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The Best Thing For Epic Might Be to NOT Win the DoD Contract

For those not familiar with the Department of Defence (DoD) EHR contract that’s being bid on right now, check out our post about the $11 billion EHR contract. Yes, you’re reading that right. That’s $11 billion with a B. I believe that would be the largest single EHR contract ever (I believe Kaiser was $4 billion to start).

Needless to say, this is an enormous contract that will make some outside companies very rich. I can’t even imagine what $11 billion of EHR consultants and software would look like. That’s a lot of EHR jobs to go around, but I digress.

Most people in the industry seem to believe that Epic is the front runner in the race. Considering the number of large deals that Epic has won, Epic winning the DoD EHR contract would be a safe bet. Although, I wonder if the best thing for Epic would be for them to not win the DoD contract.

Sure, Epic would take a short term PR hit if someone else like Cerner wins the DoD contract. You can already predict the press headlines talking about the fall from power as Epic loses to Cerner (similar to when Cerner won the Intermountain deal over Epic). That would have some damage to Epic’s reputation, but not really. It’s not like any other hospital in the US thinks that their contract would be anything like the DoD EHR contract. In fact, many of the hospitals purchasing Epic EHR will be grateful that Epic resources aren’t being tied up on a new $11 billion contract while their “small” $100 million EHR project languishes.

Indeed, the best thing for Epic might be for it to NOT win the DoD EHR contract. Let’s remember that Epic has a really good history of successful EHR implementations. Sure, there are a few examples where the Epic implementation hasn’t gone so well. However, I think the general view of the industry is that Epic implementations generally go well. In fact, there are stories of Epic contracts so stringent that when an Epic implementation starts to go bad, Epic comes in and takes over to make sure that the implementation goes well.

Long story short, Epic has the best reputation of any hospital EHR vendor when it comes to successful EHR implementations (especially large ones). Epic winning the DoD EHR contract could do a lot to tarnish that reputation.

One might argue that if Epic’s successful with the $11 billion DoD EHR contract, that it will be a boon to their current reputation. That’s fair, but the DoD EHR implementation would be unlike most other EHR implementations. First, the DoD doesn’t have a sterling reputation for successful healthcare software projects. That will likely become an issue for anyone who wins the contract. Second, we’re talking about a government entity with layers of red tape and bureaucracy. A small company like Epic (small in government contractor terms) isn’t going to carry the same weight as they usually do in their other hospital EHR implementations. Epic, the control company, won’t be able to control the DoD EHR project the same way they usually do.

One could use the same argument I used above about why even if Epic gets the DoD contract and fails, it won’t tarnish their reputation since hospitals realize that the DoD is unique. However, the difference between losing a bid and a failed $11 billion project is very different. The failed DoD EHR bid will be covered once and then generally forgotten. A failed $11 billion contract can carry on for years as timelines are delayed, budget overruns are reported, discontent leaks out, he said-she said occurs, and the media churns and speculates on what’s happening with the DoD EHR project.

We all think that winning an $11 billion contract would be great. Indeed, that’s a lot of money and would be an enormous win worth celebrating. The only question is how long will the celebration continue? If I’m Epic, I wouldn’t be too sad if I didn’t win the contract. In the long term, it might be for the best.

June 2, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

$11 Billion DoD EHR Contract

Nextgov has a great article up which outlines many of the details of the soon to be bid out Healthcare Management Systems Modernization contract. I’d prefer to call it the DoD EHR Contract or AHLTA replacement contract. Certainly there’s more to it than EHR, but that will be the core of the contract and the big name EHR vendors will all be involved.

Here’s a section of the article which gives you an idea of the size of the contract:

The DHMSM contract’s estimated lifecycle value is approximately $11 billion and would include initial operating capabilities by 2017 and full functionality by 2023, according to Dr. Jonathan Woodson, assistant secretary of Defense for health affairs, who testified in February before the House Appropriations Committee’s defense panel.

Even in Washington, $11 billion is a lot of money, and it would surely rank among the largest IT-related contracts in government. What’s unique about this effort is that the Pentagon wants a single contractor to lead the integration of a commercial electronic health records system to cover its nearly 10 million beneficiaries and large assortment of health care facilities worldwide. Defense is one of the largest health care providers in the country, on par in size with the Veterans Affairs Department and private sector leaders like Kaiser Permanente.

The article also states that they want to issue a contract with one vendor. We’ll see how that plays out. I’ve seen some rumors out there about who will be bidding. No doubt it will be a combination of the usual government contractors and EHR consultant companies together with EHR vendors like Epic and Cerner.

What’s going to be really interesting is the VA and its Vista EHR (Vista Evolution) is said to be bidding on the contract as well. We’ll see if they’re the only Vista bid or if others join in as well.

Here’s another great insight into the DoD EHR Contract:

Major data gaps in patient records occur when health care is delivered to beneficiaries outside the DOD network, and today approximately half of DOD’s 9.8 million beneficiaries receive their health care outside the network.

This was an obvious complaint of the AHLTA system. The DoD and VA couldn’t even get their EHR systems to be interoperable. I’m not optimistic that interoperability will be obtainable even under this new contract. That includes DoD to VA interoperability, let alone trying to connect with the care the DoD beneficiaries receive outside the DoD network.

I realize that nothing with the DoD health system is simple. Its an enormous system with all sorts of crazy government regulations. However, I’d hope for $11 billion, we could do better than we’re doing for our veterans.

At HIMSS, I talked with a largely military EHR vendor. They told me that they were close to being able to exchange records between different locations. That’s right. At HIMSS 2014 the amazing breakthrough was that 2 locations with the same EHR software were close to being able to exchange data.

May 1, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

DoD, VA Spent Bulk of 2012 iEHR Budget on Support Contracts

The VA and DoD’s iEHR project may or may not come together, but it seems clear that at least one party is getting ahead — the vendors the agencies retained to support the project.

A new report from the Interagency Program Office concludes that the two agencies spent more than $300 million funding support contracts for iEHR work in 2012.  The IPO’s job is  to modernize the Military Health System’s EMR software.

DoD and the VA have been working to build a joint integrated EMR, known as the iEHR, since 2009. The idea is to build an EMR which allows every service member to have and maintain a single personal electronic health record through their career and lifetime.

However, to say the project has been troubled is an understatement, with changes of strategy riddling the effort throughout its lifespan.

In February, for example, the iEHR project was halted, with officials electing to make 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.

Most recently, the DoD announced that it was looking for contractors that can support its current EMR, AHLTA, through 2018.

All  I can say is that if you’re following all of this you’re way ahead of me. With so many switches in direction, I can’t imagine anything lasting and good coming out of the process. Maybe you have to be military to get it. As for me, I see a strategy process that seems to be governed by something resembling a coin flip.

November 27, 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.

DoD Official Says Agency *Might* Select VistA Derivative

While it appears to be an outside shot, it’s possible that the Department of Defense might still consider a derivative of the VistA EMR for its VA EMR integration project, though a straight ahead VistA implementation sounds like it may be out of the question.

At a briefing by DoD, Under Secretary for Acquisition, Technology and Logistics Frank Kendall said that while using and modernizing VistA was a “reasonable decision” for VA, it’s necessarily as bright an idea for the DoD.

After doing market research, DoD technology leaders have decided that they’ll consider a mix of competing commercial products as well as Vista-based systems, and have taken in about 20 pitches from EMR vendors.

“Three of them were from VistA-based approaches, and the rest were from other approaches,” Kendall said. “So we think we have a rich field to pick from, and we can make a best value determination for DoD.”

When asked how much the DoD’s next EMR move is going to cost, Kendall did a bit of a bob and weave, saying that seamlessly integrated data is funded in the ’13 and ’14 budgets, without naming a number for those projects or long-term costs.

OK folks. You know what?  This whole thing really ticks me off — how about you?

I don’t know why the DoD is so dismissive of VistA, but despite its colossal failures with AHLTA and the death of the iEHR project, people there still seem to think they should pursue their own course rather than go with what’s been working at the VA.

And as an American taxpayer, much less a health IT analyst, I’m really tired of hearing the leadership at DoD justify their shaky moves in the EMR arena.

Come on, Mr. Kendall. Why won’t you be more specific about the costs of your health IT initiative?  Perhaps it’s because VistA-based products could cost 10 times less than, say, an Epic installation and you don’t want annoying editors like me bugging you about it?

Apparently even blistering critiques by your colleagues haven’t moved leaders like you off of your entrenched commercial approach to EMR integration.  I guess it’ll take a memo from on high — apparently one from President Obama doesn’t suffice — to get the generalissimos of HIT at the DoD to try something that might work.

June 20, 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.

DoD, VA Plan To Streamline EMR Integration Effort

The Department of Defense and VA have decided to change the way they integrate their two EMRs, in an effort they say will lower the cost and speed the pace of interoperating.  The new approach is expected to offer at least partial functionality by 2014, rather than forcing the two agencies to wait until 2017, reports FederalNewsRadio.com.

Rather than sticking to their current course, which involves a massive effort to integrate their respective EMRs into a single system, health IT leaders will attempt to make more short term  progress.

To date, the DoD and VA have been working on common requirements and data standards and developing a shared enterprise service bus, all in the service of creating a single system. Agency leaders had estimated that the existing project would cost $4 billion.

The new plan, while keeping the larger goal of integrating by 2017, will include efforts to use existing solutions to get to interoperability quickly. Leaders expect their new direction to be considerably cheaper.

By the end of this year, the two departments will begin sharing a common UI, with the rollout beginning in seven DoD and VA wounded warrior polytrauma centers. Then, by  2014, the VA and DoD expect to be exchanging seven types of critical data, including lab results, clinical notes and allergies. The VA and DoD will accomplish this by standardizing the day their systems currently use, the VA’s chief information officer told FederalNewsRadio.com.

Another key component of the two agencies’ efforts is establishing a common system for identity management.  The identity management system is drawing on the massive Defense Manpower Data Center storehouse of personnel informaton operated by the DoD.

February 12, 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.

New Open-Source GUI Can Display Multiple EMRs

A non-profit focused on HIT has released an open-source graphical user interface which will provide a common view for patient information from multiple EMRs — a very useful trick if the software delivers what it promises.

The interface, Janus, was created as part of an interoperability program designed to link Department of Defense and VA data.  Right now, Janus is deployed at the VA Pacific Islands Health Care System/Triper Army Medical Center and clinics at James A. Lovell Federal Health Care System.

This seems like a great idea. If doctors in private medical settings could look at multiple EMR outputs at one time, I’m sure they’d be grateful.  After all, it can’t be much fun going from EMR to EMR as you travel from one hospital to another.

Such a unified view would probably save lives, ultimately, as it’d make it easier for doctors to quickly spot problems and review cases distributed across hospitals and clinics. Oh, and reduce doctor burnout too.

Though I’m a big fan of open source efforts, I’m sorry to say that I doubt it will make a dent in the way hospital IT departments and commercial EMRs are deployed.  Unfortunately, most vendors seem to feel they have more to gain by creating silos than making data sharing easy.

Still, it’s good to hear that the VA and DoD are doing something to interoperate. The two have been notorious for spending billions of bucks on integration projects that go nowhere, especially here in the healthcare arena.

The DoD’s AHLTA EMR project alone consumed 13 years and $2 billion, according to one account. The project went wrong due to poor planning and what sounds like arrogance (a failure to appreciate the “significant complexity” of the program), the Government Accountability Office concluded in 2010.

May 30, 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.