The DOD will seek bids from a range of EHR vendors. Industry insiders give the edge to Epic Systems, which is currently the market leader. If it isn't Epic, however, the winner will instantly gain a competitive advantage against that giant vendor.
In Hagel's May 21 memo to subordinates, which was originally reported by NextGov, he said the DOD would continue to develop interoperability with the VistA EHR of the Department of Veteran Affairs (VA). But his directive might well be the final blow for the departments' joint iEHR, an open-source project that was supposed to replace AHLTA and VistA with a new combined system. In February, the two departments announced they were halting the iEHR initiative to save money but would continue to work on interoperability.
It's not clear, though, how these interoperability efforts can go forward during the DOD's selection and implementation of a commercial EHR, or how such a system can be integrated with VistA.
Nearly two years ago, VA said that the two departments were going to use an open-source approach to develop the iEHR's components. VA even created the Open Source Electronic Health Record Agent (OSEHRA) to manage an open-source community for this purpose. In a recent op-ed piece, Peter Levin, the VA's former chief technology officer, said he was still convinced that this is the best course, but Hagel sees it differently.
Based on a recent review of the iEHR program, the Defense Secretary said in his memo, he has concluded that putting the DOD's new system out for bid is "the optimal way to ensure we select the best value solution for DOD. A competitive process will allow DOD to consider commercial alternatives that may offer reduced cost, reduced schedule and technical risk, and access to increased current capability and future growth in capability by leveraging ongoing advances in the commercial marketplace."
Hagel added that the VA has good reasons to use VistA, but that "many of those reasons do not apply to DOD." The VA has suggested in the past that the DOD adopt its VistA system, according to EHR Intelligence.
An Institute of Medicine (IOM) task force recently urged the DOD and VA to complete their work on iEHR. The report said that the lack of seamless records across the two departments was hampering physical and mental healthcare for wounded veterans.
Congress also has been getting into the act. Earlier this month, the House Appropriations Committee said it would allot $344 million to "jumpstart" an integrated DOD-VA EHR. But the committee decided it would release the money only if the departments moved forward with a joint, open-source EHR. Meanwhile, another bill in the House military construction subcommittee specified that only a quarter of that amount would be released until the departments could show that they had a plan for a unified EHR. Hagel's move seems to fly in the face of both these bills.
"Hagel's problem is going to be with Congress," commented Mike Corrigan, VP of consulting firm Warren Suss Associates, in an interview with InformationWeek Healthcare. "They're scratching their heads about why there shouldn't be a common record across the two departments. And if he's going with a commercial system independent of VA, I think there's going to be a couple more rounds of this match."
The iEHR is not necessarily dead, Corrigan added. But even if the iEHR went forward, he noted, it would address only part of the problem of creating a unified record for veterans. Because non-VA physicians and hospitals provide much of veterans' care, the iEHR "would be of limited utility," he said. For that reason, he commended the government's Virtual Lifetime Electronic Record (VLER) project, which is testing interoperability among military, VA and private-sector systems.
The original estimates for the cost of the iEHR were $4 billion to $6 billion. That has since ballooned to an estimated $8 billion to $12 billion. Besides the lack of cost control, Congress is also concerned about VA's slow processing of claims for disability benefits.
Addressing the latter issue in his memo, Hagel wrote, "I recognize that only 4% of the current VA backlog is associated with the transfer or completeness of DOD records -- and that these EHR efforts should be not conflated with the present VA disability claim backlog...Nevertheless, improvements in interoperability and EHR modernization will impact the timely processing of future claims and will provide better continuity of care to our people."