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DoD Ditches Open Source Medical Records System In $4.3B Contract
dmr001 writes: The US Department of Defense opted not to use the Department of Veterans Affairs' open source VistA electronic health record system in its project to overhaul its legacy systems, instead opting for a consortium of Cerner, Leidos and Accenture. The initial $4.3 billion implementation is expected to be the first part of a $9 billion dollar project. The Under Secretary for Acquisition stated they wanted a system with minimum modifications and interoperability with private sector systems, though much of what passes for inter-vendor operability in the marketplace is more aspirational than operable. The DoD aims to start implementation at 8 sites in the Pacific Northwest by the end of 2016, noting that "legacy systems are eating us alive in terms of support and maintenance," consuming 95% of the Military Health Systems IT budget.
Jesus Christ what a waste of money and to the worst possible people.
Drink or die ?
4 billion leftover for all the people in charge.
It's interesting how they see integrating legacy systems any differently integrating just as many differently implemented commercial record systems. The data integrators will make the same money either way. By abandoning the open-source solution, you're just losing the possibility others might benefit from the work. Likewise, I'm curious how much those 3 vendors have lobbied in Washington DC.
follow the money and the answer is in front of you.
ELOI, ELOI, LAMA SABACHTHANI!?
Try paper, it still works.
As far as I can tell, any IT project costing a billion or more is 100% guaranteed to fail.
Also, it sounds like they decided to source IT from Lufier, Mephistopheles and Satan, which incidentally also guarantees it to fail.
SJW n. One who posts facts.
Project already failed.
OK, years late, most promised feature not done/working, Budget 3x+ over and you will move to a proprietary commercial product with 100% lock in. ;)
Sweet, yes would be fun to see who's back accounts/family members got hired to land this future failure in motion
Sounds alot like the disasterous Nhs epr systems. After 20 years weve had progress but the number suppliers is down 1 and a major cash sinkhole
The hardest part of legacy is that sometimes the software just does what it does, and no one has all the official rules to recode it. So sometimes they task unwitting coders with learning some random programming language people don't use anymore, and most people didn't even use back in the day. They task them to do that to find out what rules they're operating under by reading the spaghettiest of spaghetti code. That is by no means a fun job especially when you're talking about governmental designed rules. I can't explain just how tough this job is if they don't even know their own operating procedures. If they do know their own operating procedures, then just update the database, write the fresh code in a modern language and send it out the door.
As an Accenture stock holder I think this is definitely a step in the right direction.
wow fuck. imagine how much advancement in software libre could be had for $4.3 billion if the contract had been awared. hell, even 1% of that would make a big fucking difference. someone - such as the gnumed developers to take even one random example - could, with help, have developed a medical records system for ohhh i dunno... the U.S. Dept of Defense, with that kind of money. just to take a random example, y'ken.
They use MUMPS. I know its all supported by some people and I know the flames are coming, but really? MUMPS. I'd say integration could very well be considered a pain point in the language. In my cursory investigation, the recommended integration for other languages / technology chains is a Node.js based web services adapter... oh well.
Bye!
That is part of the problem .. trying to design a drop in replacement that replicates the current functionality and interoperability with other systems.
With government especially, you have lists of exceptions and custom one-off code to get something working, that it becomes impracticable to replace it without an equal or additional number of exceptions.
It's the kind of system that benefits from a "flush it all away" mentality of defining new standards and sticking to them.
Well, it'll solve the problem of the system eating them alive in terms of maintenance and support. Now it'll be eating them alive in terms of development costs instead.
No, wait, they'll need to keep the legacy systems running until the new ones are running, so it'll still be eating them alive in terms of maintenance and support too.
Accenture? Better double that initial estimate to $18 billion, and count on it rising further. :(
I do not fail; I succeed at finding out what does not work.
You DO know that these hacked systems were mostly closed source, right?
Iit is the only way to guarantee it can be fixed.
I offer MS Word in evidence.
Sent from my ASR33 using ASCII
This will be a disaster of Epic proportions (excuse the industry pun). Cerner (medical software company) and the others Leidos (DoD contractor) and Accenture (management, services, and outsourcing company) will make bank at the expense of taxpayers and soliders. I guarantee that this project will be over budget and never deliver what was promised. Nothing is standard in the medical system business due to the "off the shelf" software companies protecting the data in their systems, which is the real product. Even implementing the HL7 standard (which version?) for interfaces is open to interpretation. The DoD has chosen to lock their soldiers medical data into a proprietary system, which will be non trivial (expensive) to share. Makes me wonder how the wheels of procurement were greased, and how much that greasing cost Cerner/Leidos/Accenture?
Posting AC because I have to work with at least one of the mentioned companies.
US Government purchasing "works" by the payment of bribes. Usually, these are not simply cash payments, but the opportunity for lucrative "consulting contracts" at the providing companies for senior Penagon and Civil Service officials after leaving government "service". I've seen it enough to know that saving money, at equal or better performance, will not get a government contract. Maybe, if enough congresscritters and/or senaturds are bribed with campaign contributions and/or honorariums, they'll push a deal one way or the other, but that rarely has anything to do with saving purchasing costs.
And who, in the gnu community, is going to take on the responsibility for all the enterprise scale stuff that needs to be done. I can see lots of folks wanting to scratch their particular itch by coding up some piece, but who's going to do the architecture design, ride herd on the developers, etc.; make sure that the documentation gets done and is usable and readable (because, ya know, all those packages out on github and sourceforge are ever so well documented)..
I mean responsibility as in "be willing to stand up in front of Congress and explain your progress or lack thereof". I don't see a Linus or Theo or Eric or, gods forbid, Richard, filling that role.
Part of DoD's requirement, in fact, was that the EHR interoperate with private sector systems, since somewhere between 60 percent and 70 percent of care takes place outside the DoD.
4.3 Billion isn't enough. What they are asking for is that Cerner interoperate with every other system out there, a feature that does not yet exist.
You can find some news here on interoperability with other non-hopeful articles..
http://www.fierceemr.com/story...
We all know the US department of defense demands a fixed-cost project then signs an open-cost contract. The usual excuse being the contractor must build the software from scratch. Since this project copies the contractor's existing system, the government can easily demand a fixed-cost contract. Like that's going to happen!
So they're paying $9 billion for something that's already been built. It sounds overpriced already.
The US DOD is always saying they need a do-everything system that prevents data fiefdoms. It's why they're always re-inventing the wheel, so copying a non-standard, legacy system is the worst possible 'upgrade' and it throws away all the work done on VistA.
Maybe this is an attempt to not re-invent the wheel: By buying whatever is available instead of building a do-everything system from rainbows and unicorns. But the VistA system is also available, so no, it's a clever way to pay kickbacks.
So the answer is another legacy system? I'll bet the hardware for this new system will be 2 years-old. Part of that is the slow procurement system and part is the mIl-spec approval program that all DOD purchases must satisfy.
have to keep the corporate welfare train rolling!
i was interested in VistA and what all the fuss was about, so i decided to check it out. turns out the backend is nightmare code that would would swear was machine generated. after some investigation i found out it's MUMPS (Massachusetts General Hospital Utility Multi-Programming System) code. a lot of useful stuff started way back in the 1970s... but MUMPS is a 1960s nightmare come to life.
think i'm exagerating? here's a module from VistA's code which was apparently updated in 1989.
DENTA1 ;ISC2/SAW,HAG-DENTAL TREATMENT DATA SERVICE REPORTS ; 1/10/89 11:08 AM ; ;;1.2;DENTAL;**24**;JAN 26, 1989
D:'$D(DT) DT^DICRW S %O="OPT",U="^",S=";",O=$T(@(%O)),DENTV=$$VERSION^XPDUTL("DENT") I $D(^DOPT($P(O,S,5),"VERSION")),(DENTV=^DOPT($P(O,S,5),"VERSION")) G IN
K ^DOPT($P(O,S,5))
F I=1:1 Q:$T(@(%O)+I)="" S ^DOPT($P(O,S,5),I,0)=$P($T(@(%O)+I),S,3),^DOPT($P(O,S,5),"B",$P($P($T(@(%O)+I),S,3),"^",1),I)=""
S K=I-1,^DOPT($P(O,S,5),0)=$P(O,S,4)_U_1_U_K_U_K K I,K,X S ^DOPT($P(O,S,5),"VERSION")=DENTV
IN I $P(O,S,6)'="" D @($P(O,S,6))
PR S O=$T(@(%O)),S=";" S IOP=$I D ^%ZIS W:IOST'["PK-" @IOF K IOP
I $P(O,S,7)'="" D @($P(O,S,7))
E W !!,$P(O,S,3),":",!,$$VERSION^XPDUTL("DENT")," ",$P($T(+1),S,1),!!,$P(O,S,4),"S:",!
F J=1:1 Q:'$D(^DOPT($P(O,S,5),J,0)) S K=$S(J0 S Z2=Z1
G:Z3=0 W I Z3>1 S DIC="^DENT(225,",DIC(0)="AEMNQ",DIC("A")="Select STATION.DIVISION: " S:$D(DENTSTA) DIC("B")=$S(DENTSTA[" ":+DENTSTA,1:DENTSTA) D ^DIC Q:Y
Anons need not reply. Questions end with a question mark.
Of course it's costing 95% for support and maintenance, there are no licensing or purchase costs. Would that last 5% be hardware costs, management costs, biscuits for morning tea ?
When is a commercial EHR system not proprietary and when is an open source electronic health record system proprietary ?
Governments all over the world are busting to give OUR money away to big corporations !!!
Projections of $11B over 18 years, who's a betting man ? will it double or triple over the 18 years ???
The health department system implemented in Queensland, Australia was a total balls up. IBM ?
Go well
They're getting rid of a MUMPS system, so it's still a good deal.
And in the case of Accenture, if the cost actually does go over, it's the government employees fault for writing shitty requirements specifications. And it's even more the government's fault for making contractors iterate because a couple of GS 14s can't agree on what the requirements, don't fucking understand what they're asking for, and probably don't even understand what the requirements really are. Not to mention excessive overhead of paperwork to make sure they're getting what they're asking for and that Accenture isn't cheating them. Then there will be the invasive, arbitrary and ineffective security protocols because the Govt. Infosec. asshole want's to display penis size. And lastly there will be a grossly ineffective change management system that will cause huge delays in bugs actually getting fixed. And every single missed/wrong requirement will take at least twice as long to fix as it needs to--A good guess for percentage of missed/wrong requirements would probably be somewhere between 50% and 200% meaning they will let a lot of them wrong multiple times.
I've seen both sides of this shit, and as bad as the contractors are, the GS employees are just as bad because they frequently and arbitrarily change their mind about the way something needs to be done; because they can. "Yeah, I don't like the way you did this, lets do things this other way instead." Contractor, "But this is what we were told to do last year."
All of which will mean cost overruns in the billions.
So my theory for this is gonna be: Govt spec: "We're going to do this and version lock on Java 1.8_54" when the project is completed, that will no longer be a supported platform, and they will spend billions more upgrading to Java 1.10_67; and repeat because they won't be allowed to upgrade as patches and releases come out.
Here Jeez, it seems they use the GT.M embedded database and a GUI that connects directly to this database... kind of like PGAdmin3. They use the MUMPS scripting language to build logic into the database (kind of like stored procedures). the deployment doc on Linux is a mess. Wow!
I offer MS Word in evidence.
You'd be better off choosing as an example something other than a piece of software that a significant percentage of businesses on the planet pay for and use with no significant problems whatsoever. It could be argued that MS Word may be one of the most successful pieces of software in history. There are plenty of examples of terrible closed-source, proprietary software. Why not use one of those?
Irony: Agile development has too much intertia to be abandoned now.
"Space is hard" and this is harder, because it's about ourselves.
This has no chance until someone like Pres. Kennedy chooses to do it "because it is hard" to do.
I think this, updating legacy system (something I do), is close to the second problem, which is that no one person or team has a grasp on how it works now, and what ever is put in place will be in the exact the same situation: no person knows it all. The only way I've seen this addressed is that after the Big Problem is cut into the Smaller Problems, the people involved with each Small Problem have to be to only ones who understand it: it must be accepted that there will never ever be a global "this is how it works" person or team.
Then the first problem can be addressed: interoperability. Each Small Problem can then announce (or publish) how they solve their problems in their area of expertise. Then tell all the other vendors that they will interoperate with them in that way. This is not the way this has been stated so far, where the new system will interoperate to all the others, which won't happen for the simple fact that all the other vendors don't want to, its not in their self interest.
The third problem is inherent in our species: we change, so no static model can be used to organize the data about us. The next versions of HIV, Ebola, anti-Vaxers, are all changes that will strain any extensibility, but most especially a government/military/project planning approach that can only deal with statically defined, long term goals. In the 18 years of this project they will always play catchup.
So, yes, centrally defining EMR is going to fail, absolutely (or the Soviets would still be a power...).
My only poor suggestion is to find a way to give each medical specialty, including ones yet thought of, a way to define their own representations of their expertise and publish it so those working in that field can interoperate with each other. Something like a distributed/grid processing system that includes distributed people being involved.
Google searching still requires that you know that you have the results you want when you see it, where a library is organized to begin with, so Library Science has been trying to do this for a centuries and it might be worth studying to understand some of the problems.
VistA is a shit legacy system, so it seems DoD made Half a right choice. However given the companies they got involved they will just end up with something almost as bad, if not worse.
Just like the rest of the US government, DoD is run by idiots.
As an outsider, who writes software for a living (proper, highly available transactional systems [finance industry but I do know some general stuff]). This amount of money is simply staggering. Even if we assume the published number (4.3B), 3% inflation, a relatively aggressive annualised ROI and 10 years over which to apply the costs, that turns into between 80 and 160 [20% ROI to 10% _annual_ ROI] million dollars per year in costs. IN COSTS. Even if you margin those costs at 33% (profit is already accounted for so the margin is on costs and risk) that's still 50 - 100 million dollars a year of costs to develop and support this system every year for 10 years. WTF kind of project are they planning? People have written software that changed the freaking world with a fraction of that amount of money.
Now having said all that, I have a little window on the way a different government developed their budget for an IT project. They knew that the new project would make 60 people redundant so they looked at the cost of those people, multiplied it by some number of years for the scope of the new system and went... There you go 30 million dollars.
There is something very, very, very wrong with government.
BTW, There are about 20M veterans in the USA, give em all 200 bucks and let them keep scans of their own records on a freaking thumb drive. Backed up to, S3 or something. That might even actually work!
"The first thing to do when you find yourself in a hole is stop digging."
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Seriously, why not have paid for licences (if required) and make the OS software interoperable with commercial systems?
With the added benefit that the result would mean the DOD and VA systems would be compatible !
"Consensus" in science is _always_ a political construct.
If they were only planning to support legacy systems, of course that money is designated to support legacy systems. The only way to drop it from 95% is to increase the budget and add other line items, such as new systems.
Remember kids, if you're not paying for the service, YOU ARE THE PRODUCT THAT IS BEING SOLD.
FTFY.
I can't think of ANY significant open source projects that are better than their closed source competition. Linux? Don't make me laugh. Makes for an OK, if extremely unreliable and insecure, server OS, but is only popular because it was in the right place at the right time. Apache? Meh, not really a "significant" project, in that it is just a web server and few companies even care about competing in such a commodity/niche market. LibreOffice? Used by almost no serious end users, it's all about people/groups who just want to pay $0 for something that sort of works and they don't care that it actually suuuuuuucks. GIMP, same story.
Open source is a scourge on our industry. Reducing pay for coders while simultaneously devaluing our work.
Leidos just signed an outsourcing contract with HCL. They are making 100 IT workers re-apply for their old jobs through HCL, if they even get a job. But they just got part of a $4.3 billion dollar contract. Nice. This will surely work out well!
I heard Vista sucked.
Oh wait. *That Vista*. Never mind. Too late - my manager has run off to golf with someone promising something much better.
We understand if DoD does not want to go with MUMPS let them don't.
MUMPS is outdated.
Why Cerner and Accenture ? They are crap in Medical field.
Their systems are too propitiatory and no code is available anywhere to compare.