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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.

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 And Team Battle Epic and IBM for DoD Contract

Posted on June 27, 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.

Earlier this month,we shared the news that Epic and IBM had gotten together to fight for the DoD’s massive Healthcare Management Systems  Modernization project. The project is to replace the current Military Health System, which should serve some 9.7 million beneficiaries.  The winning team should make about $11 billion to do the work.

So it’s little wonder that another group of health IT giants have stepped up to fight for such a juicy prize.  A group lead by Computer Sciences Corp., whose partners include Allscripts and HP, has announced that it intends to compete for the contract.

The HMSM project is extremely ambitious. It’s intended to connect varied healthcare systems across the globe, located at Army hospitals, on Naval vessels, in battlefield clinics and more, into a single open, interoperable platform serving not only active-duty members, but also reservists and civilian contractors.

Before you burst out laughing at the idea that any EMR vendor could pull this off, it’s worth considering that perhaps their partners can.  It’s hard to argue that CSC has a long track record in both government and private sector health IT work, and HP has 50 years with of experience in developing IT projects military health and VA projects.

That being said, one has to wonder whether Allscripts — which is boasting of bringing an open architecture to the project — can really put his money where its mouth is. (One could say the same of Epic, which frequently describes its platform as interoperable but has a reputation of being interoperable only from one Epic installation to the other.)

To be fair, both project groups have about as much integration firepower as anyone on earth. Maybe, if the winner manages to create an interoperable platform for the military, they’ll bring that to private industry and will see some real information sharing there.

That being said, I remain skeptical that the DoD is going to get what it’s paying for; as far as I know, there is no massively interoperable platform in existence that meets the specs this project has.  That’s not an absolute dealbreaker, but it should raise some eyebrows.

Bottom line, the DoD seems determined to give it a try, regardless of the shaky state of interoperability in the industry overall. And its goals seem to be the right ones. After all, who  wouldn’t want an open platform that lends itself to future change and development?  Sadly, however, I think it’s more likely that will be shaking our heads over the collapse of the project some years from now.

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?

DoD, VA Move Closer To Joint EHR

Posted on October 24, 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.

It looks like the DoD and VA may yet again be making  progress toward creating an integrated health record, after a long stretch when it looked like the project was dead, according to Healthcare IT News.

This is a gigantic effort, and expenses for executing it are gigantic too. In September 2012, the Interagency Program Office estimated the final costs for the iEHR at between $8 billion to $12 billion.

The course of the project has been bumpy, with key players shifting direction more than once. Most recently, the DoD had announced in May that it was looking for an EHR on the commercial market, seemingly dropping plans for creating an iEHR with the VA. But now the two agencies have awarded a re-compete contract for creating the iEHR, HIN reports.

Last week, the Interagency Program office said that Systems Made Simple had won the contract, under which the company would provide systems integration and engineering support for creating the iEHR.  SMS had previously won the contract in 2012, but that contract called for it to bid again in a competitive process.

The idea behind the iEHR has been and continues to be creating a system that can present a single record for each military veteran, complete with all clinical information held by the two giant agencies.

However, for a time it looked like the iEHR project was dead, when the two organizations announced that they were shifting their approach to buying technology from an outside vendor. Critics — including myself  — sharply scolded the agencies when these plans came to light, with most suggesting that the new plan was doomed to fail.

Now, the integration game is on. SMS’s three main focus areas will be to establish data interoperability between the VA and DoD systems, plan a service-oriented architecture for the integration, and create terminology translation services that deliver data to users in a shared format, notes HIN.

With these goals met, SMS plans to “create data through a single, common health record between all VA and DoD medical facilities,” the company said in a statement.

Now, let’s hope that nobody in the agencies switches direction again. Let’s give this thing a chance to work, people!

DoD Official Challenges Agency’s EMR Approach

Posted on April 26, 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.

Back in 2009, the Department of Defense and the VA began an initiative, the iEHR project, which was supposed to integrate the two sprawling agencies’ EMR systems.  That initiative came to a halt in February, with the two organizations deciding make their two independent systems more interoperable and the data contained wtihin more shareable.

At least one DoD official, however, believes that the latest effort flies in the face of President Obama’s directive that agencies adopt and use open data standards. J. Michael Gilmore, director of the DoD’s operational test and evaluation office, has sent a memo to Deputy Secretary of Defense Ashton Carter arguing that the DoD’s plan to evaluate commercial EMR systems is “manifestly inconsistent” with that order.

“The White House has repeatedly recommended that the Department take an inexpensive and direct approach to implementing the President’s open standards,” Gilmore wrote. “Unfortunately, the Department’s preference is to purchase proprietary software for so-called “core” health management functions…To adhere to the President’s agenda, the iEHR program should be reorganized and the effort to define and purchase “core” functions in the near term be abandoned.”

If the DoD actually manages to successfully implement a commercial EMR system, it “would be the exception to the rule, given the Department’s consistently poor performance whenever it has attempted wholesale replacement of existing business processes with commercially derived enterprise software,” Gilmore noted tartly.

Gilmore recommends that the DoD go the open standards route by defining and testing the iEHR architecture, then purchasing a software “layer” to connect DoD’s EMR with other providers using open standards.

The VA, meanwhile, has formally proposed that the DoD migrate from its existing AHLTA EMR to the VA’s popular VistA EMR, already in place successfully throughout the agency’s hospitals and clinics. VistA is deployed at more than 1,500 sites of care, including 152 hospitals, 965 outpatient clinics, 133 community living centers and 293 Vet Centers.

VA Asks DoD To Adopt Vista

Posted on April 2, 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.

For decades, the Department of Defense has struggled to build an EMR, but 20 years and $10 billion later, still hasn’t pulled together a satisfactory system. The DoD’s system, AHLTA, has seen project failure after project failure and still isn’t doing what it’s supposed to do efficiently. Now — at long last — DoD is looking at different options.

In theory, the DoD is still hacking away at the iEHR, a joint system with the VA, which is due for testing in 2014. iEHR is slated to include a mix of commercial and open source technologies. But the evidence suggests that iEHR is another failed project.

A few weeks ago, the VA submitted a formal proposal to the DoD suggesting that the Military Health system migrate away from AHLTA,working in collaboration with open source VistA community members such as the Open Source Electronic Health Record Agent (OSEHRA), WorldVista and several other companies involved in VistA development, OpenHealthNews notes.

The prospect of seeing VistA put in place has its advocates excited, to say the least. Seeing an opportunity, the open source community has launched a petition on the White House web site urging the DoD to adopt VistA, reports OpenHealthNews.

So, is moving to VistA a good idea? For those, including myself, who aren’t up to date on just how extensive VistA’s presence is, note that it already embraces (stats courtesy of OpenHealthNews):

• Over 6 million patients, with 75 million outpatient visits and 680,000 inpatient admissions
• More than 1,500 sites of care, including 152 hospitals, 965 outpatient clinics, 133 community living centers, and 293 Vet Centers
• 244,000 employees including more than 20,000 physicians and 53,000 nurses
• Affiliations with more than 1,200 educational institutions with more than 100,000 health care students receiving clinical training from VA each year

VistA is one of the few EMRs out there that has been proven successful over time, garners universal respect and has an enthusiastic user base. Oh, and of course, the price is right even after you add in integration and development costs.  I personally signed the White House petition — will you be doing so?

Also, for another look at the integration failures of the DoD and VA check out Jon Stewart’s rant.

Having Already Failed Once, DoD Snubs Open Source For Second EMR Try

Posted on August 28, 2012 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.

In theory, the VA now has everything it needs to standardize and upgrade the open source VistA EMR, especially after forming the Open Source Electronic Health Record Agent (OSEHRA) organization.  But when it comes to bringing that expertise to the DoD’s EMR projects, it seems OSEHRA alone can’t do the trick.  Sadly, it’s no surprise to find this out, as the DoD has an abysmal track record on this subject.

OSEHRA, an independent non-profit open source group, was launched about a year ago. The group is working away at improving compatibility between versions of VistA at the 152 VA medical centers.  According to an InformationWeek piece, there’s now about 120 different versions of VistA ticking away within the VA system.  OSEHRA hopes to create a common core — a “minimum baseline standard”  for 20 VistA modules — which will make it easier for the medical centers to deploy enterprise-wide apps.

The DoD, meanwhile, is hacking away at a joint system with the VA, called iEHR, which is due for initial testing in 2014.  A few months ago, DoD told Congress that while open source technology will be part of iEHR, the agency will also include commercial and custom applications, using a service-oriented architecture.

What that means, in practical terms, is that OSEHRA will be cooling its heels waiting for DoD contractor Harris Corp. to build an Enterprise Service Bus and open source APIs to allow for open source development on the project.

Now, that wouldn’t raise my suspicions so much if DoD hadn’t proven to be a collosal failure at developing an EMR.  Did anyone else here catch the major slap GAO delivered to DoD a couple of years ago, noting that its 13-year, $2 billion AHLTA application was a near-complete fizzle?  If anyone at DoD had humility, or if their bosses were held accountable for AHLTA’s staggering losses, nobody would let them drive the technical choices on this project.

Am I the only one who sees a recipe for billions more in DoD losses here?

EMRs and Paper Records: Natural Enemies

Posted on March 5, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

How useful is an EMR when large volumes of data don’t get entered into the system?   It seems we’ll have plenty of chances to find out.

As the following story illustrates, clinical staffers will often revert to using paper documentation at their first opportunity, even if a perfectly nice EMR is available for use.

Apparently, U.S. Army mental health personnel working in Afganistan and Iraq aren’t entering patient data into the DoD’s AHLTA EMR system. The Army is now swamped with paper behavioral health records and has no system in place to scan and code the records for use within AHLTA, according to iHealth Beat.

Admittedly, entering data on the battlefield may pose some unique problems. Still, I doubt the DoD is the only organization facing this problem. After all, if you’re a clinician who’s been using paper records for decades, and somebody suddenly tells you to stand your work habits on their head, resistance is only natural.

Now, I’m well aware that even if the DoD hasn’t purchased one, there are systems available which can transform paper records into data usable by an EMR.

However, I’m fairly such systems are designed primarily to import data from  existing paper archives.  I doubt they could transform an ongoing stream of paper records into data quickly — much less in real time.

The truth is, paper and EMRs are natural enemies. You either chart it or you enter it, but the two are based on substantially different work flows.  If your health organization’s staff slips back into using  paper documentation, it’s not just an inconvenience, it’s a huge problem.

After all, just imagine the potential for patient harm if half the critical data lives on the EMR platform and half in paper.  When they need live patient data, what do clinicians do with a message from IT that says: “We’re two weeks behind on scanning — figure it out for yourself”?