than just technologically adept; and social media is how they live their lives. In addition, many of these soldiers most likely live in rural areas where access to support is thin, or many miles away.

Truly necessary? Really?

The Army plans announce in May plans to create what sounds like a social networking site that will bring together soldiers' families and specific communities within the service with the hopes that they will discuss, seemingly, mental health issues that may be common among soldiers serving in Iraq and Afghanistan. The reason we say "sounds like" and "seemingly" is because that's the only details Brig. Gen. Loree Sutton, the highest ranking psychiatrist in the Army, would give.

Speaking at a breakfast held by Government Executive on health information technology on Thursday, the director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury declined to describe what is in a broad agency announcement that is due to be release soon. But she said, "It will be amazing."

Sutton also discussed a push to bring about a cultural transformation in the Army so that soldiers and officers will seek help for post traumatic stress disorder and mental issues brought about by traumatic brain injuries, including concussions and shocks to the brain from explosions. "We're coming into the ninth year of this [Iraq] conflict, and it's clear we are in uncharted territory," she said. "We are at a cross-section of history. In the context of this, we are just now learning about the brain and we are moving away from the Cartesian view of it being separated here and our body and spiritual selves here. Now we know from young troops that it is all integrated. . . . We're doing things we've never done before."