Video conversation between Beth Teeple and Tom Munnecke about the first VA/DoD interface

Here is the video of our conversation.

This is part of an oral history of the VA VistA electronic health record system. Beth Whitney-Teeple was an Air Force lieutenant stationed at March Air Force Base in 1984 when she approached Tom Munnecke at the Loma Linda VA Hospital to look at ways of sharing IT resources. Congressman Sonny Montgomery had established legislation supporting VA/DoD sharing, and she suggested that Loma Linda and March AFB could mutually benefit from the effort. The legislation stipulated that the sharing facilities would be able to keep the savings from the sharing efforts, which motivated local managers to seek ways to cooperate and save costs.

The interface effort went very well, and we had installed a version of DHCP (Decentralized Hospital Computer Program) - now called VistA - at March AFB, as well as installing an electronic file transfer protocol between the VA and DoD. This was one of the first instances of VA/DoD sharing, and demonstrated the potential for VA and DoD to share their IT resources.

Rep. Montgomery's staff got wind of the effort, and we soon had GAO and consultants studying the interface effort. It was also replicated at Fitzsimmons Army Medical Center. All reviews came back positive, and it gave Congress confidence to require that one of the competitors from the Department of Defense Composite Health Care System (CHCS) propose an adaptation of the VA's software.

This was something of an embarrassment to the DoD, as they were trying to establish their own system at the time, called TRIMIS (Tri Military Medical Information System). They had spent $250 million developing requirements and installing a few sites prototyping an incompatible set of "Interim Operating Capabilities" (IOCs). DHCP, on the other hand, was deploying a nation-wide set of integrated capabilities for 172 hospitals for only $83 million.

I moved to SAIC in 1986 to do software architecture work to propose DHCP for the DoD project. Our 10 year life cycle cost for the proposal was just over $1b, whereas the next lowest bidders were $1.7b and $2.1b

I used this interface as a platform for designing an email-based protocol for exchanging medical information, a precursor to today's HHS Direct approach.

Unfortunately, the DoD stripped away all of the networking capabilities I had designed, and was not interested in developing the sharing capabilities of the architecture. Rather than evolving this "good enough" initial model, the agencies have continued to spiral the VA/DoD sharing effort into ever more complex, more expensive systems.

Videography by Alesha Adamson.

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