Pentagon EHR process: More scrutiny needed?

I sure don't envy the Pentagon.

I've now had the pleasure to interview representatives from the three finalist bidders for the $11 billion coveted Department Healthcare Military Systems Modernization (DHMSM) EHR contract. They all had slightly different messages.

The Computer Sciences Corp./Allscripts/HP team talked about its ability to coordinate care with other Department of Defense partners and to provide a more open system to give the agency increased freedom with its system down the road. The Center/Leidos/Accenture representatives stressed their familiarity with DoD and their culture and philosophy. The Epic/IBM partnership focused on its broad reach and ability to provide DoD with a community.

They each discussed why their partnership deserves the contract, how they would solve lingering interoperability problems with the U.S. Department of Veterans Affairs, how the new DoD EHR would have broader impact on health IT as a whole, and their views on the future of health IT. All stressed their experience, competency and capability of a deployment of such large scale.  

Everyone was committed and energized. For the winning team, this truly will be a "once in a generation opportunity."

Despite the enthusiasm shared, however, several concerns about whether DoD is taking the right path for its EHR remain.

We've already noted that the Government Accountability Office (GAO) listed federal IT acquisitions as a new high-risk area at risk of fraud, abuse, waste and mismanagement; the DoD is already on the high-risk list for infrastructure, systems and other problems. At the same time the Center for New American Security issued a report warning that DoD's current plan to use just one EHR vendor was a bad idea that will affect the agency for at least a decade.

More recently, Loren Thompson, COO at the nonprofit Lexington Institute, called the DoD's approach to buying an "off the shelf" commercial product "antiquated," adding that the Pentagon may not understand what it's buying. Thompson ultimately called for lawmakers and others to question DoD about the direction its taking.

I am certainly not going to try to second guess the Department of Defense. I'd really like to believe that it knows what it's doing to protect us and care for our soldiers. The Defense Health Agency has indicated that it is working internally to ready itself to a new EHR, consolidating IT infrastructures and standardizing medical terms.

These criticisms of the DoD's decision can't be taken lightly. They're coming from some very well regarded places, not some fly-by-night Internet troll.

The contract finalists with whom I spoke said that DoD has a very clear vision of what it wants, that the procurement has been efficient and well run, and that the RFP contains very specific requirements for interoperability, improved care and reduced costs. But $11 billion is a lot of tax payer money. And the DoD has been known to change its mind when it comes to expensive EHR plans. How much scrutiny has this decision and the RFP received?

It's much easier to question, modify or untangle a relationship before any marriage, while the parties are still dating. Perhaps stakeholders should make sure that this is absolutely the correct way to proceed before that wedding date. - Marla (@MarlaHirsch and @FierceHealthIT)

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