Reporting from the Defense Healthcare Management Systems Modernization (DHMSM) Project Vendor Day

For over a decade, DoD and the VA have been talking EHR collaboration, see-sawing between a possible open source oriented solution like VistA versus a proprietary option such as EPIC. At the second DoD Defense Healthcare Management Systems Modernization (DHMSM) Project Vendor Day held on December 4th  in Washington, D.C., the project’s program manager announced his management team will pursue a DoD 'core' EHR solution independent of the VA-DoD  Interagency Program Office (IPO).

Back in 2011, the VA and DOD Secretaries committed to developing the new iEHR solution with a goal of implementing it across both departments by 2017. However, in February 2013, the Secretaries announced that the two departments would focus on ‘modernizing’ their existing systems, rather than developing a single, integrated EHR system.

The department heads cited cost savings and the need to meet needs sooner rather than later as the reasons for this new direction. In a report and recent testimony before Congress, GAO concluded that this reversal of course raises concerns about the ability of the two departments’ to successfully collaborate to share electronic health information.

At the DHSM Vendor Day meeting, Navy Captain Windom, the program manager for the DHMSM Project, announced  that DoD intends to procure a 'best of breed' Off-The-Shelf (OTS) EHR solution. He underscored that this procurement will be Off-the-Shelf (OTS), which does not not necessarily mean Commercial-Off-the-Shelf (COTS).  COTS is usually considered pre-built software from a 3rd party vendor. 

DoD’s stated use of the label “Off-the-Shelf (OTS)” versus “Commercial-Off-The-Shelf (COTS)” leads one to conclude that a Government OTS system may be included in the DoD’s procurement process. This opens up the possible consideration of the open source VistA system as a viable best-of-breed EHR solution for DoD. Given that the existing CHCS system used in DoD hospitals  is a variant of the VA VistA system, this makes a lot of sense.

It remains to be seen whether DoD will seriously consider using one of the various open source versions of VistA offered by the Open Source Electronic Health Record Agent (OSEHRA) organization or one of several commercial vendors, e.g. DSS, Medsphere, SAIC. It was disturbing to hear a lot of the talk in the hallways about DoD already leaning towards Epic.

The first draft of the Request For Procurement (RFP) for DHMSM is due out in January, 2014.  Program Executive Office (PEO) Director Christopher Miller, on the job just over 90 days, says the organization is in listening mode as DoD goes through the acquisition requirements process for a new EHR system. Miller expects to build trust with everybody while striving to achieve the mission of improving healthcare outcomes for veterans and active duty service members need.

Regarding the scope of the DHMSM project, it must interface with all Military Treatment Facilities, DOD health administration, clinical and business systems.  There will be a need for the capability to customize and scale the system across multiple different categories of providers and facilities across the globe. The Off-the-Shelf, best of breed augmented solutions  are to be designed and developed as ‘open' modular solutions and the reuse of existing infrastructure.

The PEO said existing clinical operations will be transitioned to DHMSM with minimal disruption, ensuring the continuity of healthcare services worldwide. Other goals mentioned included: Creating seamless integration between VA and DoD; modernizing user interface software supporting clinicians; and engaging with Office of the National Coordinator for Health IT in the Department of Health & Human Services (HHS) to employ national standards for health data sharing. 

Dr. Jacob Aronson, the Chief Medical Information Officer (CMIO) for DHMSM , explained the development of the DoD EHR will involve both technical and informatics needs.  The business needs include semantically standardized computable data elements and Clinical Decision Support presented in meaningful ways that support patients and clinicians.

The DHMSM global engagement use case is based on Continuum of Care and Scope of Care. Contracting will be managed through a full and open competition, single-award Indefinite Delivery/Indefinite Quantity (IDIQ) contract.

Stay tuned - the next DHMSM industry day is in February 2014 and the Final RFP is due 4th Quarter 2014.

Author: Marc Wine, December 7, 2013