Should the DoD Buy Epic, or Cerner, or GE, or...?

The Department of Defense (DoD) is in the market for an EHR solution… again. After a lengthy foray into building its own EHR from scratch (AHLTA), with miserable results, and another shorter detour through the fantasy land of an open-source integrated EHR (iEHR) with the Veteran Administration (VA), during which no material progress was made, other than spending taxpayers’ money of course, the DoD announced that it will begin looking for a commercially available product to suit the DoD’s unique needs. This decision is the source of much angst for some and much excitement for others, because no matter what the DoD decides to do, many more billions will be flowing out of taxpayers coffers and into the hands of a lucky few.

On one hand, since most people served by a DoD EHR will eventually be served by a VA EHR, it makes sense that these two government agencies should use the same product and aggregate a lifelong record for their patients. On the other hand, the VA EHR (VistA), although held in high esteem by its creators and users, is very old, and the VA itself is engaged in a major refurbishing effort through a public open-source framework. Answering to a highly frustrated House Committee on Veterans’ Affairs, looking for explanations and bemoaning the death of the iEHR, the DoD’s Frank Kendall reiterated the insurmountable costs and difficulties inherent in building a brand new EHR from scratch (better late than never, I guess) and highlighted the reasons why VistA is not as obvious a choice for the DoD as it is for the VA. [...]