This blog was written by IRIS’ Chief Technology Officet (CTO) Roger McCreery. Roger is the systems engineering lead for IRIS’s DoD Military Health System (MHS) projects.
One of my favorite success stories of government accomplishment was the accomplishments of the MUMPS Underground within the VA to build an early electronic health record (EHR) in the 1980’s and 1990’s. Teams that were comprised of clinicians and programmers worked together to jointly design and develop a significant product that helped satisfy many of VA’s clinical needs and provide a foundation for the future technology within the VA. However, the product, the Decentralized Hospital Computer Program (DHCP), included the ability of VA Medical Center personnel to do substantial modifications to the code and code sets such that the eventual centralization of data across VA was a significant challenge. To this day, establishing standards across the enterprise is an on-going challenge at VA.
Somewhere in those early years, DoD chose to take a copy of DHCP and modify it to support DoD Military Treatment Facility needs. With significant outside assistance, most notably from SAIC, the Composite Health Care System (CHCS) had many of the same good ideas – and obstacles. AHLTA eventually provided broader enterprise-wide support including a centralized Clinical Data Repository (CDR). Vestiges of CHCS persist today. More importantly, the culture of technical staff working with clinical staff to deliver exactly what is needed continued. While certainly laudable, this approach also came with a large amount of customization and, of course, maintenance expenses. Continue reading