Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

Department Of Defense (DOD) EHR Delayed By “Aggressive Schedule”

Posted on September 7, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

The Department of Defense has announced that it will be delaying the deployment of its massive EHR project, citing issues identified in testing and an “aggressive schedule” as reasons for the decision. If the DoD and its vendors are right, the deployment delay will be a negligible few months, though one setback to an effort of this kind usually to leads to another.

On the plus side, military officials said, they’ve made significant progress with developing user-approved workflows, interfaces and technical integration of its legacy system to date. But they’re not ready to engage in the concurrent system configuration, cybersecurity risk management, contractor and government testing yet.

The deployment has been in the works for little over a year. Last summer, the DoD Healthcare System Modernization Program awarded the $4.3 billion contract to upgrade its existing Military Health System EHR to a group including Cerner and defense contracting firm Leidos. The Cerner/Leidos team won out against some tough competition, including a partnership including Allscripts, HP and Computer Sciences Corp. and an Epic/IBM bid.

The ten-year project is about as large and complex an integration effort as you’re likely to see even by Cerner standards. The effort will connect healthcare systems located at Army hospitals, on Naval vessels, in battlefield clinics across the globe. MHS GENESIS will bring all of this data — on active-duty members, reservists, and civilian contractors — into a single open, interoperable platform. The new platform should serve 9.5 million military beneficiaries in roughly 1,000 locations.

The project is upgrading the DoD from AHLTA (Armed Forces Health Longitudinal Technology Application), which has been in place since 2004. AHLTA has many flaws, though none that would surprise a health IT expert. (For example, when patients are referred to non DoD providers, the data is not captured and integrated into the system.)

Ultimately, it won’t matter very much whether the DoD manages to kick off its project on time. The larger question, here, is whether over the course of a 10-year integration effort, the project becomes, as Forbes columnist Loren Thompson puts it, “obsolete before it’s even built” and incapable of the data sharing that fueled its conception. Of course, any systems integration with a long timeline faces that risk, but not all industries are changing as quickly as healthcare.

The truth is, this is arguably an awkward time for any large entity to be making big interoperability plans. I’d argue that while there are more initiatives than ever aimed at the problem, they’ve effectively made things worse rather than better. After all, the unfortunate truth is that the more people compete over interoperability standards, the less possible data sharing becomes.

Background On Cerner’s Capture Of DoD EHR Data Center Biz

Posted on January 6, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

As many readers will know, the Department of Defense awarded Cerner the $4.3 billion Defense Healthcare Management System Modernization contract this summer, through its partnership with Leidos and Accenture. In doing so the partners beat out some formidable competition, including an Epic/IBM bid and a group, led by Computer Sciences Corp., whose partners included Allscripts and HP.

This is a system integration project on the grandest scale, connecting healthcare systems located at Army hospitals, on Naval vessels, in battlefield clinics across the glove. The idea is to bring all of this data — on active-duty members, reservists and civilian contractors — into a single open, interoperable platform. The new platform should serve 9.5 million military beneficiaries in roughly 1,000 locations.

Now, just six months into the 10-year deal, the DoD has decided to change the rules a bit. Military officials have concluded that the new records system capabilities won’t function at their best unless they’re hosted in a Center datacenter. The new system, officials said, “requires direct access to proprietary Cerner data, which is only available within Cerner-owned-and-operated data centers.”

I’m not sharing this tidbit because it nets the partnership more money — Cerner will take in a comparatively trivial $5 million per year to host the government health data — but for a few other reasons that offer ongoing perspective on this massive deal:

  • While there’s no concrete way to prove this, the buzz around the time of Cerner winning the contract was that it won because it was perceived as more open than Epic. Arguably, if the DoD has to transfer data hosting because it needs access to proprietary algorithms, maybe the whole open thing was a fake-out. Certainly, needing access to Cerner logic locks down the deal even further than a straight ahead contract award.
  • Why couldn’t the DoD anticipate that their own data centers wouldn’t meet the needs of the project?  And why didn’t planners know, in advance, that they’d need access to Cerner’s “quantitative models and strategies” prior to signing on the dotted line? Admittedly, this is a sprawling project, but planning for appropriate network architecture seems pretty basic to me. Did Cerner deliberately raise this issue only after the deal was done?
  • In the notice the DoD issued outlining its intention to shift hosting to Cerner, it noted that while it wasn’t seeking competitive proposals, “any firm believing that they can fulfill the requirement of providing these services may be considered by the Agency.” The key for late entrants would be to prove that they could both meet hosting requirements and connect to proprietary Cerner data.
  • Was the intent always to host the EHR at the Cerner data centers and this was a way to do an end around the bid process and make the initial bid look more attractive (ie. cheaper) so it won the contract? I wonder how many more of these late additions the DoD will have when implementing the Cerner EHR. We’ve seen many hospital EHR implementation budgets have skyrocketed. It’s not hard to imagine the same scenario playing out with the DoD EHR budget. This might be the first of many EHR add-ons that weren’t part of the original contract.

Could the DoD be SMART to Choose Cerner?

Posted on August 4, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Even before the health IT world could react (with surprise) to the choice of a Cerner EHR (through its lead partner, Leidos Health Solutions Group) by the Department of Defense, rumors have it that Cerner beat out Epic through the perception that it is more open and committed to interoperability. The first roll-out they’ll do at the DoD is certain to be based on HL7 version 2 and more recent version 3 standards (such as the C-CDA) that are in common use today. But the bright shining gems of health exchange–SMART and FHIR–are anticipated for the DoD’s future.

Read more..

Allscripts (MDRX) At Important Moment In Its History

Posted on May 21, 2015 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Allscripts has announced plans to move more of its software development and operations to India, while cutting 250 jobs in the U.S., or about 3.5% of its 7,200-member workforce.  While this is significant enough as it is, it’s an even more important leading indicator of how Allscripts may perform going forward. Here’s how I think things will net out.

Making a “rebalancing”:  The company has called the changes a “rebalancing” of staff which will allow it to respond more effectively and efficiently to shifts in its software design and product dev plans.

But the decision didn’t happen in a vacuum, either. Allscripts recently reported taking a $10.1 million loss for the first quarter ending March 31. That’s down from a loss of $20.7 million for Q1 2014, but the company still appears to be struggling. Allscripts’ overall revenue dropped 2% to $334.6 million for the quarter ending March 31, compared with Q1 of 2014.

What’s next? What should providers draw from these numbers, and Allscripts’ plan to shift more development work offshore? Let’s consider some highlights from the vendor’s recent past:

* Despite some recent sales gains, the vendor occupies a difficult place in the EMR vendor market — neither powerful enough to take on enterprise leaders like Epic and Cerner directly, nor agile enough to compete in the flexibility-focused ambulatory space against relentless competitors like athenahealth.

* According to an analysis of Meaningful Use data by Modern Healthcare, Allscripts is second only to Epic when it comes to vendors of complete EMRs whose customers have qualified for incentives. This suggests that Allscripts is capable of being an effective provider business partner.

* On the other hand, some providers still distrust Allscripts since the company discontinued sales of and support for its MyWay EMR in 2012. What’s more, a current class action lawsuit is underway against Allscripts, alleging that MyWay was defective and that using it harmed providers’ business.

* Partnering with HP and Computer Sciences Corp., Allscripts is competing to be chosen as the new EMR for the U.S. Department of Defense’s Military Health System, and is still in the running for the $11 billion contract. But so are Epic and Cerner.

The bottom line: Taken together, these data points suggest that Allscripts is at a critical point in its history.

For one thing, cutting domestic staff and shifting dev operations to India is probably a make or break decision; if the change doesn’t work out, Allscripts probably won’t have time to pull back and successfully reorient its development team to current trends.

Allscripts is also at a key point when it comes to growing place in the brutal ambulatory EMR market. With players like athenahealth nipping at its heels from behind, and Epic and Cerner more or less controlling the enterprise market, Allscripts has to be very sure who it wants to be — and I’m not sure it is.

Then when I consider that Allscripts is still in the red after a year of effort, despite being at a peak level for sales, that tears it.  I’m forced to conclude that the awkwardly-positioned vendor will have to make more changes over the next year or two if it hopes to be agile enough to stay afloat. I believe Allscripts can do it, but it will take a lot of political will to make it happen. We’ll just have to see if it has that will.

Epic Joins IBM To Pitch DoD Contract

Posted on June 19, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Hoping to be the lucky vendors that win a massive pending DoD deal, Epic Systems has team up with global technology giant IBM to compete for the DoD’s Healthcare’s Management Systems Modernization contract.

The new project comes after years of  struggles and changes of direction by the DoD, which has worked for years to integrate its system with the VA’s EMR. Back in 2009, the two giant federal agencies kicked off an effort to create an integrated medical record, the iEHR, which would offer every service member the ability to maintain a single EMR throughout their career and lifetime. But those efforts failed miserably, and the iEHR project was halted in February 2013.

Since then, the DoD has announced that it’s moving along with its iEHR plans once again, a sprawling project which the Interagency Program Office estimates the cost somewhere between $8 billion and $12 billion.

Meanwhile, the DoD Healthcare Management Systems Modernization is moving ahead, slated to replace the current Military Health System. The DHMSM should serve some 9.7 million beneficiaries.

The two partners certainly bring a strong bench to the table. Epic offers an interoperable platform which is one of the most adopted EMR systems in the country, and according to company officials,its open architecture supports more than 20 billion data transactions between systems every year.  Epic says that its customer community, which currently includes 100 million patients, exchanges more than 2.2 million records each month with of the EMR vendors, HISPs, HIEs, the VA, DoD and Social Security Administration.

IBM, meanwhile,is contributing its system integration, change management and expertise , ad experiments in delivering large-scale solutions in partnership with complementary software and services providers. IBM’s Federal Healthcare practice will lead the effort, backed by IBM global information technology,research and health care organizations which already collaborate with Epic in support of EMR solutions internationally.

Without a doubt, IBM is the grandfather of all big iron providers, so they don’t have a lot to prove.  And Epic is a clear leader in the enterprise EMR space, by some measures leading the pack by a considerable margin. It’s likely they’re a top contender for the job.

If the DoD does indeed choose the partnership of Epic and IBM to make its health IT transition, it seems likely that they’ll have recruited more than enough firepower to get the job done — though there’s always the question of whether Epic, which is used to bossing hospitals around, will function as well when the big bureaucracy of the DoD is calling the shots.

But what’s more worrisome is whether the DoD will work effectively with these two private sector companies, assuming t hey win the bid. As noted, the DoD’s track record with change management is nothing to write home about, to say the least, and bureaucratic waffling could conceivably undermine even the most expert efforts to bring DoD’s healthcare architecture into the future. As big and powerful as they are, IBM and Epic may be in for one heckuva ride. In fact, John’s even suggested that the best thing for Epic might be for them to not win the DoD EHR contract.

DoD May Keep Its EMR Until 2018

Posted on November 13, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Though it had previously announced plans to update its system by 2017, the Department of Defense is now looking for contractors who can support its current EMR, the Armed Forces Health Longitudinal Technology Application (AHLTA), through 2018, according to iHealthBeat.

The DoD and VA have been working for years to integrate their separate systems,but seemingly have little to show for their efforts. The two sprawling agencies kicked off their effort to create an integrated record, the iEHR, back in 2009. The idea was to offer every service member to maintain a single EMR throughout their career and lifetime, iHealthBeat reports. But the effort has been something of a disaster.

The iEHR project was halted in February 2013, with officials deciding to work on making their current EMR systems more interoperable. A few months later, DoD Secretary Chuck Hagel wrote a memo stating that the agency will consider a commercial EMR system. Most recently, the DoD asked 27 EMR vendors to provide demos of possible EMR replacements, according to iHealthBeat.

In DoD’s pre-solicitation notice, DoD announced that it would extend the contract for AHLTA’s underlying Composite Healthcare System, which is the back end of the military EMR.  The Composite Health System handles laboratory tests, prescriptions and scheduling.

That being said, the DoD is also moving along with its iEHR plans once again, a gigantic project which the Interagency Program Office estimates will cost somewhere between $8 billion and $12 billion. A contractor named Systems Made Simple recently won the contract to provide systems integration and engineering support for creating  the iEHR.

Folks, if you can follow the twists and turns of this story — they’ve giving me whiplash — you’re a better person than I am. So far as I can tell, the DoD changes its mind about once a quarter as to what it really wants and needs. Seems to me that Congress ought to keep that birch rod handy that it used on HHS over the HealthCare.gov debacle. Isn’t somebody going to get this thing once and for all on track?

Defense Department’s EHR Effort Falters

Posted on October 7, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

From reader DKBerry:

You’d think that buying a common EHR platform and deploying it across all of Defense Department’s medical centers (Army, Navy, Air Force) … that they would have done better.  How did VA succeed where DoD is failing?

Unless the Defense Department addresses weaknesses in project planning and management that have hampered its current electronic health-record system’s capabilities, it risks undermining its new EHR initiatives, according to a Government Accountability Office report (PDF) requested by Sen. Judd Gregg (R-N.H.), the ranking minority member of the Senate Budget Committee.

The report notes how the Defense Department has obligated some $2 billion since 1988 to an EHR system for the 9.6 million active-duty service members, their families and other beneficiaries but has come up short and has scaled back its original expectations for AHLTA. (AHLTA was originally an acronym for “Armed Forces Health Longitudinal Technology Application,” but the department later declared it was no longer an acronym, but a brand.)

After finding AHLTA’s early performance “problematic” in terms of speed, usability and availability, the Department of Defense has sought to acquire a new system known as EHR Way Ahead, according to the report.

The new system, according to the GAO report, “is expected to address performance problems; provide unaddressed capabilities such as comprehensive medical documentation; capture and share medical data electronically within DOD; and improve existing information sharing with the Department of Veterans Affairs,” and has initiated efforts to “stabilize” AHLTA so it can act as a bridge until the system is ready.

The Defense Department has allocated $302 million in its 2011 budget request, according to the report, but has not changed its EHR acquisition process to avoid the same shortcomings it experienced with AHLTA.

Source

Department of Defense and Veterans Affairs Deadlines for Interoperability

Posted on October 9, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Government Health IT ran an interesting article talking about the Department of Defense (DoD) and Veterans Affairs deadline for interoperability of electronic health records. Here’s a short section of the article:

For Navy Capt. Michael Weiner, acting deputy program officer of the Defense Health Information Management System, the two departments have met the relevant interoperability criteria, which were set by the Interagency Clinical Informatics Board, he said.

These included making DoD inpatient discharge notes available to the VA; increasing the number of electronic gateways deployed between the two systems; enhancing the sharing of social history; creating the ability to view scanned documents between systems; and making available DoD periodic health assessments and separation physicals to the VA.

“These were the agreed upon metrics and measures of success and we have achieved them all,” Weiner, told Government Health IT.

However, Rear Adm. Gregory Timberlake, the now retired head of the IPO, committed earlier this year to the complete and computable interoperability of six categories of data by September 30. Not all of these are now shareable in computable form, Weiner acknowledged.

Those six classes of data–for prescriptions, laboratory results, radiology results, and physician, nursing, and therapist notes–were to augment the exchange of drug interaction and allergy information for shared DoD/VA patients previously available. Lab results and radiology results are still not shareable in computable format, according to Weiner.

Of course, we should applaud those who are working on interoperability of EHR software. However, this is a small example of the complexity that’s involved in trying to make healthcare data interoperable. If two organizations that are so closely tied as the DoD and VA are having a challenge sharing their EHR records, imagine what it’s going to be like in the private sector.