A Roadmap for Health IT

Lloyd McCoy_65x85by Lloyd McCoy Jr., Consultant

In President Obama’s first weekly address back in January 2009, he called for every American to have an electronic health record by 2014. His statement at the time did not seem out of reach. After all, the benefits of consolidation and integration within Health IT were clear; lower costs and more efficiency would save money and save lives. It was a no brainer and the Department of Health & Human Services, Veterans Affairs, and Department of Defense would lead the charge.Lloyd Health IT

Several years later, after cost overruns, political squabbling, bureaucratic infighting, and technical challenges the public Health IT space has seen its fair share of battle scars. In the last 18 months alone we have witnessed the VA and DOD abandon efforts to develop a unified electronic health record, the failed initial launch of the Affordable Care Act website, and an outdated electronic scheduling system at the VA, which contributed to the ongoing scandal over excessive wait times for veterans.

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New Pentagon Health Record Procurement Offers IT Opportunities

Rick Antonucci_65x85By Rick Antonucci, Analyst

The Pentagon has released procurement information for their new Electronic Health Record (EHR) to be released by 2016 as part of the Defense Healthcare Management Systems Modernization (DHMSM) Program. The Draft RFP  has been released by SPAWAR and procures a replacement EHR for the Armed Forces Health Longitudinal Technology Application (AHLTA).

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Top 3 Procurement Priorities for the New Defense Health Agency

Lloyd McCoy_65x85by Lloyd McCoy Jr., Consultant

Those controlling the purse strings within the three-month old Defense Health Agency (DHA) are especially keen on shared services and opportunities to consolidate and are looking hard at chances for eliminating redundancies as it seeks to bring under one roof functions previously decentralized. The agency is also looking for ways to update its antiquated technology to increase efficiencies and cost savings. If you can identify opportunities and offer solutions along these lines, you are ahead of the pack.  Here are the top three procurement priorities for DHA:

1.  Upgrading its electronic health records

Last week, the DHA issued a RFP to maintain and incrementally upgrade its electronic health record (EHR) system, which is the world’s largest. The contract, worth up to $1 billion, sheds light on DHA’s timeline for entirely replacing the massive electronic health record system. The sustainment contract extends through 2018 making it likely DHA’s new EHR won’t come online until 2018/2019. The decision to extend the Pentagon’s current electronic health record for a few more years comes after the VA and DOD agreed last year to stop work on making their legacy systems interoperable. DOD decided it needed to focus on replacing its legacy healthcare IT system first. Both agencies though still plan to make their respective electronic health records interoperable. It’s worth noting that last fall DOD issued an award to continue providing systems integration and engineering support toward the interoperability effort.

2.  Consolidation

Infrastructure, portfolio rationalization, and application consolidation will be especially important over the next two fiscal years (FY14-15) as DHA seeks to bring together redundant IT functions that existed under the old Military Health System framework under its shared services model.  Also, in the absence of a proper integrated Electronic Health Record, the agency is looking for ways to enhance how VA and DOD’s respective infrastructures can better correlate patient data.

3. Mobility

Expect mobile platforms and applications to see widespread use throughout the defense medical complex. There are bound to be a lot of opportunities here given that the agency serves almost 10 million people through about 700 hospitals, clinics, and medical centers, not to mention medical facilities on naval ships. Before DHA dives into BYOD and mobility adoption, mobile security solutions will be of paramount importance.

Reprograming the IPO Could Create New Opportunities with Electronic Health Records

Tomas OKeefe_65x85by Tomas O’Keefe, Senior Analyst

The future of the Interagency Program Office (IPO) is up in the air. Originally designated to develop an integrated electronic health record (iEHR) between the Department of Veterans Affairs and the Department of Defense, the office used to boast a budget in the hundreds of millions of dollars. However, with the decision earlier this year by the Department of Defense to pursue its own EHR, the buzz seems to be that most of the IPO’s budget is being reprogrammed. We continue to hear from both DOD and VA officials that there is still the goal of having an integrated and interoperable EHR, but expect both DOD and VA to pursue their own solutions at this point, while maintaining an open dialogue about how the disparate systems can still work together.

At AFCEA Bethesda’s Health IT Day in mid-November Dr. Theresa Cullen, the Chief Medical Informatics Officer at VA, discussed one of the likely solutions to the data sharing challenges between the VA and DOD with an update to VA’s current EHR system termed VistA Evolution. VistA Evolution is relying on an agile development schedule to roll out new interfaces and applications in short development timeframes in the hope of providing “disruptive evolution” to the overall program suite by introducing new technologies. VistA is a legacy system that the VA has relied upon for quite some time, but it operates off a fundamental architecture that can be updated to meet many of the needs of today, including enhancing interoperability with DOD systems, and the only barrier to updating VistA seemed to be cost. With money now freed from a potentially defunct IPO, expect the VA to move ahead on an aggressive update schedule, with several contracts to work on VistA already awarded.

Dr. Cullen is veryiEHR Blog conscious of how the next stage in the development of the applications and databases that handle health information will be handled. Health information on VA systems remains siloed and while the Department has made progress addressing this challenge, it seemingly pales in comparison to the task of being able to interface with DOD medical systems. This may be the future of the IPO, to act as more of a governance and policy agent to determine the standards that the VA and DOD EHRs have to operate off of, rather than as a functional office that actually undertakes development opportunities.

This reprogramming could open up new opportunities for COTS vendors who can provide CRM solutions, health data and records management, and middleware and SOA tools to ensure the differing systems can actually talk to each other. These joint efforts to strengthen interoperability remain high-visibility and have a lot of support on the Hill, with language in the 2014 VA spending that would actually mandate that DOD and VA operate off of one EHR. Expect the Departments to keep this in mind when pursuing their solutions in the event that the law requiring a single EHR actually passes, however unlikely that may prove to be.

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