By Amy Ellis Nutt and Amy Brittain for The Washington Post
The Pentagon is poised within days to award one of the most coveted health information-technology contracts in history — the first phase of a deal that could ultimately be worth more than $10.5 billon over the 18-year life of the contract.
This is the first major federal IT contract since HealthCare.gov, which was so plagued by defects that hundreds of thousands of Americans were initially frustrated in trying to sign up for health insurance.
The effort, designed to provide a much-needed upgrade to the current system used by 9.5 million military personnel, including active duty and retirees, is being hotly pursued by three of the heaviest hitters in private industry: Epic Systems, Cerner and Allscripts Healthcare Solutions.
“We are not just buying an off-the-shelf system; we’re really looking to modernize how the department delivers health care,” Christopher Miller, the director of the Defense Department’s selection process, said when the contract was first announced.
Skeptics, however, say choosing any of these three big commercial systems is risky. Doctors and other health-care professionals have complained that these electronic health records systems, as now configured, are clunky to use. The proprietary software means fixes and upgrades can be performed only by the manufacturer. And because none of the systems is Internet-based, sharing information between different systems can be difficult, critics say.
Those complaints fuel concerns that the Pentagon will be unable to achieve one of its main goals anytime soon — building a records system that seamlessly interacts with the Veterans Health Administration.
“None of the three finalists has been able to improve overall outcomes or reduce costs in the private sector despite a track record spanning more than a decade with complete freedom from oversight,” said Dean Kross, a Pittsburgh cardiologist who studies health-care IT. “How can anyone expect that to change now?”
A fundamental challenge for the Pentagon project, some say, involves the nature of the commercial health IT industry itself: The software is better suited for accounting and billing than for tracking medical problems and treatment.
“Business computing and clinical computing are as different as psychiatry and neurosurgery,” said Scot Silverstein, a physician and expert in medical informatics. “They both work on the same body part and involve doctors, but if you try and treat a brain tumor with talk therapy, that’s not going to help.”
Some critics are harsher. “Epic and Cerner are mediocre products that should be a lot better for the cost,” said Ross Koppel, a sociologist at the University of Pennsylvania who studies and writes about health-care information technology. He said that requests by health professionals to make upgrades and repairs “are hundreds of thousands [of items] long. . . . These systems take years to implement.”
Through a spokesman, Allscripts said it will bring “a unique combination of deep DoD mission, medical and IT knowledge” to the project if chosen. It also said that the company “is winning new business as well as expanding its relationships with existing clients globally.” Cerner declined to comment for this story.
Col. Nicole Kerkenbush, an executive member of the Healthcare Management Systems Office at Defense, disputed the notion that commercial systems — “off-the-shelf” products — weren’t up to the job of overhauling the Pentagon’s medical records.
“The commercial EHR [Electronic Health Records] products have really matured since we first started on our modernization journey,” Kerkenbush said, indicating that, in any case, the department didn’t have much choice: “We were so far behind that by the time we invested money, people and time to develop and deploy our solution, we would find ourselves behind industry again.”
In a statement, Epic said it looked forward to the Defense Department’s announcement. “Today, about 5,800 Epic clinics, 340 Epic hospitals, and 100,000 providers use our interoperability platform to exchange data with all of the VA sites in the U.S.,” the statement said. “In addition, Epic customers exchange with the Social Security Administration, the DoD, and with third-party EHRs.”
The three finalists have teamed up with tech or defense powerhouses to bolster their chances: Epic with IBM; Cerner with Leidos and Accenture; and Allscripts with Hewlett-Packard and Computer Sciences.
VistA, the current VA system, is open-source — Internet-based — and in contrast with the billions needed to purchase and implement the programs of giants such as Epic and Cerner, its software is free. Still, earlier this year, a bid based on VistA was rejected by the Defense Department.
Most industry insiders believe Epic has the edge for the contract. The privately held company, based in Verona, Wisc., exchanges upwards of 6.3 million patient records every month, according to its Web site.
To try to counter criticism about how its system operates, Epic last year hired a lobbying firm, Card & Associates, run by Bradford Card, the brother of Andrew Card, former president George W. Bush’s chief of staff.
Concerns about whether the Pentagon and VA will ultimately be able to seamlessly share medical records stem, in large part, from the departments’ record of working together.
In 2009, President Obama urged the departments to create a single digital records program — something lawmakers in both parties had been urging for years.
That would have helped Pat Murray, a former corporal in the Marine Corps. Murray lost a leg and had other serious injuries in a 2006 bomb blast in Iraq. When he left the ranks of the active military and began seeing doctors in the VA system, he had to carry his medical records around in manila folders.
The documents explained his injuries in detail: the amputation above the knee, the broken bones, the burns, the blown eardrum, the traumatic brain injury. He needed to show the VA doctors the paper records because there was no way for VA to call them up on its computers.
“It blew my mind,” Murray said. “They don’t have it [his wheelchair] on file? I’m a right-leg amputee.”
In 2013, however, the Defense Department dropped out of the effort to create a unified medical record system with VA, after spending $1 billion.
With the joint initiative gone, the next goal became linking the two systems. In June, VA unveiled its new Enterprise Health Management Platform, which is Web-based and which VA thinks will be able to synchronize with whatever software program the Defense Department chooses.
That didn’t stop Jon Stewart from asking Obama, in a recent interview on “The Daily Show,” why there were still so many problems between VA and the Defense Department.
“If you have a government built on a 1930s model and it isn’t updated in decades, there’s going to be a gap,” Obama said. “And IT is the biggest example of that.”
This post has been updated to clarify a description of Epic’s patient healthcare records system.
Christian Davenport contributed to this report.