Last October, I wrote that a large pot of money, dedicated to protecting the world from infectious diseases, was about to run dry.

In December 2014, Congress appropriated $5.4 billion to fight the deal with the historic Ebola epidemic that was raging in West Africa. Most of that money went to quashing the epidemic directly, but around $1 billion was allocated to help developing countries improve their ability to detect and respond to infectious diseases. The logic is sound: It is far more efficient to invest money in helping countries contain diseases at the source, than to risk small outbreaks flaring up into large international disasters.

But the $1 billion pot, which was mostly divided between the Centers for Disease Control and Prevention and USAID, runs out in 2019—a fiscal cliff with disaster at its foot. As I wrote:

That money has been used well, to train epidemiologists, buy equipment, upgrade labs, and stockpile drugs. If it disappears, progress will halt, and potentially reverse. The CDC, for example, would have to pull back 80 percent of its staff in 35 countries, breaking ties with local ministries of health.

This is now coming to pass. Two weeks ago, Betsy McKay at TheWall Street Journal reported that the CDC, with no firm promise of future funding, is indeed preparing to downsize its work in 39 countries. Those include the Democratic Republic of Congo, which recently experienced its eighth Ebola outbreak, and China, which is currently undergoing its worst outbreak of H7N9 bird flu. Lena Sun of The Washington Post confirmed this report on Thursday, writing that “notice is being given now to CDC country directors” as the first part of a transition.

The CDC is not the only affected agency. USAID also received $300 million from the same dwindling pot of money, which it used to expand its work in the Middle East and Asia. Those programs may also have to shut down in 2019.

These changes would make the world—and the United States—more vulnerable to a pandemic. “We’ll leave the field open to microbes,” says Tom Frieden, a former CDC director who now heads an initiative called Resolve to Save Lives. “The surveillance systems will die, so we won’t know if something happens. The lab networks won’t be built, so if something happens, we won’t know what it is. We can’t be safe if the world isn’t safe. You can’t pull up the drawbridge and expect viruses not to travel.”

The $1 billion of Ebola money was used under the umbrella of the Global Health Security Agenda—a five-year international partnership to improve the health security of developing nations. Barack Obama convened the GHSA in 2014 with strong bipartisan support, and it has already made a significant difference.

Thanks to the GHSA, Uganda now has a secure lab for studying dangerous germs. Tanzania has a digital communications network so people can phone in information on potential outbreaks from remote locations. Liberia has more than 115 frontline disease detectives trained by the CDC. Cameroon shortened its response time to recent outbreaks of cholera and bird flu shortened from 8 weeks to just 24 hours. The DRC controlled an outbreak of yellow fever and built an emergency operations center (EOC)—a kind of war room for responding to outbreaks. But there is still much to do: The DRC, for example, still needs to train staff to run its EOC.

Last October, at a meeting in Kampala, Uganda, Tim Ziemer, the White House senior director for global health security, confirmed that the United States wants to ensure that GHSA is extended to 2024. “Distance alone no longer provides protection from disease outbreaks,” he noted. “We recognize that the cost of failing to control outbreaks and losing lives is far greater than the cost of prevention.” (Ziemer’s leadership is a promising sign for the public-health community, given his redoubtable credentials: He led George W. Bush’s President’s Malaria Initiative, and has been described as “one of the most quietly effective leaders in public health.”)

But that verbal commitment hasn’t yet been followed by a financial one. It is entirely possible that the next budget, which is due to be issued on February 12, will include money for the GHSA. But the uncertainty has already forced the CDC to begin preparing for potential pullbacks. Damage is already being done. “The reality is that people have to prepare and live their lives,” says Linda Venczel, from PATH, a nonprofit working in global health. “People are packing their bags and looking for other jobs. Things will unravel pretty quickly.”

If that happens, much of the good work that the CDC has accomplished in the last five years, and much of the $1 billion investment, will have been for naught. “To respond to an outbreak, you need to have a presence on the ground to execute emergency operations, and that has to be based on existing trust,” says May Chu, who was part of the White House Office of Science and Technology Policy during the recent Ebola outbreak. If people move on, the relationships that have been built over the last four years will erode, and would have to be built all over again come the next crisis.

“If we pull away from the GHSA in this way, other countries that provide funding and technical assistance will also likely do the same,” noted Tom Inglesby, from the Johns Hopkins Bloomberg School of Public Health, at a Senate committee hearing on America’s preparedness for 21st-century public-health threats.

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All of this is but a symptom of a greater malady: our inability to learn from the past. Time and again, diseases flare up, governments throw money at the problem, the crisis recedes, and funding dries up. It happened after anthrax attacks in 2001 alerted people to the risk of bioterrorism. It happened in 2003, after SARS showed people how quickly a new disease could spread around the globe. The world is caught in a cycle of panic and neglect.

“Every time there is an epidemic, the question that always follows is: Why were we so unprepared?” says Nahid Bhadelia, from Boston University. Ironically, the lack of funding is “undercutting the very same programs created in response to the lessons learned after the Ebola epidemic—programs that catch and halt infectious diseases threats early so we can keep U.S. communities and borders safe. We can’t get rid of programs that literally work toward global-health security and expect that the results of the next epidemic will be any different than the last.

Healthcare undoubtedly lags behind other industries when it comes to interoperability. Sadly, organizations remain stymied by systems that fail to communicate. Vendors’ sluggish efforts to make progress have only placed more distrust in the market.

There are concerted efforts underway, ranging from government officials emphasizing interoperability and information blocking, and industry standards such as HL7’s FHIR have come to the forefront. However, little has been done to motivate IT vendors to achieve better integration and data sharing. The industry will have to wait until April to see if the proposed health IT provisions within the 21st Century Cures Act will be enough to drive the final push toward true interoperability.

Having just returned from Cleveland following our annual participation in the IHE North American Connectathon—where vendors cooperatively demonstrate and test the latest industry standards for interoperability—it raises the question; “Why can’t this open collaboration successfully proliferate outside the confines of the event?”

Coordinated, accountable, patient-centered care relies on seamlessly orchestrated access to data. Despite that, providers continue to be challenged by fragmented technology and electronic medical record systems that lack communication, or that share and transmit information effectively. Disparate information trapped in silos across multiple systems and settings hinders data quality, resulting in suboptimal outcomes and avoidable costs of care. For organizations held prisoner by their legacy systems, data inefficiencies worsen as IT environments become increasingly more complex, and the growth and speed to which health information is generated magnifies.

As healthcare IT innovators, companies have a responsibility to develop solutions that allow bidirectional connectivity between systems to enable a coherent experience for clinicians and patients. This free flow of data across various providers and environments is the catalyst for comprehensive, coordinated care, enhanced clinical decision-making, healthier communities, and a better patient experience. As the Connectathon continues to encourage this open and interoperable exchange, a far greater level of industry involvement and incentive will be required to spur change.

While the intent of the IHE Connectathons are unquestionably valid, the massive size and short duration of the events allows only a superficial level of compliance testing. This unfortunately leads to a reality gap between what is tested vs. what systems are capable of doing in the field. To make more tangible progress, the event should be less about passing tests on paper and more about ensuring that products truly leverage the existing standards and IHE profiles.

To adequately ensure value in the market, applications that pass testing must go beyond simply demonstrating that a sequence of messages was sent, but rather prove that the interoperability concepts are truly integrated into the products being certified.

Despite demonstrating open and interoperable exchange, vendors seem to abandon interoperability standards when bringing integration into practice. For healthcare providers, integration projects are constant—and costly. Many organizations are struggling to remedy interface and integration deficiencies, such as resorting to ineffective screen scraping technology to manually transfer data to their local systems. Many, if not most, of the systems only act as a feed of identity data into the EMPI, specifically demographics and identifiers. This is because many systems have already been designed to produce this outbound communication for purposes other than the management of demographic data. When it comes to querying the EMPI for patient identity, this requires a fundamental paradigm shift for many vendors and a modest investment to enhance their software.

Access to comprehensive patient data is essential to drive informed clinical decision-making and delivering care quality and efficiency. Despite EHR improvements, few organizations have been able to overcome the barriers of information silos. And achieving a truly connected healthcare environment, even for the most technically advanced health systems, remains a goal rather than a reality.

With years of health IT standards in place that yield a centralized and uniform way of managing and exchanging data, the meager pace and progress of vendors to adopt them is disconcerting. As vendors continue to master additional standards, advances in system integration and interoperability stay stagnant.

As other verticals, such as banking and manufacturing, leverage standards-based exchange at a much faster pace, healthcare struggles to effectively accelerate increased adherence of standards adoption. The challenge to the industry is to engage in an open and frank dialogue to examine how vendors can be incentivized, so patients and physicians can benefit from real-time data exchange during every encounter along the healthcare journey.

For organizations to be successful in healthcare’s rapidly evolving transformation, the status quo of interoperability is no longer acceptable. An open IT infrastructure that provides a longitudinal view of patient data across the continuum is a critical component for value-based care and population health initiatives. Let’s support organizations and the communities they serve by removing the integration barriers that plague our industry’s IT systems, and facilitate access to comprehensive information at the point of care to drive better outcomes in quality, safety and delivery.

The Defense Department and the contractors building its $4.3 billion health records platform say they’re on schedule

The next two months will be a pivotal time for the Defense Department’s commercial electronic health records platform, MHS Genesis.

Developed by Cerner under a $4.3 billion contract won by defense contractor Leidos, the platform is undergoing significant optimization based on feedback—including several thousand open “trouble tickets”—across four pilot locations.

While 11,000 tickets have been closed, around 5,000 of them are “tier 3,” which means they’ve been deferred to senior decision-makers and rise to the level of possibly requiring enterprise-level changes, said Defense Healthcare Management System spokesperson David Norley.

The department, along with teams from Cerner and Leidos, will address those issues and implement additional tweaks, lessons learned and best practices over the coming eight weeks, but officials from all three sides told Nextgov they are confident the implementation period won’t derail the platform’s schedule.

“We are on schedule,” said Jerry Hogge, senior vice president for Leidos Health.

Hogge said the two-month implementation period was planned since the contract’s inception, although it was initially up to 10 months in duration in the contract’s request for proposal.

“This is not a pause or a surprise, it’s a planned element of the program,” Hogge said. “We’re going to get it done in eight weeks time.”

Travis Dalton, Cerner’s vice president and federal general manager, told Nextgov the approach mirrors what Cerner has done in the past developing electronic health records platforms in the commercial sector.

“It’s very similar to what we’ve seen with large health systems with 50-plus hospitals,” Dalton said. “There is always a period of time where you optimize what you’ve done. We have a process we use to garner best practices and feedback from our clients. Most of the content and workflow we adopt are driven by our client base along with our best thinking.”

In total, Defense wants MHS Genesis deployed at more than 1,200 sites, including 56 hospitals and medical centers, by 2022. Norley said Defense officials will decide in spring whether to fully deploy the software. If it does, Hogge said, it will be a single commercial platform “with a common set of workflows.” Whereas many Defense medical facilities are used to customized versions of software.

Hogge said one of the “guiding principles” in the contract’s competition was the need to “get away from customized one-off systems.”

Initially, that could upset some users because change, Hogge said, can be difficult.

“There is a learning curve, a temporary loss of efficiency and comfort that, over time, is more than offset by the benefits of the new system,” Hogge said. “Cerner has mountains of data that show productivity improvements over the long- and medium-term once the learning curve is overcome.”

The modernization project went over budget and didn’t yield any reusable software or equipment.

The Coast Guard is still shelling out millions for an electronic health records system that went $46 million over budget and was canceled two years ago, a congressional watchdog found.

Lawmakers were so appalled by the mismanagement, they threatened to force the Coast Guard to adopt the system the Defense Department is rolling out rather than let the agency try again.

With an original price-tag of $14 million over five years, the Integrated Health Information System cost the Coast Guard roughly $60 million before it was canned in 2015, according to the Government Accountability Office. The agency also paid out an additional $6.6 million in contract obligations after terminating the ill-fated project, investigators found.

Lawmakers grilled Coast Guard officials Tuesday at a House Transportation Subcommittee hearing about the underlying causes of the “five-year epic failure” and the steps being taken to ensure the agency’s next modernization attempt ends with a better outcome.

“IHIS was kind of a watershed event—it shook our foundations,” said Rear Admiral Michael Haycock, the Coast Guard’s assistant commandant for acquisition and chief acquisition officer. He said the agency is exploring alternative options for managing medical records, including the MHS Genesis platform being rolled out at the Defense and Veterans Affairs departments, and should have an acquisition decision “probably by the end of February.”

Though they acknowledged the importance of following the formal acquisition process, lawmakers seemed perplexed as to why the agency would not choose a system deemed sufficient by the Pentagon and VA, which both serve more patients than Coast Guard.

“It’s a waste of money and time going to look at stuff when it exists now,” said Chairman Duncan Hunter, R-Calif. “You guys don’t get to go off on your own and use taxpayer dollars because it’s fun. I’m of the mind to make you get on DOD’s thing, no matter what you think. We ought to just tell you to do it.”

“This is not that complicated,” said Ranking Member John Garamendi, D-Calif., who joined Hunter in pressing the Coast Guard to follow in the footsteps of the two larger agencies. “Electronic health records are now a standard in virtually every health system in the nation—some of this stuff is off the shelf.”

Despite the funds poured into the effort, IHIS yielded no reusable software or equipment, and forced the Coast Guard to revert to a system relying primarily on paper medical records, according to GAO.

The watchdog attributed the failure of IHIS to agency leadership’s absence from the development process. Despite creating four groups to oversee the project, the Coast Guard couldn’t prove it followed its own system development guidelines and it was not clear whether officials documented management and oversight actions in the first place, investigators found.

“While the Coast Guard chartered these various governance bodies for IHIS oversight, the agency could not provide evidence that the boards had ever been active in overseeing the project prior to its cancellation,” the report said.

The department misspent even more than government investigators initially believed in attempting to modernize its health records system.

The Veterans Affairs Department blew almost $2 billion over three attempts to modernize the electronic health records system it uses to provide care to 9 million veterans.

A recent audit by the Government Accountability Office identified $1.1 billion in wasted spending on two VA projects from 2011 to 2016, the Integrated Electronic Health Record and Veterans Health Information Systems and Technology Architecture.

Nextgov identified another $600 million VA spent on a third program, the HealtheVet initiative, which began in 2001 but was deemed a “failed project,” according to the audit, and canceled in 2010. The HealtheVet spending was not included in GAO’s audit because VA said it no longer possessed spending records. Agencies are required by the Federal Acquisition Regulation to keep contract records for six years after final payment, the audit notes.

An analysis by big data analytics firm Govini reveals nearly half of the $600 million spent on HealtheVet went to Hewlett-Packard for hardware, software and other IT services. The agency also paid a large amount to CACI, as well as Systems Made Simple, which Lockheed Martin bought and then spun off as part of the IT business it sold to Leidos.

“It is truly amazing how much federal agencies spend on electronic health records,” said Matt Hummer, director of analytics and professional services at Govini.

The audit and spending trail on failed IT projects is important as VA embarks on its fourth attempt to modernize its health IT and records systems—this one an expected $10 billion sole-source contract to Cerner Corp. Cerner ranked as the 13th highest-paid contractor in VA’s failed iEHR and VistA programs, according to GAO, receiving $13.4 million from the agency.

Cerner is also partnering with Leidos to build the Defense Department’s next-gen health records systems—valued at $4.3 billion over 10 years. When the Defense Department’s MHS Genesis platform and VA’s Cerner-built platform are fully operational, they are expected to be interoperable, or able to share records of soldiers and veterans seamlessly between each other.

However, as GAO’s audit warns, this is VA’s fourth attempt at modernizing its health records system. In the previous three instances, the agency’s planning, management and execution led to billions of dollars wasted.

“The department’s dedication to completing and effectively executing the planning activities that it has identified will be essential to helping minimize program risks and expeditiously guide this latest electronic health record modernization initiative to a successful outcome—which VA, for almost two decades, has been unable to achieve,” the audit states.