Military health care providers detailed their needs to industry in advance a decade-long multi-billion electronic health record procurement, while inside DOD an effort is underway to improve current data to pave the way for a new provider.
The top program officer in charge of the Defense Department's massive 10-year electronic health record system procurement said he expects four to six teams to compete for the contract. The winner will provide DOD with a commercial, off-the-shelf electronic records product for military hospitals, garrisons, battlefields, ships, submarines, and other care delivery sites in the military's global health care system. That system serves a population of about 10 million active duty service members, their families, reservists, civilian defense employees and others.
Publicly, the effort has an $11 billion price tag – a number offered in congressional testimony and repeated frequently in press reports, including FCW's. Chris Miller, the program executive running the procurement, dialed that back in a call with reporters June 25, indicating that the $11 billion covers the entire lifecycle of the program, through fiscal 2030. The Defense Healthcare Management System Modernization (DHMSM) will include a "multi-billion" award to a team consisting of a health record provider and a traditional IT integrator, for a 10-year period of performance.
"We wanted to build a contract structure ...with incentives on the back side to make them perform the way we want," Miller said, explaining why they are going with a 10-year contract. Additionally, the time it takes to install and train workers on the system in more than 1,000 locations argues for a longer-term contract, he said.
So far, two teams have announced plans to bid for the work. IBM and health record firm EPIC announced a partnership earlier this month, while Computer Sciences Corp. is leading an effort with health record provider Allscripts along with Hewlett Packard to go after the business. The Department of Veterans Affairs has expressed interest in bringing its VistA health record system into DOD. More such pairings are expected to be announced in the coming months as industry readies for the final request for proposals, which is due to be released by the end of September.
Military health providers from the top of the chain of command down to the service delivery level are looking forward to an upgrade. Maj. Gen. Brian Lein, the deputy surgeon general and deputy commanding eneral of the Army Medical Command, said military physicians are using multiple portals to copy and paste information into different iterations of health records. The current system is "electronic but not integrated," he said at a June 25 industry day for vendors that attracted more than 400 attendees.
Also critical to the success of the program is the ability to access and update the heath record in remote areas under hostile conditions. Col. Jennifer Caci, commander of the 62nd Medical Brigade, recalled that in Afghanistan just last year, wounded soldiers were being moved from one level of care to another with their medical orders rubber-banded to their bodies. This inevitably leads to confusion about patient information, and what interventions have been performed by medical corpsmen or field hospital personnel. "Even something as simple as a soldier's blood type can be confounded by the combat environment or a mass casualty situation, resulting in catastrophic outcomes," Caci said.
'We know we can do better'
Behind the scenes of the procurement process, a group called the Defense Medical Information Exchange (DMIX) is leading an effort to corral the legacy applications and data into compliance with current interoperability requirements, to improve coordination with the Veterans Affairs Department and with outside private health care providers who deliver 60 percent of the care used by the military population.
Currently, there is a high degree of sharing between the DOD and the VA, Miller said. The two departments have correlated five million health records, and more than 1.5 million pieces of information flow between the two departments every day.
"Worst case, we have what we have today. We know we can do better, and that's what we're working on," Miller said.
Craig Schaefer heads the DMIX effort inside the Defense Healthcare Management Systems. He sees his job as "cleaning up the battlefield," before the commercial team comes in to implement the new health record. "We don't want you to have to unravel the cobwebs that are out there," Schaefer said at the industry day. The vision is of a seamless, integrated bi-directional flow of standardized health data between DOD, VA, other federal agencies -- including the Social Security Administration -- and private providers to serve as "a foundation the winning team can come in and plug into," Schaefer said.
Once the final proposal goes out, vendors will have between 30 and 45 calendar days to respond – the timeline is still being finalized. The winner will enter into what contracting officials likened to a marriage with the military health system. Program Manager Capt. John Windom said they are looking for a partnership with a vendor that understands how to roll with "the things we can't predict – the Haitis, the Katrinas – the things that introduce additional clinical requirements on our part." The successful vendor will "understand the way DOD does business, and is able to respond on a moment's notice," Windom said.