Healthcare Analytics, Population Health Management, Healthcare Big Data

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Did Early Interoperability Focus Help Cerner Beat Epic at DOD?

By Jennifer Bresnick

- The Department of Defense has made what many industry hawks might consider a surprising move.  Today, DOD officials announced that the Pentagon has awarded its $9 billion EHR modernization contract to Leidos Health Solutions Group, the leader of the bid, as well as its partners, Cerner Corporation and Accenture Federal Services.  

Interoperability and DOD EHR modernization

The bidding, which started in August 2014 after many years of political wrangling and hemming and hawing by Pentagon officials, attracted the interest of top technology vendors in the space, including Allscripts, IBM, and PricewaterhouseCooper.   However, the DOD quickly whittled down their options to just three teams, leaving the industry breathlessly awaiting what has been widely viewed as a Cerner-Epic showdown.

The standoff may have ended with victory for Cerner, Leidos, and Accenture, but speculation about the reasoning behind the process is only beginning.  As health data interoperability becomes increasingly important for large-scale population health management and care coordination - both major challenges for the beleaguered military health system - how important is a vendor’s reputation for interoperability and openness with its big data?

While Epic Systems holds an enviable portion of the EHR and health IT market share, particularly among large, complex systems, thanks to perceptions of its stability and cohesiveness, Cerner’s vocal promotion of health data interoperability and foundational work in the CommonWell Health Alliance may have given it an edge among DOD procurement officials looking for a nimble, scalable infrastructure that can meet its incredibly diverse needs.

“We didn’t just come to this focus on interoperability,” said Travis Dalton, General Manager at Cerner Federal to EHRintelligence last November.  “This is something we’ve been working on for a long time.”

READ MORE: Will the IoT Bring a Patient Engagement, Interoperability Revolution?

“I know there’s a healthy level of cynicism out there, and everyone’s claiming they’re going to be the one who will finally do it,” he added.  “But we’ve been working on this for over a decade in terms of health information exchanges, connecting communities, and working with a number of states to do some of that work.  So I think that we’re excited that we’ve come to this point, because it’s something that we’ve really been trying to focus on for a long time.”

One of the most pressing requirements for Cerner now that it has won its bid for the DOD EHR modernization project, a massive undertaking that may last a decade, is integrating the Department of Defense’s patient data stores and documentation systems with the sprawling network of hospitals, clinics, and other care sites run by the Department of Veterans Affairs.  

The VA has been facing its own technology and care quality conundrums, and has expressed ongoing frustration with a lack of cooperation from its counterparts at the Pentagon.  Veterans seeking care at VA facilities may also receive services at civilian organizations, complicating an already-difficult process of care coordination, chronic disease management, and access to services. 

Health IT upgrades at the VA are also in progress, as the health system attempts to reform some deeply rooted cultural and operational deficiencies that have led to scandal, condemnation, and patient deaths.

The drawn-out saga has angered Congress and prompted lawmakers to withhold funding unless the two healthcare systems could agree on an approach to interoperability.  During the lengthy spat, the VA repeatedly offered to help the DOD implement its highly regarded VistA health IT systems, but the DOD demurred, opting to choose an off-the-shelf product instead.

READ MORE: Smart Big Data is Key to Population Health, Value-Based Care

The DOD took a “hard and thoughtful look” at all the major market leaders, said Jerry Hogge, Deputy Group President of Leidos Health Solutions Group.  Leidos, a member of the winning team, is a familiar name on government contracts, and the organization’s experience with federal projects may also have given the group an advantage.  “[The DOD] invited EHR developers and providers to demonstrate their products, and did research to decide what they thought were the best features available in the commercial marketplace today.”

“And then the question became how to adapt those features to meet military health requirements where needed, both in the United States and at forward operating bases around the world and then in the theater of war or in a military operational environment.”

“Its scale is unlike anything else in the world,” Hogge added.  “The system has to operate in a fully connected environment as well as low-connectivity and no-connectivity environment.  Where health care is first being supplied, there may be no network connectivity between the system and the clinician providing care to the patient.  So you have to collect data there."

"You have to have data available in a disconnected or unconnected fashion, and you have to have that data follow the patient as they move through the military health system to wherever they receive their remaining or final care, whether it’s at a base somewhere around the world, or at one of the bases in the United States.  That’s a key element of their requirements.”

While Epic Systems certainly has experience with large-scale implementations and knows how to manage big data, it has not embraced data fluidity across external systems as readily as many of its peers.  In recent months, the company has touted its involvement in Carequality, a “network of networks” approach to interoperability, but its public image has suffered somewhat from its resistance to joining the popular CommonWell Alliance since it was announced at HIMSS in 2013.  

READ MORE: 44% of Payers, Providers Find Population Health Tools Effective

Epic Systems founder and CEO Judy Faulkner labeled the group a “competitive weapon,” while the company’s Executive VP Carl Dvorak said it was “yet another distraction” taking attention away from the development of national standards.

With accusations of data blocking still plaguing EHR vendors as healthcare organizations struggle to meet the escalating data exchange requirements of meaningful use, perhaps Cerner’s more positive take on industry-wide cooperation, along with its partners’ experience in government contracting, helped tip the scales in its favor.  

The DOD is unlikely to divulge many details about the selection process, but the $9 billion contract is obviously a big win for Cerner, catapulting it into the highest echelons of the EHR vendor market - and perhaps ensuring its long-term survival in a market that may have been artificially inflated in the wake of the EHR Incentive Programs.

The finalized procurement only opens more questions: will Cerner be able to meet the interoperability, big data analytics, and population health management needs of such a complicated healthcare ecosystem?  Will the DOD implementation guide more healthcare stakeholders towards meaningful interoperability?  Can the VA and DOD cooperate during the integration process well enough to produce necessary care quality improvements?  How will the DOD ensure that the decade-long process of modernization will keep its technology on the cutting edge as innovation continues its rapid progress?

Only time will tell if the Department of Defense has made a wise decision, but one thing is abundantly clear: health data interoperability is no longer a “nice to have” for the healthcare industry, but a fundamental requirement for doing business in a new era of patient care.

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