Google joins PwC VistA team bidding open source EHR for DoD

[Roger A. Maduro]

Guys,

Big news. Google has joined the PwC team bidding VistA for the Department of Defense’s Military Health System.

PwC Announces Google, Inc. is on the PwC Team Bidding for the Department of Defense Healthcare Management Systems Modernization Program

Press Release | PwC | January 15, 2015

PwC US today announced Google Inc. is a part of the PwC team in the bid for the Department of Defense (DoD) Healthcare Management Systems Modernization (DHMSM) Electronic Health Record (EHR) contract. The DHMSM program will replace and modernize the Military Health System (MHS), which currently supports more than 9.7 million beneficiaries, including active duty, retirees and their dependents. <http://bit.ly/1yp5i94>

Roger

--

Roger A. Maduro
rama...@gmail.com

[Astute Semantics]

This sounds like a publicity play... I wonder which engineers in particular are going to take part.

Google is actually losing a lot of talent to Facebook and others.

http://www.businessinsider.com/ex-googler-tons-of-engineers-want-to-leave-google-2015-1

Sidney Tarason, CEO
Astute Semantics, LLC
(443) 420-7920

CPRS Evolution | Template GUI | Fileman GUI | JLV Evolution​ | Reminder Dialog GUI 

"Knowing is not enough, we must apply.  Willing is not enough, we must do."

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[Kevin Toppenberg]

The PwC team is going to use their own solution, not VistA, right?

Kevin

[Michael ONeill]

The PwC team solution is vxVistA, the version of VistA that DSS maintains. 

Mike

[Michael ONeill]

Sorry, I should say that the solution is based on vxVistA. There are additions to vxVistA that DSS has developed over time, and there are some additions to meet DoD’s requirements. The complete solution is called DORHS - Defense Operational Readiness Health System.

Mike

[Roger A. Maduro]

That is a really DORKY name. Can't anybody ever come with good names any more?

Roger A. Maduro
rama...@gmail.com

[Tommy Martin]

I guess DODHS was too easy. 😃

Sent from Gmail Mobile

[Richie Piovanetti]

Nice.  Maybe having PwC and Google will help MUMPS gain some credibility since nobody has been able to slow down its downward spiraling ver since

• It lost its "Standards" certification
• Was surprised left and right a a barrage of "New" programing languages (i.e. C, C++, Java, C#)
• Is constantly being undermined by computer industry "experts" as a "sunset language"; facing the same fate as Cobol, Fortran, Lisp and loosing it programers-base
• Is not a "Modern" language or infrastructure

Who knows.  Maybe Google will give it an overhaul and 'Object Oriented capabilities", "Automatic Trash collection" - in essence, make it more Jave-like and/or java-firendly so "M" stops being the "wrinkle" that has maintained VistA from flourishing.

Richie Piovanetti, MD

richiepi...@healthcareinfopartners.com

[Mike Ginsburg]

Epic is Mumps too

Sent from my iPad

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[Matt King]

Good Luck on this!!!

[Kevin Toppenberg]

Richie,

I like the ideas of adding features.  But doing so is more a political challenge than a technical one.  We have languages right now that can access the global variables in GT.M/  But they aren't useful for legacy reasons.  I'd vote for python to replace M.

Kevin

[Richie Piovanetti]

Mike.  

The computer languages battle is like the Operating Systems battle - nobody has ever won the War - which still continues. Epic as well as a few others (i.e. Meditech) are Mumps.  

On the flip-side, read the following axioms:

1. The vast majority of EHRs are built with tools for which you can find thousands of resources in the IT marketplace with the skill set and willing to collaborate.
   
2. For "Open Source" to thrive, you need its of people that are knowledgeable with the underlying infrastructure of the OSS project - to entice the creation of a "community, and grow to the point of "No-Return."  Imagine if Linux was created with Cobol, LISP or Assembly; would it have caught like it has...?  .

Mumps goes "against" the aforementioned two (2)...

 

With regards to Epic, its COST is ASTRONOMICAL.  As I had worried and spoken about for decades, Epics has proven my worst-nightmare is becoming true, that is; "IT-costs do a "cost-shift" of funds we expected to "save" - we've become the hostages to a new master."   

 

That's why I supported OSS, but for OSS to become the de-facto standard in U.S. Healthcare, we need to comply with the two axioms presented before.  Hence, many are now bragging about "improving care", BUT, "spending the savings in the tool(s)" - not a bright thing to do if you ask me.

Kevin

As I mentioned to Mike, the language battle, is like the OS battle - nobody has won the war, nor will we ever see a winner since the battlefields, weapons, justifications, and tactics will keep changing with no end.  "Python" is a nice alternative to "M", and others might state that there are even better "P's" or other letters (i.e. "C", "J"-ava, "R"-ails, "P"earl, ...).  I for one will not propose which, but just that we either need to bring "M" to the level of the "newer IT languages or infrastructures", or "M" will be our "lead-weight" pulling us down and "holding us back".  More so, "M" is NOT the issue at stake here, it's VistA; the only truly viable EHR that happens also to be OSS.

However, VistA being OSS will not suffice.  Things that succeed have to be "High Tech, High Touch" - read John Nasbitt's book "Megatrends"; a 1980's book that has hit ALL marks predicted back in the 1980's until this day and beyond.  VistA is "High Touch" - but is hindered by not being conceived as "High Tech" (i.e. which is what ALL successful OSS project have underneath.)

Proprietary EHR's don't have to protect themselves against the underlying computer languaje marketing-battle.  Epic just has to say it's based on "Caché"; and thus hide like magicians.  More so, Epic has joint forces with many other proprietary vendors who benefit from Epic's success; so there's a "Band of Brothers" that cover each other's back since money and earnings are on the line.  

Not the same for an OSS solution; since OSS has a NO possibility of "vendor lock-in", so "proprietary solutions soldiers/salespeople" will use any weapon in their arsenal to combat the OSS alternative; more so in the USA, "the world's-foremost-supporter of proprietary-systems and vendor-lock-in".  For example, just look at the worldwide trends; most large US-based IT-vendors have lost their worldwide dominance (ex. LibreOffice vs. MS-Office in Europe, Latin America, Africa and Asia | PostgreSQL and MySQL over Oracle, DB2, MS-SQL, "Big Data" and "No-SQL" which is mostly based upon OSS worldwide, etc.)

Remember.  "High Tech AND High Touch"; NOT EITHER OR...!!!

Richie

On Thursday, January 15, 2015 at 7:31:30 PM UTC-4, ramaduro wrote:

[Dana Miller]

What happened to get the PwC team removed from the competition?  

http://www.healthcareitnews.com/news/one-out-three-bids-left-dod-ehr

Quiet removal from the competition doesn't sound good.  

On Thursday, January 15, 2015 at 6:31:30 PM UTC-5, ramaduro wrote:

[ivaldes]

Per this article they were too expensive:

http://www.modernhealthcare.com/article/20150224/NEWS/150229958?utm_source=modernhealthcare&utm_medium=email&utm_content=externalURL&utm_campaign=hits

[Roger A. Maduro]

According to the iHealthBeat article, the PwC Team bid may have been out of range because it was too low! DoD will give the PwC a debrief at some future date where they are supposed to provide an explanation.

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[Nancy Anthracite]

Let's hope if that is the case that they are filing a protest.

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Nancy Anthracite

On Wednesday, February 25, 2015 07:57:55 PM Roger A. Maduro wrote:
> According to the iHealthBeat article, the PwC Team bid may have been out of
> range because it was too low! DoD will give the PwC a debrief at some
> future date where they are supposed to provide an explanation.
>
> On Wed, Feb 25, 2015 at 6:37 PM, ivaldes <ival...@gmail.com> wrote:
> > Per this article they were too expensive:
> >
> >
> > http://www.modernhealthcare.com/article/20150224/NEWS/150229958?utm_source
> > =modernhealthcare&utm_medium=email&utm_content=externalURL&utm_campaign=hi
> > ts>
> > On Wednesday, February 25, 2015 at 3:34:57 PM UTC-6, Dana Miller wrote:
> >> What happened to get the PwC team removed from the competition?
> >>
> >> http://www.healthcareitnews.com/news/one-out-three-bids-left-dod-ehr
> >>
> >> Quiet removal from the competition doesn't sound good.
> >>
> >> On Thursday, January 15, 2015 at 6:31:30 PM UTC-5, ramaduro wrote:
> >>> Guys,
> >>>
> >>> Big news. Google has joined the PwC team bidding VistA for the
> >>> Department of Defense’s Military Health System.
> >>>
> >>> PwC Announces Google, Inc. is on the PwC Team Bidding for the Department
> >>> of Defense Healthcare Management Systems Modernization Program

> >>> <http://bit.ly/1yp5i94>

[ivaldes]

Maybe but in those situations an ounce of prevention (reading the DoD update fine print) is worth a pound of cure. -- IV

[Roger A. Maduro]

I should point out that the PwC/Google team disqualification came just after the release of the CNAS white paper calling for DoD to adopt VistA. This paper received huge coverage in the media. A couple more weeks and some additional background information would have made the VistA option impossible to beat. Timing is very suspicious. Below is my article on the CNAS report. Note that one of the authors of the report is the former chairman of the joint chiefs of staff. Roger

US Defense Think Tank Calls for DoD to Adopt the Open Source VistA EHR and Avoid Closed and Proprietary EHRs.

Roger A. Maduro | Open Health News | February 13, 2015

One of the most prestigious U.S. defense think tanks, the Center for a New American Security (CNAS), issued a white paper Thursday calling on the Department of Defense (DoD) to replace their existing dysfunctional “vendor-lock” medical records system with an electronic health records system (EHR) that is "extensible, flexible and easy to safely modify and upgrade as technology improves and interoperability demands evolve." The white paper warns that a "closed and proprietary" commercial EHR - such as the ones offered by Epic, Cerner or Allscripts - will lead to "vendor-lock” and isolation of health data. http://bit.ly/1vJNIPI

[ivaldes]

The problem is that once a team slips on a banana peel and gets disqualified it is very difficult to undo. The rules are merciless. Unless something changes DoD is bye-bye for VistA and will go proprietary. The consolation is that 'winning' such a large federal contract might wreck the private-sector mission of whomever 'wins'. -- IV

[Michael ONeill]

Just a note: “competitive range” refers to the overall rating for proposals, not just to cost. It is not correct to assume that a proposal that is outside the competitive range is either too expensive or too inexpensive.

From the Federal Acquisition Regulations:

"Based on the ratings of each proposal against all evaluation criteria, the contracting officer shall establish a competitive range comprised of all of the most highly rated proposals, unless the range is further reduced for purposes of efficiency pursuant to paragraph (c)(2) of this section."

Mike

[ivaldes]

I retract my assumption of 'too expensive'. The article does not say that. 

[Frederick D. S. Marshall]

Dear Mike,

Thanks for the clarification. That's a good point. DOD treated this as the acquisition of a product, so it was primarily concerned with what features the product already does or does not have. The real secret to success with EHRs - treating them as an EHR-production-and-maintenance service driven by users - continues to elude DOD. If it DOD had an EHR clue, they would appreciate the way VISTA is optimized for rapid evolution driven by users.

Yours truly,
Rick

[Steven McPhelan]

I think you will find that DoD is not the only entity that views an EHR as "an acquisition of a product".  Many commercial and non-federal purchasers of EHRs have that same attitude.  They feel like they are being forced by the federal government to get something right now.  So they are looking for Off-The-Shelf products that meets their meaningful use requirements so that they can get the federal government off of their backs.  I am not necessarily promoting one viewpoint or another.  I am merely making an observation of what is really going on.  So for these your statement "...an EHR-production-and-maintenance service driven by users..." is often considered as secondary.  I have seen very few seekers of EHRs recently for whom that attitude is primary or at least equal to meeting the MU requirements.  Since they are being "forced" to do it then they expect a product out of the box.

It has been such a long time and so very few remain who remember how much forcing and cajoling and selling the VA had to do to get staff to accept DHCP.

Steve

Vision without action is just a dream, action without vision just passes the time, and vision with action can change the world.  -  Nelson Mandela

[Frederick D. S. Marshall]

Dear Ignacio,

No, I rather suspect they were "too inexpensive."

Yours truly,
Rick

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[Joseph Dal Molin]

The fundamental issue is that big bang procurement processes are ripe
for creative destruction.... they are not transparent, they are costly
for both vendor and client, they have a very low correlation to success,
they are a great way to mask tunnel vision and bias, and most deadly of
all end users are completely disenfranchised in these processes... I
could go on for pages. The failure of the NHS CfH initiative is the best
example.... it will be interesting to see if DoD follows in the
footsteps of that white elephant.

Frankly I am relieved that this pot of fools gold has evaporated....
it's been a distraction for anyone interested in VistA for far too long.
BTW someone should FOIA the evaluation criteria and definition of
competitive range if it isn't publicly available... the vendors will
have a hey day creating anti-VistA FUD with this.

Joseph

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[Michael ONeill]

Joseph, 

The evaluation criteria are public in that the whole RFP package, which includes evaluation criteria, is public. How DoD applies those criteria… that’s another matter. 

Your last point is the reason that I would rather not see folks assume that competitive range = price range and conclude that the VISTA proposal was either too expensive or too cheap. That would not be a correct assumption and only feeds the misinformation.

Mike

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