The following is a guest blog post by Carrie Yasemin Paykoc, Senior Instructional Designer / Research Analyst at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Numerous medical advances can be traced back to development and research conducted by the U.S. military. In most instances, these developments were directly related to mitigating casualties and disease during times of war. The U.S. Civil War is seen as one of the most influential military events to advance modern medicine. Life-saving amputations, anesthesia, thoracic surgery, wound treatment, facial reconstruction, and the inception of the ambulance-to-ER transport system all originated with military intervention. While today’s medical advancements have certainly surpassed anything ever imagined by Civil War surgeons a century and a half ago, the model of healthcare innovations spurring from military initiatives remains steadfast. In fact, the U.S. military is one of the largest payers and providers within the modern day healthcare system, and the Department of Defense’s (DoD) current Electronic Health Records (EHR) project presents an unparalleled opportunity for development and implementation of an innovative solution that will inform advancement in both the military and private health systems. With this DoD decision, the contracted vendors will have opportunities and challenges to fulfill the reality of this EHR, and all other vendors will have an opportunity to innovate and capitalize on the private sector.
While the massive undertaking to update the DoD’s EHR system holds great promise, many health information technology experts have expressed skepticism surrounding the approach and associated costs of implementation via a complex public-private partnership model. Skeptics also continue to point to the failed implementation of HealthCare.gov as a litmus test for potential success. Potential pitfalls aside, the DoD EHR project does create opportunity for health information technology (HIT) vendors and start-ups across the industry who recognize that disruptive innovation can easily erupt in the private sector, and new market opportunities will arise as a result of this government-private sector partnership. Both critics and supporters should pay attention to the developments in the coming months.
The DoD contract will likely span 10 years with the aim of creating a new electronic health system to replace the DoD’s Armed Forces Health Longitudinal Technology Application (AHLTA). This collective effort, referred to as the Defense Healthcare Management System Modernization (DHMSM), or “Dimsum” as commonly called by health IT insiders, creates opportunity for development of a commercial, off-the-shelf version of the government system. The price tag for this contracted venture is $4.34 billion, but that certainly may increase as development evolves. Compared to prior attempts by the DoD and the U.S. Department of Veterans Affairs (VA) to create an integrated electronic health record at an estimated costs of $28 billion, the $4.34 billion price tag appears to offer staggering savings; however, the two projects differ greatly. The initial integrated EHR was scrapped due to cost estimates and disagreement between DoD and VA leadership, ultimately leading to DHMSM and the VA moving forward with a separate update to that EHR, which later became known as the Veterans Health Information Systems and Technology Architecture (VistaA) program. Despite leadership disagreements and technological difficulties, one of the goals of DHMSM is interoperability between the new DoD system and the VA system.
Dr. Jonathan Woodson, assistant secretary of defense for health affairs, articulated the need for interoperability between both military and private systems during a July 29 briefing. He stated that the goal is for the new military system and the private sector systems to become interoperable. If private sector health IT vendors – whether partners in the contract or not – figure out how to easily exchange data and communicate with other platforms, they will truly capitalize on this opportunity and improve care simultaneously.
Interoperability between private and military systems is underway. For example, the Military Health System in Colorado Springs, Colorado joined efforts with the Colorado Regional Information Organization (CORHIO) and is making progress with interoperability and data sharing through the utilization of Health Information Exchanges (HIEs). They are able to share patient information and data in both private and military health systems. As presented at this years’ HIMSS conference, the initial collaboration and efforts between the two organizations have shown promising results.
Dr. Karen DeSalvo, federal health IT coordinator, echoes further support and enthusiasm for DHMSM and private system interoperability. “[The DHMSM is] an important step toward achieving a nationwide interoperable health IT infrastructure.” As contributors to the Office of the National Coordinators Interoperability Roadmap, Dr. Karen DeSalvo and her cohorts appreciate the potential impact of establishing interoperability on such a large scale. It will be an incredible milestone in HIT history to attain true interoperability of military and private systems. Conversely, if large-scale interoperability is not achieved, it may lead to more spending and potentially the demise of the project altogether. To the chagrin of DHMSM supporters, this failure would only support assertions that the failed Healthcare.gov website was only the beginning of a litany of government HIT challenges. But given the track record of medical advances related to military research and development, the DHMSM project will likely achieve some level of interoperability and attain the goals set during the initial request-for-proposal phase.
The next opportunity and challenge is already happening. The selected DHMSM health IT vendors must maintain their private sector customer base while rapidly developing the new military system. This is no small task. Doing so will require additional resources and new partnerships to successfully manage this effort. It also means that if these vendors are not successful, their customer base may decide to switch EHRs and implement another EHR platform altogether. Either way, there are opportunities for HIT vendors and consultants to innovate and gain entry to new markets and customers.
Alternatively, the HIT vendors not selected for the DHMSM contract are positioned to innovate and create new technologies and supporting systems. Although the military is responsible for many medical advances, numerous technological advances have been developed in the private sector and can be traced to simple beginnings in a garage or dorm room without any direct military or government involvement. Those across the HIT marketplace have the opportunity and motivation to develop new, cutting-edge technology, by capitalizing upon the bright light currently being shone on new health technologies as a means of improving patient safety and health outcomes.
Data security is another area to pay attention to in the coming months. The DHMSM is an excellent opportunity to develop sophisticated systems to protect patient health information. Conversely, creating such a massive interoperable system opens up risk for data security of all integrated systems. In an age where devices, web searching, and systems leave a trail of bread crumbs and create an internet-of-things (ioT) or web of data points, the new DHMSM system must effectively protect this web of data to avoid compromising personal and national security.
We must also consider the ability to successfully implement and adopt the DHMSM system. This type of system will require a coordinated and focused effort of massive proportions. After coordinating logistics, adopting the new system will require another heroic level of effort. Difficulties may lie in establishing proper governance between the selected HIT vendors and military projects and ensuring that all companies involved have the stamina and focus for the entire life cycle of the system. The DoD began laying the foundation for governance structures during the initial proposal process, but it is yet to be seen if all involved parties will be able to adhere to the outlined parameters and work collaboratively to create their new DHMSM system. Additionally, once the system is designed and implemented, if proper funds are not available to sustain the system, the DoD would have to consider a potential redesign.
The military’s track record with medical advances positions them to successfully implement the new DHMSM system. Remarkably, this project has the potential to lay the foundation for interoperability and data security in the U.S. Despite the obvious challenges associated with the DHMSM EHR project, a system that is able to communicate and safely share data for large populations is worth the investment. From a global perspective, many countries are far ahead of the U.S. in designing and implementing national health records (e.g. Denmark, Finland, Sweden, UK, and Australia). There is also the potential for the DHMSM system to evolve one day into a national electronic health record, but doing so would require a national paradigm shift and lot more than $4.3 billion. Additionally, the challenges associated with this initial venture will surely be exacerbated due to the scale of the project and sheer importance. Health IT vendors and start-ups not directly involved in DHMSM should remain optimistic and on the lookout for new opportunities and challenges on the horizon. If the DoD and the contracted health IT vendors can successfully develop and deploy the DHMSM system, new opportunities, research and medical advances will likely follow. It’s up to both HIT vendors and non-vendors of the DoD contract to decide whether they walk through this “door” of opportunity and make the most of this historic initiative.
Xerox is a sponsor of the Breakaway Thinking series of blog posts.