The Department of Defense (DoD) is in the midst of selecting a vendor to overhaul its electronic health record (EHR) systems, which facilitate the transfer of information pertaining to patient’s medical history, conditions, prescriptions, and other data across multiple healthcare providers over time. The Healthcare Management Systems Modernization (DHMSM) program is projected to cost $11 billion through the year 2023. DHMSM will replace the DoD’s existing EHR system, the Armed Forces Health Longitudinal Technology Application (AHLTA), as well as elements of the Theater Medical Information Program-Joint (TIMP-J) and the inpatient Composite Health Care System. When DHMSM launches in 2017, it will become the largest EHR system in the United States, with more than 9.6 million patients associated with over 400 hospitals (Brewin, 2014).
The DoD’s impetus to replace AHLTA stems from the current system's lack of interoperability with other EHR systems, such as the Veterans Health Information Systems and Technology Architecture (VistA), which is used by the Department of Veterans Affairs (VA). Built-in interoperability in an EHR system is difficult, as only a limited amount of information is easily categorizable or structured; information such as doctor notes or patient descriptions of symptoms is highly variable from patient to patient. Unstructured information makes up approximately 80% of all patient information stored in EHR systems (Konel, 2014).
Despite the significant challenges of designing an interoperable EHR system, four teams of vendors have responded to the DoD’s request:
The IBM-Epic bid was the first team to respond, and indicated their interest back in June of 2014. The team has subsequently created an advisory board consisting of reputable EHR experts drawn from the Duke University Health System and School of Medicine, Mercy Health, American Medical Informatics Association, Yale-New Haven Hospital, and Sentara Healthcare (Konkel, 2015). The IBM-Epic team has made significant process in the development of their EHR submission to DHMSM, “IBM and Epic have also built a working and interoperable system at its data center in West Virginia in order to test capabilities and make sure the group of companies had a system that could be deployed quickly if it won the contract. The early version being tested by IBM is already successfully connecting to partner organizations across the country” (Medici, 2015). The Hewlett Packard, Allscripts, and Computer Sciences Corporation will provide a strong source of competition to the IBM-Epic team, as collectively the team has extensive experience with Federal IT projects and EHR systems (McCann & Sullivan, 2014). Relevant experience of other vendors includes Leidos' (as SAIC) work as one of the major contractors on the TIMP-J program, and Accenture's efforts to improve Healthcare.gov.
It remains to be seen if DHMSM will meet the DoD's ambitious objectives, as previous measures to overhaul the DoD's EHR systems have resulted in few tangible improvements. The DoD had previously sought to integrate its EHR systems with the VA, but the initiative was canceled in 2013 after the program costs were projected to reach nearly $30 billion (Konel, 2014).