While turf wars between the DOD and VA have effectively blunted efforts for a unified electronic health record system, both agencies are at least moving toward improving interoperability. On the DOD side, three initiatives are budgeted for continuing development — some seeing request increases, others flat, per the DOD’s overall budgeting trends.
Before we get to the programs DOD is betting on to put some legs under its interoperability initiative, here’s a little history to bring us up to date:
Following the money
In early 2011, the Secretaries of DOD and VA agreed to work cooperatively on developing one common integrated electronic health record (iEHR) system by 2017. An interagency program office (IPO) formed by the National Defense Authorization act assumed responsibilities for the iEHR. Disputes erupted between VA and DOD, unfortunately, because each had its own domain and ways of doing things, and neither was willing to cede ownership.
Along with costs skyrocketing from an estimated $5 billion to nearly $30 billion, the project was doomed from the start. And so, in February of last year, the Secretaries of both Departments announced that instead of building a single integrated EHR, both DOD and VA will concentrate on integrating VA and DOD health data by focusing on interoperability and using existing technological solutions. (It’s worth noting that the iEHR still appears in the President’s annual budget request as a program, but it is now focused on improving technical collaboration between the two agencies.)
[Related: Top 10 Government Health IT stories of 2014, so far.]
The FY15 Unified Medical Budget is $47.4 billion, of which $32 billion is allocated to the Defense Health Program (DHP). This DHP budget is where interoperability funding resides, managed by the still relatively new Defense Health Agency (DHA). This budget pays for operations and maintenance, R&D and procurement for both DHA and service-specific needs that fall out of DHA’s purview. The overall Health IT budget, controlled by DHA, will be about $2 billion for FY15. That pays for centrally managed IT systems and infrastructure as well as IT spending by the specific services.
The consolidation of critical functions such as health information technology into DHA gives VA a single point of contact within DOD for interoperability initiatives.
Modernization, information and management
All that history aside, what are the top program-level activities that DHA is backing for FY15?
1. DOD Healthcare Management System Modernization (DHMSM). This is the replacement for legacy DOD inpatient and outpatient HR systems including AHLTA, CHCS, and Essentris. DOD is looking for COTS solutions as the lynchpin for this tech initiative. An RFP is expected in Q4 FY14, with an award expected in early FY15. DME funding for this initiative is growing by almost five times over its FY14 levels of $29.6 million, up to $148.95 million in FY15. Requirements will include information sharing, records management, data/information management and databases and enterprise architecture.
2. Defense Medical Information Exchange (DMIX). DMIX is the redefined Integrated Electronic Health Record program, encompassing health data sharing and interoperability across the lifecycle, including data sharing/interoperability with the VA, private healthcare providers and patients. Ultimately, the program aims to migrate information from multiple legacy systems into one modernized lifetime EHR. Funding for this program is at $79.95 million in FY14 for DME funding, with an additional $14.97 million in steady state budgeting. In FY15, the proposed funding will increase slightly for DME (to $81.77 million), while steady state will drop somewhat to $13.09 million
3. Theater Medical Information Program – Joint (TMIP-J). This is a family of systems designed to support both warfighters and health care providers in theater, by maintaining patient EHRs, integrating medical logistics information, tracking patient movement and providing medical command and control data. The program integrates with medical systems at sites that support theaters. The latest improvement to the system, dubbed “Increment 2” will upgrade legacy systems and add functionality, including increased support for wounded warriors. The latest lifecycle estimate for the TMIP – J Increment 2 program increased an astonishing 2,233 percent from an estimated $67.7 million in November 2002 to $1.58 billion as of December 2013. In FY14, the program was budgeted at $57.01 million in DME funding, with an additional $33.66 million in steady state funding. In FY15, the DME funding request has decreased to $53.10 million in DME, while steady state funding will drop only slightly to $33.55 million overall.
So, what’s the upshot here?
To the extent that the DOD and VA have decided to play nice, they are redefining the idea of electronic health records. They are seeking comprehensive systems that together will provide a holistic view of an individual from the moment they enter military service through to veteran status. Major opportunities will include the development and modernization of electronic health record systems, and different modules comprising the system – as well as the role of DHA as a shared service provider across the entire DOD enterprise.
Let’s hope that this will be enough to get both sides to stand down, and start working to protect the well-being of the men and women who protect the rest of us.
Lloyd McCoy is a market intelligence consultant with immixGroup, which helps technology companies do business with the government. He can be reached at Lloyd_McCoy@immixgroup.com.
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